|Year : 2015 | Volume
| Issue : 3 | Page : 116-120
Erectile dysfunction in a sub-saharan African population: Profile and correlates in a tertiary care hospital
DG Yovwin1, FA Imarhiagbe2, EM Obazee3, TC Oguike4
1 Department of Family Medicine, Delta State University Teaching Hospital, Oghara, Nigeria
2 Department of Medicine, Neurology Unit, University of Benin Teaching Hospital, Benin City, Nigeria
3 Department of Family Medicine, University of Benin Teaching Hospital, Benin City, Nigeria
4 Department of Surgery, Urology Unit, University of Benin Teaching Hospital, Benin City, Nigeria
|Date of Web Publication||10-Nov-2015|
F A Imarhiagbe
Department of Medicine, Neurology Unit, University of Benin Teaching Hospital, P.O. Box 7184, GPO, Benin City
Background: Erectile dysfunction (ED) is a common complaint in general medical practice. This study describes the clinicodemographic features of ED. Materials and Methods: Two hundred and twelve subjects in the outpatient clinic of a tertiary care hospital were interviewed for demographic data, tobacco smoking, alcohol consumption, history of medications, previous abdominal surgery, history of diabetes mellitus, hypertension and ED, duration of ED if present, self-assessment of the level of sexual satisfaction, partner's assessment of the level of sexual satisfaction, type of remedies sought and used for ED in the past, whether or not subject has discussed the problem and patients' perception of the cause of the ED, all were interviewed with the international index of erectile function questionnaire for ED. Data was analyzed as appropriate. Results: Forty-two (19.8%) had ED and ED score was associated with age (P = 0.013), educational level (P < 0.001), monthly income (P < 0.001), alcohol consumption (P = 0.026), type of abdominal surgery done in the past (P = 0.002), self-rating of ED (P < 0.0001), partner rating (P < 0.0001), partner complaint (P < 0.0001), and frequency of complaint (P < 0.0001), it was however not significantly associated with marital status (P = 0.133), tobacco smoking (P = 0.259), quantity of tobacco smoked in pack years (P = 0.370), duration of ED (P = 0.141), drugs taken (P = 0.680). 77 (36.3%) never discussed ED before, 40 (19%) claimed that someone else was responsible, and only 15 (7.1%) had taken a phosphodiesterase inhibitor. ED score correlated negatively with fasting blood sugar with a trend toward significance (r = −0.134, P = 0.064). Conclusion: ED may be more frequent in the population studied considering the level of knowledge and attitude.
Keywords: Africans, attitude, correlation, demography, erectile dysfunction
|How to cite this article:|
Yovwin D G, Imarhiagbe F A, Obazee E M, Oguike T C. Erectile dysfunction in a sub-saharan African population: Profile and correlates in a tertiary care hospital. Sahel Med J 2015;18:116-20
|How to cite this URL:|
Yovwin D G, Imarhiagbe F A, Obazee E M, Oguike T C. Erectile dysfunction in a sub-saharan African population: Profile and correlates in a tertiary care hospital. Sahel Med J [serial online] 2015 [cited 2019 Aug 23];18:116-20. Available from: http://www.smjonline.org/text.asp?2015/18/3/116/169286
| Introduction|| |
Erectile dysfunction (ED) is the persistent inability to have or sustain an adequate erection for satisfactory sexual function, and it is a relatively common complaint in general medical practice.,, Prevalence of ED ranges from 15% to as high as 45% depending on the study setting and methodology and it is projected that ED prevalence globally stands at par with the increasing prevalence of diseases like diabetes mellitus.,, The etiology of ED can be classified as organic, psychogenic or mixed, and most of the time it is due to a chronic health condition.
Erectile dysfunction is associated with biopsychosocial comorbidities like advancing age, diabetes mellitus, chronic alcoholism, depression, drugs particularly antihypertensives, dyslipidemia, cigarette smoking, and previous abdominal surgery., ED could be a cause of strained marital relationships, and the reactive depression that is associated with it takes a toll on general health., Cultural mores surrounding ED may preclude discussions in the clinic and to wit the seeking of proper medical treatment in some population and it is also known that physicians are sometimes reluctant to initiate discussion regarding the sexual functions of their patients. Whereas most patients withhold information regarding their sexual difficulties mainly as a result of embarrassment, others do not see it as a medical problem.
