Most Men With Erectile Dysfunction Don't Seem to Get Treatment

In study of 6 million ED patients, 75 percent either didn't receive or fill prescriptions

By Kathleen Doheny

HealthDay Reporter

MONDAY, May 6 (HealthDay News) -- Never mind the commercials with men talking freely to their doctor about their erectile dysfunction, taking a prescription for treatment to the pharmacy and settling in for a romantic evening.

Despite a wide range of treatment options, most men with erectile dysfunction (ED) don't get treated, according to a new study.

"ED treatments, overall, are underutilized," said Dr. Brian Helfand, an assistant clinical professor of urology at Northshore University Health System and the University of Chicago. "Only 25 percent of men are actually treated."

Helfand led the study, which looked at the medical records of more than 6 million men with an ED diagnosis. He is due to present his findings Monday at the American Urological Association annual meeting, in San Diego.

The study was funded by the Havana Day Dreamers Foundation (which promotes men's health), the Goldstein Fund in Male Pelvic Health and the SIU Urology Endowment Fund.

Helfand used an insurance claims database and looked for the medical code for erectile dysfunction from June 2010 through July 2011. He found 6.2 million men aged 30 and older who received a diagnosis of erectile dysfunction. ED is defined as an inability to maintain an erection satisfactory for sexual performance.

He then looked to see how many filled a prescription. Patients were considered treated if they filled a prescription for an erectile dysfunction drug such as Viagra (sildenafil) or Cialis (tadalafil), drugs called prostaglandins that are given by injection or urethral suppositories, or androgen (hormone) replacement.

He considered them untreated if they received a diagnosis of erectile dysfunction but did not fill a prescription.

He took into account, too, the men's ages and other health problems.

Even though erectile dysfunction is likely to become more common with age, he actually found older men the least likely to be treated. Only about 18 percent of men aged 65 and above were treated.

When Helfand looked to see what bearing other health conditions might have had on treatment, he found those with prostate cancer were least likely to be treated. Only 15 percent were.

The study didn't have information on why the men went untreated, he said. But he speculates there are probably several reasons.

The undertreatment, Helfand said, is probably a result of doctors often not offering the prescription or patients getting a prescription but not filling it at the pharmacy.

"Men may not be bothered by it," he said. Or a doctor may not write a prescription because he may not think the man is a candidate, or perhaps they didn't respond to erectile dysfunction treatment in the past.

Other reasons, he said, could include costs and embarrassment.

For men, Helfand said, the message is: "There are available therapies out there. These can be useful if you have ED."

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Erectile Dysfunction Tied to Long-Term Narcotic Use in Men

In study, more men on impotence meds were taking opioids for chronic back pain

By Serena Gordon

HealthDay Reporter

WEDNESDAY, May 15 (HealthDay News) -- If you're a man, the pain-killing medications known as opioids may do more than relieve pain -- they may also put a damper on your sex life.

A new study found that men who were prescribed medications for erectile dysfunction or low testosterone levels were more likely to be taking opioid (narcotic) medications for chronic back pain.

"People who have persistent pain problems need to know that a potential side effect of long-term opioid use may be erectile dysfunction," said lead study author Dr. Richard Deyo, a clinical investigator for the Kaiser Permanente Center for Health Research in Portland, Ore. "This is not a well-known potential side effect among patients, and it should be considered when thinking about treatment."

Deyo also noted, however, that "the nature of this study as an observational study limits our ability to make a causal [cause-and-effect] inference. Opioid use and erectile dysfunction seem to go together, but we have to be cautious about saying one causes the other."

Results of the study were published in the May issue of the journal Spine.

More than 4 million people use opioids on a regular basis, Deyo said. Commonly prescribed opioids include hydrocodone, oxycodone and morphine. In this study, use of opioids was considered long-term if patients used them for more than 120 days, or more than 90 days if more than 10 prescriptions were filled for the drugs.

The study included data on about 11,000 men who had back pain. In that group, more than 900 received medications for erectile dysfunction or testosterone replacement. Those who were given prescriptions for erectile dysfunction medications or testosterone were older than those who didn't get such prescriptions. They also were more likely to have depression and other health conditions.

And those who were taking erectile dysfunction medications or testosterone tended to be smokers or users of sedative medications, according to the study.

Erectile dysfunction drug prescriptions were for sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra).

Age was the most significant factor in getting a prescription for erectile dysfunction, according to the study. Men between the ages of 60 and 69 were 14 times more likely to receive a prescription for an erectile dysfunction medication than men who were between 18 and 29.

After adjusting the data to account for other possible factors, including age, the researchers found that men who took opioid pain medications for long periods were about 50 percent more likely to take erectile dysfunction medications or testosterone replacement therapy.

Dr. Daniel Shoskes, a professor of urology at the Cleveland Clinic's Glickman Urological and Kidney Institute, said the study doesn't prove that the pain medications cause the erectile dysfunction.

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Erectile Dysfunction May Signal Hidden Heart Disease

TUESDAY, Jan. 29 (HealthDay News) -- Doctors should look more closely at the overall health of impotent men, a large new study suggests.

Men with even mild erectile dysfunction -- but no known heart problems -- face a major extra risk of developing cardiovascular conditions in the future. And as erectile dysfunction becomes more pronounced, signs of hidden heart disease and earlier death risk grow.

Not surprisingly, men already known to have a heart condition along with severe erectile dysfunction fare worst of all, the Australian researchers found.

Among men aged 45 and up without diagnosed heart disease, those with moderate or severe erectile dysfunction were up to 50 percent more likely to be hospitalized for heart problems, according to an adjusted analysis. Erectile dysfunction boosted the risk for hospitalization even more when men had a history of cardiovascular disease.

Erectile problems, which become more likely as men grow older, aren't a guarantee of heart problems. Still, men with erectile dysfunction should "take action by seeing a health professional and asking for a heart check," said study lead author Dr. Emily Banks. "Men with erectile dysfunction need to be assessed for their future risk of cardiovascular disease, and any identified risk must be managed appropriately."

Banks is a professor of epidemiology at the Australian National University's National Center for Epidemiology and Population Health.

Banks said an estimated 60 percent of men aged 70 and up suffer from moderate to severe erectile dysfunction. The condition can place major limits on sexual activity and require the use of drugs like Viagra that can come with side effects and awkward challenges when it comes to the timing of doses.

A variety of causes can contribute to impotence, but "it is widely acknowledged that erectile dysfunction is predominantly the result of underlying cardiovascular disease," Banks said.

Doctors already believe that erectile dysfunction is an early warning sign of heart problems, but it's not clear why. It's possible, Banks said, that the arteries of the penis are smaller than those of other parts of the body and may be more likely to reveal problems when their lining deteriorates.

The new study aims to gain more insight into how the severity of erectile dysfunction translates into a higher risk of cardiovascular disease. The researchers tracked more than 95,000 men aged 45 and up, and compared data collected between 2006 and 2009 to data collected in 2010.

The researchers adjusted their statistics so they wouldn't be thrown off by factors like high or low numbers of men who smoked or drank alcohol, or were wealthy or poor. They found that the men with severe erectile dysfunction, compared to those with no problem, were eight times more likely to have heart failure, 60 percent more likely to have heart disease and almost twice as likely to die of any cause.

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