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Rapid Responses: Rapid Responses published:
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Erectile dysfunctions and Viagra!
- Dr. Naseem A. Qureshi (29 April 2004)
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High expectations
- david baker (1 May 2004)
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Impotence,erectile failure or erectile dysfunction,it was quite late to find effective treatment?
- AK Al-Sheikhli (2 May 2004)
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Keeping things in perspective
- Mike R Clayton (3 May 2004)
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Impact of erectile dysfunction?
- Philip D Welsby, Jennifer B Thorn (8 May 2004)
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Validated measure on the impact of Erectile Dysfunction.
- Ruaraidh P MacDonagh, Timothy Porter, Paul Ewings (10 May 2004)
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Dr. Naseem A. Qureshi, Medical Director [A], Director, CME&R Postcode 2292, Buraidah Mental Health Hospital, Saudi Arabia
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Dear Sir: The paper by Tomlinson and Wright(2004)that examines the effects of sildenafil citrate on patients with erectile dysfunctions [EDs]is extremely important and informative to a great proportion of the population suffering from EDs. Sexual dysfunctions among both genders are known to cause tremendous personal stresses, low self-esteem, disgrace and marital complications including separations and divorce. EDs may cause a variety of mental disorders including different types of anxieties and depressions. EDs are also known to be caused by an array of factors, which include physical diseases, mental disorders, and medications used to treat these psychophysical disorders. Cultural factors are also very important determinants of EDs. Hence, EDs are heterogeneous disorders and need to be addressed likewise. Viagra and other medications used to treat EDs are potentially useful drugs if chosen properly in properly selected individuals. If a patient with EDs has tremendous expectation as regard treatment with viagra, and if this drug fails, the anxietiy of such patient increases and which further aggravates the intensity of EDs. Thus, a vicious cycle emerges, which should be tackled immediately by proper drug as well as psychotherapeutic means. Reference: John Tomlinson and David Wright.Impact of erectile dysfunction and its subsequent treatment with sildenafil: qualitative study.BMJ 2004; 328: 1037-0 Competing interests: None declared |
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david baker, GP Principal Dorset
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I agree with the authors that this is an issue of high expectations. I note that of those who had success with Viagra, only 10/20 were happy & only 6/20 felt a "return to manhood". Given that relatively recently injecting the penis or applying a penile ring and a vacuum pump were the treatments of choice, I would expect these patients to be amazed & delighted at such medical progress. It does make me wonder about the "extreme distress" and "devastation" suffered (difficult to quantify, I realise) - some external references would have been helpful. How does ED compare with bereavement, redundancy, divorce, terminal diagnosis? I'm not saying it doesn't compare, I'm saying I'd like to know. If it is that bad, why are we not allowed to issue NHS presriptions? Competing interests: None declared |
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AK Al-Sheikhli, Psychiatrist Medical Centre,2 Manor court avenue,Nuneaton ,CV11 5HX,UK.
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1st ,May,2004 EDITOR,It was interesting to read the paper of Tomlinson & Wright,Impact of erectile dysfunction and its subsequent treatment with sildenafil :qualitative study(1).My comment that, 1.As one of my interests are psychosexual disorders of which erectile dysfunction is one of them,I started to treat patients early in 1980s in Baghdad,Iraq,It followed reading the papers of Virag,Brindley..etc,and their method of injecting potent vasodilators by using of intracavernosal approach(2). 2.I was surprised by the large number of those who asked for treatment!,I started my work with pipaverine,phentolamine,verapamil,sodium nitroprusside,..and then alprostadil..etc. 3.I was at that time surprised too by the fact that how in the field of medicine it took such a long time to think of it as the treatment of choice? 4.My patients were suffering from erectile dysfunction either due to psychological,vascular,neurogenic ,drug induced,hormonal,and even chromosomal(Klinefilter syndrome). 5.During treatment sessions,some of them get cured,others need repeated injections,majority ounce a week,failure rate could be less than 5%. 6.Seperated?divorced couples were able to return bach,single patients who were frightened to get married were able to do that. 7.It was interesting to see how my patients become gradually more confident. AK.Al-Sheikhli, References, 1.Tomlinson J and Wright D,Impact of erectile dysfunction and its subsequent treatment with silenafil:qualitative study,BMJ 2004;328,1037-0 2.Al-Sheikhli AK,Intracavernosal injection of potent vasodilators for erectile dysfunction had revolutionised..etc?,http://bmj.com/cgi/eletters/326/7386/424#29856,21 Feb 2003 Competing interests: None declared |
