Dropout in the treatment of erectile dysfunction with PDE5: A study on predictors and a qualitative analysis of reasons for discontinuation
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INTRODUCTION: Phosphodiesterase type 5 inhibitors (PDE5) are currently the first line treatment for erectile dysfunction (ED). However, previous research shows that PDE5 treatments have high discontinuation rates. Understanding the reasons for discontinuing PDE5 will be necessary to optimize the response to treatment. AIM: The main goals were: (i) to analyze discontinuation rate of PDE5; (ii) to identify the discontinuation predictors; and (iii) to study the reasons for discontinuation using a qualitative methodology. MAIN OUTCOME MEASURES: The PDE5 discontinuation rates, predictors, and reasons for discontinuation treatment. METHODS: A total of 327 men with clinical diagnosis for ED who had been treated with PDE5 were successfully interviewed by telephone, after giving their informed consent by snail mail. Telephone interviews, concerning their ongoing treatment, were carried out using a standardized questionnaire form with quantitative and qualitative items. Participation rate was 71.8%. RESULTS: Of the total sample, 160 men (48.9%) had discontinued PDE5 treatment. The discontinuation rate was higher among men with diabetes (73%) and in iatrogenic group (65%), and lower in venogenic etiology (38.7%). We differentiated three groups of men who discontinued treatment (i) during the first 3 months (55.1%); (ii) between 4 and 12 months (26.9%); and (iii) after a period of 12 months (18%). Qualitative analyses revealed diverse reasons for discontinuation: non-effectiveness of PDE5 (36.8%), psychological factors (e.g., anxiety, negative emotions, fears, concerns, dysfunctional beliefs) (17.5%), erection recovery (14.4%), and concerns about the cardiovascular safety of PDE5 (8.7%) were the most common. Older men and men whose partners were involved in the treatment, were less likely to discontinue treatment. CONCLUSION: Half the subjects discontinued medication. Mostly, there was a combination of factors that led to discontinuation: non-effectiveness and psychosocial factors appear to be the main reasons. Addressing those factors will allow following up with appropriate focus on relevant topics in order to improve compliance.
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Discontinuation rates across medical interventions for erectile function are exceedingly high (50-61%) irrespective of treatment effectiveness.
“and discontinuation rates are exceedingly high (50–61%) irrespective of treatment effectiveness.21, 22, 23, 24, 25, 26”
From Preliminary Development of a Mindfulness-Based Group Therapy to Expand Couples’ Sexual Intimacy after Prostate Cancer: A Mixed Methods Approach (2021) · cites this paper as [25]
More than 50% of couples do not adhere to medical aids for erectile function after the first year of treatment.
“Research has shown that more than 50% of the couples do not adhere to medical aids for erectile function after the first year of treatment.99,100,102”
From A Psychosocial Approach to Erectile Dysfunction: Position Statements from the European Society of Sexual Medicine (ESSM) (2021) · cites this paper as [99]
Long-term adherence to medical treatment for ED is poor and erectile function recovery is not always achieved.
“Although medical treatments have been shown to be physiologically effective, long-term adherence to medical treatment is poor and erectile function recovery is not always achieved, often depending on how well men are instructed about (correct) use of the medical aids.99, 100, 101”
From A Psychosocial Approach to Erectile Dysfunction: Position Statements from the European Society of Sexual Medicine (ESSM) (2021) · cites this paper as [99]
Relationship conflicts are an important reason for lack of compliance or drop-out.
“In addition, therapy should identify and treat underlying relational dynamics because relationship conflicts are an important reason for lack of compliance or drop-out.59,99”
From A Psychosocial Approach to Erectile Dysfunction: Position Statements from the European Society of Sexual Medicine (ESSM) (2021) · cites this paper as [99]
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- Authors
- Carvalheira, A. A., Pereira, N. M., Maroco, J., & Forjaz, V.
- Affiliations
- Research Unit of Psychology and Health, University Institute of Applied Psychology , Lisbon , Portugal
- iSex—Association for the Advanced Study of Human Sexuality, ULHT , Lisbon , Portugal
- Corresponding author
- Carvalheira, Ana A.
- Venue
- The Journal of Sexual Medicine
- Publisher
- Oxford University Press (OUP)
- Published
- 2012-09-01
- Volume
- 9
- Issue
- 9
- Pages
- 2361-2369
- ISSN
- 1743-6095 (ISSN-L)
- 1743-6109
- OpenAlex
- W1514818611
- Cited by
- 132
- References
- 26
- Citations by year
- 2026: 2 · 2025: 7 · 2024: 6 · 2023: 8 · 2022: 9 · 2021: 8 · 2020: 13 · 2019: 11 · 2018: 10 · 2017: 12 · 2016: 12 · 2015: 15 · 2014: 13 · 2013: 4 · 2012: 2
- FWCI
- 7.77
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Licence
- Locations
- The Journal of Sexual Medicine (publishedVersion)
- PubMed (publishedVersion)
- LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (submittedVersion)
- Portuguese National Funding Agency for Science, Research and Technology (RCAAP Project by FCT) (submittedVersion, other-oa)
- Funders
- Pfizer
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Sexual function and dysfunction studies
- Health Sciences › Medicine › Urology › Urological Disorders and Treatments
- Health Sciences › Medicine › Urology › Urinary Bladder and Prostate Research
- Keywords
- erectile dysfunction, phosphodiesterase-5 inhibitors, treatment discontinuation, predictors of discontinuation, reasons for discontinuation, treatment effectiveness, psychosocial factors, anxiety, diabetes mellitus, partner involvement, medication adherence
- MeSH terms
- Adult, Age Factors, Aged, Aged, 80 and over, Diabetes Mellitus, Humans, Iatrogenic Disease, Erectile Dysfunction, Male, Middle Aged, Patient Dropouts, Sexual Partners, Logistic Models, Impotence, Vasculogenic, Medication Adherence, Phosphodiesterase 5 Inhibitors
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