857

ORIGINAL RESEARCH—ED PHARMACOTHERAPY

Couples’ Reasons for Adherence to, or Discontinuation of, PDE

Type 5 Inhibitors for Men with Erectile Dysfunction at 12 to
24-Month Follow-Up after a 6-Month Free Trial jsm_2625 857..865

Helen M. Conaglen, PhD and John V. Conaglen, MD, MBChB

Faculty of Medical and Health Sciences, University of Auckland, Hamilton, New Zealand

DOI: 10.1111/j.1743-6109.2011.02625.x

ABSTRACT

Introduction. The history of treatments for erectile dysfunction (ED) has involved a repeated pattern of uptake, followed
by abandonment of the various therapies in the medium term. Even effective and simple to use medications are not
necessarily continued; discontinuation rates range between 15% and 60%. Despite the association between partner sexual
function and men’s use of PDE5, no previous studies have reported any contact with partners of men taking PDE5 for
their ED. This study involved both partners in couples followed up at least 1 year after treatment of ED.
Aim. The study sought clarification of factors influencing adherence to, or discontinuation of, oral ED medications
from couples. We hypothesized that many factors contribute to decision making about ED medication use at >12
months.
Main Outcome Measures. The main outcome measures of this article were interviews and International Index of
Erectile Function-erectile function domain.
Methods. A total of 155 interviews were conducted seeking details of frequency of usage and preference for the drugs
available; reasons for that choice, or for discontinuation of use, were also sought.
Results. Of men interviewed, 71% were using PDE5 at 18 months. Most men interviewed were using the oral
medications either 1–2x/week or 1–2x/month. Forty-four percent of men who had decreased their use of the
medications reported less need for them. Thirty-four men said the main reason they were using less medication was
cost. “Partner issues” from the men’s perspective were seldom reported in this study. However, for a number of
women, “partner issues” meant a range of problems from separation to alcohol abuse, lack of communication, and
lack of confidence, or fear of failure.
Conclusions. This is the first study to ask couples why they decided to continue or stop using PDE5 when followed
up. Female partners provided a different perspective on “partner issues” often cited as reasons for discontinuing
PDE5 use. It was also clear that discontinuation did not mean couples were no longer sexually active. Conaglen HM
and Conaglen JV. Couples’ reasons for adherence to, or discontinuation of, PDE type 5 inhibitors for men
with erectile dysfunction at 12 to 24-month follow-up after a 6-month free trial. J Sex Med 2012;9:857–865.
Key Words. Adherence; Discontinuation; Phosphodiesterase Type 5 Inhibitors; Erectile Dysfunction; Couples;
Sildenafil; Tadalafil; Vardenafil

Introduction usually by the clinician [1–6]. One reason given for

discontinuation of the earlier treatments was the

T he history of the treatments for erectile

dysfunction (ED) has involved a repeated
pattern of uptake, followed by abandonment of
the various therapies in the medium term even
when the “treatment” has been deemed successful,
relatively difficult application of these therapies.
Treatments such as intracavernosal injections,
intraurethral suppositories, and vacuum devices,
all lacked the ease of use of the more recent
oral medications for ED [1,3,5,7–9], and early

