Clinical Review

Veterans’ Satisfaction With Erectile Dysfunction Treatment

Fed Pract. 2016 May;33(5):33-37

References

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Finally, most veterans reported few attempted behavioral changes to address ED, such as taking medications at a different time or decreasing use of tobacco, caffeine, or alcohol (M = 1.3; SD = 1.1). Thirty percent had not tried any behavioral changes; 34.1% tried 1 change; and 35.9% had tried more than 1 behavioral change. In contrast, 89% of participants reported using a PDE5 medication. Eight-two percent of participants reported currently receiving ED treatment of some kind; within this group, 97.4% reported currently taking a PDE5 medication. Only 2.5% of veterans reported using other kinds of treatment, such as vacuum pump, suppository, over-the-counter medication, injections, and not using a PDE5 medication, whereas 6.7% were using other kinds of treatment as well as a PDE5 medication.

In addition to the quantitative responses, 48 participants wrote unsolicited comments about their experiences with ED treatment on their returned questionnaires. The principal investigator also received 9 telephone calls from intended study participants, who provided verbal feedback regarding their experience with ED treatment. Comments unrelated to the study were eliminated, and the remaining written and verbal responses were grouped into categories to identify themes. Mirroring the quantitative results, participants providing qualitative feedback were dissatisfied with their ED treatment. Specifically, 43% of the comments consisted of complaints regarding the ineffectiveness and/or undesirable adverse effects (AEs) of ED medications and other ED treatments, including physical AEs (eg, headaches), sentiments that treatment does not feel “natural,” and dissatisfaction with the quality and length of sexual encounters despite treatment. Yet 24% of the comments entailed requests for more and/or different ED medications. Less frequent, although significant, comments related to decreased sexual interest and performance because of other medical conditions, such as pain, prostate surgery, and hypertension (15%); desire for additional information about ED treatments from health care providers (9%); use of nonpharmacologic ED interventions (eg, vacuum pump, 7%); and concerns about their partners’ level of sexual dissatisfaction as a result of their ED (7%).

Discussion

The present study examined knowledge of ED risk factors and level of satisfaction with ED treatment in a veteran population. Pharmacologic interventions comprised the most prevalent form of ED treatment. Both quantitative and qualitative results indicated areas for improvement in veteran satisfaction with ED treatment. Overall, veterans reported being neither satisfied nor dissatisfied with their current ED treatment, although very few reported being satisfied in response to a single item. The discrepancy may be related to the negative wording of the latter question (“Why are you dissatisfied with your erectile dysfunction treatment?”), which potentially biased participants’ responses. Several veterans also provided many unsolicited comments regarding areas for improvement. Despite feeling neutral to dissatisfied with treatment, 80% planned to continue with treatment. Sources of dissatisfaction included restricted access to ED medication (eg, limiting pills to 4 per month), ineffectiveness of treatment (eg, poor quality of erection, lack of climax), physical AEs, a desire for more information about ED, and psychological and relational concerns (eg, partner sexual dissatisfaction). As one veteran in his 80s lamented in describing the apparent end to his sexual life despite current ED treatment, “Is that all there is? It is the end of the road.”

The authors identified several barriers to implementing potentially beneficial interventions other than ED medications. Specifically, despite receiving long-term treatment for ED, veteran participants showed average knowledge of information related to ED risk factors. Of concern, discussing sexual health concerns with a PCP was not associated with increased knowledge of ED risk factors. This may explain the finding that veterans plan to continue with medication treatment despite feeling only neutral to dissatisfied about their current ED treatment.

Veterans who talked to their PCP about ED were less satisfied with treatment than were those who did not talk to their PCP, likely because those who felt their treatment was working for them felt less need to talk to their provider. Indeed, those who talked to their PCP tended to have more severe ED than those who did not. It may be that veterans avoid discussing ED with their PCP until they reach advanced ED when it is too late for treatment to make a difference. The principal investigator’s receipt of unsolicited telephone calls from intended study participants desiring to discuss ED—something that has not occurred during the researchers’ involvement in dozens of prior health-related studies—illustrates the importance veterans place on sexual concerns and the need to encourage discussion about the topic in the context of health care appointments. Specifically, older adults would benefit from more conversations with PCPs as they reported less knowledge of ED risk factors and fewer conversations with PCPs about sexual concerns than did younger men.