International Journal of Impotence Research (2004) 16, S1–S2 & 2004 Nature Publishing Group All rights reserved 0955-9930/04 $30.00 www.nature.com/ijir
Introduction
Introduction and methodologic aspects of the consensus document JM Pomerol1*, A Martin-Morales2 and I Moncada3 1 Department of Andrology, Fundacio´n Puigvert, Barcelona, Spain; 2Departament of Urology, Hospital Carlos Haya, Ma´laga, Spain; and 3Fundacio´n para la Investigacio´n y el Desarrollo en Andrologı´a, Hospital Ramo´n y Cajal, Madrid, Spain
International Journal of Impotence Research (2004) 16, S1–S2. doi:10.1038/sj.ijir.3901234 Keywords: erectile dysfunction; sexual health
Erectile dysfunction (ED) is a highly prevalent health problem that has a significant impact on quality of life of those affected by the disorder and their partners.1 Until recently, epidemiological data on ED was limited, because there was a shortage of research studies examining the relevance of this problem. Another aspect that has contributed to the lack of data is that patients and health professionals find it difficult to discuss problems related to sexual matters during office visits, partly due to cultural, religious, or moral factors. Results from the first epidemiological study on ED in Spain confirmed the magnitude of this problem by showing a prevalence rate of 12%, implying that approximately 2 million Spanish men are affected by ED.2 However, according to the results of this study, only 18% of affected men see a physician.(unpublished observation). The recent availability of an effective and welltolerated oral treatment for ED3 has simplified the diagnostic and therapeutic approach to this problem. Until 5 years ago, patients with ED were almost systematically referred to a specialist. However, the fact that it is now possible to treat ED with oral medication, such as sildenafil citrate, has increased the number of physicians involved in the care of patients with ED. Because of the multiple causes of ED and its impact on the quality of life of the patient, ED treatment often requires an integral (owing to its physical and psychological impact) and integrated (with the participation of different specialists in the care of the patient) approach. As
*Correspondence: JM Pomerol, Department of Andrology, Fundacio´n Puigvert, Barcelona, Spain. E-mail:
[email protected]
limited information on sexual health and ED is provided to healthcare professionals during university and specialty training, a joint effort must be made to increase their knowledge in the area of sexual health. Also, growing awareness and the subsequent increased demand for information on ED by the population requires an adequate response from health professionals; in fact, sharing of vital information with the patient may promote good sexual health habits within the population. It has become clear that recommendations for action and coordination need to be established to support all healthcare professionals that are involved in treating ED. The Forum on Men’s Health in ED is an initiative of the Spanish Association of Andrology (ASESA) in cooperation with the Spanish Association of Urology (AEU), and includes the participation of nine scientific societies as well as the Madrid Official Association of Pharmacists, which aims to respond to these concerns. The final result of this initiative was the preparation of the Spanish Consensus on ED and its subsequent dissemination, which laid out the following objectives: To provide guidance and training to health professionals on the management and treatment of ED. To lay the foundations for an integral approach to patient care, coordination among health professionals, and clear criteria for referrals to specialists. To inform and educate the general population about ED and sexual health. To help raise the awareness of the health administration regarding the health problems caused by ED, facilitating the introduction of measures to improve the care received by the patient. The following scientific bodies have participated in the preparation of this consensus: the Spanish
Introduction JM Pomerol et al S2
Association of Andrology, the Spanish Association of Urology, the Spanish Society of Cardiology, the Spanish Society of Psychiatry, the Spanish Society of Endocrinology and Nutrition, the Spanish Society of Family and Community Medicine, the Spanish Society of Rural and General Medicine, the Spanish Society of Paraplegia, the Spanish Society of Hypertension-Spanish League for the Fight against High Blood Pressure, the Spanish Federation of Sexology Societies, the Spanish Medical Society of Sexology, and the Madrid Official Association of Pharmacists. The Board of Directors of each scientific body designated delegates for its representation in the Forum on Men’s Health in ED. Delegates were requested to prepare a first document with epidemiologic, diagnostic, and therapeutic aspects of ED in specific populations (diabetic, hypertensive, psychiatric patients, and so on). These documents were disseminated via e-mail to all members of the Forum and were subsequently widely discussed at the first meeting involving all the delegates. Modifications were made and reviewed by all Forum members via e-mail. A final meeting of the delegates was held, resulting in the current version of the document. After publication, the document was presented in the most important cities in Spain at several meetings attended by health authorities, general practitioners, medical specialists, and pharmacists. The Spanish Consensus on ED consists of five sections: 1. A comprehensive approach to ED. This document contains key aspects for care of the patient with ED and is meant to be a practical guide for any professional dealing with the subject of ED in his office. It has been agreed upon by consensus of each society participating in the Forum. 2. Specialty section. This consists of seven documents (urology/andrology, spinal cord injury, cardiology, hypertension, endocrinology, psychiatry, and sexology) that focus more specifically on care of a patient with ED secondary to an underlying medical condition. They were written by and agreed upon by each of the societies involved.
International Journal of Impotence Research
3. Pharmacists. This document contains information that may be helpful for the pharmacist who dispenses drugs for the treatment of ED, and who is often asked for advice by the patient. 4. Health administration. This document stresses the significance and impact of ED as a health problem, as well as the needs raised by health care of these patients in Spain. It was written by consensus of each society participating in the Forum. 5. General public. This document includes the most relevant information about ED in a form com-prehensible to the patient; it contains 10 recommendations on sexual health (the ‘Ten Commandments’ of Sexual Health). It has been agreed by consensus of each society participating in the Forum. This Spanish Consensus Document on Erectile Dysfunction is the result of a laborious process of work and coordination carried out by representatives of each of the scientific bodies participating in the Forum over the last year. We would like to express our gratitude to all the experts and scientific bodies that participated in the preparation of the consensus, as well as to Pfizer SA, whose sponsorship and logistical support were vital in making this project possible. We hope that this document will provide support and guidance in your daily practice and thus enable us to achieve our ultimate goal, which is to improve health care for the patient with ED.
References 1 Althof SE. Quality of life and erectile dysfunction. Urology 2002; 59: 803–810. 2 Martin-Morales A et al. Prevalence and independent risk factors for erectile dysfunction in Spain: results of the Epidemiologia de la Disfuncion Erectil Masculina Study. J Urol 2001; 166: 569–574, discussion 574–575. 3 Boolell M, Gepi-Attee S, Gingell JC, Allen MJ. Sildenafil, a novel effective oral therapy for male erectile dysfunction. Br J Urol 1996; 78: 257–261.
