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 Table of Contents  
ORIGINAL ARTICLE
Year : 2013  |  Volume : 33  |  Issue : 1  |  Page : 32-36

Quality of life in erectile dysfunction patients and their partners responding to tadalafil versus sildenafil citrate


Department of Dermatology, Venerology and Andrology, Al-Azhar University, Cairo, Egypt

Date of Submission01-Mar-2013
Date of Acceptance20-Apr-2013
Date of Web Publication23-Jun-2014

Correspondence Address:
Mohamed I Kamel
MD, 115 Manial Street, PO Box 11553 Cairo
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.7123/01.EJDV.0000431583.00793.33

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  Abstract 

Background

Erectile dysfunction (ED) is considered the most common sexual problem in men, with a direct impact on the life of the patient and their partners. Quality of life (QOL) has become a useful variable to assess the overall impact of diseases and medical treatments from the patient’s point of view.

Aim

The aim of this study was to estimate the QOL in ED patients responding to tadalafil versus sildenafil citrate as well as that of their partners and also to find out the type of treatment associated with the best QOL among these patients.

Methods

The present study was carried out over a period of 2 months and involved 60 diagnosed ED patients and their partners who were divided into two groups. Group A comprised 30 male patients who responded to tadalafil (20 mg) on demand therapy as well as their partners. Group B comprised 30 male patients who responded to sildenafil citrate (50 mg) on demand therapy as well as their partners. All patients included in the study were subjected to a thorough medical history taking, physical and genital examination, and QOL assessment using the WHO QOL BREF questionnaire before administration of tadalafil or sildenafil as a treatment for their condition; they were then reassessed after 2 months.

Results

The present study showed that ED has a negative impact on all domains of QOL.

Conclusions

Treatment with tadalafil or sildenafil improves QOL for both the patients and their partners in different domains of QOL.

Keywords: partners, quality of life, sildenafil, tadalafil


How to cite this article:
Attia AA, Hassan FA, Kamel MI, Ayoub MR. Quality of life in erectile dysfunction patients and their partners responding to tadalafil versus sildenafil citrate. Egypt J Dermatol Venerol 2013;33:32-6

How to cite this URL:
Attia AA, Hassan FA, Kamel MI, Ayoub MR. Quality of life in erectile dysfunction patients and their partners responding to tadalafil versus sildenafil citrate. Egypt J Dermatol Venerol [serial online] 2013 [cited 2017 Dec 18];33:32-6. Available from: http://www.ejdv.eg.net/text.asp?2013/33/1/32/135112


  Introduction Top


Erectile dysfunction (ED) is considered the most common sexual problem in men and is thought to affect up to one-third of men throughout their lives. Researchers predict that by the year 2025, 322 million men worldwide will suffer from ED 1–3.

Despite the therapeutic modalities that have emerged to treat ED, especially phosphodiesterase type 5 (PDE5Is), it still represents a major impact on the quality of life (QOL) for both the patients and their partners 1,4.

QOL has become increasingly popular as a useful variable tailored tool to assess the overall impact of diseases and medical treatments from the patient’s point of view 5.

The PDE5 inhibitor as a treatment for men with ED has resulted in an increased health-related quality of life (HRQOL), relationship satisfaction, and perceived general health as well as decreased symptoms of depression 4.


  Patients and methods Top


The present study included 60 diagnosed ED patients and their partners, all of whom were recruited from among patients attending the Andrology clinic of Al-Azhar University hospital between March 2010 and September 2011. The study was approved by IRB of dermatology, venereology and urology department, Al-Azhar University for boys Cairo, Egypt.

All patients in the study were diagnosed as having ED for at least 3 months and had not received medical treatment for at least 4 weeks before enrolment in the study.

Informed consent was obtained from both the patients and their female partners.

All patients included in the study were subjected to the following: thorough medical history taking, physical and genital examination to exclude genital anatomical deformities in men, and tests for the detection of other sexual disorders (other than ED) such as paraphilia and major psychiatric and psychological disorders.

Patients receiving nitrates declared that their dissatisfaction was because of inadequate intimacy, and patients known to be nonresponsive to sildenafil or tadalafil were excluded.

In the present study, patients and their wives were divided into two groups. Group A comprised 30 male patients responding to tadalafil (20 mg) on demand therapy as well as their partners (30). Group B comprised 30 male patients who responded to sildenafil citrate (50 mg) on demand therapy as well as their partners (30). The study was conducted over a period of 2 months.

In the present study, QOL was assessed for all patients and their partners using the WHO QOL BREF questionnaire before administration of tadalafil or sildenafil as a treatment for their condition; they were then reassessed after 2 months of treatment according to each arm of the study 6.

For assessment of the WHO QOL BREF questionnaire, 26 questions were asked to each patient and his wife. All questions were answered by choosing one of five answers, and each answer was scored ranging from 1 to 5.

