PATTERN AND CORRELATES OF ERECTILE DYSFUNCTION AMONG ADULT MEN AGED 40 – 70 YEARS ATTENDING FAMILY MEDICINE CLINIC, OBAFEMI AWOLOWO UNIVERSITY TEACHING HOSPITALS COMPLEX, ILE-IFE.

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PATTERN AND CORRELATES OF ERECTILE DYSFUNCTION AMONG ADULT MEN AGED 40 – 70 YEARS ATTENDING FAMILY MEDICINE CLINIC, OBAFEMI AWOLOWO UNIVERSITY TEACHING HOSPITALS COMPLEX, ILE-IFE.

SUMMARY

Background: Sexual health has an important impact on quality of life. Erectile dysfunction

(ED) is one of the most frequent chronic health conditions in men older than 40 years of age. Sexual dysfunction causes impairment of sexual fulfilment which leads to considerable distress for a couple and predisposes to dysfunctional relationships and family life. There are limited epidemiological data on ED in the Family Medicine setting in Nigeria.

Objectives: This study determined the prevalence and pattern of erectile dysfunction among men aged 40-70 years presenting at the Family medicine Clinic of the OAUTHC, Ile-Ife. It identified the factors associated with ED and its relationship with family function.

Methodology: This was a cross-sectional study involving 414 subjects recruited by simple random sampling from the Family Medicine Clinic, OAUTHC, Ile-Ife. Subjects were interviewed using a questionnaire which contained items on socio-demographic

characteristics, medical history and lifestyle habit. It also included the erectile function domain of the International Index of Erectile Function (IIEF) scale and the Patient Health

Questionnaire (PHQ-9). The respondent’s family function was assessed using the family APGAR scale. The height, weight, body mass index, blood pressure and blood glucose of each subject were also measured. Univariate, bivariate and multivariate analyses of data were done.  

Results: The mean age (± SD) of the respondents was 52.7 (± 10.0) years. Among the study subjects, 168 (40.6%) had erectile dysfunction. The prevalence and severity increased with age from 27.6% in the age group 40-50 years, through 46.7% among those aged 51-60 years to 60% among the age group 61-70 years (p<0.001). The other factors associated with ED on bivariate analysis include: hypertension (p<0.001), diabetes (p=0.001), depression (p<0.001), the use of anti-hypertensives (p=0.002), smoking (p=0.001), alcohol consumption (p=0.004), low level of physical activity (p=0.29) and family dysfunction (p<0.001).

A significant proportion (42.3%) of the men with ED had never raised the issue with their doctors and had no intention of doing so. However, almost all (95.2%) supported the idea of routine inquiry about sexual health by doctors.

Logistic regression analysis showed that age, depression and family dysfunction were the independent predictors of ED among the respondents. Compared with those in the 40-50 age group, those aged 51-60 were twice more likely to have ED (OR = 2.186, CI = 1.265 – 3.778) while those in the 61-70 age group were about four times more likely to have ED.(OR = 3.937; CI = 2.155 – 7.193). Similarly, those who had depression were more than thrice likely to have ED (OR = 3.334, CI = 1.694 – 6.563), and respondents with a dysfunctional family had close to two and half times chances of having ED (OR = 2.433, CI = 1.406 – 4.211).

Conclusion: About four out of every ten adult men presenting to the Family Medicine clinic of the OAUTHC has ED and a significant proportion of them are reluctant to raise the issue with their health care provider. Routine sexual evaluation of men is recommended.

 

TABLE OF CONTENTS

Declaration ..................................................................................................................           ii

Certification ................................................................................................................           iii

Dedication ...................................................................................................................           iv

Acknowledgement ......................................................................................................           v

List of Abbreviations .................................................................................................            vi

Table of contents …………………………………………………………………….           vii

List of tables …………………………………………………………………………..        xi

List of figures …………………………………………………………………………         xii

List of appendices ……………………………………………………………………...       xiii

Summary ………………………………………………………………………………..      xiv

CHAPTER ONE ................................................................................................................................. xiv

CHAPTER TWO ................................................................................................................................. xx

CHAPTER THREE ........................................................................................................................... xliii

CHAPTER FOUR ................................................................................................................................. li

4.1       Socio-demographic Characteristics of Respondents .......................................................... li

4.4: Factors associated with Erectile Dysfunction among the respondents .............................. lvii