© 2012 International Society for Sexual Medicine J Sex Med 2012;9:857–865

858
follow-up studies of men received surgical
implants detailed how seldom these were used
after surgery [10], although more recent reviews
report high levels of user satisfaction [11].
Another explanation given for ceasing treat-
ment is the assumption that once the man’s failing
erection is corrected with oral ED medication,
their relationship will recover to the way they were
before ED. Althof has suggested a number of
patient, partner, and interpersonal variables that
can negatively impact sexual activity despite the
medication assisted erection [1]. With the advent
of oral therapies, it was anticipated that greater
adherence to medication use in men for whom the
tablets work well to overcome their ED would
occur. However, a number of follow-up studies
and reviews have reported that even the effective
and simple to use medications are not necessarily
continued when men have been questioned some-
time after treatment initiation [12–25]. The
reasons for this vary among populations studied
and the methods used by the investigators.
The earliest studies were conducted during the
years when only one oral ED medication was avail-
able to men, and reports of discontinuation rates in
those ranged between 9.1% and 53%, although the
latter figure was prompted by one government’s
policy change on subsidizing the medication
[13,16,18,19,23,25]. A small number of studies ana-
lyzed prescription records to ascertain repeat script
filling and concomitant other products prescribed,
in order to understand reasons for lack of continua-
tion [15,17,20,24]. A 2002 review also reported that
79% of discontinuations were not treatment-related
[21], suggesting investigation of factors involved in
discontinuation may be useful in understanding
patients’ needs. When phone surveys were under-
taken, some of these factors began to emerge
[13,16,18,22,23]. With greater available range of
product, it was noted that discontinuation rates were
lower where patients could exercise choice among
available products [19]. Since then, reviews have
reported discontinuation rates ranging between
15% and 60% of users [14,21]. Some studies have
recorded no reasons for the discontinuation rates
given [15,20,22], and one has asserted that the dis-
continuation was not treatment related [21]. Several
gave a range of reasons why patients discontinued
using PDE5; these included cost [13,18,25], recov-
ery of natural erectile capability [19,23,25], emo-
tional reasons [23], loss or lack of efficacy [13,16,22],
side effects [18,25], loss of desire [18], and lower
International Index of Erectile Function (IIEF)
scores at treatment initiation [22].
J Sex Med 2012;9:857–865
Conaglen and Conaglen
A further consideration in continued use of
phosphodiesterase type 5 inhibitors (PDE5) is
the role of the partner. A number of studies have
indicated an association between partner sexual
function and men’s use of PDE5 [23–34], and
guidelines now urge the involvement of partners
in decision making about ED treatment [35].
However, while partner issues are reported to
contribute to discontinuation [14,16,18,21], none
of the studies investigating adherence or discon-
tinuation cited previously, reported any contact
with the partners of the men taking PDE5 for
their ED.
The continuation study reported here involved
both partners in couples who had previously been
involved in a 6-month trial of two PDE5 (provided
free of charge), the partners preference (PP) study
[30]. In that study, 100 men with ED and their
partners were randomly assigned to therapy with
sildenafil or tadalafil for 3 months, then switched
to the other medication for a further 3 months.
During the final interview of that study, partners
had suggested that 81% of the men would con-
tinue to use oral ED medications once the study
was completed. During the PP study follow-up
period (continuation study), the couples were
determining choice and funding use themselves.
This follow-up study was designed to ascertain
how many of the original cohort continued to use
oral ED medications as anticipated. The principal
hypothesis was that many factors contribute to
adherence to, or discontinuation of, ED medica-
tion use at >12 months, e.g.,
• Cost of medication is a potential barrier for low-
