|Year : 2018 | Volume
| Issue : 2 | Page : 111-115
The Association between Interpersonal Relationship and Erectile Dysfunction of Middle-Aged and Elderly Men in a Rural Area of Zhejiang, China
Qun-Feng Liang1, Xiao-Hua Yu2, Shu-Cheng Zhang3, Jian-Hui Li2, Jing Zhao4, Jun-Biao Zheng2, Yi-Hua Gu5, Wei-Jin Zhou5, Guo-Qing Liang6, Qian-Xi Zhu5
1 Department of Epidemiology, School of Public Health; Department of Reproductive Epidemiology and Social Science, Key Laboratory of Reproduction Regulation of NPFPC, SIPPR, IRD, Fudan University, Shanghai 200030, China
2 Department of Urology, The First People's Hospital of Jiashan, Jiaxing, Zhejiang 314000, China
3 Department of Cell Biology, National Research Institute of Family Planning, Beijing 100191, China
4 Department of Reproductive Epidemiology and Social Science, Key Laboratory of Reproduction Regulation of NPFPC, SIPPR, IRD, Fudan University, Shanghai 200030; Department of Cardiology, The Key Laboratory of Cardiovascular Disease, The First Hospital of Lanzhou University, Lanzhou 730050, China
5 Department of Reproductive Epidemiology and Social Science, Key Laboratory of Reproduction Regulation of NPFPC, SIPPR, IRD, Fudan University, Shanghai 200030, China
6 Department of Andrology, The Seventh People's Hospital of Shanghai University of TCM, Shanghai 200120, China
|Date of Submission||22-Mar-2018|
|Date of Web Publication||4-Oct-2018|
Shanghai Institute of Planned Parenthood Research, 779 Old Humin Road, Shanghai 200237
Department of Urology, The First People's Hospital of Jiashan, 1218 South Tiyu Road, Luoxing Street, Jiashan, Jiaxing, Zhejiang 314100
Source of Support: None, Conflict of Interest: None
Objective: To explore the association between interpersonal relationship and erectile dysfunction (ED) of middle-aged and elderly men.
Methods: A population-based cross-sectional research was conducted in the rural area of Jiashan County, Zhejiang Province, in 2016. Middle-aged and elderly men (aged 40–80) were selected as study participants. The face-to-face questionnaire was collected, including basic information, lifestyles, interpersonal relationship, and sexual function. The interpersonal relationship was evaluated based on marital relationship, neighborhood relationship, and relatives/friends relationship. According to the International index of erectile function, the study participants were divided into ED group (mild ED, moderate-to-severe ED), and non-ED group. Correlations were evaluated between interpersonal relationship indices and the prevalence or the severity of ED. Potential confounders were adjusted by the logistical regression model.
Results: There were 674 study participants with average age of 60.4 ± 8.5 years, and 489 ED patients with prevalence of 72.6%. With age increasing, the prevalence and the severity of ED increased significantly. The men who could get help from spouse when an emergency occurred or who were more cared about by their neighbors had lower ED risk, and odds ratios (ORs) (95% confidence intervals [CIs]) were 0.23 (0.13–0.42) and 0.58 (0.46–0.75), respectively. After the adjustment of the covariates (age, education degree, household income, smoking, and drinking), the ORs (95% CIs) were 0.29 (0.14–0.60) and 0.54 (0.39–0.74), respectively. Good marital relationship and good neighborhood relationship were associated with a less severity of ED.
Conclusions: The risk of ED was negatively correlated with marital relationship and neighborhood relationship.
