The impact of psychosocial factors on the risk of erectile dysfunction and inhibition of sexual desire in a sample of the Brazilian population
Keywords:
Impotence, Depression, Education, UnemploymentAbstract
CONTEXT: Sexual dysfunctions can have origins in physical, psychological and psychosocial factors. OBJECTIVE: To describe the frequency of erectile dysfunction (ED) and female inhibition of sexual desire (ISD) in a Brazilian sample, and to estimate the risks of these dysfunctions. TYPE OF STUDY: Non-random survey. SETTING: Ten Brazilian cities. METHODS: 2,835 subjects (53% women) aged over 18 years answered a questionnaire about their general health and sex life. The chi-squared test and multivariate logistic regression were used. Values of p 0.05 were considered significant. RESULTS: The women’s average age was 36.6 years (± 13.3) and the men’s was 39.5 (± 13.3). 14.7% of men presented moderate/complete ED and 34.6% of women presented ISD. Depression was mentioned by 16.8% of men and 29.7% of women. The chances of having ED and ISD were higher for subjects who had had lower school attainment. Lack of a job and depression gave rise to 1.5 times (95% CI: 1.0 – 2.3) and 1.9 times (95% CI: 1.2 – 3.0) greater chances of ED respectively. Compared with men aged up to 25 years, those aged 41-60 had 1.9 times (95% CI: 1.0 – 3.4) and those aged 61 and over had 5.4 times (95% CI: 2.3 – 12.6) greater risk of ED. For women, lack of a job gave rise to 1.5 times (95% CI: 1.1 – 1.9) greater chance of ISD; depression was not associated with higher risk. Compared with women aged up to 25 years, those aged 41-60 and 61 or over had, respectively, 2.9 times (95% CI: 2.0 – 4.1) and 7.5 times (95% CI: 3.0 –18.6) greater risk of ISD. DISCUSSION: Increasing unemployment has affected the whole population, but especially those with lower levels of school attainment. Such levels are positively linked with presence of sexual dysfunctions. CONCLUSION: Lack of jobs, age and low school attainment are risks for the sexual dysfunctions studied. Depression increased the risk of ED but not female ISD.
Downloads
References
APA (American Psychiatric Association). Transtornos Sexuais e da Identidade de Gênero [Sexual Disorders and Gender Identity]. In: APA (American Psychiatric Association). Manual Diagnóstico e Estatístico de Transtornos Mentais [Diagnostic and Statistical Manual of Mental Disorders] (DSM IV). 4th edition. Porto Alegre: Artes Médicas; 1995. p. 467-510.
Benet AE, Melman A. The epidemiology of erectile dysfunction. Urol Clin North Am. 1995;22(4):699-709.
Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol. 1994;151(1):54-61.
McDonagh R, Ewings P, Porter T. The effect of erectile dysfunc- tion on quality of life: psychometric testing of a new quality of life measure for patients with erectile dysfunction. J Urol. 2002;167(1):212-7.
Araujo AB, Durante R, Feldman HA, Goldstein I, McKinlay JB. The relationship between depressive symptoms and male erectile dysfunction: cross-sectional results from the Massachusetts Male Aging Study. Psychosom Med. 1998;60(4):458-65.
Nicolosi A, Moreira ED, Shirai M, Bin Mohd Tambi MI, Glasser DB. Epidemiology of erectile dysfunction in four countries: cross-national study of the prevalence and correlates of erectile dysfunction. Urology. 2003;61(1):201-6.
Rajfer J, Aronson WJ, Bush PA, Dorey FJ, Ignarro LJ. Nitric oxide as a mediator of relaxation of the corpus cavernosum in response to nonadrenergic, noncholinergic neurotransmission. N Engl J Med. 1992;326(2):90-4.
Burnett AL. Role of nitric oxide in the physiology of erection. Biol Reprod. 1995;52(3):485-9.
Park K, Goldstein I, Andry C, Siroky MB, Krane RJ, Azadzoi KM. Vasculogenic female sexual dysfunction: the hemodynamic basis for vaginal engorgement insufficiency and clitoral erectile insufficiency. Int J Impot Res. 1997;9(1):27-37.
Boolell M, Gepi-Attee S, Gingell JC, Allen MJ. Sildenafil, a novel effective oral therapy for male erectile dysfunction. Br J Urol. 1996;78(2):257-61.
Heaton JP, Morales A, Adams MA, Johnston B, el-Rashidy R. Recovery of erectile function by the oral administration of apomorphine. Urology. 1995;45(2):200-6.
Morales A, Heaton JP, Johnston B, Adams M. Oral and topical treatment of erectile dysfunction. Present and future. Urol Clin North Am. 1995;22(4):879-86.