income couples.
• ED severity may be related to continuation.
• Age may be related to continuation.
• Sexual desire may be related to continuation.
We sought clarification of the factors that play a
significant role in decision making about discon-
tinuation or ongoing use of PDE5 from the man
and his partner.
Methods
This follow-up study, conducted at 12–24 months
(mean 16.7, standard deviation 5.2) following
completion of the PP study, was approved by the
Regional Ethics Committee. Investigators con-
tacted 90 of the original 100 couples by phone; 66
of the 90 couples agreed that both partners be
interviewed. The female partner in a further 11
couples was interviewed, and the male partner in a
Couples’ Reasons for Continuation of PDE5
further 12 couples also agreed; thus, a total of 155
interviews were conducted. The interviewer (HC)
followed a question schedule that sought details of
frequency of usage and preference for the drugs
available to participants. Reasons for that choice,
or for discontinuation of use, were also sought.
Men interviewed responded to the IIEF-erectile
function (EF) schedule, and couples gave an indi-
cation of their combined income range.
Results
Recorded telephone interviews conducted with 78
men and 77 women averaged 10.5 minutes in
length (range 2.2–36 minutes). Demographic
characteristics for the participant couples are
shown in Table 1.
Key findings are summarized as follows.
Table 1 Participants’ characteristics
Variable
Age, mean (SD) years
Ethnicity
Maori or Pacific Islander
Caucasian/European
Mixed Ethnicity
Other
History of sexual relationships*
Had one sexual partner only
Had 2 or more sexual partners
Years with current partner, mean (SD)
Baseline menstrual status (females)
Still menstruating regularly
Currently perimenopausal (periods
irregular but still occurring)
Menopausal (no period for 1 year)
Other—please explain
Hysterectomy, postmenopausal, using
IUD
Baseline current medications
None
Taking prescription or OTC medicines
including:
*Missing data = 2
ACE = angiotensin-converting enzyme; IUD = intrauterine device; OTC = over the counter
859
Adherence to Use of Oral PDE5
Fifty-five of the men interviewed said they were
using PDE5 1 year after the study had ended, and
23 men said they were not. Forty-nine of the
women interviewed said their partners were using
one or other of the two study medications (tadalafil
or sildenafil citrate) at 1 year after the study.
Twenty-eight of the women said their partners
were not using PDE5 at follow-up.
In total, 104 of the 155 people interviewed said
they had continued using PDE5 1 year after the
end of the PP study. Fifty-three of the couples
contacted gave clear reports about which drug
they were currently using, 44 reported using tad-
alafil (Cialis), while nine were using sildenafil
citrate (Viagra). A further 28 couples reported they
were no longer using either oral ED medication at
that time.
Males (N = 78) Females (N = 77)
58.6 (8.3) 53.1 (8.9)
N N
4 4
64 64
8 3
2 6
27 31
49 46
24.4 (14.9) 24.6 (14.4)
18
11
27
19
33 32
45 45
ACE inhibitors, antibacterials, ACE inhibitors, antibacterials,
anticoagulants, antidepressants, antidepressants, antidiarrheal,
antidiarrheal, antidiuretics, antidiuretics, antihistamines,
antihistamines, antihyperuricemic, antihypertensives, anti-inflammatories,
antihypertensives, anti-inflammatories, antimalarials, antiviral agent, aspirin,
antimalarials, antiviral agent, aspirin, asthma medications, beta-blockers, birth
asthma medications, beta-blockers, control meds, blood pressure tablets,
blood pressure tablets, calcium, calcium calcium, calcium channel blockers,
channel blockers, corticosteroids, corticosteroids, diabetes meds,
decongestants, diabetes meds, diuretics, folates, glucosamine, lipid
diuretics, folates, glucosamine, lipid lowering agents, magnesium,
lowering agents, magnesium, Metamucil, migraine meds,
Metamucil, migraine meds, multivitamins, osteoarthritis meds,
multivitamins, osteoarthritis meds, osteoporosis meds, phosphates, proton
osteoporosis meds, phosphates, proton pump inhibitors, ranitidine, Tegretol,
pump inhibitors, ranitidine, Tegretol, thyroxine, topical estrogen cream
thyroxine
J Sex Med 2012;9:857–865
860
Table 2 Tablet usage frequency
Frequency of use Number of men Percentage
>2x/week 3 3.8%
