Male Erectile Dysfunction Problems in Healthcare Facilities in Dar-es-Salaam, Tanzania
Abstract
Male erectile dysfunction is a significant public health problem that considerably impacts one's relationships and affects sexual life. However, few studies have been conducted in Sub-Saharan Africa to explore male erectile dysfunction. This study explored how healthcare professionals identify and manage male erectile dysfunction in Dar es Salaam, Tanzania. Eighteen (18) focus group discussions were conducted with healthcare practitioners (N=60) and students (N=61), stratified by midwifery, nursing, or medicine. Thematic analysis resulted in two main themes: history taking and disease management. Providers and students highlighted different approaches to handling erectile dysfunction, and the results revealed inadequate knowledge among providers on male erectile dysfunction. In addition, the results presented the unmet need of patients with erectile dysfunction in the community, forcing patients to seek care from traditional healers. Therefore, this study recommends comprehensive health training and continuous education for practicing health professionals on sexuality and sexual health across disciplines. Training would potentially increase confidence among healthcare providers when engaging with patients and provide referrals to specialized care to optimize patient outcomes
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Agaba, P. A., Ocheke, A. N., Akanbi, M. O., Gimba, Z. M., Ukeagbu, J., Mallum, B. D., & Agaba, E. I. (2017). Sexual Functioning and Health-related Quality of Life in Men. Nigerian Medical Journal: Journal of the Nigeria Medical Association, 58(3), 96–100. https://doi.org/10.4103/nmj.NMJ_225_16
Ajao, A. A., Sibiya, N. P., & Moteetee, A. N. (2019). Sexual prowess from nature: A systematic review of medicinal plants used as aphrodisiacs and sexual dysfunction in sub-Saharan Africa. South African Journal of Botany, 122, 342–359. https://doi.org/10.1016/j.sajb.2018.08.011
Albaugh, J. A., Tenfelde, S., & Hayden, D. M. (2017). Sexual Dysfunction and Intimacy for Ostomates. Clinics in Colon and Rectal Surgery, 30(03), 201–206. https://doi.org/10.1055/s-0037-1598161
Amidu, N., Owiredu, W. K. B. A., Woode, E., Addai-Mensah, O., Gyasi-Sarpong, K. C., & Alhassan, A. (2010). Prevalence of male sexual dysfunction among Ghanaian populace: Myth or reality? International Journal of Impotence Research, 22(6), Article 6. https://doi.org/10.1038/ijir.2010.24
Annon, J. S. (1976). The PLISSIT Model: A Proposed Conceptual Scheme for the Behavioral Treatment of Sexual Problems. Journal of Sex Education and Therapy, 2(1), 1– 15. https://doi.org/10.1080/01614576.1976.11074483
Ayta, I. A., McKinlay, J. B., & Krane, R. J. (1999). The likely worldwide increase in erectile dysfunction between 1995 and 2025 and some possible policy consequences. BJU International, 84(1), 50–56. https://doi.org/10.1046/j.1464-410x.1999.00142.x
Brooten-Brooks, M. C. (2021, October 13). Stress and Erectile Dysfunction: Tips for Better Mental Health. Verywell Health. https://www.verywellhealth.com/stress-and-erectile-dysfunction-5202285
Chirca, N., Streinu-Cercel, A., Stefan, M., Aurelian, J., & Persu, C. (2023). A Novel Risk Calculator to Predict Erectile Dysfunction in HIV-Positive Men. Journal of Personalized Medicine, 13(4), 679. https://doi.org/10.3390/jpm13040679
Correia, M. C., Ogola, E. N., Kayima, J. K., Joshi, M. D., Silverstein, D. M., & Kabinga, S. K. (2022). Erectile dysfunction in hypertensive males in Kenya: A tertiary referral hospital experience. African Health Sciences, 22(2), 420–427. https://doi.org/10.4314/ahs.v22i2.48
Correia, M., Ogola, E., Kayima, J., Joshi, M., Silverstein, D., & Kabinga, S. (2022). Erectile dysfunction in hypertensive males in Kenya: A Tertiary Referral Hospital experience. African Health Sciences, 22, 420–427. https://doi.org/10.4314/ahs.v22i2.48
Haboubi, N. H. J., & Lincolin, N. (2009). Views of health professionals on discussing sexual issues with patients. Https://Doi.Org/10.1080/0963828021000031188, 25(6), 291–296. https://doi.org/10.1080/0963828021000031188