4.4.1:       Socio-demographic factors associated with ED among the respondents .................. lvii

CHAPTER FIVE ................................................................................................................................ lxx

CHAPTER SIX ................................................................................................................................ lxxxi

REFERENCES ............................................................................................................................... lxxxiii

 

CHAPTER ONE

INTRODUCTION 

1.1:      Background

Sexual health is perceived to be an integral part of general health as it can markedly affect quality of life. A man's sexuality changes as he grows older, but sexual activity remains important for most men throughout their adult lives.1 For many men, the ability to achieve a satisfactory erection defines their masculinity.2 This is easy to understand, as an erection is the most obvious physiological change that occurs during male sexual arousal and is mandatory for penetrative vaginal intercourse. Furthermore, a man’s ability to achieve a good and well-sustained erection is essential to his maintaining a positive body image.2

Erectile dysfunction (ED) is defined as the inability to attain and/or maintain penile erection sufficient for satisfactory sexual intercourse.1 It is one of the most frequent chronic health conditions in men older than 40 years of age.3 Even though sexual dysfunction is not life threatening, it should not be considered a benign disorder, as it may have a strong negative effect on patients’ interpersonal relationships and compromise their well-being and quality of life.4 ED causes impairment of sexual fulfilment which often leads to considerable distress for a couple and predisposes to dysfunction in relationship and family life.2

Previous surveys in North and South America, Europe, Asia, and Africa have demonstrated

that erectile dysfunction is a significant problem worldwide.5-11

The majority of men with ED are ashamed of their condition, which may partly explain why only about 58% of men seek help.12 It might also explain why men who do talk to a doctor about their ED often do so only when their symptoms are severe, despite the fact that men with all grades of ED are often extremely distressed by the problem.12 For this reason, Dean et al. suggested that physicians and other health professionals should, as a general rule, regularly and routinely discuss sexual health and function in consultations with their

patients.2

Despite these facts, the data on ED are relatively scarce especially in the primary care setting. Most of the available information in the literature emanates from population based studies.

The prevalence of ED has differed somewhat among different populations and clinical settings. In a multinational study across Europe, North and South America, Rosen et al. found an overall age-adjusted prevalence of 16% among 27,839 men aged 20-75 years who were interviewed in eight countries (United States, United Kingdom, Germany, France, Italy, Spain, Mexico, and Brazil). The prevalence however varied from one country to another ranging from 10% in Spain to 22% in the United States.5 In another study by Teles et al. in Portugal, the prevalence of ED was as high as 48.1%.6

A similar study in Brazil showed a prevalence of 45.1% (mild - 31%, moderate – 12.2% and

1.7% - severe / complete) among adult men 18 years and above.7 Chew et al. reported that 25.1% of adult men of all ages in Western Australia had some form of ED. Of these, 8.5% had the severe or complete form.8

A multiregional study among Asians revealed that the overall prevalence of self-reported ED in the study population of men aged 20-75 years was 6.4%.9

In Nigeria, studies in the published literature are very scanty. Fatusi et al. reported an overall ED prevalence of 43.8% among 355 married men, aged between 30 years and 70 years in the general population in south-western Nigeria. The estimated prevalence was made up of 8.0% severe and 35.8% moderate ED. This condition increased significantly with age, varying from 38.5% for age 31–40 years to 63.9% for the older group of 61–70 years.10

Virtually all these studies were either population-based or among patients in specialty clinics. Data on ED in primary care settings are hard to come by in the literature. Ariba et al. noted that the burden of this problem appears to be poorly recognized especially among patients in primary care as the diagnosis is seldom documented in primary care.13

In a study by Shaeer et al. the age-adjusted prevalence of all forms of ED from mild to complete among men attending some selected primary care clinics in Nigeria was 57.4%.11

1.2:      Association with Depression

ED can have a profound adverse effect on psychological well-being. It causes loss of selfesteem and sexual confidence, and it is also associated with depression.14 Many psychological disorders can occur co-morbidly with erectile dysfunction and it may sometimes be difficult to decide whether erectile dysfunction is the cause of the disorder or vice versa. Depressive symptoms are common in men with ED and have been found to sometimes be severe enough to meet the criteria for major depressive disorder (MDD).15 Secondary depression and loss of self-confidence occur in men with ED while ED is sometimes a symptom of a primary depressive disorder.16

