A Research Study of Underserved Patients with Erectile Dysfunction in a County Hospital, Community Based Health System

Graduation Date


Document Type

Master's Thesis

Document Form


Degree Name

Master of Science



Department or Program Chair

Barbara Ganley, PhD

Thesis Advisor

Luanne Linnard-Palmer, EdD, RN


Purpose: The purpose of this study was to explore the lived experience of underserved patients with erectile dysfunction (ED) evaluated in a county hospital. The research focused on the challenges (barriers/issues) that patients face in seeking treatment for ED. In addition, the study analyzed how treatment or non-treatment of ED affected their quality of life.

Background: In the United States, it is estimated that more than 30 million men between the ages of 40 to 70 experience some degree of erectile dysfunction. Studies have shown that ED is more prevalent and severe in men with hypertension, among 43% of men who have had a stroke, and 50% of men with diabetes (Eardley & Kirby, n.d.). The condition worsens with age, with the rate of complete ED tripling from 5 to 15 percent among men between the ages of 40 to 70. Erectile dysfunction is a problem as sexual function continues to be a significant issue for men as they get older and research suggests there is negative impact on partner relationships and overall quality of for elderly men (Wagner, Montorsik, Auervach, & Collins, 2001). Additionally, ED may lead to depression, confusion, and anxiety.

Methods: A combined qualitative (phenomenological) and quantitative research study was conducted in a county hospital outpatient setting. The participants were recruited and non-randomly chosen during urology clinic consultation (Tuesday and Friday) from December 2006 to March 2007. The primary investigator (PI) interviewed thirteen ED patients using the Erectile Dysfunction- Effect on Quality of Life (ED-EQoL) questionnaire as well as Quality of Life (QOL) personal questions developed by the researcher. Copies of the Sexual Health Inventory for Men (SHIM) completed by the participants during the clinic visit were photocopied. The responses to the ED-EQoL questionnaire were analyzed using a statistical program SPSS version 15.0. Furthermore, the primary investigator extrapolated common themes from the participants’ responses to highlight the effects of living with ED.

Results: Thirteen male urology patients with ages ranging from 51 to 78 years (mean age 62) participated in the study. The participants included 4 African- Americans, 1 Caucasian, 1 Chinese, 2 Filipinos, 2 Arabic, 2 Hispanics, and 1 Ethiopian. Drug cost was identified as the main barrier in seeking ED treatment. Thirty percent (4 out of 13) felt preoccupied with ED and that the problem affected their self-esteem. Furthermore, thirty-eight percent (5 out of 13) said they are sad or tearful a great deal of the time. Forty-six percent (6 out of 13) felt that other people were happier and more sexually fulfilled. The most common themes included sadness/depression, partner blame, damaged self-esteem, and hope in finding other ED treatment. Overall, the participant’s quality of life improved after receiving some type of ED treatment.

Discussion: Some barriers identified in seeking treatment for ED included drug cost (main), lack of money, long appointment wait, embarrassment, and treatment contraindications due to heart problem and nitrate therapy (nitroglycerin). Although not everyone was successful with oral ED drugs, patients were still optimistic in finding other solutions. Undoubtedly, erectile dysfunction has negative impact on the quality of life as shown from the responses to the ED-EQoL questionnaires and the QOL personal questions. Damaged self-esteem, feeling envious of other people who they perceive were happier because they were sexually fulfilled, feeling preoccupied and worried about their erection problems, and feeling sad or tearful were rated as highly by the participants. Sadness/depression, partner blame, hopeful about other ED treatment methods, and damaged self-esteem were the highlights from the personal interviews reflecting some of the responses from the ED-EQoL questionnaires. The time constraint, small sample size (n= 13), and partner exclusion in the interview were the major limitations of the study.

Implications/Conclusions: A majority of the participants indicated positive responses in meeting with doctors; however, no one mentioned their encounter with the nurses. It is crucial that nurses portray an active role as patient educators about ED and the various treatment methods available as well as incorporate sexuality in their health assessment since we are in the best position to do so as front-line healthcare providers. Most of the patients that nurses come across inpatient or outpatient have one or more of the risk factors present in developing ED. It is also imperative to increase the patient’s awareness as well as other members of the nursing staff that ED is a common treatable health problem. Establishing trust and being sensitive is critical in the nurse-patient relationship. The participants in the study reported that they were not embarrassed discussing with the PI or physicians about the problems they face with ED. They were not embarrassed because they wanted treatment to enjoy life. A future question that can be asked is would they still be open to respond or share if their partner is present during interview? Another guiding research question to consider is how does the patient’s ED affect their partner’s life?