Abstract
Introduction:
Erectile dysfunction (ED) has a profound impact not only on sexual functioning but also on the well-being and self-esteem of an individual. Men with ED frequently encounter psychological distress in their relationships, including challenges in discussing ED, feelings of guilt, denial, depression, anger, decreased self-confidence, and self-esteem issues.
Methodology:
This was a cross-sectional study conducted on 60 participants with ED. Basic sociodemographic and clinical profile data were collected using a self-designed performa. The PGI General Well-Being Measure Scale (Hindi version) was used to assess the general well-being of the participants. The Stress Coping Behavior Scale (Hindi adaptation) was applied to measure stress-coping behavior in patients diagnosed with ED. The Rosenberg Self-Esteem Scale (Hindi version) was used to evaluate individual self-esteem.
Results:
Majority of the participants fell within the age range of 21 to 40 years. They were predominantly married, employed, with a graduate level of education, and belonged to the middle socioeconomic class. Majority of the individuals experiencing ED exhibited a moderate level of general well-being, a moderate level of self-esteem, and utilized both adaptive and maladaptive coping strategies.
Conclusion:
A proper and detailed understanding of the psychosocial impact of ED will facilitate holistic treatment and improve mental well-being and overall life satisfaction.
Introduction
Sexual dysfunction is an omnipresent reality that profoundly impacts diverse facets of human existence, including psychological, emotional, and social well-being. It encompasses a spectrum of conditions that impede an individual’s capacity to engage in a gratifying sexual life.
According to the International Classification of Disease (ICD-10), sexual dysfunction can manifest in various forms devoid of any organic etiology. These encompass deficiencies or loss of sexual desire, aversion or absence of enjoyment, failure of genital response, orgasmic dysfunction, premature ejaculation, nonorganic vaginismus, nonorganic dyspareunia, excessive sexual desire disorder, and other unspecified sexual dysfunctions.
Erectile dysfunction (ED) is the difficulty in developing or sustaining an erection suitable for satisfactory intercourse. If an erection occurs normally in certain circumstances, such as during sleep, masturbation, or with a different partner, the causality is likely psychogenic. The dysfunction can range from a complete absence of erection during sexual activity to partial or inadequate erection. 1 The prevalence of ED in India is approximately around 15%. 2
Erectile dysfunction can emerge from diverse factors. Organic causes entail hormonal imbalances, pharmacologically induced effects, vascular issues, traumatic or postsurgical complications, and neurological disorders. Psychogenic causes encompass depression, relational problems, and performance anxiety. 3
The adverse psychological impact of ED can precipitate psychiatric morbidity, particularly in men with a history of mental health conditions. Studies have evinced that a substantial proportion of men with ED receive psychiatric diagnoses, primarily within the context of depressive and anxiety disorders.4,5 The distress accompanying ED can contribute to the onset of depressive illness in susceptible individuals. 6 Depression, in turn, can exacerbate ED as it is linked to diminished libido, erectile function, and sexual activity. 4
Erectile dysfunction not only impairs sexual functioning but also exerts influence on general well-being. 7 General well-being encompasses emotional, psychological, and social dimensions. Men with ED frequently encounter psychological distress in their relationships, including challenges in discussing ED, feelings of guilt, denial, depression, anger, decreased self-confidence, and self-esteem issues. Socioeconomic status can indirectly exacerbate ED progression and contribute to the diminished overall quality of life in comparison to healthy men.8,9
Managing ED necessitates the consideration of both the physical and psychological facets. It is pivotal to address the psychosocial factors alongside erectile functioning. Neglecting the psychosocial dimension can impede the representation of illness and hinder effective treatment, particularly when patients disregard this aspect in their interpersonal relationships. 10
Erectile dysfunction exerts a substantial impact on self-esteem. Men with ED often experience feelings of emasculation, aging, and concerns about their romantic relationships, giving rise to anxiety, strain in relationships, and loss of self-esteem and self-confidence. Low self-esteem contributes to various psychological issues, and deficits in self-esteem impact nearly all aspects of life. 11
The epidemiology of ED reveals its escalating prevalence, particularly within the aging population; yet there remains a paucity of research in this domain, hindering our comprehensive understanding of the matter. The insufficiency of studies in this field poses a formidable challenge, impeding our ability to grasp the full complexity and magnitude of the problem. Hence, the current study aimed to understand the impact of ED on various psychosocial outcomes and to determine how the participant’s sociodemographic and clinical variables are associated with the study’s outcome variable.
