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Assessing Satisfaction of Erectile Dysfunction Patients after Using 5 mg Once Daily Tadalafil for 30 Days

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Introduction

Erectile Dysfunction (ED), also known as impotence, is the inability to get and keep an erection firm enough for sexual intercourse. Estimates suggest that one of every 10 men will suffer from ED at some point during his lifetime. ED mainly affects men older than 40 years. It can be due to a variety of psychological and/or physiological factors, including depression, testosterone deficiency, spinal cord injury, ageing, diabetes mellitus and cardiovascular disease [1]. Furthermore, the prevalence of ED in men with diabetes is 35%-75% [2,3]. The prevalence of ED is greater in diabetic patients and, likewise, men with diabetes are at a significantly higher risk for ED [4,5].

ED is a common side effect of a number of prescription drugs. While these medications may treat a disease or condition, in doing so they can affect a man's hormones, nerves or blood circulation. The result may be ED or an increase in the risk of ED. These drugs include diuretics, antihypertensive, antidepressants, and antihistamines. Moreover, erectile dysfunction is a strong predictor for coronary artery disease, and cardiovascular assessment of a non-cardiac patient presenting with erectile dysfunction is now recommended [6]. The prevalence of ED is approximately 15.77% in southern India, 15.0%-49.5% in China, 56.1% in Iran and 58.9% in south-western Nigeria [7,8].

In recent years, the most commonly used treatments for ED have been inhibitors of the Phospho-Di-Esterase 5 (PDE5Is) enzyme: Sildenafil citrate (sildenafil), tadalafil, and vardenafil HCl (vardenafil). These oral therapies are taken on demand prior to anticipate sexual activity and are efficacious and well tolerated [9,10].

Tadalafil (Cialis^®) is used to improve sexual function in men by increasing blood flow to the penis. Men who are on medicines that contain nitrates such as nitroglycerine should not take oral ED medications. The combination of nitrates and these specific medications can lead to hypotension. Tadalafil has been licensed for treating Erectile Dysfunction (ED) since 2003. It is effective from 30 minutes after administration and its efficacy is maintained for up to 36 hours [11]. It has a unique feature that its half-life is longer than other available PDE5Is. Furthermore, tadalafil half-life is 17.5 h, compared with approximately 4-5 h for sildenafil and vardenafil [12,13].

This is an advantage to men taking Tadalafil by providing a wide range of possibilities in which to engage in sexual intercourse [11]. Moreover, Tadalafil’s efficacy and safety is similar to sildenafil and significantly improves the sexual confidence of the patients, however, patients and their partners prefer Tadalafil to sildenafil. Hence, Tadalafil may be a better choice to treat ED [14]. The associated adverse effects with Tadalafil were widely mild to moderate and decreased in frequency with continued administration. The most commonly reported adverse effects were headache and dyspepsia [15].

Study objective

To assess the satisfaction of erectile dysfunction patients who came to the andrology and dermatology clinic at Thamar University Al- Wahdah Teaching Hospital (TUWTH) after using 5 mg once daily tadalafil for 30 days.

Materials and Methods

Study area

This study was conducted at andrology and dermatology clinic at Thamar University Al-Wahdah Teaching Hospital (TUWTH), Dhamar, Yemen.

Study design

It is a longitudinal study.

Study population

A total of 124 erectile dysfunction patients attending the andrology and dermatology clinic at Thamar University Al-Wahdah Teaching Hospital (TUWTH) on 2022.

Data collection

The study data was obtained from the medical archive files of Thamar University Al-Wahdah Teaching Hospital.

Data analysis

The Collected data was analyzed by Statistical Package for the Social Sciences (SPSS) program. Non continuous variable presented as frequency and percentage.

Results and Discussion

The total number of the patients who participated in this study was 124, and all of them were older than 20 years old. Most of the participants were between 40-50 years old (Table 1). Most of the participants -111 of them- were married, 7 participants were divorced and 6 participants were single (Figure 1).

Table 1: Most age of participants were between 40-50 years old.

Figure 1: Marital status of the participants. Note: Single 5% Divorced 6% Married 89%

Regarding to the number of the times the participating patients have gotten married, this study showed that (68.5%) of the patients were married only once, (22.5%) of the patients were married twice, (4%) of them were married more than twice and (4.8%) of them were Regarding to the duration of marriage, most of the not married (Table 2). the participants -(64.4%) of them- have been married for more than 3 years, (21.1%) of them between 1 to 3 years, (7.6%) of them between 3 months to a year and (6.7%) of them have been married for less than 3 months.

