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Factors associated with discontinuation of erectile dysfunction treatment

The most influential factors reported were treatment ineffectiveness, side effects, the quality of one’s intimate relationship and cost of treatment.

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Photo by Scott Sanker from Unsplash.com

The factors associated with men ending treatment for erectile dysfunction have been reviewed in a study published in IJIR: Your Sexual Medicine Journal. The most influential factors reported were treatment ineffectiveness, side effects, the quality of one’s intimate relationship and cost of treatment. The review also highlights the importance of men’s beliefs with regards to erectile dysfunction and its treatment and suggests that these beliefs are potentially modifiable.

Erectile dysfunction, the persistent inability to develop or maintain a penile erection during sexual activity, is thought to affect up to 10% of men under 40 years and 70% of men over 70 years. Treatment includes medications delivered orally. Where these fail or are contraindicated, treatments are available which are administered via injection, or via suppositories. Finally, penile implants are available where all other treatments have failed.

The lead author; Mr Paul Williams said: “Erectile dysfunction can have a negative effect on men’s quality of life. However, this can potentially be improved with successful treatment for the condition. The findings from our research indicate that rates of discontinuation for treatment are high. Understanding the reasons for discontinuation of treatment is essential with regards to improving treatment use and subsequently quality of life in this patient population”.

Reviewing data on 14,371 men from 50 previous studies, researchers at City, University of London and East London NHS Foundation Trust, UK assessed the rates of discontinuation of erectile dysfunction treatment and the factors associated with it. Results indicated that discontinuation rates varied across treatments and that adherence to erectile dysfunction treatment is suboptimal.

The authors found that 12.1% of men taking oral medication, 15.2% of men taking injected medication and 31.5% of men taking suppositories reported inadequate or inconsistent erectile responses as their reason for discontinuing treatment. 2.5% of men taking oral medication, 8.1% of men injecting medication and 15% of men taking suppositories stated that they stopped treatment due to side effects including headaches, Peyronie’s disease (a build-up of scar tissue in the penis) or urethral pain.

Regarding the quality of sexual relationships, the most commonly reported factors influencing whether men continued with erectile dysfunction treatment were loss of interest in a sexual relationship. This was reported by 6.6% of men taking oral medication, 8.8% of injecting medication, 8.9% of men taking suppositories and 6.9% of men with penile implants. 5.5% of men taking oral medication reported stopping treatment due their partner’s perceived lack of interest in the sexual relationship, 5.5% of men described not being emotionally ready for sexual activity and 4.1% discontinued treatment because of conflict within their relationship. The findings appear to highlight the influence of the quality of a couple’s sexual relationship on treatment use.

Mr. Paul Williams said: “Men’s perceptions of their sexual relationships and their emotional readiness for sexual activity are important when considering the most appropriate treatment for a man and his partner.”

The authors caution that due to an under-reporting of data on duration and severity of erectile dysfunction and relationship status in the majority of the included studies, the influence of these factors on treatment use could not be fully explored in this study. Further research should explore how beliefs affecting treatment adherence can be addressed during treatment to improve the quality of life of men and their partners, according to the authors.

The review also highlights the importance of men’s beliefs with regards to erectile dysfunction and its treatment, with a potential effect on treatment continuation.

Mr Williams said: “Perceived ineffectiveness of treatment has a subjective element based on, for example, treatment expectations prior to treatment. We found that men who reported treatment side effects to a healthcare professional were more likely to continue with treatment. Exploring any misconceptions patients may have in relation to their treatment could potentially be beneficial to increasing treatment utilisation and therefore something that could help health care professionals when faced with treatment failure.”

The authors suggest that future research would benefit from using psychological theory to explore barriers and enablers to treatment utilisation, as well as from measuring how treatment is utilised by patients. Taking such steps may lead to interventions aimed at improving treatment utilisation in this patient population, according to the authors.

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How to help children build a growth mindset

Consider these three tips to help children build a growth mindset.

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A new year is a perfect time to consider the habits you want to keep and the ones you’d like to develop. One resolution to consider is helping your children develop a growth mindset this year.