Keywords: Erectile Dysfunction; Interpersonal Relationship; Marital Relationship; Middle-Aged and Elderly Men
|How to cite this article:|
Liang QF, Yu XH, Zhang SC, Li JH, Zhao J, Zheng JB, Gu YH, Zhou WJ, Liang GQ, Zhu QX. The Association between Interpersonal Relationship and Erectile Dysfunction of Middle-Aged and Elderly Men in a Rural Area of Zhejiang, China. Reprod Dev Med 2018;2:111-5
|How to cite this URL:|
Liang QF, Yu XH, Zhang SC, Li JH, Zhao J, Zheng JB, Gu YH, Zhou WJ, Liang GQ, Zhu QX. The Association between Interpersonal Relationship and Erectile Dysfunction of Middle-Aged and Elderly Men in a Rural Area of Zhejiang, China. Reprod Dev Med [serial online] 2018 [cited 2019 Nov 22];2:111-5. Available from: http://www.repdevmed.org/text.asp?2018/2/2/111/242753
| Introduction|| |
Aging population has sharply increased in China, and there will be more requirements on healthy aging. The previous studies indicated that the reproductive health of middle-aged and elderly men is closely associated with their general health. However, most of the studies on reproductive health in China mainly focus on the childbearing-age men or the patients with reproductive system diseases. The general middle-aged and elderly men are always the neglected population. As age increases, men's sexual function gradually declines, which is mainly manifested as erectile dysfunction (ED). Surveys conducted in different regions of China have demonstrated that the prevalence of ED is 40.56%–79.1% among men aged over 40.,,, It has been widely accepted that the occurrence of ED is correlated with age, smoking, vascular diseases, and psychological factors.,, Psychological factors have a wide range of sources, including psychological trauma, depression, dissatisfaction of partner, family/social pressures, and interpersonal relationship problems. However, studies directly focusing on the relationship between ED and interpersonal relationship are absent. In the present study, we analyzed the marital relationship, neighborhood relationship, and relatives/friends relationship, and further explored the correlation between interpersonal relationship and ED.
| Methods|| |
A population-based cross-sectional survey was conducted in the rural area of Jiashan County, Zhejiang Province, in 2016. Two-stage cluster sampling method was used. First, one subdistrict was randomly selected from two in the county, and then, three villages were selected from the subdistrict. The middle-aged and elderly men (aged 40–80) living in the selected villages were told to voluntarily participate in the reproductive health examination and related survey. All the study participants were local healthy residents, and those who had mental diseases, cognitive impairment, administration of hormone, antiandrogen or psychotropic drugs, pelvic cavity surgical operation history, were excluded from the study. This study was approved by the Ethics Committee of Shanghai Institute of Planned Parenthood Research.
During the research, professional physicians of andrology were responsible for the reproductive health examination on the study participants. Trained investigators were responsible for the face-to-face questionnaire to each study subject. The questionnaire consisted of general information regarding sociodemographics (age, education degree, occupation, marital status, and annual household income), lifestyles (smoking history and drinking history), interpersonal relationship, and sexual function. The interpersonal relationship, including marital relationship, neighborhood relationship, and relatives/friends relationship, was evaluated based on the widely accepted Social Support Revalued Scale (designed by Xiao Shuiyuan, in 1986). The questions included whether your spouse offers you help when an emergency occurs (yes, no); how much were you cared about by your neighbors (slightly or not, very by some of them, very by most of them); how many relatives and friends offer you help when an emergency occurs (one or less, two, three or more); whom will you talk with when meet trouble (a few very close ones or nobody, friends who asked, relatives and friends); how often do you ask for help when meet trouble (seldom or never, sometimes, often). International Index of Erectile Function (IIEF-5) was used to evaluate the sexual function, and the contents included five questions related with erectile function. One to five points were scored for each question, and the total score was 5–25.
Definition and grouping
According to the IIEF-5 scale evaluation criteria, participants were divided into ED (total score ≤21) and non-ED group (total score ≥22), and the ED group was categorized into mild ED (total score 12–21) and moderate-to-severe ED (total score ≤11). The age range was 41–80 years old, and the study participants were divided into four groups with ages of 41–50, 51–60, 61–70, and 71–80 years. In the basic information, the education degree was divided into illiterate, primary school, junior high school, and senior high school or above. Occupation was divided into worker, farmer, and other occupations. Annual household income was divided into 0~, 40,000~, 60,000~, and 100,000~ based on quartile. The body type was classified based on body mass index (Chinese standard): <18.5 is thin, 18.5–23.9 is normal, 24–27.9 is fat, and ≥28 is obese.