Table 2: The number of times the patients was married.

This study demonstrates that the majority of the patients who participated actually have children, the rest do not have children (Figure 2). 34.6% of the participants confirmed that they have been treated before for their erectile dysfunction problem by another doctor, and 65.3% of them have not been treated before. Moreover, 27.9% of the patients who have been treated before claimed that there is improvement in their previous treatment, and 72.1% of them have not found and noticed any improvement. The patients who noticed improvement thought that the improvement was not satisfactory, because of that, they sought for medical care again at a different hospital.

Figure 2: Showing whether the patients have children or not. Note: Yes 80% No 20%

The majority 65.3% of patients complain of early ejaculation and the rest 34.6% complain of difficulty erection. The period of early ejaculation for most patients -40.7% of them- is between 1 and 3 minutes, between 3 to 5 minutes for 21% of them, more than 5 minutes for 14.8% of them and less than a minute for 23.4% of them (Table 3). Some patients had medical conditions, and these conditions are important due to that they may have effect on the drug used in the treatment. These conditions include prostate problems, heart disease, hypertension and diabetes mellitus (Figure 3). After the participating patients have used 5 mg once daily of Tadalafil for 30 days and came to the clinic again, 50.8% of the participants claim to be extremely satisfied with the treatment, 33.1% are satisfied, 10.5% are slightly satisfied and have noticed slight improvement and 5.6% of the participants are not satisfied and have not noticed any improvement (Figure 4).

Table 3: The period of early ejaculation for the participants.

Figure 3: Showing the medical conditions that may have effect on the drug used in the treatment. Note: Prostate problems Heart disease Hypertension Diabetes mellitus

Figure 4: Showing the satisfaction of the participating patients. Note: Extremely satisfied 51% Satisfied 33% Slightly satisfied 10% Not satisfied 6%

This study was carried out to assess the treatment satisfaction of erectile dysfunction patients attending the andrology and dermatology clinic at Thamar University Al-Wahdah Teaching Hospital (TUWTH). The participating patients were given 5 mg of Tadalafil once daily for 30 days to treat their erectile dysfunction problem. After 30 days of treatment, the participating patients were asked to visit the clinic again to assess if they are satisfied with the treatment and if there is an improvement in their erectile function. The majority of the patients who participated in this study were satisfied after using Tadalafil for 30 days. Therefore, Tadalafil can significantly improve EF in most people. Some studies shows that were done in different regions, support the same finding of this study. A study found that Tadalafil significantly improved erectile function and patient satisfaction [16]. Another study indicated that Tadalafil treatment was associated with significant improvements in ejaculatory function, orgasmic function and sexual satisfaction [17]. Also, it is concluded that Tadalafil 5 mg taken once daily as a treatment for ED improved overall satisfaction for the patient [18,19].

According to a study, younger erectile dysfunction patients and those with a shorter history of the condition were on average more satisfied than older patients and patients with longer history of ED [20]. Furthermore, erectile dysfunction patients with hypertension and diabetes mellitus are less likely to be satisfied with the Tadalafil treatment 5 mg once daily [20]. The reason why ED patients with diabetes mellitus are less satisfied is due to that efficacy is lower in men with ED and diabetes [21,22], perhaps due to impaired endothelium derived factors in penile arteries [23] and underlying endothelial dysfunction [24,25]. This might demonstrate why ED is more refractory to treatment in men who also have diabetes.

Conclusion

Most of participating patients who came to the andrology and dermatology clinic for their erectile dysfunction problem were satisfied with the treatment using 5 mg once daily of Tadalafil for 30 days, and they have noticed a great improvement in their erectile function. The more likely satisfied patients are those who are younger and have a shorter history of the condition. On the other hand, ED patients with hypertension and diabetes mellitus are less satisfied.

Acknowledgement

The authors extend their thanks to the study participants who were the erectile dysfunction patients attending the andrology and dermatology clinic at Thamar University Al-Wahdah Teaching Hospital (TUWTH), Dhamar, Yemen for their cooperation in this study.

Ethics Statement

The study was approved by the Thamar University Medical Ethics Committee (TUMEC). All the collected information was strictly kept confidential. No names were used in the study and only numbers were used instead.

Conflict of Interest

The authors declare that there are no conflicts of interest.

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