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ORIGINAL ARTICLE
Year : 2017  |  Volume : 30  |  Issue : 2  |  Page : 607-613

Quality of life in patients with erectile dysfunction in Shebin El Kom District


1 Department of Family Medicine, Faculty of Medicine, Menoufia University, Menoufia, Egypt
2 Department of Dermatology and Andrology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
3 Demira Family Medicine Center, Talkha District, Dakahlia Governorate, Egypt

Date of Submission30-Aug-2016
Date of Acceptance04-Mar-2017
Date of Web Publication25-Sep-2017

Correspondence Address:
Ibrahim A Ismail
Talkha District, Deqahlia Governorate
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mmj.mmj_474_16

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  Abstract 

Objective
This study aimed to assess the risk factors for erectile dysfunction(ED) and the sociodemographic characteristics of patients with ED in Shebin El Kom District who attended the Andrology Clinic in Menoufiya University Hospital.
Background
ED is a common disorder that affects the quality of life(QoL) of millions of people worldwide. Numerous factors can disrupt erectile function–for example, age, smoking, cardiovascular disease, and diabetes mellitus(DM).
Patients and methods
This was a cross-sectional study that was conducted on 169patients with ED from Shebin El Kom District who attended the Andrology Clinic in Menoufiya University Hospital during the period 1December 2015 to 31May2016. Information on sociodemographic data, risk factors for ED, and effect of ED on QoL was collected using self-administered questionnaires: a sociodemographic questionnaire, the International Index of Erectile Dysfunction(IIEF) questionnaire, a risk factors questionnaire, and the shorter version of the World Health Organization Quality of Life questionnaire.
Results
The main sociodemographic characteristics affecting ED were age of the patient(P=0.001) and age of the patient's wife(P=0.0001). The main risk factors for ED were lifestyle risk factors such as smoking (P=0.000) and obesity(P=0.005), medical conditions such as DM(P=0.0001), hypertension (P=0.0002), heart disease(P=0.019), dyslipidemia(P=0.013), lower urinary tract symptoms (P=0.005), and hypogonadism(P=0.004), intake of drugs (β-blockers (P = 0.000), insulin (P = 0.016), psychiatric drugs (P = 0.006), and silymarin (P = 0.001)), and penile and pelvis injury(P=0.032). Pychogenic factor was present in most cases of ED. In patients with ED other domains of IIEF, including orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction(89.7%) were reduced. Also ED negatively affected all domains of QoL.
Conclusion
According to our results, the main risk factors are aging, cardiovascular disease, DM, dyslipidemia, lifestyle issues(such as smoking and obesity), penile or pelvic injury, and side effects from medication. ED has a significant negative impact on other domains of IIEF and on the QoL.

Keywords: erectile dysfunction, quality of life, risk factors


How to cite this article:
Farahat TM, Maraee AH, Hegazy NN, Ismail IA. Quality of life in patients with erectile dysfunction in Shebin El Kom District. Menoufia Med J 2017;30:607-13

How to cite this URL:
Farahat TM, Maraee AH, Hegazy NN, Ismail IA. Quality of life in patients with erectile dysfunction in Shebin El Kom District. Menoufia Med J [serial online] 2017 [cited 2019 Jun 17];30:607-13. Available from: http://www.mmj.eg.net/text.asp?2017/30/2/607/215465


  Introduction Top


Sexuality is an integral part of a human being's well-being. Proper sexual functioning is one of the most important components of the quality of life(QoL)[1].

Epidemiological data have shown a high prevalence and incidence of erectile dysfunction(ED) worldwide. Massachusetts Male Aging Study(MMAS) reported an overall prevalence of 52% for ED in noninstitutionalized 40–70-year-old men in the Boston area; prevalence of minimal, moderate, and complete ED was 17.2, 25.2, and 9.6%, respectively[2].

The National Institutes of Health Consensus Development Conference on Impotence(1992) defined impotence as male ED–that is, the inability to achieve or maintain an erection sufficient for satisfactory sexual performance[3].

The prevalence of complete ED in Egypt is 13.4%, which is higher than that in the MMAS. Stratification of complete ED in Egypt according to age emphasizes the higher prevalence in Egypt. Men in their 40s have 8% complete ED, men in their 50s have 25% complete ED, and those above 60years have 50% complete ED[4].