Scoring of HRQOL is assessed according to four domains including physical, psychological, social, and environmental domains.

The WHO QOL BREF questionnaire revealed the percentage of affection of QOL for each domain separately 6.

The collected data were organized, tabulated, and statistically analyzed using the Epi info program (Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA) on a Microsoft windows-based personal computer. The collected data were coded, entered, analyzed, and tabulated. Mean±SD and χ 2 were the statistical methods used in the present study. A P value less than 0.05 was the accepted level of significance during the study.


  Results Top


In the present study, mean age of patients in group A was 40.6±4.7 and that of patients in group B was 43.6±2.1. The mean age among partners in group A was 33.2±2.6 and that of partners in group B was 30.7±5.2. No statistically significant difference was observed between the two groups.

In the present study, four of the following domains of QOL according to the WHO QOL BREF questionnaire were assessed: physical affection, psychological, social, and environmental.

As regards the physical affection domain, the present study showed that statistically significant differences were present.

For patients receiving tadalafil (group A), the physical domain showed a statistically significant difference with respect to physical pain, need for medical treatment, poor ability to get around, dissatisfaction with sleep, and dissatisfaction with the ability to perform.

For partners of patients receiving tadalafil, there were statistically significant differences with respect to physical pain, not having enough energy, poor ability to get around, and dissatisfaction with sleep and the capacity for work.

For patients receiving sildenafil, statistically significant differences were found with respect to physical pain and a poor ability to get around.

With regard to the degree of affection among the physical aspects of QOL before and after treatment, most of the patients in group A and their partners belonged to the category 80 to less than 60% affection before treatment and to the category 60 to less than 40% affection after treatment.

Most of the patients in group B and their partners belonged to the category 60 to less than 40% affection before and after treatment.

There was a statistically significant difference among patients in group A with degree of affection of the physical aspects of quality of life of 40% to less than 20% affection; moreover, there was also a significant difference before treatment among the partners in the same group with degree of affection of the physical aspects of quality of life of 60 to less than 40% affection [Table 1].
Table 1: Post-treatment effect on the degree of physical affection of quality of life among the studied groups

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For the psychological domain, a statistically significant difference was found among patients receiving tadalafil and their partners with respect to their inability to enjoy life and accept their body appearance.

For patients receiving sildenafil, there was a statistically significant difference with respect to their inability to enjoy life and accepting their body appearance, whereas their partners showed a significant difference with regard to their inability to concentrate and accept their body appearance.

In the present study, nonstatistically significant differences were found in terms of self-dissatisfaction and having negative feelings before and after treatment in all groups.

As regards the degree of affection of the psychological aspects of QOL before and after treatment, most of the patients in group A belonged to the category 80 to less than 60% affection before treatment and to the category 40 to less than 20% affection after treatment.

Most of the partners of patients receiving tadalafil belonged to the category 100 to less than 80% affection before treatment and to the category 60 to less than 40% affection after treatment.

Most of the patients and their partners in group B belonged to the category 60 to less than 40% affection before treatment, and this did not change after treatment.

There was statistically significant difference between group A patients before n=4 (13.3%) and after treatment n=15 (50%) as regards degree of psychological affection of quality of life for 40% to less than 20% affection category [Table 2].
Table 2: Post-treatment effect on the degree of psychological affection of quality of life among the studied groups

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As regards the social aspects of QOL, there were statistically significant differences with respect to dissatisfaction with sex life before and after intervention among group A and B patients and their partners.

The degree of affection among the social aspects of QOL before and after treatment showed no statistically significant differences.

Most of the patients receiving either tadalafil (group A) or sildenafil (group B) belonged to the category 100 to less than 80% affection before and after treatment.

Partners of patients receiving tadalafil belonged to the category 100 to less than 80% affection before treatment and to the category 60 to less than 40% and 40 to less than 20% affection after treatment [Table 3].
Table 3: Post-treatment effect on the degree of social affection of quality of life among the studied groups

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As regards the environmental aspects of QOL, there was a statistically significant difference with regard to dissatisfaction with the access to healthcare services before and after treatment in all groups. In addition, there were statistically significant differences with respect to dissatisfaction with the transportation among group A partners only.

Most of the patients and partners included in this study belonged to the category 100 to less than 80% affection before and after treatment as regards the environmental aspects of QOL [Table 4].
Table 4: Post-treatment effect on the degree of environmental affection of quality of life among the studied groups

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  Discussion Top


The present study was carried out to compare between QOL in ED patients responding to sildenafil citrate versus tadalafil as well as their partners.

To our knowledge, to date, there are not many studies comparing HRQOL in ED patients responding to tadalafil versus sildenafil citrate and their partners.