The introduction of effective oral therapy and other current advances in the treatment options have generated great public interest among men and their partners in ED.
The international index of erectile function (IIEF) questionnaire in the original or modified form, is a simple and validated tool that has enabled the standardization and facilitated comparative systematic research in ED. IIEF is a 15 question and 30-point instrument with five domains of erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall sexual satisfaction. A score of 14 or less out of 30 particularly in the domain of erectile function is diagnostic of ED with a potential benefit from phosphodiesterase 5 inhibitors like sildenafil.
This study describes the clinicodemographic features of ED in a sub-Saharan African population making use of the IIEF questionnaire.
| Materials and Methods|| |
Two hundred and twelve subjects on routine visit to the general outpatient clinic of a tertiary care hospital were consecutively interviewed with a study proforma for basic demographic data of age, sex, marital status, level of education, income per month, tobacco smoking and alcohol consumption, history of use of medications, previous abdominal surgery, history of diabetes mellitus, history of hypertension, history of ED, duration of ED if present, self-assessment of the level of sexual satisfaction, partner's assessment of the level of sexual satisfaction, type of remedies sought and used for ED in the past, whether or not subject has discussed the problem and patients' perception of the cause of the ED, all were subsequently interviewed with the IIEF questionnaire for ED. Operationally, ED was defined as IIEF score of <14 out a maximum score of 30. All interviews were conducted by one of the authors and trained assistants in the clinic, and physical examination including height and weight was carried out on all study subjects by one of the authors. All subjects were referred for urinalysis and fasting blood sugar (FBS). Body mass index (BMI) was calculated as weight in kilograms over height in meters squared, urinalysis and blood sugar were done in the hospital's main laboratory.
Data were presented as appropriate and analyzed on cross-tabulation statistics with Pearson's Chi-square and measures of association were tested with phi or contingency coefficient as appropriate between IIEF ED scores and demographic and clinical data. Correlation of ED scores with BMI, FBS, systolic blood pressure (SBP), and diastolic blood pressure (DBP) was tested with Pearson's correlation statistics. Data analysis was done with IBM SPSS ® version 20 (IBM, Chicago IL) and a P < 0.05 was taken as significant for all tests.
| Results|| |
A total of 212 subjects were studied, age range of 31–68 years, median 46, mean 48 ± 12.34 years. Median ED score was 20.00, range 0–25, interquartile range (24–15) = 9. 42 (19.8%) had ED and 170 (80.2%) did not. Basic characteristics of study subjects are shown in [Table 1].
Erectile dysfunction score was significantly associated with age (P = 0.013, phi = 0.244), educational level (P < 0.001, phi = 0.342), monthly income (P < 0.001, phi = 0.403), alcohol consumption (P = 0.026, phi = 0.153), type of abdominal surgery done in the past (P = 0.002, phi = 0.286), self-rating of ED (P < 0.0001, 0.445), partner rating (P < 0.0001, 0.526), partner complain (P < ;0.0001, 0.347), and frequency of complain (P < 0.0001, 0.402). It was however not significantly associated with marital status (P = 0.133), tobacco smoking (P = 0.259), quantity of tobacco smoked in pack years (P = 0.370), duration of ED (P = 0.141), drugs taken (P = 0.680) [Table 2].
|Table 2: The association between ED score and some clinicodemographic parameters|
Click here to view
About 77% (36.3%) of subjects with ED have never discussed it before with a medical practitioner, while 65 (30.7%) have and in 70 (33%) there was no response as to whether they have discussed it or not.
Sixty-six (31%) felt it was not necessary to discuss it, 20 (9.5%) felt it was not an easy thing to talk about, and 5 (2.4%) said it was forbidden to discuss it, and the remaining 121 (57.1%) gave no reason for not discussing it.
Forty (19.0%) claimed someone was responsible, 5 (2.3%) claimed it was the work of the devil, 15 (7.1%) believed partner may be unfaithful, 30 (14.1%) were not sure and there was no response in 122 (57.5%).
Ninety-two (43.4%) have sought help for ED, 30 (14.1%) have never and 90 (42.5%) did not indicate if they have sought help before or not.