ED is divided into two etiologic categories: psychogenic and organic. Most causes of ED were once considered to be psychogenic, but current evidence suggests that up to 80% of cases have an organic cause[5].

The risk factors for ED are sedentary lifestyle, obesity, smoking, hypercholesterolemia, and metabolic syndrome, which are very similar to the risk factors for cardiovascular disease[6].

ED affects the QoL of millions of people worldwide. ED is associated with many psychosocial problems such as decreased QoL, low self-esteem, depression, anxiety, relationship problems, and marital tension[7].

The goals of primary care are to assess the likely cause of ED and identify medical or psychologic conditions that may be contributing to the dysfunction or that may influence treatment options[8].

The aim of the study was to improve the sexual health of men and thus improve their QoL. The main objectives of this work were to assess the risk factors for ED and the sociodemographic characteristics of the study group.


  Patients and Methods Top


Patients

This was a cross-sectional study that was conducted on 169patients with ED. All patients with ED from Shebin El Kom District who attended The Andrology Clinic in Menoufiya University Hospital from 9:00 a.m. till 2:00 p.m. on Thursday every week (because it is the only day for andrology patients in the clinic) during the period from 1December 2015 to 31May2016 were invited to participate in the study. Approximately 176patients attended The Andrology Clinic, of whom seven patients refused to participate in the study and 169 completed the questionnaires.

Ethical consideration

The study was approved by the ethical committee of the Faculty of Medicine, Menoufiya University. Written informed consent was taken from each participant after explaining the purpose of the study and ensuring that there was no obligation to participate. The consent form was developed according to the international ethical guidelines for medical research involving human and quality improvement of the Egyptian Ministry of Health.

Inclusion criteria

  1. Having ED and living in Shebin El KomDistrict and attending The Andrology Clinic in Menoufiya University Hospital
  2. Giving consent to participate


Exclusion criteria

  1. Refusal to participate
  2. Having normal erectile function
  3. Not being from Shebin El Kom District.


Methods

The study group was subjected to an interview for the following purposes:

  1. To discuss the study aims and design and to take consent for participation
  2. To fill up the questionnaire in the patient's own words, thus registering his answers. The questionnaire was divided into four parts:
    1. The first part contained questions on sociodemographic aspects for social classification for health research[9]
    2. The second part was the 15-question International Index of Erectile Function questionnaire, which is a validated, multidimensional, self-administered investigation that has been found useful in the clinical assessment of ED and treatment outcomes in clinical trials[10]
    3. The third part asked about risk factors that may lead to ED. This questionnaire was obtained from the Andrology Clinic of Menoufiya University Hospital with some modifications to cover all risk factors involved in the research[11]
    4. The fourth part was the World Health Organization Quality of Life(WHOQOL)-Bref(Field Trial Version) questionnaire about QoL prepared by the Department of Mental Health, WHO[12].


Data were collected using a prestructured questionnaire in Arabic language. It was distributed to all patients with ED living in Shebin El Kom District who were attending The Andrology Clinic in Menoufiya University from 9:00 a.m. to 2:00 p.m. on Thursday every week during the period from 1December 2015 to 31May2016.

Statistical analysis

Data were collected, coded, translated into English to facilitate data manipulation, and double-entered into Microsoft Excel. Data analysis was performed using statistical package for the social sciences software, version18(an IBM Company)(SPSS, version18; SPSS Inc., Chicago, Illinois, USA) for Microsoft Windows.

Qualitative data were presented as simple descriptive analysis in the form of numbers and percentages. The c2-test was used to compare two or more qualitative groups. Odds ratio was used to determine significant risk factors and logistic regression was used to test the association between variablesand risk factors.

Quantitative data were expressed as arithmeticmean and SD for measures of central tendency and measures of dispersion, respectively. P values less than or equal to 0.05 were considered the cutoff value for significance.


  Result Top


Out of 169patients with ED, 66(39.05%) were found to have mild ED, 89(52.66%) had moderate ED, and 14(8.28%) had severe ED[Figure 1]. Their ages ranged from 21 to 61years(42.51±10.11years).
Figure 1: The classification of erectile dysfunction according to severity within the studied group.

