Is sex only for the healthy and wealthy?

To study reasons for Sildenafil (a phosphodiesterase type 5 inhibitor) treatment abortion in erectile dysfunction (ED), with special regard to the relation between cost and use.

Men (N = 132) with ED, where treatment with Sildenafil was instituted between 1998 and 2000, were mailed a questionnaire in February 2003, regarding their current ED treatment, including frequency of use, reasons for change or discontinuation, effect on partner relations, and total income of the household.

The response rate was 69%. Nearly every second man (47%) still used Sildenafil at least twice per month. The remaining 53% had aborted oral ED treatment: 10% due to return of normal erections, 43% due to (either alone or in combination): cost of treatment, impaired health, loss of efficacy, change to another ED treatment, or side-effects. Cost was the most common cause (48%) for discontinuation. In low-income households, rationing of treatment or abortion due to the cost was reported significantly (P < 0001) more often (86%) than in high-income households (35%).

Just under half of all the patients (47%) used Sildenafil for more than 2 years after initiation of treatment. The cost of the treatment is an important factor for patient compliance in households with a low income, despite the fact that the treatment is highly effective and improves the partner relationship.