Only 15 (7.1%) indicated they have taken a phosphodiesterase inhibitor at least once, 45 (21.2%) have taken herbal remedies, 5 (2.4%) have taken other over the counter preparations and in 147 (69.3%) there was no indication of having used any remedy before presentation in the clinic [Table 3].
|Table 3: The percentage distribution of some knowledge, attitude, and practices concerning ED in study subjects|
Click here to view
Erectile dysfunction score did not correlate with BMI, r = 0.060, P = 0.383 and SBP, r = 0.115, P = 0.094 but showed a trend toward significance with DBP r = 0.125, P = 0.069 and negatively with FBS, r = −0.134, P = 0.064 [Table 4].
| Discussion|| |
The prevalence (20%) of ED found in this study is consistent with earlier related studies and the median ED score of 20 is reflective of the higher percentage (80.2%) of study subjects who did not have ED.,,, The significant association of age with ED scores may be linked largely with the higher incidence of vascular disease with advancing age from arteriosclerosis, endothelial dysfunction, and other comorbidities. Educational level and monthly income which are both measures of social status were found significantly associated with ED scores in consonance with what has been reported previously.,,, Alcohol consumption was associated with ED, a finding that may be related to the comorbidities that are linked with chronic alcohol consumption like dyslipidemia.,, It is important to mention that that the relationship between alcohol and ED has been a subject of some controversy. Different views have been canvassed depending largely on the study design and methodological rigor. While some have clearly shown a negative effect of alcohol on ED, others have not sufficiently demonstrated this., Type of abdominal surgery has been linked with ED, which may suggest a direct consequence of the disruption of sensitive neural substrate for erectile function., The strength of the association of partner rating and partner complain and less so with self-rating and ED score is worthy of note as it may suggest the sensitive and somewhat predictive roles of partner and self-assessment of erectile function before using objective clinimetric tools like IIEF score.
Marital status and duration of ED were not associated with ED score as in related works apparently because their effect on the biology of erection is minimal compared to medications and comorbidities like diabetes mellitus. Tobacco smoking and quantity of tobacco smoked were also not associated with ED score in this study which may be suggestive of the fewer number of smokers and the quantity of tobacco smoked in the population studied compared to what obtains in Western climes.,
The 31% frequency of study participants with ED that discussed it as a medical problem with the aim of finding solution with health care provider is notably low, which may not be unconnected with the prevalent perception of ED in the study population in which about 45% of those with ED blamed spiritual or spousal infidelity as the cause of ED. It is also noteworthy that only 45% of subjects with ED sought medical help for their condition, which is close to about 55% of those with ED who perceived ED as a medical problem and not due to spiritual or spousal infidelity.
About 25% of study subjects who got herbal remedies and over the counter preparations as treatment is suggestive of the channels through which medical care was accessed, again bringing to the fore the overall perception of ED among the study subjects in particular and the universal population in the environment they were drawn from, in general.
Remarkably, ED score was negatively associated with FBS with a trend toward significance, which is suggestive of the abnormal effect of hyperglycemia on erectile function.
We concluded that ED may likely be more frequent than what is found in this study population apparently because a warped perception of the cause of ED is prevalent, and as a corollary, seeking proper medical care is poor reflecting the yawning gap in health education and information of the local population; the correlation of elevated FBS with poor erectile function is also evident in this work.
| Acknowledgments|| |
We appreciate colleagues and staff at the general practice clinic of the University of Benin Teaching Hospital, Benin City, Nigeria.
| References|| |
National Institute of Health Consensus Conference. National Institute of Health Consensus Development Panel on Impotence. JAMA 1993;270:89-99.
Davies KP, Melman A. Markers of erectile dysfunction. Indian J Urol 2008;24:320-8.
Brotons FB, Campos JC, Gonzalez-Correales R, Martín-Morales A, Moncada I, Pomerol JM. Core document on erectile dysfunction: Key aspects in the care of a patient with erectile dysfunction. Int J Impot Res 2004;16 Suppl 2:S26-39.
Grover SA, Lowensteyn I, Kaouache M, Marchand S, Coupal L, DeCarolis E, et al
. The prevalence of erectile dysfunction in the primary care setting: Importance of risk factors for diabetes and vascular disease. Arch Intern Med 2006;166:213-9.
William AF, Siegfred M. Communication about erectile dysfunction among men with erectile dysfunction, partners of men with erectile dysfunction and physicians. The strike up conversation study (I). J Mens Health Gend 2005;2:64-78.
Levinson IP, Khalaf IM, Shaeer KZ, Smart DO. Efficacy and safety of sildenafil citrate (Viagra) for the treatment of erectile dysfunction in men in Egypt and South Africa. Int J Impot Res 2003;15 Suppl 1:S25-9.
