Never mind the commercials with men talking freely to their doctor about their erectile dysfunction, taking a prescription for treatment to the pharmacy and settling in for a romantic evening.
Despite a wide range of treatment options, most men with erectile dysfunction (ED) don't get treated, according to a new study.
"ED treatments, overall, are underutilized," said Dr. Brian Helfand, an assistant clinical professor of urology at Northshore University Health System and the University of Chicago. "Only 25 percent of men are actually treated."
Helfand led the study, which looked at the medical records of more than 6 million men with an ED diagnosis. He is due to present his findings Monday at the American Urological Association annual meeting, in San Diego.
The study was funded by the Havana Day Dreamers Foundation (which promotes men's health), the Goldstein Fund in Male Pelvic Health and the SIU Urology Endowment Fund.
Helfand used an insurance claims database and looked for the medical code for erectile dysfunction from June 2010 through July 2011. He found 6.2 million men aged 30 and older who received a diagnosis of erectile dysfunction. ED is defined as an inability to maintain an erection satisfactory for sexual performance.
He then looked to see how many filled a prescription. Patients were considered treated if they filled a prescription for an erectile dysfunction drug such as Viagra (sildenafil) or Cialis (tadalafil), drugs called prostaglandins that are given by injection or urethral suppositories, or androgen (hormone) replacement.
He considered them untreated if they received a diagnosis of erectile dysfunction but did not fill a prescription.
He took into account, too, the men's ages and other health problems.
Even though erectile dysfunction is likely to become more common with age, he actually found older men the least likely to be treated. Only about 18 percent of men aged 65 and above were treated.
When Helfand looked to see what bearing other health conditions might have had on treatment, he found those with prostate cancer were least likely to be treated. Only 15 percent were.
The study didn't have information on why the men went untreated, he said. But he speculates there are probably several reasons.
The undertreatment, Helfand said, is probably a result of doctors often not offering the prescription or patients getting a prescription but not filling it at the pharmacy.
"Men may not be bothered by it," he said. Or a doctor may not write a prescription because he may not think the man is a candidate, or perhaps they didn't respond to erectile dysfunction treatment in the past.
Other reasons, he said, could include costs and embarrassment.
For men, Helfand said, the message is: "There are available therapies out there. These can be useful if you have ED."
An expert who reviewed the study but was not involved said he isn't sure if it mirrors real life.
"To conclude from this study that three-fourths of the men who carry a diagnosis of ED are not treated doesn't fit with what we see in clinical practice," said Dr. Jacob Rajfer, a professor of urology with the David Geffen School of Medicine, at the University of California, Los Angeles.
"In order to determine how many men were treated or not treated, you need to interview the people," Rajfer said.
Men might get to the pharmacy, see the cost of the erectile dysfunction drug, and decide to go out of the country to get it and save money, or might get it by mail order, Rajfer said.
Another expert discussed possible barriers to men getting these drugs.
"Cost might be a big issue," said Dr. Ajay Nangia, an associate professor of urology at the University of Kansas Medical Center. He is familiar with the study findings.
Costs vary, but some erectile dysfunction drugs are about $4 a pill.
"It's becoming much more open to talk about this stuff," Nangia said. Even so, some men may still be embarrassed.
In an effort to combat sales of counterfeit Viagra online, drugmaker Pfizer will sell the drug directly to patients with prescriptions via its website, the Associated Press reported Monday.
Because the new study was presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.