Hurisa, A. D., & Negera, G. Z. (2020). Erectile Dysfunction among Diabetic Patients in a Tertiary Hospital of Southwest Ethiopia. The Open Public Health Journal, 13(1), 240–245. https://doi.org/10.2174/1874944502013010240
Kessler, A., Sollie, S., Challacombe, B., Briggs, K., & Hemelrijck, M. V. (2019). The global prevalence of erectile dysfunction: A review. BJU International, 124(4), 587–599. https://doi.org/10.1111/BJU.14813
Luo, L., Deng, T., Zhao, S., Li, E., Liu, L., Li, F., Wang, J., & Zhao, Z. (2017). Association Between HIV Infection and Prevalence of Erectile Dysfunction: A Systematic Review and Meta-Analysis. The Journal of Sexual Medicine, 14(9), 1125–1132. https://doi.org/10.1016/j.jsxm.2017.07.001
Makoye, K. (2019, July 2). Tanzania approves herbs to treat erectile Dysfunction—Health Policy Watch. Health Policy Watch: Independet Global Health Reporting. https://healthpolicy-watch.news/tanzania-approves-herbs-to-treat-erectile-dysfunction/
Malviya, N., Malviya, S., Jain, S., & Vyas, S. (2016). A review of the potential of medicinal plants in the management and treatment of male sexual dysfunction. Andrologia, 48(8), 880–893. https://doi.org/10.1111/and.12677
McCabe, M. P., Sharlip, I. D., Lewis, R., Atalla, E., Balon, R., Fisher, A. D., Laumann, E., Lee, S. W., & Segraves, R. T. (2016). Incidence and Prevalence of Sexual Dysfunction in Women and Men: A Consensus Statement from the Fourth International Consultation on Sexual Medicine 2015. The Journal of Sexual Medicine, 13(2), 144–152. https://doi.org/10.1016/j.jsxm.2015.12.034
Mgopa, L. R., Ross, M. W., Lukumay, G. G., Mushy, S. E., Mkonyi, E., Massae, A. F., Mwakawanga, D. L., Leshabari, S., Mohamed, I., Trent, M., Wadley, J., Bonilla, Z. E., & Rosser, B. R. S. (2021). Perceptions of Sexual Healthcare Provision in Tanzania: A Key Informant Qualitative Study. Sexuality Research and Social Policy. https://doi.org/10.1007/s13178-021-00607-5
Mkonyi, E., Mwakawanga, D. L., Rosser, B. R. S., Bonilla, Z. E., Lukumay, G. G., Mohammed, I., Mushy, S. E., Mgopa, L. R., Ross, M. W., Massae, A. F., Trent, M., & Wadley, J. (2021). The management of childhood sexual abuse by midwifery, nursing and medical providers in Tanzania. Child Abuse & Neglect, 121, 105268. https://doi.org/10.1016/j.chiabu.2021.105268
Mkonyi, E., Trent, M., Mwakawanga, D. L., Massae, A. F., Ross, M. W., Bonilla, Z. E., Mohammed, I. S., Lukumay, G. G., Mushy, S. E., Mgopa, L. R., Wadley, J., Mkoka, D. A., & Rosser, B. R. S. (2023). Evaluating the History-Taking Process of Sexual Reproductive Health Problems in Tanzania: Lessons from a Study of Health Students and Practitioners. East African Journal of Health and Science, 6(1), Article 1. https://doi.org/10.37284/eajhs.6.1.1239
Muhrer, J. C. (2014). The importance of the history and physical in diagnosis. The Nurse Practitioner, 39(4), 30–35. https://doi.org/10.1097/01.NPR.0000444648.20444.e6
Mutagaywa, R. K., Lutale, J., Aboud, M., & Kamala, B. A. (2014). Prevalence of erectile dysfunction and associated factors among diabetic men attending diabetic clinic at Muhimbili National Hospital in Dar-es-Salaam, Tanzania. The Pan African Medical Journal, 17. https://doi.org/10.11604/PAMJ.2014.17.227.2695
Mutebi, S. (2017, December 13). Male Sexual Dysfunction in Tanzania. https://www.polsoz.fu- berlin.de/ethnologie/forschung/arbeitsstellen/medical_anthropology/forschung/male-sexual-dysfunction-in-tanzania/index.html
National Institute of Health. (1993). Impotence: NIH Consensus Development Panel on Impotence. JAMA, 270(1), 83–90. https://doi.org/10.1001/jama.1993.03510010089036
Nyalile, K. B., Mushi, E. H. P., Moshi, E., Leyaro, B. J., Msuya, S. E., & Mbwambo, O. (2020). Prevalence and factors associated with erectile dysfunction among adult men in Moshi municipal, Tanzania: Community-based study. Basic and Clinical Andrology 2020 30:1, 30(1), 1–7. https://doi.org/10.1186/S12610-020-00118-0
Olugbenga-Bello, A. I., Adeoye, O. A., Adeomi, A. A., & Olajide, A. O. (2013). Prevalence of erectile dysfunction (ED) and its risk factors among adult men in a Nigerian community. Nigerian Postgraduate Medical Journal, 20(2), 130.