1–2x/week 20 25.6%
1–2x/month 22 28.2%
1/month 11 14.1%
NA 21 26.9%
Missing data 1 1.3%
Frequency and Quantity of PDE5 Used
Most of the men interviewed (42/56) were using
the oral medications either once or twice a week
(N = 20) or once or twice a month (N = 22). Three
men reported using tablets more than twice per
week, and 11 men reported using tablets about
once per month. Twenty-one men were not using
medication, and there was no data for two men.
The detail of usage frequency is shown in Table 2.
The majority of users said they did not need the
tablet every time they had sex (N = 45), although
14 men said they did need medication each time.
Of the 46 men using Cialis, 29 would typically
take a full 20 mg dose, while a further 17 men
would halve or cut the tablet into thirds or quar-
ters. Similarly, there were two men taking a full
100 mg dose of Viagra, and a further seven men
halving, or in one case quartering, the tablet.
The largest group of men who had decreased
their use of the medications (N = 39, 44%) stated
that they had less need for them. Thirty-four men
(38%) said the main reason they were using less
medication was due to cost. Five men (6%)
reported decreasing the dose of the medications
used because they had less need of the tablets,
while two men (2%) reported increasing their use
because of a greater need for the medications. One
man reported needing to increase the dose he used
to get the efficacy he required, and a further five
men said their usage was the same as it had been
during the PP study (1.9 tablets/week).
During the PP study, tablets were provided free
of charge, but several men reported taking less
than the full dose to see how it worked. At follow-
up, 24 men reported currently using half tablets
now that they are funding their own medication.
Eight of these men had tried half tablets during the
PP study, while 15 had not, but were now cutting
costs, or using less because they did not need a full
dose.
Reasons for Discontinuation of PDE5
The main reasons given for no longer using PDE5
are shown in Table 3.
J Sex Med 2012;9:857–865
Conaglen and Conaglen
Illness was the most common reason given for
PDE5 discontinuation. The men involved (N = 8)
had serious ongoing health issues or recent injuries
or operations that had occurred since the end of
the PP study. Health issues included heart prob-
lems, minor stroke, possible pituitary issues,
trauma, and surgical problems.
The next most often cited reason for discontinu-
ation was cost (N = 7, 30%), given by men whose
incomes were less than New Zealand dollar (NZD)
56,000. (October 11, 2011 conversion: United
States dollar [USD] 43,101; Great Britain pound
[GBP] 27,698; Euro 32,213). Several were retired
and relying on the pension for income and others
had low paying or intermittent income sources.
Too dear for me . . . what is it, $20 a pill . . . pension
won’t let me do that . . .” (73-year-old man in 43-year
relationship).
The wife of an 82-year-old diabetic man in a
51-year relationship reported:
Gone back to using the ring . . . D is still very sexual
without taking any medication . . . probably average
about once every 5 or 6 days . . . not bad for 82 next
month is it? . . . it (Cialis) was good but for the money.
And a younger man’s partner explained:
Not using medication . . . D got made redundant so it
tends to be something that came under the luxury
(heading) . . . (56-year-old partner of diabetic man in
32-year relationship).
Participants were asked how their usage of PDE5
might alter if there were a subsidy or cheaper price
structure. The majority thought they would use
more than currently or resume use of the products
if this were to happen. One comment in response
to this line of questioning:
O yeah, we save for it . . . NZD100 every six weeks
. . . got to be money in the account (50-year-old man in
a 25-year relationship).
Table 3 Participants’ reasons for discontinuing PDE5 use
Main reason given for nonuse of ED Men, Women,
medication N (%) N (%)
Illness 8(34.8) 5 (17.9)
Cost 7(30.4) 11 (39.3)
Not needed 3(13) 3 (10.7)
Partner problems 2(8.7) 7 (25)
No partner 2(8.7) 2 (7.1)
Lack of efficacy 1(4.3) —
Side effects — —
Total number of men reported to be no 23 (100) 28 (100)
longer using ED medication
Couples’ Reasons for Continuation of PDE5 861