Epidata 3.0 software (Epidata 3.0 for windows, Epidata Association Odense, Denmark) was used for double entry and consistency test. SAS 9.4 software (SAS Institute Inc., Cary, NC, USA) was used for data analysis. Pearson Chi-square test was used to analyze the correlation between sociodemographic characteristics and ED. Nonconditional binary logistic regression and ordinal logistic regression were used to explore the association between interpersonal relationship and the prevalence or the severity of ED. Based on the univariate analyses and literature reports, we identified five covariates: age group, education degree, annual household income, smoking and drinking to be included in multivariate analyses to adjust potential confounders. P < 0.05 was termed as statistical significance.
| Results|| |
Totally 700 valid questionnaires were collected. Twenty-six questionnaires were excluded, for the reason that they were single and were not eligible to be evaluated by IIEF-5 scale. Finally, 674 men were enrolled in this study. [Table 1] shows the distribution of sociodemographic characteristics and interpersonal relationships in ED and non-ED groups. The age range of the study participants was 41–80 years with average age of 60.4 ± 8.5 years. There were 100 (14.8%), 218 (32.3%), 266 (39.5%), and 90 (13.4%) men aged 41–50, 51–60, 61–70, and 71–80, respectively. Of them, the education degrees were mainly primary school (48.2%) and junior high school (38.5%), and occupations were mainly worker (38.2%) and farmer (29.7%). The study participants with annual household income 40,000–100,000 accounted for more than 50%. Those with normal body type and fat accounted for 51.1% and 35.4%, respectively. Those who smoked or drank during the recent 1 year accounted for 55.6% and 52.9%, respectively, and those who had toxic exposure accounted for 15.8%.
|Table 1: Distribution of sociodemographic characteristics in ED and non-ED groups|
Click here to view
There were 489 ED patients with prevalence 72.6%. The severity-specific prevalences of mild ED and moderate-to-severe ED were 35.6% and 36.9%, respectively. The ED prevalence in 41–50, 51–60, 61–70, and 71–80 age groups were 31.0%, 62.8%, 88.7%, and 94.4%, respectively. A positive correlation between age and the severity of ED was observed and of significance [Figure 1]. Statistical differences in the prevalence of ED exist between subgroups of education degrees, occupations, household income, smoking, drinking, and toxic exposure [Table 1].
|Figure 1: Distribution of ED severity across age groups and interpersonal relationship. ED: Erectile dysfunction.|
Click here to view
Correlation between interpersonal relationship and erectile dysfunction
Analysis between interpersonal relationship and ED showed some correlations [Table 2]. People who could get help from spouse when an emergency occurred had lower ED risk compared with those who could not get the help (odds ratio [OR] = 0.23, 95% confidence interval [CI]: 0.13–0.42). People who were more cared about by their neighbors were less likely to have ED (OR = 0.58, 95% CI: 0.46–0.75). After the adjustment of the covariates (age group, education degree, household income, smoking, and drinking), these association persisted, and ORs (95% CIs) were 0.29 (0.14–0.60) and 0.54 (0.39–0.74), respectively. People who could get more help from relatives/friends when an emergency occurred, who would actively talk with or more frequently ask for help from relatives/friends when met trouble did not show a different odds of developing ED compared with others.
|Table 2: Association between interpersonal relationship and ED or severity of ED|
Click here to view
We conducted ordinal logistic regression to analyze the relationship between the severity of ED and interpersonal relationships. ED severity was rated at 1–3 level corresponding to moderate-to-severe, mild, and non-ED. Probabilities modeled was cumulated over the lower ordered values. The results showed that people who could get help from spouse when an emergency occurred had 0.43 (95% CI: 0.30–0.62) times the odds of developing a more severe ED, and that ratio was 0.66 (95% CI: 0.55–0.79) for those who were more cared about by their neighbors. When mutivariate regression was conducted, results were similar as above.
