Association of psychological factors, patients’ knowledge, and management among patients with erectile dysfunction

Figures & data

Figure 1 Overview of study procedure.

Abbreviations: ED, erectile dysfunction; PIS, patient information sheet; UMMC, University of Malaya Medical Centre.

Table 1 Definition

Questions/terms	Definitions	Reference
ED-EQoL instrument	An instrument used for quantifying the effect of ED-QoL	^Citation17
Psychological scale	<15: mild impairment of QoL 15–28: moderate impairment of QoL ≥29: severe impairment of QoL
ED	A recurrent inability to achieve or maintain an adequate erection during partnered sexual activities	^Citation1
Expectation from ED therapy	Improving penile erections suitable for intercourse	^Citation2
Time of administration	Recommended practice: Sildenafil: Taken approximately 1 hour before intercourse Tadalafil: Taken prior to intercourse Vardenafil: Taken 25–60 minutes before intercourse	^Citation19, ^Citation20
Frequency of administration	Recommended practice: take oral ED tablet once daily
Storage method	Recommended practice: store the medication at room temperature (20°C–25°C)

Abbreviations: ED, erectile dysfunction; ED-QoL, Erectile Dysfunction-Effect on Quality of Life.

Figure 2 Flowchart of patient disposition.

Abbreviations: ED, erectile dysfunction; UMMC, University of Malaya Medical Centre.

Table 2 Patients’ demographic characteristics

Demographic characteristics	Number of patients
Age, years
<65 (nonelderly)	52 (55.9)
≥65 (elderly)	41 (44.1)
Mean ± SD	60.8±11.4
Ethnicity
Malay	42 (45.2)
Chinese	34 (36.5)
Indian	17 (18.3)
Marital status
Never married	1 (1.1)
Currently married	86 (92.5)
Divorced/separated/widower	6 (6.5)
Education level
No formal schooling	0 (0)
Primary school	2 (2.2)
SRP/PMR/LCE	4 (4.3)
SPM/MCE/O level	17 (18.3)
STPM/HSC/A level/certificate	8 (8.6)
Diploma	25 (26.9)
Bachelor’s degree	31 (33.3)
Master’s degree	5 (5.4)
PhD	1 (1.1)
Occupation
Government employee	15 (16.1)
Nongovernment employee	9 (9.7)
Self-employed	15 (16.1)
Pensioner	54 (58.1)
Unemployed	0 (0)
Types of profession
Professional	16 (17.2)
Nonprofessional	22 (23.7)
Not applicable	55 (59.1)
Household income
RM0–RM399	5 (5.4)
RM400–RM699	1 (1.1)
RM700–RM999	4 (4.3)
RM1,000–RM1,999	10 (10.8)
RM2,000–RM2,999	17 (18.3)
RM3,000–RM3,999	13 (14.0)
RM4,000–RM4,999	15 (16.1)
≥RM5,000	28 (30.1)

Note: Data are reported as number (percentage) unless otherwise stated.

Abbreviations: SD, standard deviation; SRP, Sijil Rendah Pelajaran; PMR, Penilaian Menengah Rendah; LCE, Lower Certificate of Education; SPM, Sijil Pelajaran Malaysia; MCE, Malaysian Certificate of Examination; STPM, Sijil Tinggi Persekolahan Malaysia; HSC, Higher School Certificate.