The results of the present study show that ED has a negative impact on all domains of QOL, and the degree of affection for most patients in group A were in the range of 80 to less than 60% as regards the physical and psychological domains, whereas those in group B were in the range of 60 to less than 40% affection. Most patients of group A and B were in the category 100 to less than 80% affection as regards the social and environmental domains.

Our results are in agreement with those of MacDonach et al. 7, who stated that the individual reaction to ED varies among men and has a different impact on their QOL. Some men do not seem to be considerably annoyed by a poor erectile function, whereas others may exhibit particular concern and anxiety, resulting in an impaired QOL.

With regard to the physical domain of QOL in the tadalafil group, five of seven aspects improved in case of both the patients and their partners.

In contrast, in the sildenafil group, two of seven aspects of the physical domain improved for men, whereas for women only one of the seven aspects improved.

As regards the physical aspect of QOL before treatment, most patients of the tadalafil group belonged to the category 80 to less than 60% affection, whereas those in the sildenafil group belonged to the 40–60% category of affection; these results were compatible with those of McCabe 8, who investigated the relationship between sexual dysfunction and QOL among men and women and found that men with ED experienced deficits in their objective levels of well-being and energy for everyday life and to a lesser extent in their levels of health and safety.

After treatment with sildenafil, the present study assessed the physical aspect of QOL and found that the majority of the patients belonged to the category 40–60% affection (which is the same degree of affection before treatment); this may be attributed to the fact that physical pain, which prevents the male patient from engaging in satisfactory sexual activities, significantly decreased, with a statistically significant difference (P<0.04) [from 17 patients (56.7%) before treatment to 12 patients (40%) after treatment]. However, other physical domains whether in male or female partners were not significantly improved. These results can be explained by the fact that sildenafil is not an energy enhancer.

There were statistically significant differences among both the patients and their partners in the tadalafil group before and after treatment as regards the aspect of dissatisfaction with sleep; this is compatible with the results of Meyer et al. 9, who studied life satisfaction with male sexual dysfunction and found that satisfaction with sexual life has been shown to be an important predictor of satisfaction with life as a whole and reflected on many aspects of life, especially satisfaction with sleep.

With regard to the psychological domain of QOL, in the tadalafil group, three of six aspects improved for men, whereas two of six aspects improved for women.

In contrast, in the sildenafil group, two of six aspects improved for both men and women.

As regards the psychological aspects of QOL, before treating ED, the majority of the patients in group A were affected by a degree of 80 to less than 60%, whereas those in group B were in the range of 60 to less than 40% affection; this is compatible with the results of the following authors: Laumann et al. 10, who demonstrated that sexual dysfunction has an effect on the QOL, especially on the low levels of emotional satisfaction and happiness; Althof 11, who studied QOL with ED and found that ED greatly affected the self-esteem and concentration and is associated with anxiety and depression; and Jeong et al. 12, who significantly associated ED with highly depressive symptoms, regardless of age, health habit, or concomitant comorbidity.

The results of this study are in agreement with those of Rosen et al. 13, who demonstrated that psychological pain induced by ED can be more disabling than the physical problems associated with chronic illnesses.

The present study shows that the psychological domain of HRQOL was greatly impaired, which is in agreement with the results of Rosen et al. 14, who reported that ED was associated with a poorer psychosocial function than what was observed in normal populations and that the emotional domain of QOL was more profoundly affected by ED than was the physical domain.

After treatment with sildenafil majority of the patients n=17 (56.7%) in group B patients were affected in the psychological aspects of their quality of life by a degree of 60 to <40% and this may be related to the small percentage of male patients were significantly improved in all aspects of the psychological domain of quality of life, the improvement was significant only in 2 aspects of the psychological domain which are enjoying life n=13 (43.3%) P value 0.008*, and n=18 (60%) were able to accept their body appearance P value 0.04.

After treatment with sildenafil, the majority of the male patients did not significantly improved upon the psychological aspects of their QOL, which is in disagreement with the results of Cappelleri et al. 15, who found that sildenafil citrate improves the self-esteem, confidence, and relationships with their partners in men with ED; this difference in results may be because of the use of another type of questionnaire, that is, the Self-Esteem And Relationship Questionnaire, which is a 14-item questionnaire focusing only on the aspects of self-esteem, confidence, and relationships and also because of the larger number of patients in the latter multicenter study.

There was a statistically significant difference in group B before and after treatment as regards as having negative feelings such as depression and anxiety; this is compatible with the results of Kaminetsky et al. 16, who reported that satisfaction with the erection attained on using sildenafil correlates with emotional well-being.

With regard to the social domain of QOL in the tadalafil and sildenafil group, one of three aspects, that is, dissatisfaction with sex life, improved for both men and women.