| Discussion|| |
In this study, the overall prevalence of ED was 72.6% in general population of men older than 40. This result is consistent with the previous studies. In a certain community in Shanghai, Xu et al. observed a positive rate of 70.0% of ED among men aged 40–79. Similar results were also found in studies conducted in men aged 40–70 in Zhejiang and Jilin provinces, which were 79.1% and 76.5%, respectively., The Massachusetts Male Aging Study, the first large population-based study focusing on sexual function, reported a lower prevalence of 52% of ED (age between 40 and 70). Besides the race differences, this lower rate was also because that participants in our study were much older, with a higher mean age and a higher proportion of men older than 60.
Our study indicated that with age increasing the prevalence and severity of ED increased significantly. This had been confirmed by a lot of studies that age could be considered to be an independent risk factor for ED., With aging, gonad function declines, secretion of testosterone decreases, and sex hormone-binding globulin increases, which result in lower concentration of bioavailable testosterone. Moreover, the age-associated increase in atherosclerosis of the penile artery and the reduction of nitric oxide production in endothelial cells may lead to an increased risk of ED.
We found that good marital relationship and good neighborhood relationship were related with the decrease in ED risk and in ED severity. Stressful daily life and depressed character are risk factors for ED. Psychogenic factors that can contribute to ED are often partner related, performance related, or associated with psychological distress. The poor interpersonal relationship may bring mental stress and tense life, leading to psychological depression and bad feelings. It may also be associated with unsociable characters (such as loneliness and cold temperament). Besides, the unharmonious marital relationship can directly cause decreased male sexual desire and erectile dysfunction.,,,
As to relatives/friends relationship, no significant correlations were found with ED. We infer that neighborhood relationship may be a more representative relationship for residents living in rural areas, for they have more chances and more time to interact with each other. This enlightens us to pay more attention to building harmonious communities and promoting communication between neighbors. Troubles are very common in daily life, and we did not classify the severity of troubles. More detailed information may help to verify the influence of these factors.
This study was a population-based cross-sectional study with a large sample size. The obtained information was complete, so the results had relatively high reliability. All the investigators were well trained, and the unified questionnaire was used to conduct the face-to-face survey. Thus, the information bias was controlled to a certain extent. Study participants might conceal the illness because of self-esteem in some privacy questions, which might result in the underestimate of ED. However, the ED prevalence in our study was not lower than other studies and might not be underestimated.
We find that the prevalence of ED has a negative correlation with marital relationship and neighborhood relationship. This provides more evidence for relationship interventions in the prevention and treatment of ED. The investigation is a part of one cohort study of male reproductive health, and we look forward to exploring more information in the future.
Financial support and sponsorship
The project from National Science and Technology Basic Work Program (2013FY110500) and the open project from Key Laboratory of Reproduction Regulation of NPFPC in 2017 (2017KF03).
Conflicts of interest
There are no conflicts of interest.
| References|| |
Dean J, Shechter A, Vertkin A, Weiss P, Yaman O, Hodik M, et al.
Sexual Health and Overall Wellness (SHOW) survey in men and women in selected European and Middle Eastern countries. J Int Med Res 2013;41:482-92. doi: 10.1177/0300060513476429.
Laumann EO, Nicolosi A, Glasser DB, Paik A, Gingell C, Moreira E, et al.
Sexual problems among women and men aged 40-80 y: Prevalence and correlates identified in the global study of sexual attitudes and behaviors. Int J Impot Res 2005;17:39-57. doi: 10.1038/sj.ijir.3901250.
Xu G, Li S, Tu Y, Hu Y, Ni J, Chen L. Epidemiology survey and research on the late-onset hypogonadism of a certain community in Shanghai. Chin Prim Health Care 2016;9:16-8. doi: 10.3969/j.issn.1001-568X.2016.09.0007.