Table 3 The association between duration of ED and demographic characteristics

Demographic characteristics	Duration of ED (years)					Total	P-value
	<1	1–3	4–6	7–9	≥10
Age-group
<65 years	8	11	14	11	8	52	0.001*
≥65 years	0	5	6	6	24	41
Ethnicity
Malay	4	5	12	9	12	42	0.333
Chinese	1	8	6	4	15	34
Indian	3	3	2	4	5	17
Marital status
Unmarried	0	0	0	0	1	1	0.929
Currently married	8	15	19	16	28	86
Divorced/widower	0	1	1	1	3	6
Educational level
Primary	1	0	0	0	1	2	0.294
Secondary	3	2	4	6	6	21
Tertiary	4	14	16	11	25	70
Occupation
Government employee	5	4	4	2	0	15	0.001a
Nongovernment employee	2	1	3	2	1	9
Self-employed	1	7	6	1	0	15
Pensioner	0	4	7	12	31	54
Household income
<RM5,000	5	10	12	14	24	65	0.524
≥RM5,000	3	6	8	3	8	28

Notes: χ² test was done to obtain the P-value

* P-value was significant (P<0.05)

a P-value was not reliable due to more than 20% of the cells have expected frequencies that are less than 5.

Abbreviation: ED, erectile dysfunction.

Figure 3 Overall psychological score rated by patients.

Note: Frequency refers to number of ED patients affected by ED and classified as mild, moderate and severe.
Abbreviation: ED, erectile dysfunction.

Table 4 Overall psychological scales

Psychological scale	Number of patients
Mild	48 (51.6)
Moderate	28 (30.1)
Severe	17 (18.3)

Note: Data are reported as number (percentage).

Table 5 Psychological factors associated with ED patients

Psychological factors	Psychological scale			Total	χ^2	P-value
	Mild	Moderate	Severe
Dissatisfaction on household income
Not at all	43	18	6	67	35.201	0.001a
A little	5	8	3	16
Somewhat	0	2	8	10
Blame themselves
Not at all	32	5	0	37	48.500	0.001*
A little	13	10	2	25
Somewhat	3	13	15	31
Feelings of guilt
Not at all	31	5	0	36	57.508	0.001*
A little	16	6	1	23
Somewhat	1	17	16	34
Less desirable
Not at all	41	6	0	48	72.162	0.001a
A little	7	13	2	28
Somewhat	0	9	15	17
Feeling hurt
Not at all	38	11	0	49	45.277	0.001a
A little	8	7	3	18
Somewhat	2	10	14	26
Feel “less a man”
Not at all	11	1	1	48	28.305	0.001a
A little	17	1	0	28
Somewhat	20	26	16	17
Angry or bitter
Not at all	32	3	0	35	57.185	0.001*
A little	12	9	0	21
Somewhat	4	16	17	37
Depression
Not at all	31	0	0	31	62.147	0.001*
A little	12	9	0	21
Somewhat	5	19	17	41
Low self-esteem
Not at all	26	1	0	27	61.140	0.001*
A little	19	8	0	27
Somewhat	3	19	17	39
Feel like a failure
Not at all	35	3	0	38	60.908	0.001*
A little	11	9	1	21
Somewhat	2	16	16	34
Feel had let down partner
Not at all	26	0	0	26	60.561	0.001*
A little	18	11	0	29
Somewhat	4	17	17	38
Worry ED will affect closeness with partner
Not at all	40	13	0	53	67.632	0.001a
A little	7	10	1	18
Somewhat	1	5	16	22
Worry for future relationship
Not at all	43	17	1	61	64.131	0.001a
A little	4	6	0	10
Somewhat	1	5	16	22
Preoccupied with ED
Not at all	26	0	0	48	58.055	0.001a
A little	17	10	0	28
Somewhat	5	18	17	17

Notes: χ² test was done to obtain the P-value

a P-value was not reliable due to more than 20% of the cells have expected frequencies that are less than 5

* P-value was significant (P<0.05).

Abbreviation: ED, erectile dysfunction.