Figure 1 Percentage of each income

group using oral ED medications at
follow-up.

Relationship between Income and PDE5 Use
Current household income data were collected to
allow examination of the relationship between
income and PDE5 use in this cohort who knew the
tablets worked well for them following their 6
months in the PP study. Relating the income levels
to non-usage of medications, we found that 25%
of those in the lowest income group were not using
medication, and 55% of those in the next group
were no longer using tablets. About one-third of
the men in each of the next three income levels
were not using ED medication when interviewed.
Not surprisingly, the smallest proportion of men
not using these drugs (8%) was found in the group
with the highest income (see Figure 1). A chi-
square analysis across income categories regarding
use found that there was not a significant differ-
ence; 53% of the couples earning less than the
New Zealand average income were using the
PDE5 at follow-up. From the interview data, we
found that cost was the single most quoted factor
determining why men who were well were not
using as many or any tablets for their ED at
follow-up.
use of the medications. Only one man reported
discontinuation because of lack of efficacy.
A number of couples reported not using the
medications because they had recovered their
ability to have reliable erections. The three men
who gave this reason scored between 22 and 28 on
the IIEF-EF at the time of interview:
I’ve sort of got my confidence back, . . . because a lot of
it, I was worried about it all the time (59-year-old man in
a 33-year relationship).
Because of the PP study, couples communicated
better about the issue:
We’ve sort of discussed it. As a result of taking part in
the survey (PP study) we are taking more effort I suppose
you could say, in the foreplay things and that . . . Also
the fact that we are not embarrassed to say that things
are not going to work, or they are not going to proceed
to full erection or something like that, so I think that
was good . . . the study was definitely worthwhile for
us . . . it’s not necessary every time . . . it was a guaran-
tee (56-year-old partner in 34-year relationship).
And understanding the need for sexual stimulation
with or without medication had also helped
couples:

Relationship between ED Severity and PDE5 Use The study woke D up to what was required more
A further factor hypothesized to be responsible for than anything . . . that it’s a two way street, you know,

discontinuation was the ED severity of the men

involved. Table 4 details the men’s IIEF-EF scores Table 4 Continuation study IIEF-EF compared with
at the beginning and end of the PP study and at the partners preference (PP) baseline and end of study scores
time of this continuation study. Men who reported PP study PP study and Continuation study
IIEF-EF scores in the mild to moderate, moder- baseline end of study (~1 year after PP)
ate, or severe ranges (IIEF-EF < 17) were more IIEF-EF (N = 78) (N = 78) (N = 78)
likely to be continuing use of PDE5 at follow-up Mean (SD) 12.92 (5.80) 24.37 (6.21) 21.05 (7.70)
(60–71%). Those with only mild (IIEF-EF 17–21) Min–max 1–20 1–30 0–30
Median 14 26 23
or no dysfunction were less likely to be continuing