“We know one of the greatest boosts to parents’ confidence over the past year came from knowing their children’s whole selves are being nurtured, and we want to see that trend continue,” said Carter Peters from KinderCare Learning Center’s education team. “A growth mindset helps children try new things despite fear of failure. It’s the kind of thinking that allows inventors and creative thinkers to get excited about trying something new and ensures they have the cognitive flexibility and problem-solving skills to work through hurdles.”

Adults can often easily spot when children are engaged in creative thinking and prideful of their work, but that confidence may be lost as failures turn into insecurities. By nurturing a growth mindset and showing children they can learn and develop new skills in any area, it better sets them up for long-term success.

Consider these three tips to help children build a growth mindset:

Photo by Markus Spiske from Unsplash.com

1. Praise effort

It’s easy to fall into the habit of praising successes. However, praising effort encourages children to try new things without the fear of failing. It also teaches children personal growth and achievement are possible, even if their overall effort wasn’t a success.

“Young children often get excited to try something new,” Peters said. “By praising effort and showing children they’ll still be loved and valued despite the outcome, you can reframe how they approach challenges and teach them that difficult doesn’t mean impossible.”

2. Encourage the process

People often withhold praise until there’s a result, which leads children to hurriedly scribble a picture to hold up for a “good job” instead of taking time to focus on their efforts. When children know adults will encourage them during the process, instead of only upon the achievement, they’re more likely to try new things or master a new skill. For example, try providing encouragement such as, “I can see you’re focused on drawing that tree. It looks so lifelike because you’re putting so much thought into what you’re doing.” Once their project is finished, continue the encouragement by hanging up their artwork or school projects in a prominent place.

3. Model a growth mindset

You can model a growth mindset for children by narrating your actions when you are facing a challenge: “I am having a difficult time putting this shelf together, but it’s OK. I’ll take a break then read the instructions again.” Remove negative words from your vocabulary, such as “I can’t” or “I’m stupid.” Even when you are joking, children may not be able to tell the difference. You can also ask your children to join you in problem-solving. Take time to hear their ideas and try them even if you think they won’t work. This not only supports the development of their growth mindset, but the quality time and encouragement reinforces their sense of self-worth and builds confidence.

For more tips to help children develop a growth mindset, visit kindercare.com.

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Signs of a Healthy Marriage

Although there are many different ways to define a healthy marriage, these three qualities are essential for any lasting and fulfilling relationship.

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A healthy marriage is built on trust, respect, and communication. Couples with these qualities in their relationship tend to be more satisfied with their marriage and overall life. They also report feeling closer to their partner and having stronger well-being. With 2.3 out of every 1000 people in the US experiencing divorce in 2022, it is important to frequently check in on the health of your marriage.

Although there are many different ways to define a healthy marriage, these three qualities are essential for any lasting and fulfilling relationship.

Signs of a Healthy Marriage

A healthy marriage is built on trust, communication, and mutual respect. If you and your partner can effectively communicate and share a mutual level of respect, then your relationship is off to a good start. Trust is also important in a healthy marriage, as it allows you and your partner to feel secure in your relationship and rely on each other.

Many other signs can indicate whether or not a marriage is healthy. For example, couples who can spend quality time together and enjoy shared activities usually do well. Couples who can openly discuss their relationship with each other and work through difficulties together are also more likely to have a happy and healthy marriage. Finally, marriages, where both partners feel like they can be themselves without judgment from their spouse tend to be the strongest and most lasting.

Freedom to be yourself

In a healthy marriage, partners feel free to be themselves. They don’t have to put on a facade or pretend to be someone they’re not. They can be open and honest with each other and feel comfortable sharing their thoughts, feelings, and desires.

Both partners should pursue their interests and hobbies without compromising or sacrificing for the sake of the relationship. There’s no need to agree on everything – in fact, it’s healthy to have some separate interests – but overall, both partners should feel like they’re able to be true to themselves within the relationship.