Methodology
The study was conducted at the outpatient department of the State Institute of Mental Health, Pandit Bhagwat Dayal Sharma University of Health Sciences, Rohtak, Haryana, India. It was a cross-sectional, hospital-based study. Ethical permission was obtained from the Institution Ethical Committee wide number BREC/21/016 (dated: March 30, 2021), and data collection was done from December 2021 to July 2022. Purposive sampling was used to select 60 subjects who were experiencing ED and receiving treatment at the institute. Inclusion criteria included individuals with ED, aged 18 to 50 years, and with a minimum education level of 8th grade and the ability to read, write, and understand Hindi and English languages. Exclusion criteria involved the presence of any chronic physical or mental illness and any other sexual dysfunction.
The procedure involved patients referred to the psychosexual clinic of the institute from various departments, including medicine, dermatology, urology, and surgery, after ruling out organic causes. Patients directly visiting the clinic were also considered for the study. Diagnosis of male erectile disorder (ICD-10) was made by a psychiatrist, and those meeting the research criteria were included.
The assessment utilized a sociodemographic datasheet to collect personal and sociodemographic details of the subjects. The PGI General Well-Being Measure Scale (Hindi version) was used to assess the general well-being of the participants. The PGI General Well-Being Scale comprises 20 items, with participants marking applicable items with a tick (✓). Scores range from 0 to 20, with higher scores indicating greater well-being. 12
The Stress Coping Behavior Scale (SCBS) (Hindi adaptation) was applied to measure stress-coping behavior in patients diagnosed with ED (PdwED). The SCBS (Hindi adaptation) assesses coping in patients with ED (PwED). It features 23 “Yes/No” items, scored 2 for “Yes” and 1 for “No.” Item analysis is related to 2 factors, adaptive coping and maladaptive coping behaviors. There are 15 items in factor 1 and 8 items in factor 2, respectively. 13
The Rosenberg Self-Esteem Scale (Hindi version) was used to evaluate individual self-esteem. Rosenberg Self-Esteem Scale (Hindi version) is a 10-item self-report tool assessing global self-worth using a 4-point Likert scale. Items 2, 5, 6, 8, and 9 are reverse scored. Scores ranging from 1 to 4 are summed for a continuous scale, with higher scores reflecting greater self-esteem. 14
The information collected through the questionnaires was checked, coded, and entered into a computer database for statistical analysis. Data were processed using SPSS version 16.0. Descriptive statistics included the computation of percentages, means, and standard deviations.
Results
Table 1 illustrates that a significant proportion of participants fell within the age range of 21 to 40 years with the mean age being 31.5 years (±7.8). They were predominantly married, employed, with a graduate level of education, and belonged to the middle socioeconomic class. Moreover, the majority hailed from urban areas, resided in nuclear families, and enjoyed financial independence. The prevailing duration of illness ranged from 6 to 10 years, and the majority reported no family history of psychiatric illness.
Sociodemographic and Clinical Profile.
Table 2 presents the general well-being of the participants, revealing a mean score of 19.87 ± 8.613. These findings indicate that individuals experiencing ED exhibited a moderate level of overall well-being.
Analysis of General Well-being of Population.
Table 3 displays the stress-coping behavior of the participants. The findings reveal that the mean score of adaptive dimensions is 23.80 ± 2.057, with active coping, the use of emotional support, positive reframing, planning, acceptance, and religion being higher than other domains. Additionally, the mean score of maladaptive dimensions is 12.65 ± 1.132, with self-distraction and venting being higher than other domains.
Analysis of Stress-Coping Behavior of Population.
Table 4 presents the self-esteem levels of the study population. The findings reveal that the mean score of self-esteem is 23.40 ± 3.120, indicating a moderate level of self-esteem among the participants.
Analysis of Self-Esteem of Population.
As shown in Table 5, middle-aged participants (41–60 years) and individuals who were divorced, unemployed, below graduate, urban residents, of higher socioeconomic status, from nuclear families, financially independent, with the illness duration of 0 to 5 years, and without family history of psychiatric illness exhibited higher well-being scores.
Comparison of Sociodemographic and Clinical Profile with Psychosocial Well-being, Coping, Self-Esteem.
Younger participants, divorced, employed, below graduate urban residents with higher socioeconomic status and in joint families exhibited elevated adaptive coping, whereas middle-aged participants, married, unemployed, urban residents, nuclear families, financially independent individuals, those with the illness duration of 0 to 5 years, and without a family history of psychiatric illness manifested augmented maladaptive coping.
