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Erectile dysfunction in primary care: prevalence and patient characteristics. The ENIGMA study

International Journal of Impotence Research volume 16, pages 358–364 (2004)Cite this article

Abstract

The availability of adequate treatment for erectile dysfunction (ED) triggers studies into the prevalence of ED in the general population. Yet, previous studies showed different prevalence estimates partly due to differences in patient selection, in (unclear) definitions of ED and in assessment. ENIGMA has been designed to study the prevalence of ED in the general population of The Netherlands, using the WHO definition with a description of the way of assessment. In all, 5721 mail surveys were sent to all men, aged 18 y and older in 12 general practices in The Netherlands. A total of 5601 were included in the study and 2117 (38%) were completed. A total of 38% of the men reported to have ever had some kind of erectile problem. The prevalence of ED was 17% (6% mild, 4% moderate and 7% complete). Age, diabetes, cardiovascular diseases, penile disorders, irradiation in the pelvic region, relational problems, fear for failure, surmenage, medication use and regular consumption of alcohol were independently related to ED. Men with ED were less content with their (sexual) life and had less confidence in sexual performance. Presence of ED was negatively related to affected happiness in life. ED is commonly found in men and is related to age, medication, comorbidity and lifestyle factors. Men with ED perceive a lower quality of (sex)life. Doctors should be aware of the presence of ED and its consequences in patients.

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Authors and Affiliations

  1. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands

    B J de Boer, M L Bots, H M Pieters & Th J M Verheij

  2. Department of Urology, Leiden University Medical Center, Leiden, The Netherlands

    A A B Lycklama a Nijeholt

  3. General Practitioner, Rosmalen, The Netherlands

    J P C Moors

Authors
  1. B J de Boer
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  2. M L Bots
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  3. A A B Lycklama a Nijeholt
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  4. J P C Moors
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  5. H M Pieters
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  6. Th J M Verheij
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Corresponding author

Correspondence to B J de Boer.

Appendix

Appendix

Questions on erectile (dys)function*

  1. 1

    Have you ever noticed that your penis did not get rigid, while you wanted it to be (during sexual activity, for instance if you wanted to have intercourse)? Yes/No/I do not remember

  2. 2

    If yes is it still present at the moment? Yes/No

  3. 3

    How long ago did it start? 1–3 weeks/1–3 months/4–6 months/7–12 months/1–5 y/more than 5 y

  4. 4

    How long did it last? 1–3 weeks/1–3 months/4–6 months/7–12 months/1–5 y/more than 5 y

  5. 5

    How often did it happen or does it happen? (almost) every time, most of the times, as many times yes as no/seldom/(almost) never

  6. 6

    How much do you get bothered by it? Very much/much/moderate/little, not at all

  7. 7

    Were you less in the mood for sex in the last half year? Yes/No

  8. 8

    Are there any circumstances in which the penis does not get rigid? Yes/No

  9. 9

    Did you masturbate the last half year? Yes/No

  10. 10

    If yes, is the penis getting rigid enough (more than 50%) during masturbation? Yes/No

  11. 11

    If not, how often does the penis get insufficient rigid? (Almost) always/most of the times/as often yes as no/seldom/(almost) never

  12. 12

    Did the penis ever get not sufficient rigid during sexual activity? This means; there was sufficient stimulation and some form of rigidity, but not sufficient for a fulfilling sexual activity (for instance for sexual intercourse)? Yes/No/I do not remember

  13. 13

    Did the complaint start suddenly or more slowly? During weeks/during months

  14. 14

    If yes is it still present at the moment? Yes/No

  15. 15

    How long ago did it start? 1–3 weeks/1–3 months/4–6 months/7–12 months/1–5 y/more than 5 y

  16. 16

    How long did it last? 1–3 weeks/1–3 months/4–6 months/7–12 months/1–5 y/more than 5 y

  17. 17

    How often did it happen or does it happen? (almost) every time/most of the times/as many times yes as no/seldom/(almost) never

  18. 18

    How much do you get bothered by it? Very much/much/moderate/little/not at all

  19. 19

    Did the penis remain shorter rigid than you wanted? Yes/no/I do not remember

  20. 20

    How difficult was it to maintain your erection until the end of the sexual activity (for instance during sexual intercourse)? Did not try/very difficult/difficult/a little difficult/not very difficult/not at all difficult

  21. 21

    Is it still present at the moment? Yes/No

  22. 22

    How long ago did it start? 1–3 weeks/1–3 months/4–6 months/7–12 months/1–5 y/more than 5 y

  23. 23

    How long did it last? 1–3 weeks/1–3 months/4–6 months/7–12 months/1–5 y/more than 5 y

  24. 24

    How often did it happen or does it happen? (almost) every time, most of the times, as many times yes as no/seldom/(almost) never

  25. 25

    How much do you get bothered by it? Very much/much/moderate/little, not at all

  26. 26

    Do you notice any spontaneous erections, in the night or while waking up? Always/most of the times/sometimes/seldom/never

  27. 27

    How often during the last half year did you notice that? Never/once a month or less/more than once a month

  28. 28

    How rigid was the penis at most during last half year in the night or during waking up? 50% or less/more than 50%

  29. 29

    How strong is your confidence to obtain or maintain an election during sexual activity? Very strong/strong/more or less/weak/very weak or absent

*Originally in Dutch, translated into English.

ED (according to the definition of WHO)=(Q1: yes and Q2: yes and Q5: excluding seldom and (almost) never) or (Q12: yes and Q14: yes and Q11: excluding seldom and (almost never)) or (Q19: yes and Q21: yes and Q24: except for little and not at all) and (Q20: very difficult–little difficult).

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de Boer, B., Bots, M., Lycklama a Nijeholt, A. et al. Erectile dysfunction in primary care: prevalence and patient characteristics. The ENIGMA study. Int J Impot Res 16, 358–364 (2004). https://doi.org/10.1038/sj.ijir.3901155

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