Impact of erectile dysfunction and its subsequent treatment with sildenafil: qualitative study
BMJ 2004; 328 doi: https://doi.org/10.1136/bmj.38044.662176.EE (Published 29 April 2004) Cite this as: BMJ 2004;328:1037
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We read with some amazement the paper Impact of erectile dysfunction
and its subsequent treatment with sildenafil (BMJ 2004;328:1037-1039).
Firstly, the juxtaposition of the words impact and erectile
dysfunction is unfortunate and does not inspire confidence in what
follows. Secondly, because the authors’ focus was specifically on the
patient rather than on relational dynamics, they should have focussed
exclusively on restoring erections for masturbation. Thirdly, the authors
made no reference to psychological factors, either involving intercourse
or masturbation, in effect treating erectile dysfunction as though it were
a simple matter of pharmacological “two of sand and one of cement.”
Fourthly, most men who can masturbate but have erectile dysfunction with a
partner have a psychological problem which should be addressed and not
just treated with sildenafil. No wonder the distress was severe in those
for whom sildenafil did not work. Fifthly, does anyone really need a BMJ
paper to “be aware of the extreme distress erectile dysfunction can
cause.”
Philip D Welsby
Consultant Physician
Jennifer B Thorn
Psychosexual Counsellor.
Competing interests:
None declared
Competing interests: No competing interests
The paper does describe the severe impact that impotence can have,
particularly after failure of treatment.
However, I make one small but important point.
The sample was of 40 men who had not only attended a men's health
clinic but also been prescribed sildenafil; the "top end" of the range I
would argue. From the comments patients made, this is obviously a group in
which the whole concept of sexuality - and in particular what it means to
be male - is very important indeed. Whether this is secondary to the
problem having arisen, part of the problem itself,or just reflecting what
is typical of UK men in general is open for debate.
So when it comes to "What this study adds" just the clarification
that it is "SOME men are more shocked by impotence than has generally
been...,etc. After all, The same edition of the BMJ includes an article in
which the WHO DG mentions that at least one million children die every
year in Africa from malaria.
There are some men who really do struggle with impotence and this
study vividly conveys some of the depth of that. Whilst all GP's will know
patients like this, I do hope that we can still keep things in perspective
against the major disease burdens both nationally and globally.
Competing interests:
None declared
Competing interests: No competing interests
1st ,May,2004
EDITOR,It was interesting to read the paper of Tomlinson &
Wright,Impact of erectile dysfunction and its subsequent treatment with
sildenafil :qualitative study(1).My comment that,
1.As one of my interests are psychosexual disorders of which erectile
dysfunction is one of them,I started to treat patients early in 1980s in
Baghdad,Iraq,It followed reading the papers of Virag,Brindley..etc,and
their method of injecting potent vasodilators by using of intracavernosal
approach(2).
2.I was surprised by the large number of those who asked for treatment!,I
started my work with pipaverine,phentolamine,verapamil,sodium
nitroprusside,..and then alprostadil..etc.
3.I was at that time surprised too by the fact that how in the field of
medicine it took such a long time to think of it as the treatment of
choice?
4.My patients were suffering from erectile dysfunction either due to
psychological,vascular,neurogenic ,drug induced,hormonal,and even
chromosomal(Klinefilter syndrome).
5.During treatment sessions,some of them get cured,others need repeated
injections,majority ounce a week,failure rate could be less than 5%.
6.Seperated?divorced couples were able to return bach,single patients who
were frightened to get married were able to do that.
7.It was interesting to see how my patients become gradually more
confident.
AK.Al-Sheikhli,
References,
1.Tomlinson J and Wright D,Impact of erectile dysfunction and its
subsequent treatment with silenafil:qualitative study,BMJ 2004;328,1037-0
2.Al-Sheikhli AK,Intracavernosal injection of potent vasodilators for
erectile dysfunction had
revolutionised..etc?,http://bmj.com/cgi/eletters/326/7386/424#29856,21 Feb
2003
Competing interests:
None declared
Competing interests: No competing interests
I agree with the authors that this is an issue of high expectations.
I note that of those who had success with Viagra, only 10/20 were happy
& only 6/20 felt a "return to manhood".