Okulate and his coworkers investigated the prevalence of ED and its relationship with depression and alcohol abuse, in a sample of 829 personnel of the Nigerian Army. They found overall prevalence of 39.6% made up of 26.5% mild, 8.4% moderate, 2.3% severe, and 2.4% very severe. In addition, their study revealed ED prevalence of 36% in men that were 30 years and below, 31% in those between 31–40, 46% in men between 41–50 years, 58% in men between the age bracket of 51–60, and 100%  in those 61–63 years. Among those men identified as having ED, 10% were depressed with 10% having history of alcohol abuse.17

1.3:      Correlates of erectile dysfunction

In addition to depression, many other factors have been found to be correlates or predictors of ED. Having knowledge of specific risk factors present in a population can aid physicians in diagnosing ED in men who may be reluctant to raise this sensitive issue particularly during its early phase.

ED has been consistently shown to increase with age and to be associated with some sociodemographic factors such as education, income, marital status, medical conditions such as hypertension, diabetes, heart disease, renal failure, depression and the use of certain medications including antihypertensives, antidepressants, antipsychotics, antiulcer agents

cholesterol-lowering agents and antihistamines.5-9,18-23 Lifestyle factors such as smoking, alcohol consumption, body size, and physical exercise have also been found to be important

correlates of ED.24-33

1.4:      Justification and Relevance of the Study

Erectile dysfunction (ED) is relatively common worldwide.5-11 It is a distressing condition which often leads to considerable distress for a couple and predisposes to dysfunction in relationship and family life.10 This therefore falls within the domains of interest and care in family medicine. Family physicians should be adequately equipped in the holistic understanding, evaluation and management of erectile dysfunction.

Studies in western countries have shown that only about 58% of men suffering from this ED seek medical help probably because of its sensitive nature.12 This statistic may be worse in our part of the world where the cultural and societal stigma associated with the condition is strong.

Clinicians at the primary care level have an important role to play in the management of ED, since this setting provides opportunity for early detection of affected individuals and prompt treatment or referral to specialist care.13 Family physicians as providers of primary and longitudinal care are uniquely positioned to identify and initiate appropriate management strategies for patients with ED. By virtue of their longitudinal relationship with their patients in the setting of the family and commitment to comprehensive and holistic care, family physicians are well placed to inquire about a patient's sexual function during a routine office visit.33 This requires that family physicians routinely discuss sexual health and function in consultations with their patients especially with those who are ‘at risk’ of developing erectile dysfunction. Recommending such an approach is contingent upon the availability of relevant local data. Defining the prevalence, pattern and correlates of the condition is the first step in this direction.

The urgent need for local data on ED in primary care setting with regards to its prevalence, determinants and consequences cannot be over-emphasized. Data generated from this study on the prevalence of ED and its association with the common risk factors in the setting of family practice should alert family physicians to the problem in real life across the consulting table so that suitable management strategies may be initiated.Information of this nature would be very helpful in the development of appropriate family medicine interventions. This will potentially add value to the practice of family medicine and to the services rendered by family physicians who are well known for their commitment to the preventive and holistic models of care.

There are scanty local epidemiological data on ED among patients seen in primary care. Most studies to date have used community-based observational surveys or cohorts of individuals attending specialty clinics.

The need for current local data from primary care setting on the burden, determinants, and consequences of ED is thus urgent. This cross-sectional, primary care-based study is being conducted to determine the prevalence of erectile dysfunction among primary care patients and to explore its socio-demographic, medical, and lifestyle correlates.

1.5:      AIM

To assess the prevalence and pattern of erectile dysfunction among men aged 40-70 years attending the family medicine clinic of the Obafemi Awolowo University Teaching Hospital Complex (OAUTHC), Ile Ife.

1.6:      OBJECTIVES

  1. To determine the prevalence of ED among men aged 40 – 70 years attending the family medicine clinic of the OAUTHC, Ile-Ife.
  2. To identify the socio-demographic characteristics, medical conditions, and lifestyle factors associated with erectile dysfunction among the subjects.
  3. To assess the association between erectile dysfunction and the subjects’ family function.

PATTERN AND CORRELATES OF ERECTILE DYSFUNCTION AMONG ADULT MEN AGED 40 – 70 YEARS ATTENDING FAMILY MEDICINE CLINIC, OBAFEMI AWOLOWO UNIVERSITY TEACHING HOSPITALS COMPLEX, ILE-IFE.

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