Chen ZQ, Bao XZ, Lin GB, Chen BJ, Chen J, Zhang CM, et al
. A survey on the epidemiology of late onset of hypogonadism in Wenlin city of Zhejiang province. Chin J Androl 2016;30:34-8. doi: 10.3969/j.issn.1008-0848.2016.09.008.
Ju CL, Sun GY, Liu XH. Incidence investigation of late onset of hypogonadism in middle-aged men of Jihua community. Chin Community Doctors 2015;10:156-7. doi: 10.3969/j.issn.1007-614x.2015.10.99.
Zhang XY, Yang B, Li N, Li HJ. Prevalence and risk factors for erectile dysfunction in Chinese adult males. J Sex Med 2017;14:1201-8. doi: 10.1016/j.jsxm.2017.08.009.
Oyelade BO, Jemilohun AC, Aderibigbe SA. Prevalence of erectile dysfunction and possible risk factors among men of South-Western Nigeria: A population based study. Pan Afr Med J 2016;24:124. doi: 10.11604/pamj.2016.24.124.8660.
Aghighi A, Grigoryan VH, Delavar A. Psychological determinants of erectile dysfunction among middle-aged men. Int J Impot Res 2015;27:63-8. doi: 10.1038/ijir.2014.34.
Johannes CB, Araujo AB, Feldman HA, Derby CA, Kleinman KP, McKinlay JB, et al.
Incidence of erectile dysfunction in men 40 to 69 years old: Longitudinal results from the Massachusetts male aging study. J Urol 2000;163:460-3. doi: 10.1097/00005392-200002000-00015.
Pastuszak AW, Khera M. Erectile dysfunction: Etiology and risk factors. In: Köhler TS, Mcvary KT, editors. Contemporary Treatment of Erectile Dysfunction: A Clinical Guide. Cham: Springer International Publishing; 2016. p. 57-70.
Rosen RC, Cappelleri JC, Smith MD, Lipsky J, Peña BM. Development and evaluation of an abridged, 5-item version of the international index of erectile function (IIEF-5) as a diagnostic tool for erectile dysfunction. Int J Impot Res 1999;11:319-26. doi: 10.1038/sj.ijir.3900472.
WGOC, Guidelines for Prevention and Control of Overweight and Obesity in Chinese Adults. Acta Nutrimenta Sinica 2004;26:1-4. doi: 10.3321/j.issn:0512-7955.2004.01.001.
Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB. Impotence and its medical and psychosocial correlates: Results of the Massachusetts male aging study. J Urol 1994;151:54-61. doi: 10.1016/S0022-5347(17)34871-1.
Colson MH, Cuzin B, Faix A, Grellet L, Huyghes E. Current epidemiology of erectile dysfunction, an update. Sexologies 2018;27:9-17. doi: 10.1016/j.sexol.2018.01.018.
Hockenberry MS, Masson P. Erectile dysfunction in the elderly. Curr Geriatr Rep 2015;4:33-43. doi: 10.1007/s13670-014-0107-4.
Yang Y, Dong B, Chen R, Li Y, Ding S, Zhang C, et al
. Study on the related factors of erectile dysfunction in Yunnan Province. Chin J Hum Sex 2016;25:95-101. doi: 10.3969/j.issn.1672-1993.2016.05.032.
Lian W, Zeng Y, Liu W, Deng X, Lin W, Tang Z, et al
. Analysis of related risk factors of erectile dysfunction in adult men. Hainan Med J 2017;28:731-3. doi: 10.3969/j.issn.1003-6350.2017.05.015.
Dong L, Cheng DA, Zhang PH, Ren FQ, Yu XJ, Chang DG. Effect of female psychological factors on male erectile dysfunction. Chin J Hum Sex 2015;24:117-9. doi: 10.3969/j.issn.1672-1993.2015.07.041.
Boddi V, Fanni E, Castellini G, Fisher AD, Corona G, Maggi M, et al.
Conflicts within the family and within the couple as contextual factors in the determinism of male sexual dysfunction. J Sex Med 2015;12:2425-35. doi: 10.1111/jsm.13042.
[Table 1], [Table 2]