Abstract
OBJECTIVE: To assess health-related quality of life (HRQOL)
DESIGN: Descriptive survey with general and disease-specific measures. The instrument contained three established, validated HRQOL measures, a validated comorbidity checklist,] and sociodemographics. The RAND 36-Item Health Survey 1.0 (SF-36) was used to assess general HRQOL. Sexual function and sexual bother were assessed using the UCLA Prostate Cancer Index. The marital interaction scale from the Cancer Rehabilitation Evaluation System Short Form (CARES-SF) was used to assess each patient’s relationship with his sexual partner.
SETTING: Urology clinics at a university medical center and the affiliated Veterans Affairs (VA) Medical Center.
PARTICIPANTS: Thirty-five (67%) of 54 consecutive university patients presenting for erectile dysfunction and 22 (42%) of 52 VA patients who were awaiting a previously prescribed vacuum erection device participated.
MAIN RESULTS: The university respondents scored slightly lower than population normals in social function, role limitations due to emotional problems, and emotional well-being. The VA respondents scored lower than expected in all eight domains. Scores for the VA population were significantly lower than those for the university population in physical function, role limitations due to physical problems, bodily pain, and social function. A significant correlation was seen between marital interaction and sexual function (r = –.33, p = .01) but not between marital interaction and sexual bother (r = –.15, p = .26) in the total sample. Sexual function also correlated significantly with general health perceptions (r = .34, p = .01), role limitations due to physical problems (r = .29, p = .03), and role limitations due to emotional problems (r = .30, p = .03). Sexual bother did not correlate with any of the general HRQOL domains. Affluent men reported better sexual function (p = .03).
CONCLUSIONS: The emotional domains of the SF-36 are associated with more profound impairment than are the physical domains in men with erectile dysfunction. Erectile dysfunction and the bother it causes are discrete domains of HRQOL and distinct from each other in these patients. With increased attention to patient-centered medical outcomes, greater emphasis has been placed on such variables as HRQOL. This should be particularly true for a patient-driven symptom, such as erectile dysfunction.
Similar content being viewed by others
References
Althof S, Turner L, Levine S, et al. Why do so many people drop out from auto-injection therapy for impotence? J Sex Marital Ther. 1989;15:121–9.
Bechara A, Casabe A, Cheliz G, Romano S, Fredotovich N. Pros-taglandin E1 versus mixture of prostaglandin E1, papaverine and phentolamine in nonresponders to high papaverine plus phentolamine doses. J Urol. 1996;155:913–4.
Gee WF, Holtgrewe HL, Albertson PC, et al. Practice trends of American urologists in the treatment of impotence, incontinence, and infertility. J Urol. 1996;156:1778–80.
Hollander JB, Gonzalez J, Norman T. Patient satisfaction with pharmacologic erection program. Urology. 1992;39:439–41.
Irwin MB, Kata EJ, High attrition rate with intracavernous injec-tion of prostaglandin E1 for impotency. Urology. 1994;43:84–7.
Turner LA, Althof SE, Levin SB, Bodner DR, Kursh ED, Resnick MI. Twelve-month comparison of two treatments for erectile dys-function: self-injection versus external vacuum devices. Urology. 1992;39:139–44.
Godschalk M, Gheorghiu D, Chen J, Katz PG, Mulligan T. Longterm efficacy of a new formulation of prostaglandin E1 as treatment for erectile dysfunction. J Urol. 1996;155:915–7.
Hedlund H, Anderson K-E. Contraction and relaxation induced by some prostenoids in isolated human penile erectile tissue and cavernous artery. J Urol. 1985;134:1245–50.
Porst H. The rationale for prostaglandin E1 in erectile failure: a survey of worldwide experience. J Urol. 1996;155:802–15.
Sidi AA, Reddy PK, Chen KK. Patient acceptance of and satisfaction with vasoactive intracavernous pharmacotherapy for impotence. J Urol. 1988;140:293–4.