Table 6 The association between psychological scale and demographic characteristics

Demographic characteristics	Psychological scale			Total	χ^2	P-value
	Mild	Moderate	Severe
Age-group
<65 years	19	20	13	52	10.841	0.004*
≥65 years	29	8	4	41
Ethnicity
Malay	19	12	11	42	4.658	0.324
Chinese	20	9	5	34
Indian	9	7	1	17
Marital status
Unmarried	1	0	0	1	7.097	0.131
Currently married	41	28	17	86
Divorced/widowed	6	0	0	6
Occupation
Government employee	3	6	6	15	18.483	0.005a
Nongovernment employee	3	2	4	9
Self-employed	6	6	3	15
Pensioner	36	14	4	54
Educational level
Primary	1	0	1	2	3.312	0.507
Secondary	13	6	2	21
Tertiary	34	22	14	70
Household income
<RM5,000	36	20	9	65	2.948	0.229
≥RM5,000	12	8	8	28

Notes: χ² test was done to obtain the P-value

* P-value was significant (P<0.05)

a P-value was not reliable due to more than 20% of the cells have expected frequencies that are less than 5.

Figure 4 Causes of ED as perceived by patients.

Abbreviation: ED, erectile dysfunction.

Table 7 Patients’ knowledge about ED and its occurrence

ED knowledge	Number of patients
How long you experienced ED?
Less than a year	8 (8.6)
1–3 years	16 (17.2)
4–6 years	20 (21.5)
7–9 years	17 (18.3)
10 years and more	32 (34.4)
What is ED?
Inability to achieve or maintain an erection sufficient for satisfactory sexual function	85 (91.4)
ED is defined as complete impotence	7 (7.5)
Do not know	1 (1.1)
Causes of ED
Aging	18 (18.6)
Diseases	27 (27.8)
Medications	12 (12.4)
Surgery	1 (1.0)
Lifestyle	9 (9.3)
Psychological factors	10 (10.3)
Socioeconomic factors	4 (4.1)
Do not know	16 (16.5)
Most expected outcome from ED treatment
Total recovery from ED	31 (33.3)
Improving penile erections suitable for intercourse	33 (35.5)
Feeling of satisfaction during intercourse	9 (9.7)
Spouse satisfaction during intercourse	4 (4.3)
Do not know	16 (17.2)

Note: Data are reported as number (percentage).

Abbreviation: ED, erectile dysfunction.

Figure 5 Type of medication taken by the study population.

Table 8 Knowledge of patient on ED treatment

ED knowledge	Sildenafil (N=54)	Tadalafil (N=22)	Vardenafil (N=17)
When to take ED medication
Just before sexual activity	19 (35.2)	8 (36.4)	7 (41.2)
1 hour before sexual activity	27 (50.0)	8 (36.4)	6 (35.3)
3–4 hours before sexual activity	0 (0)	1 (4.5)	0 (0)
Anytime preferable	3 (5.6)	2 (9.1)	2 (11.8)
Do not know	5 (9.3)	3 (13.6)	2 (11.8)
Maximum frequency in a day
Once daily	31 (57.4)	14 (63.6)	10 (58.8)
Twice daily	10 (18.5)	1 (4.5)	6 (35.3)
Three times daily	1 (1.9)	0 (0)	0 (0)
More than 3 times daily	0 (0)	0 (0)	0 (0)
Do not know	12 (22.2)	7 (31.8)	1 (5.9)
Correct way of medication storage
Store in refrigerator (0°C–4°C)	12 (22.2)	5 (22.7)	5 (29.4)
Store at room temperature (20°C–25°C)	42 (77.8)	17 (77.3)	12 (70.6)
Do not know	0 (0)	0 (0)	0 (0)
Experiencing side effects of medication
Indigestion	3 (3.9)	0 (0)	3 (12.0)
Nausea	1 (1.3)	0 (0)	1 (4.0)
Vomiting	3 (3.9)	0 (0)	1 (4.0)
Facial flushing	15 (19.5)	9 (29.0)	2 (8.0)
Dizziness	19 (24.7)	7 (22.6)	4 (16.0)
Muscle pain	2 (2.6)	3 (9.7)	3 (12.0)
Back pain	7 (9.1)	2 (6.4)	4 (16.0)
Visual disturbances	1 (1.3)	0 (0)	0 (0)
Nasal congestion	1 (1.3)	0 (0)	0 (0)
Do not experience	25 (32.5)	10 (32.3)	7 (28.0)
Knowing it has side effect
Yes	35 (64.8)	14 (63.6)	10 (58.8)
No	19 (35.2)	8 (36.4)	7 (41.2)

Note: Data are reported as number (percentage).