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The c2-test showed statistically significant difference between the studied groups as regards age (≥60years) of the patient(P=0.003), age of the patient's wife(P=0.0001), and occupation of the patient's wife(P=0.003). There was a statistically nonsignificant difference as regards residence of the patient, education level of the wife, crowding index, and family income(P=0.066, 0.578, 0.063, and 0.267, respectively) [Table1].
Table 1: Relation between sociodemographic characteristics of the patient and erectile dysfunction

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According to the c2-test, there was a statistically significant difference between studied groups as regards lifestyle risk factors such as smoking(P=0.000) and obesity (P=0.005) and a statistically nonsignificant difference as regards sedentary lifestyle(P=0.838) [Table2].
Table 2: Relation between erectile dysfunction and lifestyle risk factors

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According to the c2-test, there was a statistically significant difference as regards diabetes mellitus (DM) (P=0.0001), heart disease((P=0.019), hypertension (HTN)(P=0.0002), dyslipidemia (P=0.013), hypogonadism(P=0.004), lower urinary tract symptoms (LUTS)(P=0.005), and pelvic or penile injury (P=0.032) [Table3]. There was a statistically significant difference as regards intake of β-blockers(BB) (P=0), insulin(P=0.016), psychiatric drugs (P=0.006), and silymarin(P=0.001) as well, but a statistically nonsignificant difference between the studied groups as regards intake of diuretics(P=0.06) and oral antidiabetics(P=0.297)[Table3].
Table 3: Relation of medical conditions and drugs with erectile dysfunction

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This study divided ED into three categories–organic(42.6%), psychogenic(33.73%), and mixed organic and psychogenic(23.67%)–with statically significant difference between them except with respect to mixed organic and psychogenic(P=0.000, 0.05, and 0.105, respectively)[Figure 2].
Figure 2: The relation between erectile dysfunction cases and classification of erectile dysfunction according to etiology. ED, erectile dysfunction.

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In this study, ED was statistically significant with other sexual domains, where 92.3% of patients had reduced orgasmic function, 64% had reduced sexual desire, 87.5% had reduced intercourse satisfaction, and 89.3% had reduced overall sexual satisfaction(P=0.000) [Table4].
Table 4: Relation between type of sexual function domain and level of dysfunction

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In this study the scores of the domains of WHOQOL-Bref were negatively associated with the degree of ED(P=0.000): 1.52% of patients with mild ED expressed their QoL as being very low and 9.09% expressed it as being low; 13.48% of patients with moderate ED expressed their QoL as being very low and 26.97% expressed it as being low; and 57.14% of patients with severe ED expressed their QoL as being very low and 14.29% expressed it as being low[Figure 3].
Figure 3: The relation between quality of life score and erectile dysfunction cases. ED, erectile dysfunction.

Click here to view



  Discussion Top


In the studied group of 169patients, 39.05% had mild ED, 52.66% had moderate ED, and 8.28% had severe ED.

In this study, the prevalence of ED increased statistically significantly with the age of the patient(P=0.0002). This was in agreement with the results of Moreira etal.[13], who reported that the incidence of ED was 33/1000 person-years among 40–49-year-old men and 190/1000 person-years among 60–70-year-old men.

This study showed no significant difference as regards socioeconomic status(income, education, and occupation) (P=0.267, 0.917, and 0.285, respectively). This was in agreement with Akkus et al. [14], Feldman HA [15], Grover et al. [16], and Nicolosi et al. [17], who reported no association and evaluated only the association between low education level and ED and socioeconomic status.

This study showed no significant difference between the studied groups regarding geographical location (P=0.066); the study showed that urban areas had more ED(65.1%) than did rural areas(42.1%). This is in agreement with the findings of Akkus etal.[14] and Seyam etal.[4], who reported that rural areas had more ED than did urban areas.

In this study, the prevalence of ED increased statistically significantly with diabetes(P=0.0001); 52.1% of the study group had DM. This is in agreement with the findings of Moreira etal.[13], who reported that men with baseline diabetes had a 2.49 higher risk for developing ED.

The prevalence of ED increased statistically significantly with heart disease(P=0.019); 29.6% of the study group had heart disease. This is in agreement with the observations of Feldman etal.[15] in the MMAS, in which 39% of the sample was completely impotent compared with 10%.