Oyelade, B. O., Jemilohun, A. C., & Aderibigbe, S. A. (2016). Prevalence of erectile dysfunction and possible risk factors among men of South-Western Nigeria: A population-based study. Pan African Medical Journal, 24(1), Article 1. https://doi.org/10.4314/pamj.v24i1
Palinkas, L. A., Horwitz, S. M., Green, C. A., Wisdom, J. P., Duan, N., & Hoagwood, K. (2015). Purposeful Sampling for Qualitative Data Collection and Analysis in Mixed Method Implementation Research. Administration and Policy in Mental Health and Mental Health Services Research, 42(5), 533–544. https://doi.org/10.1007/s10488-013-0528-y
Pallangyo, P., Nicholaus, P., Kisenge, P., Mayala, H., Swai, N., & Janabi, M. (2016a). A community-based study on prevalence and correlates of erectile dysfunction among Kinondoni District Residents, Dar Es Salaam, Tanzania. Reproductive Health, 13(1), 140. https://doi.org/10.1186/s12978-016-0249-2
Pallangyo, P., Nicholaus, P., Kisenge, P., Mayala, H., Swai, N., & Janabi, M. (2016b). A community-based study on prevalence and correlates of erectile dysfunction among Kinondoni District Residents, Dar Es Salaam, Tanzania. Reproductive Health, 13(1), 140. https://doi.org/10.1186/s12978-016-0249-2
Reno, H. E., Park, I., Workowski, K., Machefsky, A., & Bachmann, L. (2022). A guide to taking a sexual history. Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention. https://www.cdc.gov/std/treatment/sexualhistory.htm
Ribeiro, S., Alarcão, V., Simões, R., Miranda, F. L., Carreira, M., & Galvão‐Teles, A. (2014). General Practitioners’ Procedures for Sexual History Taking and Treating Sexual Dysfunction in Primary Care. The Journal of Sexual Medicine, 11(2), 386–393. https://doi.org/10.1111/jsm.12395
Robinson, B. `Bean’ E., Bockting, W. O., Simon Rosser, B. R., Miner, M., & Coleman, E. (2002). The Sexual Health Model: Application of a sexological approach to HIV prevention. Health Education Research, 17(1), 43–57. https://doi.org/10.1093/her/17.1.43
Ross, M. W., Newstrom, N., & Coleman, E. (2021). Teaching Sexual History Taking in Health Care Using Online Technology: A PLISSIT-Plus Zoom Approach During the Coronavirus Disease 2019 Shutdown. Sexual Medicine, 9(1), 100290–100290. https://doi.org/10.1016/j.esxm.2020.100290
Rosser, B. R. S., Mgopa, L. R., Leshabari, S., Ross, M. W., Lukumay, G. G., Massae, A. F., Mkonyi, E., Mohammed, I., Mushy, S. E., Mwakawanga, D. L., Trent, M., & Wadley, J. (2020). Legal and ethical considerations in the delivery of sexual health care in Tanzania. 3(7), 84–102.
Saldana, J., & Omasta, M. (2018). Qualitative research: Analyzing life. SAGE Publications.
Seyam, R. M., Albakry, A., Ghobish, A., Arif, H., Dandash, K., & Rashwan, H. (2003). Prevalence of erectile dysfunction and its correlates in Egypt: A community-based study. International Journal of Impotence Research, 15(4), Article 4. https://doi.org/10.1038/sj.ijir.3901000
Sheng, Z. (2021). Psychological consequences of erectile dysfunction. Trends in Urology & Men’s Health, 12(6), 19–22. https://doi.org/10.1002/tre.827
Skelton, J. R., & Matthews, P. M. (2001). Teaching sexual history taking to health care professionals in primary care. Medical Education, 35(6), 603–608. https://doi.org/10.1046/j.1365-2923.2001.00926.x
Traish, A. M., Hassani, J., Guay, A. T., Zitzmann, M., & Hansen, M. L. (2011). Adverse Side Effects of 5α‐Reductase Inhibitors Therapy: Persistent Diminished Libido and Erectile Dysfunction and Depression in a Subset of Patients. The Journal of Sexual Medicine, 8(3),872–884. https://doi.org/10.1111/j.1743-6109.2010.02157.x
Wang, W., Fan, J., Huang, G., Zhu, X., Tian, Y., Tan, H., & Su, L. (2017). Meta-Analysis of Prevalence of Erectile Dysfunction in Mainland China: Evidence Based on Epidemiological Surveys. Sexual Medicine, 5(1), e19–e30. https://doi.org/10.1016/J.ESXM.2016.10.001
Workowski, K. A., & Bolan, G. A. (2015). Sexually Transmitted Diseases Treatment Guidelines, 2015. MMWR. Recommendations and Reports: Morbidity and Mortality Weekly Report. Recommendations and Reports, 64(RR-03), 1–137.
Yovwin, D., Imarhiagbe, F., Obazee, E., & Oguike, T. (2015). Erectile dysfunction in a sub-saharan African population: Profile and correlates in a tertiary care hospital. Sahel Medical Journal, 18, 116. https://doi.org/10.4103/1118-8561.169286
Copyright (c) 2024 Ever Mkonyi, PhD, Maria Trent, Dorkasi L. Mwakawanga, Agnes Fredrick Massae, PhD, Michael W. Ross, PhD, Zobeida E. Bonilla, PhD, Inari S. Mohammed, Gift Gadiel Lukumay, Stella Emmanuel Mushy, PhD, Lucy Raphael Mgopa, James Wadley, PhD, Dickson Ally Mkoka, PhD, Brian Robert Simon Rosser, PhD
This work is licensed under a Creative Commons Attribution 4.0 International License.