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Mike R Clayton, GP Partner Preston PR1 3NA
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The paper does describe the severe impact that impotence can have, particularly after failure of treatment. However, I make one small but important point. The sample was of 40 men who had not only attended a men's health clinic but also been prescribed sildenafil; the "top end" of the range I would argue. From the comments patients made, this is obviously a group in which the whole concept of sexuality - and in particular what it means to be male - is very important indeed. Whether this is secondary to the problem having arisen, part of the problem itself,or just reflecting what is typical of UK men in general is open for debate. So when it comes to "What this study adds" just the clarification that it is "SOME men are more shocked by impotence than has generally been...,etc. After all, The same edition of the BMJ includes an article in which the WHO DG mentions that at least one million children die every year in Africa from malaria. There are some men who really do struggle with impotence and this study vividly conveys some of the depth of that. Whilst all GP's will know patients like this, I do hope that we can still keep things in perspective against the major disease burdens both nationally and globally. Competing interests: None declared |
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Philip D Welsby, Consultant Physician Infectious Diseases Unit, Western General Hospital, Edinburgh Eh4 2XU, Jennifer B Thorn
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We read with some amazement the paper Impact of erectile dysfunction and its subsequent treatment with sildenafil (BMJ 2004;328:1037-1039). Firstly, the juxtaposition of the words impact and erectile dysfunction is unfortunate and does not inspire confidence in what follows. Secondly, because the authors’ focus was specifically on the patient rather than on relational dynamics, they should have focussed exclusively on restoring erections for masturbation. Thirdly, the authors made no reference to psychological factors, either involving intercourse or masturbation, in effect treating erectile dysfunction as though it were a simple matter of pharmacological “two of sand and one of cement.” Fourthly, most men who can masturbate but have erectile dysfunction with a partner have a psychological problem which should be addressed and not just treated with sildenafil. No wonder the distress was severe in those for whom sildenafil did not work. Fifthly, does anyone really need a BMJ paper to “be aware of the extreme distress erectile dysfunction can cause.” Philip D Welsby
Jennifer B Thorn
Competing interests: None declared |
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Ruaraidh P MacDonagh, Senior Clinical Lecturer, Dept Surgery, Bristol & Consultant Urologist, Taunton Taunton and Somerset Hospital, Timothy Porter, Paul Ewings
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This article describes well the significant psychosocial impact of erectile dysfunction. The introduction suggests that “comparative little attention” has been given to the psychological and social impact of erectile dysfunction and its subsequent treatment. A few studies are quoted in the references, but the largest published works on the impact of impotence on the quality of life of men have been omitted. The first publication involves a study conducted to assess the psychometric properties of a new quality of life-specific instrument (ED-EQoL) developed to quantify the effect of erectile dysfunction on men (1). Validity and reliability of this questionnaire was assessed in a cohort of 283 men recruited from 11 centres in the United Kingdom. The second study, only recently published, describes the rigorous qualitative methodology employed to develop the ED-EQoL (2). This methodology was similar to that used in your published study and illustrated that men with erectile dysfunction exhibited a complex array of psychosocial morbidity relating both to themselves and their partners. This study produced a statistically robust 15 item measure which performed well psychometrically and illustrated the impact of this condition on quality of life. The questionnaire has been subsequently used in numerous other published and unpublished studies (3) providing further evidence of validation. It is disappointing that none of these highly relevant and current studies, published in high profile journals were referenced in your published article. The authors conclude by suggesting that “more sensitive and reliable measures need to be developed to detect the results of treatment”. It would seem that such a measure has been developed somewhat quicker than was anticipated. R P MacDonagh MD MBBS FRCS
T Porter
P Ewings
1) The effect of ED on QoL: Psychometric testing of a new QoL measure for patients with erectile dysfunction. MacDonagh RP, Porter T, Ewings P. J Urol 2002 Jan;167(1):212-217. 2) The ED-EQoL: The development of a new quality of life measure for patients with erectile dysfunction. MacDonagh RP, Porter T, Pontin D, Ewings P. Qual Life Res 13: 361-368, 2004. 3) The effect of radical prostatectomy on the quality of life of men after radical prostatectomy. Meyer J, Gillatt DA, Lockyer R, MacDonagh R. BJU Int 2003 Nov; 92(7):703-6. Competing interests: Some of the studies quoted were funded by Pfizer |
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