madman
Super Moderator
ABSTRACT
Objectives: To investigate satisfaction with a vacuum constriction device for middle-aged and older male Veterans with erectile dysfunction and their female partners.
Methods: Patients (N = 57; mean age = 64.28 years; SD = 8.7) received comprehensive education and training and ongoing follow-up of device use, which included a semi-structured interview. Female partners (n = 41) also rated their satisfaction with the device.
Results: Over 96% of patients (n = 53/56 responses) endorsed the ability to maintain an erection with the device and 100% (n = 56/56 responses) indicated they would recommend the device to others. Female partners generally rated sex as better with the device (83.8%; n = 31/37 responses). Physical discomfort using the device was reported among 23% of patients (n = 16), and often due to difficulty or pain with the constriction bands. Difficulty obtaining erections with the device, though infrequently reported, was more common with older age.
Conclusions: The majority of male patients and their female partners receiving comprehensive training for vacuum constriction device use reported satisfaction with the device.
Clinical Implications: Vacuum constriction devices can be highly effective in improving the sexual health and intimacy of Veterans of all ages experiencing erectile dysfunction.
Introduction
Male erectile dysfunction (ED) is the most prevalent sexual dysfunction diagnosis among older men (Albersen, Orabi, & Lue, 2012). Men with chronic medical conditions such as hypertension, dyslipidemia, and diabetes are particularly at risk for ED (Albersen et al., 2012; Mulhall, Luo, Zou, Stecher, & Galaznik, 2016). Among men aged 75 years or older, as many as 77.5% have experienced ED (Saigal, Wessells, Pace, Schonlau, & Wilt, 2006). According to a systematic review, untreated ED negatively impacts psychosocial functioning including diminished sexual quality of life-based on sexual relationships and sexual satisfaction and has associations with adverse mental health outcomes, such as low confidence, low self-esteem, and high depressive symptoms (McCabe & Althof, 2014). Among 606 older adults of both sexes from the Successful Aging Evaluation study (SAGE), high depressive symptoms emerged as the most robust correlate of poor sexual health, over and above age, sex, physical functioning, general cognitive functioning, anxiety symptoms, and perceived stress (Wang et al., 2015).
First-line treatment for ED involves lifestyle changes, such as engaging in exercise, improving dietary choices, quitting smoking, and under medical supervision, eliminating or reducing the usage of medication found to contribute to ED (Heidelbaugh, 2010). Pharmacological interventions with phosphodiesterase type 5 inhibitors (PDE5i) are common, with sildenafil being the most popular and effective medication for ED (Carvalheira, Pereira, Maroco, & Forjaz, 2012). Yet, these medications can have high discontinuation rates (48.9%) due to adverse effects such as headache, flushing, dyspepsia, rhinitis, and abnormal vision, and non-effectiveness in some patients (Carvalheira et al., 2012; Heidelbaugh, 2010). Insufficient education regarding the medication can lead to ineffective use, which lowers the medication’s success rate (Atiemo, Szostak, & Sklar, 2003). Further, these medications have many contraindications such as co-administration with alpha-adrenergic blocking agents and nitrates (Huang & Lie, 2013). If ED is not alleviated with first-line treatments, patients are offered second-line treatments, including vacuum constriction pump devices (Najari & Kashanian, 2016). Devices are often prescribed as a secondary-line treatment because they require more time and motivation on the part of the patient than taking medication. These devices consist of an acrylic cylinder that operates by hand pump or battery to create a vacuum (negative pressure) and is employed to bring blood into the penis to obtain an erection. To retain the blood and maintain the erection, a rubberized constriction band is placed at the base of the penis for up to a half-hour.
Prior research indicates that vacuum constriction devices facilitate erections in up to 90% of males (Albersen et al., 2012). Success rates, including continued use of the device, are associated with the amount of training and education men receive on device usage and possible side effects (Atiemo et al., 2003; Lewis & Witherington, 1997). However, comprehensive training alone may not be enough. In one study, over two-thirds of participants with ED discontinued using a vacuum constriction device by three-year follow-up, despite receiving a medical evaluation and multimodal training in device use by a device representative (Dutta & Eid, 1999). On average, participants reported discontinuing the device 4 months after receiving it. Typical reasons for discontinuation included participants reporting the device was unwieldy, too painful to use, or ineffective for improving erections. Device training aimed at fostering both realistic expectations and proper usage of the device has the potential to increase treatment success.
Results from this program evaluation may be useful to inform clinicians regarding their decision to prescribe the device to patients with erectile dysfunction. Because many older patients may be reluctant to add another medication to their regimen, and the device option has few negative side effects, psychoeducation about this option earlier in treatment and not after frontline treatment is tried, could be useful. Overall, this evaluation of patient satisfaction suggests that vacuum constriction devices can be highly effective in treating ED and improving sexual relationships, especially when patients are assessed by psychology within a primary care clinic team and are provided with adequate training in device use. Effectively treating ED may have positive effects on the sexual health functioning of male patients, particularly older adults for whom ED is a common experience.
Clinical implications
● The vacuum constriction device effectively treated erectile dysfunction in male Veterans of all ages.
● Female partners reported an increased ability to engage in sexual activities with male partners who used the device.
● Male patients primarily used the device for vaginal intercourse. Expanding device use to other sexual activities could be beneficial.
● Future studies should compare the effectiveness of device use of our model of team care, which includes psychology, with other care models.