Given that relatively recently injecting the penis or applying a
penile ring and a vacuum pump were the treatments of choice, I would
expect these patients to be amazed & delighted at such medical
progress.
It does make me wonder about the "extreme distress" and "devastation"
suffered (difficult to quantify, I realise) - some external references
would have been helpful. How does ED compare with bereavement, redundancy,
divorce, terminal diagnosis? I'm not saying it doesn't compare, I'm saying
I'd like to know. If it is that bad, why are we not allowed to issue NHS
presriptions?
Competing interests:
None declared
Competing interests: No competing interests
Dear Sir:
The paper by Tomlinson and Wright(2004)that examines the effects of
sildenafil citrate on patients with erectile dysfunctions [EDs]is
extremely important and informative to a great proportion of the
population suffering from EDs. Sexual dysfunctions among both genders are
known to cause tremendous personal stresses, low self-esteem, disgrace
and marital complications including separations and divorce.
EDs may cause a variety of mental disorders including different types of
anxieties and depressions. EDs are also known to be caused by an array of
factors, which include physical diseases, mental disorders, and
medications used to treat these psychophysical disorders. Cultural factors
are also very important determinants of EDs. Hence, EDs are heterogeneous
disorders and need to be addressed likewise. Viagra and other medications
used to treat EDs are potentially useful drugs if chosen properly in
properly selected individuals. If a patient with EDs has tremendous
expectation as regard treatment with viagra, and if this drug fails, the
anxietiy of such patient increases and which further aggravates the
intensity of EDs. Thus, a vicious cycle emerges, which should be tackled
immediately by proper drug as well as psychotherapeutic means.
Reference:
John Tomlinson and David Wright.Impact of erectile dysfunction and
its subsequent treatment with sildenafil: qualitative study.BMJ 2004; 328:
1037-0
Competing interests:
None declared
Competing interests: No competing interests
Validated measure on the impact of Erectile Dysfunction.
This article describes well the significant psychosocial impact of
erectile dysfunction. The introduction suggests that “comparative little
attention” has been given to the psychological and social impact of
erectile dysfunction and its subsequent treatment. A few studies are
quoted in the references, but the largest published works on the impact of
impotence on the quality of life of men have been omitted. The first
publication involves a study conducted to assess the psychometric
properties of a new quality of life-specific instrument (ED-EQoL)
developed to quantify the effect of erectile dysfunction on men (1).
Validity and reliability of this questionnaire was assessed in a cohort of
283 men recruited from 11 centres in the United Kingdom. The second
study, only recently published, describes the rigorous qualitative
methodology employed to develop the ED-EQoL (2). This methodology was
similar to that used in your published study and illustrated that men with
erectile dysfunction exhibited a complex array of psychosocial morbidity
relating both to themselves and their partners. This study produced a
statistically robust 15 item measure which performed well psychometrically
and illustrated the impact of this condition on quality of life. The
questionnaire has been subsequently used in numerous other published and
unpublished studies (3) providing further evidence of validation.
It is disappointing that none of these highly relevant and current
studies, published in high profile journals were referenced in your
published article. The authors conclude by suggesting that “more
sensitive and reliable measures need to be developed to detect the results
of treatment”. It would seem that such a measure has been developed
somewhat quicker than was anticipated.
R P MacDonagh MD MBBS FRCS
Senior Clinical Lecturer and Consultant Urologist
T Porter
Consultant Urologist
P Ewings
Statistician and Research and Development Co-ordinator
1) The effect of ED on QoL: Psychometric testing of a new QoL measure for patients with erectile dysfunction. MacDonagh RP, Porter T, Ewings P. J Urol 2002 Jan;167(1):212-217.
2) The ED-EQoL: The development of a new quality of life measure for patients with erectile dysfunction. MacDonagh RP, Porter T, Pontin D, Ewings P. Qual Life Res 13: 361-368, 2004.
3) The effect of radical prostatectomy on the quality of life of men after radical prostatectomy. Meyer J, Gillatt DA, Lockyer R, MacDonagh R. BJU Int 2003 Nov; 92(7):703-6.
Competing interests:
Some of the studies quoted were funded by Pfizer
Competing interests: No competing interests