PARIS — How a physician responds to a male patient's disclosure of erectile dysfunction can determine whether the patient uses medical treatment, investigators said at the annual congress of the European Association of Urology.
In an eight-country study of nearly 3,000 men with erectile dysfunction, patients who were dissatisfied or extremely dissatisfied with their physician-patient interaction during the disclosure were about half as likely to use a phosphodiesterase-5 (PDE-5) inhibitor more than once, compared with men who were extremely satisfied with their doctors' responses. Men who felt neutral about the discussion were most apt to stop treatment (odds ratio 0.20 for continued use).
Patients were less likely to stay on a PDE-5 inhibitor in three other circumstances: if they felt the doctor was not positive (OR 0.24), if they discussed the problem only once (OR 0.33), or if the doctor advised something other than a prescribed treatment (OR 0.53).
“Clearly the perception that you [the physician] are taking me [the patient] seriously, that you are interested in this problem, will make an impact on my continuing with therapy,” coinvestigator Michael Sand, R.N., said in an interview after Dr. Raymond C. Rosen reported on the multinational Men's Attitudes to Life Events and Sexuality (MALES) phase II study.
“I am sure part of this is because men are uncomfortable to begin with,” Mr. Sand said. “The other key is men are recognizing that their physicians know more about this problem than they do, so they are looking for some signal from what they consider to be a knowledgeable source that this is a good idea.”
Mr. Sand, a sexologist, is based in Germany with the Bayer Corporation, maker of vardenafil (Levitra). Dr. Rosen is a psychologist at Robert Wood Johnson Medical School in Piscataway, N.J. Their coauthors were based in Canada and the United Kingdom.
The MALES study recruited 2,912 men, aged 20–75 years, who self-reported erectile dysfunction. This analysis was based on follow-up questions that were posed to 1,907 men who reported discussing erectile dysfunction with their physicians.
Patients were most likely to continue therapy if the doctor prescribed a PDE-5 inhibitor (OR 4.67), but referral to another physician also favored staying on a drug (OR 1.75). All of the differences were statistically significant.
The investigators reported on interviews with 293 female partners of men in the MALES study. Men were more likely to seek treatment if their female partners were concerned about the impact of erectile dysfunction on their sex lives, if they believed that it was caused by a medical condition, and if they believed that the condition could be treated medically.
“If she believes this is a medical problem, [that] it is related to an organic disease, that it is not going away, he is more likely to seek therapy,” Mr. Sand said.