Cho BL, Kim YS, Choi YS, Hong MH, Seo HG, Lee SY, et al
. Prevalence and risk factors for erectile dysfunction in primary care: Results of a Korean study. Int J Impot Res 2003;15:323-8.
Pommerville P. Erectile dysfunction: An overview. Can J Urol 2003;10 Suppl 1:2-6.
Idung AU, Abasiubong F, Udoh SB, Akinbami OS. Quality of life in patients with erectile dysfunction in the Niger Delta region, Nigeria. J Ment Health 2012;21:236-43.
Marwick C. Survey says patients expect little physician help on sex. JAMA 1999;281:2173-4.
Boolell M, Gepi-Attee S, Gingell JC, Allen MJ. Sildenafil, a novel effective oral therapy for male erectile dysfunction. Br J Urol 1996;78:257-61.
Bayraktar Z, Atun AI. Despite some comprehension problems the International Index of Erectile Function is a reliable questionnaire in erectile dysfunction. Urol Int 2012;88:170-6.
Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A. The international index of erectile function (IIEF): A multidimensional scale for assessment of erectile dysfunction. Urology 1997;49:822-30.
Adebusoye LA, Olapade-Olaopa OE, Ladipo MM, Owoaje ET. Prevalence and correlates of erectile dysfunction among primary care clinic attendees in Nigeria. Glob J Health Sci 2012;4:107-17.
Amidu N, Owiredu WK, Woode E, Addai-Mensah O, Gyasi-Sarpong KC, Alhassan A. Prevalence of male sexual dysfunction among Ghanaian populace: Myth or reality? Int J Impot Res 2010;22:337-42.
Selvin E, Burnett AL, Platz EA. Prevalence and risk factors for erectile dysfunction in the US. Am J Med 2007;120:151-7.
Martin-Morales A, Sanchez-Cruz JJ, Saenz de Tejada I, Rodriguez-Vela L, Jimenez-Cruz JF, Burgos-Rodriguez R. Prevalence and independent risk factors for erectile dysfunction in Spain: Results of the epidemiologia de la disfuncion erectil masculina study. J Urol 2001;166:569-74.
Tan JK, Hong CY, Png DJ, Liew LC, Wong ML. Erectile dysfunction in Singapore: Prevalence and its associated factors – A population-based study. Singapore Med J 2003;44:20-6.
Martin SA, Atlantis E, Lange K, Taylor AW, O'Loughlin P, Wittert GA, et al
. Predictors of sexual dysfunction incidence and remission in men. J Sex Med 2014;11:1136-47.
Oladiji F, Kayode OO, Parakoyi DB. Influence of socio-demographic characteristics on prevalence of erectile dysfunction in Nigeria. Int J Impot Res 2013;25:18-23.
Horasanli K, Boylu U, Kendirci M, Miroglu C. Do lifestyle changes work for improving erectile dysfunction? Asian J Androl 2008;10:28-35.
Olugbenga-Bello AI, Adeoye OA, Adeomi AA, Olajide AO. Prevalence of erectile dysfunction (ED) and its risk factors among adult men in a Nigerian community. Niger Postgrad Med J 2013;20:130-5.
Boddi V, Corona G, Monami M, Fisher AD, Bandini E, Melani C, et al
. Priapus is happier with Venus than with Bacchus. J Sex Med 2010;7:2831-41.
Chew KK, Bremner A, Stuckey B, Earle C, Jamrozik K. Alcohol consumption and male erectile dysfunction: An unfounded reputation for risk? J Sex Med 2009;6:1386-94.
Lee AC, Ho LM, Yip AW, Fan S, Lam TH. The effect of alcohol drinking on erectile dysfunction in Chinese men. Int J Impot Res 2010;22:272-8.
Hamilton Z, Mirza M. Post-prostatectomy erectile dysfunction: Contemporary approaches from a US perspective. Res Rep Urol 2014;6:35-41.
Cao S, Yin X, Wang Y, Zhou H, Song F, Lu Z. Smoking and risk of erectile dysfunction: Systematic review of observational studies with meta-analysis. PLoS One 2013;8:e60443.
Glina S, Sharlip ID, Hellstrom WJ. Modifying risk factors to prevent and treat erectile dysfunction. J Sex Med 2013;10:115-9.
[Table 1], [Table 2], [Table 3], [Table 4]