Erectile Dysfunction and Peyronie's Disease
Published In: Urologic Diseases In America / Edited By Mark S. Litwin and Christopher S. Saigal (Washington, D.C.: US Department of Health and Human Services, Public Health, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, 2007), Chapter 15, p. 485-528, NIH Pub. no. 07-5512
Posted on RAND.org on December 31, 2006
Male sexual health has taken on increased importance as the United States population ages, develops coexisting medical conditions, and undergoes interventions that can affect sexual health. This chapter focuses on two major areas of male sexual health, erectile dysfunction (ED) and Peyronie's disease (PD). Related domains, including sexual desire, vitality, ejaculatory and orgasmic function, partner intimacy, and female sexual health, are also important, but they are beyond the scope of this chapter. It is estimated that ED affects as many as 30 million men in the United States. In 1985, the estimated total direct costs for ED exceeded $146 million. Patient interest in and treatment for ED surged with the introduction of oral phosphodiesterase-5 inhibitors (PDE-I) in 1998, and expenditures for office visits and other outpatient treatments increased during that time. The available data likely underestimate current treatment utilization given that in the 22 months after the first PDE-I, sildenafil (Viagra), was launched, nearly 18 million prescriptions were filled at an approximate cost of $90 per 10-tablet prescription. The emergence of effective, convenient, and generally well-tolerated new treatment options (along with educational campaigns initiated by the pharmaceutical industry) has contributed to increased public awareness and a greater acceptability of and attention to the health and socioeconomic impacts of male sexual health. This is an important issue for men considering or having received treatment for prostate cancer, a condition that is increasingly being identified through widespread prostate specific antigen testing. In addition, the use of androgen replacement has increased in recent years, as testosterone is often equated with youth, vitality, strength, and sexual performance. Neither ED nor PD is life-threatening. However, these conditions may result in withdrawal from sexual intimacy, reduced quality of life, decreased working productivity, and increased healthcare utilization. Dramatic changes in first-line treatment options for ED are likely to lead more men to seek treatment. Patterns of care may shift away from surgical and device therapies provided by urologists and toward pharmacologic treatments and/or multidisciplinary approaches coordinated by primary care providers. With men increasingly seeking to preserve sexual function and quality of life as they age, it is important to characterize the burden and severity of disease, treatment patterns, and economic consequences of male sexual health.