J Sex Med 2012;9:857–865

862
stimulation and all that sort of thing. Well I have had
very little trouble ever since then . . . (64-year-old man in
41-year relationship).
Relationship between Age and PDE5 Use
A higher proportion of men in their 50s and 60s
were continuing to use the oral ED medications;
men in their 70s most often reported lesser levels
of income following their retirement and reliance
on pension as sole income influenced their con-
tinuing usage. Men in their 40s had other reasons
for no longer using the drug; one man cited cost,
but the remainder had illness or injury affecting
their current ED medication use. But the idea that
age played a part was typified by this participant:
. . . The relationship thing is important as well . . . both
of us have to feel that it’s what we want to do, rather
than one of us wanting it more than the other . . . I
think age has a lot to do with things, and mood swings
and stuff like that . . . the poor medication really had a
battle on its hand to make things work at times (74-year-
old man in 25-year relationship).
However, among the men in the groups using the
medication the most, there were those whose
embarrassment about this problem overcame the
availability of assistance, and two men “Had not
got around to getting any more medication yet”
(#70 and #100). The latter participant had issues
with the cost but was also embarrassed to collect
prescriptions in his small town context:
I was tempted to order some over the net . . . lately
we’ve been seeing all these things about what you’re
getting is not what you want . . . because it’s such a
small town if you go in there then everybody knows
your business . . . then I went into A (pharmacy in city 45
minutes away) and got it there (64-year-old man in
24-year relationship).
And:
D (partner) gets it. I don’t go to the doctors (48-year-old
man in 11-year relationship).
However, about half the participants were com-
fortable sourcing the product from their local
pharmacy; the remainder purchased online or had
prescriptions filled in a more anonymous location.
Relationship between Partner Issues and PDE5 Use
“Partner issues” from the men’s perspective were
seldom reported in this study, although one par-
ticipant reported separating 6 months following
the PP study:
No, I haven’t got a partner any more . . . but if I
did . . . I would go to my doctors if I need it . . . it
worked well the whole weekend . . . it was more
J Sex Med 2012;9:857–865
Conaglen and Conaglen
than 48 hours! . . . Erectile function is more instant
now than before . . . I had a lot of troubles prior to
that with her with . . . just constant interference you
know from her parents and the kids and stuff like that.
I would immediately lose the erection . . . A lot
of anxiety? . . . Yeah . . . (54-year-old man in 2-year
relationship—separated).
However, there were a number of women for
whom “partner issues” meant no further use of
PDE5 by the men. These issues related to a range
of problems from separation to alcohol abuse,
lack of communication, and lack of confidence, or
fear of failure.
We have separated . . . The fact that there was little
sexual contact certainly would have contributed towards
it . . . part of not getting your needs met really . . . it’s
not only the actual sexual act, its also the intimacy that
goes along with it (58-year-old former partner from a
12-year relationship).
We’ve actually separated . . . for last 4 months . . . it
wasn’t anything to do with that actually, and if the truth
be told even though we’ve separated we still do that (have
sex) . . . but it’s because we’re comfortable with each
other (36-year-old partner from a 4-year relationship).
We decided not to carry on with it; there was nothing in
it for me . . . P wasn’t prepared to talk about it . . . or
even let me know when he’d taken the tablet so I could
prepare or any damn thing. So . . . we’ve been married
48 years and had a jolly good sex life but now we don’t
have any, so there we go (partner of 62-year-old man in a
45-year relationship).
I wouldn’t know (which drug I prefer) we haven’t had sex
since (end of PP study) . . . I think we’re just a bit scared
to try . . . we’ve got medication here; it’s available but
we just don’t make time for ourselves basically
. . . worry about failure, mainly . . . it is quite expensive,
so they’re sort of like gold, you know you hold onto
them . . . He took a tablet one night but nothing hap-
pened so . . . (with stimulation?) well I tried! I did my
best (partner aged 54, in 35-year relationship).
One further area postulated to affect PDE5 usage
has been a lack of interest in or desire for sex. In
this study, few men (N = 2) and women (N = 2)
reported a lack of interest in sexual activity.
Discussion
This is the first study to ask couples for the reasons
why they have decided to continue or stop using
PDE5 in a follow-up about 18 months after suc-
cessful treatment for the man’s ED. Input from the
female partners has yielded quite a different per-
spective on the “partner issues” that are often cited
as a reason for discontinuing use of PDE5. Most
previous studies have intimated a lack of female
partner interest, while our participants reported
on problems determining the man’s lack of partici-
pation in sexual activity.
Overall, the rate of adherence to PDE5 use was
71%, slightly lower than the 81% anticipated by
Couples’ Reasons for Continuation of PDE5