Padma-Nathan H, Hellstrom WJ, Kaiser FE, et al. Treatment of men with erectile dysfunction with transurethral alprostadil. N Engl J Med. 1997;336:1–7.
Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol. 1994;151: 54–61.
Mulligan T, Moss CR. Sexuality and aging in male veterans: a cross-sectional study of interest, ability, and activity. J Arch Sex Behav. 1991;20:17–25.
Carrier S, Brock G, Kour NW, Lue TF. Pathophysiology of erectile dysfunction. Urology. 1993;42:468–81.
Gheorghiu S, Godschalk M, Gemtili A, Mulligan T. Quality of life in patients using self-administered intracavernous injections of prostaglandin E1 for erectile dysfunction. J Urol. 1996;156:80–1.
Helgason A, Fredrikson M, Adolfsson J, Steineck G. Decreased sexual capacity after external radiation therapy for prostate cancer impairs quality of life. Int J Radiat Oncol Biol Phys. 1995; 32:33–9.
Litwin MS. Measuring health-related quality of life in men with prostate cancer. J Urol. 1994;152:1882–7.
Ware JE, Sherbourne CD. The MOS 36-Item short-form health survey (RAND 36-Item Health Survey), I: conceptual framework and item selection. Med Care. 1992;30:473–83.
Stewart AL, Greenfield S, Hays RD, et al. Functional status and well-being of patients with chronic conditions: results from the Medical Outcomes Study. JAMA. 1989;262:907–13.
Ware JE, Snow KK, Kosinski M, et al. RAND 36-Item Health Survey: Manual and Interpretation Guide. Boston, Mass: The Health Institute, The New England Medical Center; 1993.
Litwin MS, Hays RD, Fink A, et al. Quality of life outcomes in men treated for localized prostate cancer. JAMA. 1995;273:129–35.
Guyatt GH, Feeny DH, Patrick DL. Measuring health-related quality of life. Ann Intern Med. 1993;118:622–9.
Ganz PA, Schag CAC, Lee JJ, et al. The CARES: a generic measure of health-quality of life for patients with cancer. Qual Life Res. 1992;1:19–29.
Schag CAC, Ganz PA, Heinrich RL. Cancer Rehabilitation Evaluation System Short Form (CARES-SF): a cancer-specific rehabilitation and quality of life instrument. Cancer. 1991;68:1404–13.
Schag CAC, Heinrich RL. Cancer Rehabilitation Evaluation System (CARES) Manual. Los Angeles, Calif: CARES Consultants; 1988.
Schag CAC, Heinrich RL. Development of a comprehensive quality of life measurement tool: CARES. Oncology. 1990;4:135–8.
Greenfield S, Apolone G, McNeil BJ, Cleary PD. The importance of coexistent disease in the occurrence of post-operative complications and one-year recovery in patients undergoing total hip replacement: comorbidity and outcomes after hip replacement. Med Care. 1993;31:141–54.
Cronbach LJ. Coefficient alpha and the internal structure of tests. Psychometrika. 1951;16:297–334.
Ware JE, Kosinski M, Keller SK. SF–36 Physical and Mental Health Summary Scales: A User’s Manual. Boston, Mass: The Health Institute, New England Medical Center; 1994.
Testa MA, Simonson DC. Assessment of quality-of-life outcomes. N Engl J Med. 1996;334:835–40.
Author information
Authors and Affiliations
Additional information
Supported by a New Investigator Award from the American Foundation for Urologic Disease.
Rights and permissions
About this article
Cite this article
Litwin, M.S., Nied, R.J. & Dhanani, N. Health-related quality of life in men with erectile dysfunction. J GEN INTERN MED 13, 159–166 (1998). https://doi.org/10.1046/j.1525-1497.1998.00050.x
Issue Date:
DOI: https://doi.org/10.1046/j.1525-1497.1998.00050.x