Despite the ready availability of drugs that safely and effectively treat erection problems, nearly 75 percent of all men diagnosed with impotence decide not to pursue treatment.
This was the surprising finding of a study published in the October 2014 issue of “The Journal of Sexual Medicine.” Conducted by urological researchers from the medical schools of Southern Illinois and Northwestern universities, the study analyzed the insurance claims from 6.2 million American men who were diagnosed with impotence during the 12 months ending in June 2011.
Why Do So Few Get Help?
Although the purpose of the study was to find out how widely treated impotence is among American men, the study’s findings beg the question of why so many men opt not to treat impotence. Most answers to that question are based on anecdotal experience or informed speculation and not hard, verifiable facts.
One member of the research team, Brian Helfand, M.D., an assistant clinical professor of urology at NorthShore University Health System and the University of Chicago, told WebMD that there are probably plenty of reasons and suggested a few based on his own observations. Further down in this article, we’ll take a closer look at his reasons as well as those suggested by others.
Another member of the research team was urologist Kevin McVary, M.D., chairman of the urology department at Southern Illinois University’s School of Medicine. In an interview with the “State Journal-Register” of Springfield, Illinois, Dr. McVary said that while he had seen some reluctance of patients to seek treatment for impotence, he was surprised at the data the study produced.
Not All Want Treatment
“Many people would think every guy wants treatment,” he told the newspaper, adding that the study made it quite clear that such an assumption was “not true.”
Although the study was not published until the fall of 2014, its findings were previewed in May 2013 at the annual meeting of the American Urological Association in San Diego. In summing up the study’s findings at the conference, Dr. Helfand said that “ED treatments, overall, are underutilized. Only 25 percent of men are actually treated.”
The research team of which Drs. Helfand and McVary were a part analyzed insurance claims records covering 87.6 million men for medical care received between July 1, 2010, and June 30, 2011. From this pool, they identified more than 6.2 million men — age 30 and over — whose records bore the diagnostic code for impotence.
Insurance Claims Tracked
The insurance claims of these 6.2 million men were then followed closely to determine if treatment for impotence was sought. Researchers considered the erection problems treated if men went on to pursue any one of three forms of treatment:
- Filling a prescription for one of the popular impotence drugs known as PDE5 inhibitors. These include Viagra (sildenafil citrate), Levitra and Staxyn (vardenafil), Cialis (tadalafil), and Stendra (avanafil).
- Treatment with a prostaglandin, such as alprostadil, which can help some impotent men to have erections and is delivered via penile injection or a suppository inserted into the urethra.
- Androgen (male hormone) replacement therapy, which involves supplemental testosterone that can be delivered via a host of different mediums, including oral medication, dermal patches, and injection.
Possible Reasons
Although both Drs. Helfand and McVary took care to emphasize that the purpose of their study was to determine how many men actually treated their erection problems, both had some thoughts about possible reasons for undertreatment.
- Dr. Helfand said that in some cases doctors may opt not to recommend treatment to men that they feel are less than ideal candidates for currently available treatment methods. This could include men who have serious health conditions that make sexual activity problematic. It very likely would also include men who must take nitrates to relieve the pain of angina pectoris. Taking nitrate-based drugs along with PDE5 inhibitors can cause a life-threatening decline in blood pressure.
- Dr. Helfand also told WebMD that some men “may not be bothered by it (impotence).” Although popular culture might lead us to believe that all men think about little else other than sex, that can sometimes be a misleading picture. As they age, some men lose interest in sex, and still others may not have found their sexual lives to be that fulfilling in the first place and don’t really care to take remedial steps.
- Yet another possible reason cited by Dr. Helfand is an unsatisfactory prior experience with treatment for impotence. In some cases, men who have tried one method of treating their erection problems lose hope when that avenue of treatment turns out to be unsuccessful. Because of their subtle differences in chemical makeup, one impotence drug may work well for an individual who found another to be less effective. It pays to try more than one such drug before dismissing them all.
- For some men with erection problems, embarrassment could be holding them back from seeking further treatment, said Dr. Helfand. Although their doctors may have been able to ferret out of them enough information to confirm a diagnosis of impotence, the men themselves may not want to share their problem with others, including pharmacy personnel, as likely would happen if they decided to fill a prescription for an ED drug.
- Dr. Helfand also said that the relatively high cost of treatment may very well be a factor for still other men who have limited financial resources. Although all the men covered in the study carried some form of health insurance, such coverage doesn’t necessarily cover the cost of impotence medication. If impotence patients must fund that out of their own pockets, it’s likely that some choose not to proceed because of the cost. An individual dose of one of the popular impotence drugs runs $20 to $35, which could put the cost of maintaining a relatively normal sex life out of reach for some men. On the cost issue, Dr. McVary pointed out that many of the men diagnosed with erection problems are older and may be covered by Medicare, which doesn’t cover the cost of impotence drugs. For men whose medical costs are covered by Medicaid, the same policy applies to impotence drugs.
- In addition to men who just aren’t that bothered by their erection problems, others may have partners who don’t want them to take the drugs, according to Dr. McVary. Shedding additional light on partner opposition to impotence drug use, Dr. McVary told the “State Journal-Register” that the introduction of a costly medication into a couple’s relationship isn’t always as simple as it may sound. “Here’s the expectation: ‘We spent $20 on this. Let’s use it,’ ” said Dr. McVary. “It can create a tension. There’s more to having a sexual relationship than the erection. They have to get this pill to work for them as a couple.”
- Some men may find they have little incentive to treat their erection problems because they have lost a partner or because they have no partner at all, according to Dr. McVary.
Don Amerman is a freelance author who writes extensively about a wide array of nutrition and health-related topics.
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