the partners of the men treated in the PP study,
but this rate was similar to that in previous studies
[14,18]. An important point common to all these
studies is the availability of a choice of medication
to the men being treated. The point of difference
for the current study is that the female partners
had some input as to which medication the couple
chose. While only 55% of the women said their
partner was using the medication she had pre-
ferred in the PP study, 92% of women were happy
with the drug currently being used.
The hypothesis that cost might be a potential
barrier to adherence in low-income couples was
not fully supported in this study, because contin-
ued usage was not significantly different across
income groups. However, cost was a factor
reported by several as deciding their discontinua-
tion; in addition, several couples stated that while
it did not change their usage, they thought it
would influence decision making by other couples.
The majority of participants thought a subsidy or
cheaper price for these drugs would increase their
use, a scenario that is now being realized with the
increasing availability of generic tablets. Putting
these findings in context, this study was carried out
in a country where the average individual annual
income was $35,568 and tablets cost ~$25 each.*
The proportion of people citing cost as the main
factor was similar to that in the published Swedish
studies [19,25]. One clinically relevant point to
draw from these findings is the fact that low-
income couples might value the use of medications
and restoration of their sex lives to a greater extent
than higher income earners; this is not something
a clinician should decide on. Patients and their
partners should be given the option.
Previous studies have identified ED severity as
a factor determining ongoing use of PDE5
[23,36]. While one man reported not using medi-
cation because of lack of efficacy, most in this
study had no such issue. However, it was found
that the proportion of men in the “severe” ED
group using medications was significantly less
than the proportion of men in the “no to mild”
dysfunction group (P = 0.02). These men were
also in their mid-late 60s, experiencing some
other health issues, with relatively low incomes,
all factors likely to have also contributed to their
decision not to use PDE5.
*Conversion October 10, 2011: NZD 35,568.00 = USD
27,375.30; GBP 17,592.30; Euro 20,459.70. NZD
25 = USD 19.24; GBP 12.37; Euro 14.38.
863
Age alone did not feature as a factor for adher-
ence or discontinuation; while about half of the
men in their 40s and their 70s were using PDE5 at
follow-up, 70–80% of men in their 50s and 60s
had continued to use the medications. However,
differences in group sizes and factors associated
with age such as income differences and health
issues all confounded this enquiry.
Some previous studies have pointed to a lack of
interest in sexual activity as a factor in discontinu-
ation and this was found in a small number of our
participants. But unlike previous studies where
patients have been surveyed, in this study, a
number of the female partners reported the men
to be lacking interest in sexual activity or in inti-
macy within their relationship. This highlights
the importance of understanding the couple’s
attitude to their relationship at the time of pre-
scribing and reinforcing the need for involving a
man’s partner during the assessment for sexual
dysfunction. The positive result from a couples
approach is underlined by the high level of agree-
ment between the participants, as to effect of
PDE5 over the duration of the studies, on
improvements in their quality of life (men 88.5%,
women 74%), life with their partner (men 85.9%,
women 71.4%), and sexual relationship (men
97.4%, women 87%).
One further factor that couples identified as
contributing to ongoing sexual experiences with
or without PDE5 was the improvement in their
communication due to their participation in the
studies and the opportunities to talk together
about their ED. Men reported the opportunity to
use PDE5 for 6 months had resulted in greater
confidence and less distress in their relationships.
The men’s partners welcomed the communication
generated by the study and the increase in inti-
macy most enjoyed as a result of this focus on
their sex lives.
In conclusion, it is clear that a number of factors
contribute to couple’s decision making about use of
PDE5, but it is also clear that discontinuation does
not mean the couple is no longer sexually active.
This study has emphasized that involving partners
in men’s assessment and treatment for ED will
result in better outcomes for both partners.
Corresponding Author: Helen Conaglen, PhD,
Faculty of Medical and Health Sciences, University of
Auckland, Waikato Clinical School, Private Bag 3200,
Hamilton 3240, New Zealand. Tel: +64 7 839 8710; Fax:
+64 7 839 8712; E-mail: h.conaglen@auckland.ac.nz
Conflict of Interest: None.
J Sex Med 2012;9:857–865
864
Statement of Authorship
Category 1
(a) Conception and Design
Helen M. Conaglen; John V. Conaglen
(b) Acquisition of Data
Helen M. Conaglen
(c) Analysis and Interpretation of Data
Helen M. Conaglen; John V. Conaglen
Category 2
(a) Drafting the Article
Helen M. Conaglen
(b) Revising It for Intellectual Content
Helen M. Conaglen; John V. Conaglen
Category 3
(a) Final Approval of the Completed Article
Helen M. Conaglen; John V. Conaglen
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