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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.<\/p>\n
Insurance Claims Tracked <\/b><\/p>\n
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:<\/p>\n
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- 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).<\/li>\n
- 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.<\/li>\n
- 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.<\/li>\n<\/ul>\n
Possible Reasons <\/b><\/p>\n
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.<\/p>\n
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- 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.<\/li>\n
- Dr. Helfand also told WebMD that some men \u201cmay not be bothered by it (impotence).\u201d 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\u2019t really care to take remedial steps.<\/li>\n
- 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.<\/li>\n
- 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.<\/li>\n
- 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\u2019t necessarily cover the cost of impotence medication. If impotence patients must fund that out of their own pockets, it\u2019s 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\u2019t cover the cost of impotence drugs. For men whose medical costs are covered by Medicaid, the same policy applies to impotence drugs.<\/li>\n
- In addition to men who just aren\u2019t that bothered by their erection problems, others may have partners who don\u2019t want them to take the drugs, according to Dr. McVary. Shedding additional light on partner opposition to impotence drug use, Dr. McVary told the \u201cState Journal-Register\u201d that the introduction of a costly medication into a couple\u2019s relationship isn\u2019t always as simple as it may sound. \u201cHere\u2019s the expectation: \u2018We spent $20 on this. Let\u2019s use it,\u2019 \u201d said Dr. McVary. \u201cIt can create a tension. There\u2019s more to having a sexual relationship than the erection. They have to get this pill to work for them as a couple.\u201d<\/li>\n
- 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.<\/li>\n<\/ol>\n