Middle-aged participants (41-60 years age group), divorced individuals, unemployed participants, those with a graduate and above education levels, urban residents, individuals from higher socioeconomic status, participants in nuclear families, financially dependent individuals, those with the illness duration of 0 to 5 years, and participants without a family history of psychiatric illness displayed higher self-esteem. However, no significant difference was seen among the different groups in the sociodemographic profile.
Discussion
The study aimed to assess the general well-being, coping, and self-esteem in PwED.
This study findings suggest that individuals experiencing ED tend to exhibit a moderate level of general well-being. Similar findings were seen in other studies that uncovered significant associations between ED and distressing emotions, including blame, guilt, anger or bitterness, depression, feelings of personal inadequacy, and a sense of disappointment toward one’s partner during intimate encounters. 15 Research conducted by Montorsi et al 16 shed light on the manifestation of sexual dysfunction frequently presenting as a distressing predicament for both affected individuals and their partners, instigating a cascade of symptoms, such as depression, anxiety, emotional instability, and diminished self-esteem. Similarly, Latini et al 17 highlighted the interconnectedness of psychological distress, and sexual dysfunction in men grappling with the psychological ramifications of ED also exhibited greater impairments in functional abilities, reduced sexual self-efficacy, and heightened levels of depression and anxiety during sexual encounters.
In the current study, participants exhibited a repertoire of both adaptive and maladaptive coping behaviors as they struggled with the stress associated with their condition. Notably, the mean score for adaptive coping dimensions was 23.80 ± 2.057, indicating a tendency to utilize constructive and resilient strategies to navigate the difficulties posed by ED. Conversely, the mean score for maladaptive coping dimensions was 12.65 ± 1.132, suggesting the presence of less effective and potentially detrimental coping mechanisms. In the same line, Pakpour et al 18 yielded noteworthy findings, highlighting the impact of religious coping strategies on erectile function. Specifically, patients who employed positive religious coping strategies exhibited better erectile function than the individuals who relied on negative religious coping strategies.
Our study revealed that participants exhibited a mean score of 23.40 ± 3.120 in terms of self-esteem, indicating a moderate level of self-regard among the individuals. Echoing similar findings, a study conducted by Ozkent et al 19 demonstrated a significant association between sexual satisfaction and individuals’ social lives. Studies conducted in India also report depression and anxiety in PwED, which leads to decreased self-esteem and poor well-being. 20 Specifically, individuals with mild ED reported lower levels of satisfaction despite engaging in normal sexual frequency, leading to diminished self-esteem among men. Past studies have also underscored the detrimental effects experienced by men grappling with ED, including heightened anxiety, depression, reduced self-esteem, and a decline in the overall quality of life. These distressing psychological consequences further accentuate the significance of addressing and managing ED in order to improve mental well-being and enhance overall life satisfaction. 19
Conclusion
The primary objective of this study was to evaluate the general well-being, coping mechanisms, and self-esteem of PdwED. The findings of this study offer valuable insights into professionals, researchers, and policymakers working in the field of sexual dysfunction. Additionally, it underscores the significance of sexual health, highlighting the impact of sexual activity on maintaining smooth social functioning.
Consequently, this study holds substantial practical and clinical implications, particularly in terms of further investigation, research endeavors, and the development of intervention strategies.
However, it is important to acknowledge certain limitations of this study. First, the research was conducted within a tertiary care hospital, catering to individuals from diverse socioeconomic backgrounds. As a result, the generalizability of the findings to the broader population may be limited. Furthermore, the sample size for this study was relatively small, potentially impacting the statistical power and precision of the results. Lastly, owing to time constraints, a cross-sectional design was adopted, restricting the ability to establish causal relationships or assess changes over time.
Footnotes
Acknowledgements
We acknowledge our teachers, seniors, colleagues, and students for providing guidance, support, and love for reporting this valuable research in the field of medical education. At last! It is implausible without my patient’s undue support.
Author Contributions
All the authors equally contributed in the preparation of the manuscript. YKM and PK drafted the initial manuscript. YKM, AR, PK, and RG critically evaluated the statistical analysis and have drafted the final manuscript.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.
Ethical Approval
Ethical approval was obtained from the Institution Ethical Committee wide number BREC/21/016.
Funding
The authors received no financial support for the research, authorship and/or publication of this article.
Informed Consent
The participant has consented to the submission of the article to the journal.