Background: Erectile dysfunction (ED) is a common problem in the United States, with a prevalence of 52 percent in men 40 to 70 years of age and an increase of 5 percent per decade after 40 years of age. Prevalence studies from other countries indicate that ED is common worldwide. Sildenafil (Viagra) has been shown to be effective for ED. Although improvements in sexual function appear to be related to quality of life, the relationship between quality of life and successful treatment of ED has been difficult to ascertain. The Self-Esteem And Relationship (SEAR) questionnaire, a validated instrument for measuring sexual relationship satisfaction and confidence that includes a self-esteem subset, has been demonstrated to be useful in determining whether patients across cultures improve in psychosocial domains. Althof and colleagues analyzed results from a randomized controlled trial of patients from five nations to gather information about response to sildenafil across cultures and the psychosocial impact of treatment.

The Study: The study outcome measure was a change from baseline score on the self-esteem subsection of the SEAR questionnaire. Additional outcome measures were response to other aspects of the SEAR questionnaire and other measures of sexual function, as well as number of successful attempts at intercourse. Patients were randomized to sildenafil or placebo.

Results: Patients taking sildenafil had greater changes in baseline scores on the self-esteem portion of the SEAR questionnaire compared with patients taking placebo. Sildenafil patients had significant improvement in all other questionnaire domains. In terms of other measures of sexual function, intervention patients also had higher scores in all domains of the International Index of Erectile Function. There was a fivefold increase in the percentage of successful intercourse attempts in the sildenafil group compared with a twofold increase in the placebo group.

Conclusion: The authors conclude that patients treated with sildenafil have a large increase in psychosocial functioning, including improved quality of life, as manifested by improved confidence, relationships, and self-esteem. The study also showed that this benefit held true for patients from different cultures.