Rosen RC, Ashton AK. Prosexual drugs: empirical status of the “new aphrodisiacs”. Arch Sex Behav. 1993;22(6):521-43.
Segraves RT, Croft H, Kavoussi R, et al. Bupropion sustained release (SR) for the treatment of hypoactive sexual desire disorder (HSDD) in nondepressed women. J Sex Marital Ther. 2001;27(3):303-16.
Akkus E, Kadioglu A, Esen A, et al. Prevalence and correlates of erectile dysfunction in Turkey: a population-based study. Eur Urol. 2002;41(3):298-304.
Moreira ED, Lisboa Lôbo CF, Villa M, Nicolosi A, Glasser DB. Prevalence and correlates of erectile dysfunction in Salvador, northeastern Brazil: a population-based study. Int J Impot Res. 2002;14(Suppl 2):S3-9.
Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United States: prevalence and predictors. JAMA. 1999;281(6):537-44.
May JL, Bobele M. Sexual dysfunction and the unemployed male professional. J Sex Marital Ther. 1988;14(4):253-62.
Morokoff PJ, Baum A, McKinnon WR, Gillilland R. Effects of chronic unemployment and acute psychological stress on sexual arousal in men. Health Psychol. 1987;6(6):545-60.
Meisler AW, Carey MP. Depressed affect and male sexual arousal. Arch Sex Behav. 1991;20(6):541-54.
Kantor J, Bilker WB, Glasser DB, Margolis DJ. Prevalence of erectile dysfunction and active depression: an analytic cross-sectional study of general medical patients. Am J Epidemiol. 2002;156(11):1035-42.
Nurnberg HG, Seidman SN, Gelenberg AJ, Fava M, Rosen R, Shab- sigh R. Depression, antidepressant therapies, and erectile dysfunction: clinical trials of sildenafil citrate (Viagra) in treated and untreated patients with depression. Urology. 2002;60(2 Suppl 2):58-66.
Shabsigh R, Zakaria L, Anastasiadis AG, Seidman AS. Sexual dysfunction and depression: etiology, prevalence, and treatment. Curr Urol Rep. 2001;2(6):463-7.
Morillo LE, Díaz J, Estevez E, et al. Prevalence of erectile dysfunction in Colombia, Ecuador and Venezuela: a popula- tion-based study (DENSA). Int J Impot Res. 2002;14(Suppl 2):S10-8.
Simons JS, Carey MP. Prevalence of sexual dysfunctions: results from a decade of research. Arch Sex Behav. 2001;30(2):177-219.
Rosen RC. Prevalence and risk factors of sexual dysfunction in men and women. Curr Psychiatry Rep. 2000;2(3):189-95.
Stuart FM, Hammond DC, Pett MA. Psychological character- istics of women with inhibited sexual desire. J Sex Marital Ther. 1986;12(2):108-15.
Nathan SG. The epidemiology of the DSM–III psychosexual dysfunctions. J Sex Marital Ther. 1986;12(4):267-81.
Hällström T, Samuelsson S. Changes in women’s sexual desire in middle life: the longitudinal study of women in Gothenburg. Arch Sex Behav. 1990;19(3):259-68.
Purifoy FE, Grodsky A, Giambra LM. The relationship of sexual daydreaming to sexual activity, sexual drive, and sexual attitudes for women across the life-span. Arch Sex Behav. 1992;21(4):369-85.
Kadri N, McHichi Alami KH, McHakra Tahiri S. Sexual dys- function in women: population based epidemiological study. Arch Women Ment Health. 2002;5(2):59-63.
Abdo CHN, Moreira Jr. ED, Fittipaldi JAS. Estudo do comportamento sexual no Brasil - ECOS [Brazilian study of sexual behavior (BSSB)]. RBM Rev Bras Med. 2000;57(11):1329-35.
IBGE – Instituto Brasileiro de Geografia e Estatística. Censo Demográfico 2000 – Resultados do Universo. Available from URL: http://www.ibge.gov.br/home/estatistica/populacao/censo2000/default.shtm. Accessed in: 2004 (Oct 5).
Shabsigh R, Klein LT, Seidman S, Kaplan SA, Lehrhoff BJ, Ritter JS. Increased incidence of depressive symptoms in men with erectile dysfunction. Urology. 1998;52(5):848-52
Ducrocq F. Dépression et troubles de la fonction sexuelle [De- pression and sexual disorders]. Encephale. 1999;25(5):515-6.
Intili H, Nier D. Self-esteem and depression in men who present with erectile dysfunction. Urol Nurs. 1998;18(3):185-7.
Hartmann U. Psychische Belastungsfaktoren bei erektilen Dys- funktionen. Verursachungsmodelle und empirische Ergebnisse [Psychological stress factors in erectile dysfunctions. Causal models and empirical results]. Urologe A. 1998;37(5):487-94.