Abstract
Introduction
Erectile dysfunction has a significant impact on the sexual health of males. Erectile dysfunction can potentially erode the confidence of men and hamper healthy relationships and has been linked with depression and diminished quality of life. In Singapore, a prior study amongst the general male population reported a high prevalence of erectile dysfunction. 1 A link has been well established between erectile dysfunction and cardiovascular risk factors/disease 2 and we aim to understand the prevalence of erectile dysfunction, as well as its predictors, in this high risk cohort in Singapore.
Methods
A cross-sectional survey was performed on consecutive male patients attending the outpatient cardiology clinics at our tertiary institution from June 2014 to July 2014. All patients with cardiovascular disease (coronary artery disease, congestive heart failure, stroke) and/or cardiovascular risk factors (hypertension, hyperlipidaemia, diabetes) were included. The patient-administered questionnaire included questions on demographics as well as the validated five-item version of the International Index of Erectile Function (IIEF-5). Erectile dysfunction severity was categorized as absent (IIEF-5 score: 22–25), mild (IIEF-5 score: 17–21), moderate (IIEF-5 score: 8–16) and severe (IIEF-5 score: <8).
Results
A total of 468 male respondents (mean age 57±11.2 years) were included (see Table 1). The prevalence of erectile dysfunction in this high risk cohort was 69% (
Demographics of the study population.
Categorical data are presented as number (%) and continuous data are presented as mean (standard deviation).
ED: erectile dysfunction; ITE: Institute of Technical Education; BMI: body mass index.
Discussion
In a prior local study of the local general male population (<15% with cardiovascular disease/risk factors), Tan et al. found a prevalence of erectile dysfunction of 51%. 1 We found a higher prevalence of 69% in this higher risk cohort, which is not unexpected given the well-known association between cardiovascular disease and erectile dysfunction. 2
Old age and diabetes being predictive factors for erectile dysfunction has been described in prior Western cohorts3,4 as well as locally. 1 This is in line with our current findings. Diabetes affects penile erection both by vascular mechanisms (atherosclerosis in the penile and pudendal arteries) and neurological mechanisms (autonomic neuropathy). In the elderly, multiple mechanisms may come into play, including the above mentioned, as well as hormonal, drug-related and psychological causes. Interestingly, in our study, patients with higher education levels had lower rates of erectile dysfunction. This is similar to some prior published findings. 5 One postulation is the known association of higher socioeconomic status and better health.
Several limitations exist. First, the sample population was recruited from a single-centre tertiary cardiac centre and may not reflect the true incidence of erectile dysfunction amongst the general population with cardiovascular disease. Second, data were not readily available on the presence of erectile dysfunction by types and severity of cardiovascular disease; such analysis is the work of future research.
The high prevalence of ED amongst cardiovascular patients has largely been under-reported locally. The majority of patients may not reveal this problem to their doctors due to cultural reasons and embarrassment. There exists a potential need for screening protocols for physicians to screen for erectile dysfunction in patients with known cardiovascular risk factors/disease, allowing for therapeutic options for those identified with this debilitating condition.