Objectives: To investigate satisfaction with a vacuum constriction device for middle-aged and older male Veterans with erectile dysfunction and their female partners.
Methods: Patients (N = 57; mean age = 64.28 years; SD = 8.7) received comprehensive education and training and ongoing follow-up of device use, which included a semi-structured interview. Female partners (n = 41) also rated their satisfaction with the device.
Results: Over 96% of patients (n = 53/56 responses) endorsed the ability to maintain an erection with the device and 100% (n = 56/56 responses) indicated they would recommend the device to others. Female partners generally rated sex as better with the device (83.8%; n = 31/37 responses). Physical discomfort using the device was reported among 23% of patients (n = 16), and often due to difficulty or pain with the constriction bands. Difficulty obtaining erections with the device, though infrequently reported, was more common with older age.
Conclusions: The majority of male patients and their female partners receiving comprehensive training for vacuum constriction device use reported satisfaction with the device.
Clinical Implications: Vacuum constriction devices can be highly effective in improving the sexual health and intimacy of Veterans of all ages experiencing erectile dysfunction.
Introduction
Male erectile dysfunction (ED) is the most prevalent sexual dysfunction diagnosis among older men (Albersen, Orabi, & Lue, 2012). Men with chronic medical conditions such as hypertension, dyslipidemia, and diabetes are particularly at risk for ED (Albersen et al., 2012; Mulhall, Luo, Zou, Stecher, & Galaznik, 2016). Among men aged 75 years or older, as many as 77.5% have experienced ED (Saigal, Wessells, Pace, Schonlau, & Wilt, 2006). According to a systematic review, untreated ED negatively impacts psychosocial functioning including diminished sexual quality of life-based on sexual relationships and sexual satisfaction and has associations with adverse mental health outcomes, such as low confidence, low self-esteem, and high depressive symptoms (McCabe & Althof, 2014). Among 606 older adults of both sexes from the Successful Aging Evaluation study (SAGE), high depressive symptoms emerged as the most robust correlate of poor sexual health, over and above age, sex, physical functioning, general cognitive functioning, anxiety symptoms, and perceived stress (Wang et al., 2015).
First-line treatment for ED involves lifestyle changes, such as engaging in exercise, improving dietary choices, quitting smoking, and under medical supervision, eliminating or reducing the usage of medication found to contribute to ED (Heidelbaugh, 2010). Pharmacological interventions with phosphodiesterase type 5 inhibitors (PDE5i) are common, with sildenafil being the most popular and effective medication for ED (Carvalheira, Pereira, Maroco, & Forjaz, 2012). Yet, these medications can have high discontinuation rates (48.9%) due to adverse effects such as headache, flushing, dyspepsia, rhinitis, and abnormal vision, and non-effectiveness in some patients (Carvalheira et al., 2012; Heidelbaugh, 2010). Insufficient education regarding the medication can lead to ineffective use, which lowers the medication’s success rate (Atiemo, Szostak, & Sklar, 2003). Further, these medications have many contraindications such as co-administration with alpha-adrenergic blocking agents and nitrates (Huang & Lie, 2013). If ED is not alleviated with first-line treatments, patients are offered second-line treatments, including vacuum constriction pump devices (Najari & Kashanian, 2016). Devices are often prescribed as a secondary-line treatment because they require more time and motivation on the part of the patient than taking medication. These devices consist of an acrylic cylinder that operates by hand pump or battery to create a vacuum (negative pressure) and is employed to bring blood into the penis to obtain an erection. To retain the blood and maintain the erection, a rubberized constriction band is placed at the base of the penis for up to a half-hour.
Prior research indicates that vacuum constriction devices facilitate erections in up to 90% of males (Albersen et al., 2012). Success rates, including continued use of the device, are associated with the amount of training and education men receive on device usage and possible side effects (Atiemo et al., 2003; Lewis & Witherington, 1997). However, comprehensive training alone may not be enough. In one study, over two-thirds of participants with ED discontinued using a vacuum constriction device by three-year follow-up, despite receiving a medical evaluation and multimodal training in device use by a device representative (Dutta & Eid, 1999). On average, participants reported discontinuing the device 4 months after receiving it. Typical reasons for discontinuation included participants reporting the device was unwieldy, too painful to use, or ineffective for improving erections. Device training aimed at fostering both realistic expectations and proper usage of the device has the potential to increase treatment success.
Results from this program evaluation may be useful to inform clinicians regarding their decision to prescribe the device to patients with erectile dysfunction. Because many older patients may be reluctant to add another medication to their regimen, and the device option has few negative side effects, psychoeducation about this option earlier in treatment and not after frontline treatment is tried, could be useful. Overall, this evaluation of patient satisfaction suggests that vacuum constriction devices can be highly effective in treating ED and improving sexual relationships, especially when patients are assessed by psychology within a primary care clinic team and are provided with adequate training in device use. Effectively treating ED may have positive effects on the sexual health functioning of male patients, particularly older adults for whom ED is a common experience.
Clinical implications
● The vacuum constriction device effectively treated erectile dysfunction in male Veterans of all ages.
● Female partners reported an increased ability to engage in sexual activities with male partners who used the device.
● Male patients primarily used the device for vaginal intercourse. Expanding device use to other sexual activities could be beneficial.
● Future studies should compare the effectiveness of device use of our model of team care, which includes psychology, with other care models.
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