In this study, the prevalence of ED increased statistically significantly with HTN(P=0.0002); 30.8% of the study group had HTN. This is in agreement with the findings of Mutagaywa[1], who reported that the prevalence of ED in hypertensive patients was significantly higher(65.8%) than that in nonhypertensive individuals(44.2%)(P<0.001).

In this study, the prevalence of ED increased statistically significantly with LUTS(P=0.005); 4.7% of the study group had LUTS. This is in agreement with the observations of Macfarlane etal.[18], who reported that ED is highly prevalent in patients with LUTS.

Also, the prevalence of ED increased statistically significantly with hypogonadism(P=0.004); 4.7% had hypogonadism. This is in agreement with the findings of Tsertsvadze etal.[19], who reported that 23–36% of men with ED are hypogonadal.

The prevalence of ED increased statistically significantly with BB intake(P=0.000); 11.8% of the study group was taking BB. However, use of diuretics was statistically insignificant(P=0.06); 5.63% of the study group was taking diuretics. This is in disagreement with the results of Mikhailidis etal.[20], who reported that ED may affect 10–20% of patients taking thiazide diuretics, and, to a lesser extent, patients using BB. This disagreement in the study group as regards the use of diuretics may be due to the nature of the participants in the study, where about 8% were less than 50years old.

The prevalence of ED increased statistically significantly with insulin(P=0.016) and nonsignificantly with antidiabetic drugs(P=0.297); 8.2% of the study group was taking insulin and 2.4% was taking oral antidiabetics. This is in contrast with the study of Mikhailidis etal.[20], who reported that hypoglycemia resulting from insulin or oral hypoglycemic agents can cause ED or orgasmic function. This disagreement in the study group as regards the use of oral antidiabetics may be due to the nature of the participants in the study, where about 8% of them were less than 50years old.

Further, the prevalence increased statistically significantly with use of psychiatric drugs(P=0.006); 10.2% were taking psychiatric drugs. This is in agreement with the findings of Shaeer etal.[21] and Safarinejad[22]. The prevalence of ED increased statistically significantly with silymarin(P=0.005); 14.6% of the study group was taking silymarin. This result needs further validation in future studies.

In this study, the prevalence of ED increased statistically nonsignificantly with sedentary lifestyle(P=0.838); 59.17% had ED. This is in contrast with the observations ofFeldman etal.[15] in the MMAS, in which men who were initially sedentary but took up exercise had a lower risk for ED compared with those who remained inactive throughout.

In this study, obesity was found to be a statistically significant risk factor for ED as 56patients(33.14%) were obese(P=0.005). This is in agreement with the findings of Feldman etal.[15], who found that being overweight had a strong independent effect on ED.

In this study, smoking was found to be a statistically significant risk factor for ED as 45.6% of the studied group consisted of current smokers and of them 56.1% had mild ED, 36% had moderate ED, and 57.1% had severe ED. This is in agreement with Safarinejad[22], who found that men who smoked were 2.4(95% confidence interval, 1.5–3.3) times more likely to have ED compared with nonsmokers.

In this study the scores of all domains of WHOQOL-Bref were negatively associated with the degree of ED(P=0.000). This was in agreement with the observations of Seyam etal.[4], who showed that ED was negatively associated with better life satisfaction and QoL(P<0.001).


  Conclusion Top


According to our results, the main sociodemographic characteristics affecting ED are age of the patient and age and occupation of the patient's wife. The main risk factors for developing ED are lifestyle risk factors(smoking and obesity), medical conditions(DM, HTN, heart disease, dyslipideamia, LUTS, hypogonadism), drugs(BB, insulin, psychiatric drugs, and silymarin), and penile and pelvis injury. Pychogenic factor is present in most cases of ED and hence there is a need to encourage the prevention of ED, including correction of the modifiable risk factors.

ED has a significant negative impact on the QoL of both the affected individual and his partner, and hence there is a need to encourage treatment of ED. The family physician should be educated and well trained about sexual health so that most patients with ED can be safely and effectively treated.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
MutagaywaRK, LutaleJ, AboudM, KamalaBA. Prevalence of ED and associated risk factors among diabetic men attending diabetic clinic at Muhimbili National Hospital in Dar-es-Salam, Tanzania. Pan Afr Med J 2014; 17:227.  Back to cited text no. 1
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    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table1], [Table2], [Table3], [Table4]


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