Given the AEs reported by veterans and the significant cost of ED medications within the VA system,2 increased use of alternative nonpharmacologic and preventive behavioral approaches would be clinically and economically beneficial. For example, in one study, men with ED who engaged in a lifestyle program that focused on weight loss, diet, and exercise were found more likely to experience improvements in erectile functioning compared with men who did not participate.6 Yet in the current study, 30% of participants had not attempted behavioral changes to address ED.
The VA’s Health Promotion and Disease Prevention (HPDP) Program focuses on preventive services and behavioral interventions to reduce health risks within primary care settings.19 This program may provide a framework for efforts to prevent and ameliorate ED. Specifically, coaching and education by HPDP experts could reduce PCPs’ discomfort with sexual health discussions and normalize the value of such conversations for both providers and patients. Existing HPDP behavioral interventions targeting areas such as weight loss and smoking cessation also could emphasize the potential secondary benefit of improved sexual functioning. To that end, preventive health campaigns could include sexual health and ED prevention as topics on patient education materials. Including sexual functioning on telephone or in-person prescreening questionnaires prior to routine appointments with PCPs also may facilitate destigmatization of sex as an important health topic.
Limitations of the current study include its correlational design, which precludes conclusions regarding casual relationships among the variables in question. The authors cannot speculate about how well their sample represents the general veteran population given its low response rate (although comparable to a similar study).10 In addition, the lack of a validated measure of ED risk-factor knowledge meant reliance on an online questionnaire with unknown psychometric properties. To identify alternatives to pharmacologic treatment for ED, it would be beneficial for future research to examine the reasons for dissatisfaction among veterans, assessing satisfaction changes after implementation of behavioral and/or preventive interventions.
This study deepens the understanding of ED treatment efficacy among veterans in light of the paucity of available information. Overall, veterans are neutral to dissatisfied with their ED treatment, yet plan to continue it in the context of limited alternatives and possible lack of knowledge of behavioral methods shown to improve erectile functioning. Future studies that examine the reasons for continuing medication despite neutral satisfaction would help explore this finding. Based on these results, the authors recommend increased attention and discussion of sexual health during PCP visits and enhanced efforts toward using behavioral strategies to prevent and reduce ED. Encouragement from PCPs to address sexual health concerns earlier in a veteran’s treatment course—and in the context of behavioral and lifestyle change—may assist in preventing veterans’ sexual lives from prematurely reaching “the end of the road.”
This material is the result of work supported with resources and the use of facilities at the Clement J. Zablocki VA Medical Center in Milwaukee, Wisconsin.