Lots of good communication

In a healthy marriage, partners can communicate effectively. It means expressing needs and wants and listening and responding to what the other person is saying. There are mutual respect’s opinions, even if there are disagreements. Couples in a healthy marriage feel comfortable communicating with each other about both the good and the bad.

Good sex life

A good sex life can be a major sign of a healthy marriage. A lack of sexual activity can be an early warning sign that something is wrong in the relationship. Often, couples who have a good sex life are more connected emotionally and physically. They are also more likely to trust each other and communicate openly.

Trust in each other

In any relationship, trust is essential. Without trust, there is no foundation for the relationship to grow. In a marriage, trust is even more important. Trusting your spouse means you feel confident in their ability to support you emotionally and financially. It also means that you feel safe sharing your innermost thoughts and feelings with them.

When you trust your spouse, you know they have your best interests. You feel comfortable being yourselves around each other and sharing your hopes, dreams, and fears. Openness and honesty in your relationship allow you to be vulnerable with each other. This vulnerable honesty creates a deeper level of intimacy in your marriage.

When you trust each other, you can be more forgiving when mistakes are made. You know that everyone makes mistakes and that nobody is perfect. You also understand that your spouse is human and capable of making mistakes like anyone else. If they make a mistake, you are more likely to forgive them because you know they are sorry and will try not to make the same mistake again.

Trust is one of the most important foundations of a healthy marriage. If you want your marriage to thrive, build trust in each other.

A successful, strong marriage takes work, but with communication, trust, respect, vulnerability, and affection as its core components, you can together create a partnership that will be long-lasting.

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Obesity linked to macular degeneration

Immune cells are also activated when the body is exposed to stressors such as excess fat in obesity, making being overweight the number one non-genetic risk factor for developing AMD, after smoking.

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A Canadian study published in the prestigious journal Science elucidates a new molecular mechanism that may cause age-related macular degeneration (AMD).

The research at Hôpital Maisonneuve-Rosement, in Montreal, shows how life stressors such as obesity reprogram immune system cells and make them destructive to the eye as it ages.

“We wanted to know why some people with a genetic predisposition develop AMD while others are spared,” said Université de Montréal ophtalmology professor Przemyslaw (Mike) Sapieha, who led the study by his postdoctoral fellow Dr. Masayuki Hata.

“Although considerable effort has been invested in understanding the genes responsible for AMD, variations and mutations in susceptibility genes only increase the risk of developing the disease, but do not cause it,” Sapieha explained.

“This observation suggests that we must gain a better understanding of how other factors such as environment and lifestyle contribute to disease development.”

AMD is a major cause of irreversible blindness worldwide and affected approximately 196 million people in 2020. It comes in two forms:

  • dry AMD, characterized by the accumulation of fatty deposits at the back of the eye and the death of nerve cells in the eye,
  • and wet AMD, which is characterized by diseased blood vessels that develop in the most sensitive part of the sight-generating tissue, called the macula.

Contact with pathogens

It is already known that the immune system in the eye of a person with AMD becomes dysregulated and aggressive. Normally, immune cells keep the eye healthy, but contact with pathogens such as bacteria and viruses can make them go awry.

At the same time, immune cells are also activated when the body is exposed to stressors such as excess fat in obesity, making being overweight the number one non-genetic risk factor for developing AMD, after smoking.

In their study, Sapieha and Hata used obesity as a model to accelerate and exaggerate the stressors experienced by the body throughout life.

They found that transient obesity or a history of obesity leads to persistent changes in the DNA architecture within immune cells, making them more susceptible to producing inflammatory molecules.

“Our findings provide important information about the biology of the immune cells that cause AMD and will allow for the development of more tailored treatments in the future,” said Hata, now an ophthalmology professor at Kyoto University, in Japan.

The researchers hope their discovery will lead other scientists to broaden their interest beyond obesity-related diseases to other diseases characterized by increased neuroinflammation, including Alzheimer’s disease and multiple sclerosis.

About this study

“Past history of obesity triggers persistent epigenetic changes in innate immunity and exacerbates neuroinflammation,” by Mike Sapieha and Masayuki Hata, was published in Science.

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