As regards the social aspect of QOL before treatment, the majority of patients belonged to the category 100 to less than 80% affection. This is compatible with the results of MacDonach et al. 7, who observed that ED greatly affects and decreases patient satisfaction with their sexual life and partners and also has a negative impact on their social relationships.

After treatment with sildenafil, the majority of the patients belonged to the category 100 to less than 80% affection as regards the social aspect of QOL.

There was a statistically significant difference between the male group before and after treatment (P=0.004) as regards as the aspect of dissatisfaction with sex life. These results are compatible with those of Fisher et al. 17, who reported that sildenafil improves the satisfaction with sex life and men’s attitude toward sex.

Further studies are needed to confirm the findings of the present study and analyze the feelings of men with ED, their partners, and their perception of treatment, as it has a dramatic effect on the different domains of QOL [Table 4].[17]

 
  References Top

1.Carson CC.Phosphodiesterase type 5 inhibitors: state of the therapeutic class.Urol Clin North Am 2007;34:507–515.  Back to cited text no. 1
    
2. Wentzell E, Salmeron J.Prevalence of erectile dysfunction and its treatment in a Mexican population: distinguishing between erectile function change and dysfunction.J Mens Health 2009;6:56–62.  Back to cited text no. 2
    
3. Heidelbaugh JJ.Management of erectile dysfunction.Am Fam Physician 2010;81:305–312.  Back to cited text no. 3
    
4. Mulhall JP, King R, Brimmer DJ, Harnett J, Hvidsten K, Kennedy SS, et al..Attitudes, beliefs, and values regarding the sexual experience in men: development of the Sexual Experience Questionnaire.J Mens Health 2010;7:20–30.  Back to cited text no. 4
    
5. Berlim MT, Fleck MP.‘Quality of life’: a brand new concept for research and practice in psychiatry.Rev Bras Psiquiatr 2003;25:249–252.  Back to cited text no. 5
    
6. .Measuring quality of life (MSA/MNH/PSF/974) 1997.Geneva, Switzerland:WHO.  Back to cited text no. 6
    
7. MacDonach R, Ewings P, Porter T.The effect of erectile dysfunction on quality of life: psychometric testing of a new quality of life measure for patients with erectile dysfunction.J Urol 2002;167:212–217.  Back to cited text no. 7
    
8. McCabe MP.Intimacy and quality of life among sexually dysfunctional men and women.J Sex Marital Ther 1997;23:276–290.  Back to cited text no. 8
    
9. Meyer AR, Lodnert G, Bränholm IB.On life satisfaction in male erectile dysfunction.Int J Impotence Res 1997;9:141–148.  Back to cited text no. 9
    
10. Laumann EO, Wilton L, Waite LJ.Sexual dysfunction among older adults: prevalence and risk factors from a nationally representative U.S. probability sample of men and women.J Sex Med 2008;5:2300–2311.  Back to cited text no. 10
    
11. Althof S.Quality of life and erectile dysfunction.Urology 2002;59:803–810.  Back to cited text no. 11
    
12. Jeong JY, Lee SK, Kang YW, Jang SN, Choi YJ, Kim DH.Relationship between ED and depression among middle-aged and elderly men in Korea: Hallym aging study.Int J Impot Res 2011;23:227–234.  Back to cited text no. 12
    
13. Rosen RC, Cappelleri JC, Smith M.Development and evaluation of an abridged, 5-item version of the international index of erectile function (IIEF-5) as a diagnostic tool for erectile dysfunction.Int J Impot Res 1999;11:319–326.  Back to cited text no. 13
    
14. Rosen RC, Seidman SN, Menza MA, Shabsigh R, Roose SP, Tseng LJ, et al..Quality of life, mood, and sexual function: a path analytic model of treatment effects in men with erectile dysfunction and depressive symptoms.Int J Impot Res 2004;16:334–340.  Back to cited text no. 14
    
15. Cappelleri JC, Althof SE, O’Leary MP.Sildenafil citrate improves selfesteem, confidence, and relationships in men with erectile dysfunction: results from an international, multi-center double-blind, placebo-controlled trial.J Sex Med 2006;3:521–529.  Back to cited text no. 15
    
16. Kaminetsky JC, Depko AJ, Buvat J, Tseng LJ, Stecher VJ.In men with erectile dysfunction, satisfaction with quality of erections correlates with erection hardness, treatment satisfaction, and emotional well-being.J Sex Med 2009;6:800–808.  Back to cited text no. 16
    
17. Fisher WA, Rosen RC, Eardley I, Niederberger C, Nadel A, Kaufman J, Sand M.The multinational Men’s Attitudes to Life Events and Sexuality (MALES) Study Phase II: understanding PDE5 inhibitor treatment seeking patterns, among men with erectile dysfunction.J Sex Med 2004;1:150–160.  Back to cited text no. 17
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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Abstract
Introduction
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Introduction
Patients and methods
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