Abbreviation: ED, erectile dysfunction.

Table 9 The overall results of patient’s knowledge of ED therapy

ED knowledge	Number of patients
Definition of ED
Correct	85 (91.4)
Incorrect	8 (8.6)
Expectation from ED therapy
Correct	33 (35.5)
Incorrect	60 (64.5)
Time of administration
Correct	42 (45.2)
Incorrect	51 (54.8)
Frequency of administration
Correct	55 (59.1)
Incorrect	38 (40.9)
Storing method
Correct	71 (76.3)
Incorrect	22 (23.7)
Knowledge about side effects
Yes	59 (63.4)
No	34 (36.6)

Note: Data are presented as number (percentage).

Abbreviation: ED, erectile dysfunction.

Table 10 The association between educational level and patient’s knowledge about ED

ED knowledge	Educational level			Total	χ^2	P-value
	Primary	Secondary	Tertiary
Definition of ED
Correct	2	20	63	85	0.756	0.685
Incorrect	0	1	7	8
Expectation from ED therapy
Correct	0	6	27	33	1.830	0.401
Incorrect	2	15	43	60
Time of administration
Correct	2	9	31	42	2.495	0.287
Incorrect	0	12	39	51
Frequency of administration
Correct	2	11	42	55	1.800	0.407
Incorrect	0	10	28	38
Storing method
Correct	2	16	53	71	0.635	0.728
Incorrect	0	5	17	22
Knowledge about side effects
Yes	1	10	48	59	3.217	0.200
No	1	11	22	34

Note: χ² test was done to obtain the P-value.

Abbreviation: ED, erectile dysfunction.

Table 11 The association between occupation and patient’s knowledge about ED

ED knowledge	Occupation				Total	P-value
	Government	Nongovernment	Self-employed	Pensioner
Definition of ED
Correct	15	9	15	46	85	0.097a
Incorrect	0	0	0	8	8
Expectation from ED therapy
Correct	4	4	4	21	33	0.658
Incorrect	11	5	11	33	60
Time of administration
Correct	7	5	10	20	42	0.200
Incorrect	8	4	5	34	51
Frequency of administration
Correct	8	3	11	33	55	0.259
Incorrect	7	6	4	21	38
Storing method
Correct	14	7	13	37	71	0.163
Incorrect	1	2	2	17	22
Knowledge about side effects
Yes	10	7	12	30	59	0.252
No	5	2	3	24	34

Notes: χ² test was done to obtain the P-value

a P-value was not reliable due to more than 20% of the cells have expected frequencies that are less than 5.

Abbreviation: ED, erectile dysfunction.

Table 12 The association between household income and patient’s knowledge about ED

ED knowledge	Household income (RM)		Total	χ^2	P-value
	<5,000	≥5,000
Definition of ED
Correct	58	27	85	1.290	0.241
Incorrect	7	1	8
Expectation from ED therapy
Correct	23	10	33	0.001	0.976
Incorrect	42	18	60
Time of administration
Correct	27	15	42	1.144	0.285
Incorrect	38	13	51
Frequency of administration
Correct	38	17	55	0.041	0.839
Incorrect	27	11	38
Storing method
Correct	46	25	71	3.715	0.054
Incorrect	19	3	22
Knowledge about side effects
Yes	37	22	59	3.954	0.057a
No	28	6	34

Notes: χ² test was done to obtain the P-value; P-value was significant (P<0.05)

a Fisher’s exact test was employed to obtain P-value.

Abbreviation: ED, erectile dysfunction.

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