Mixed-design cross-sectional study on the impact of quality of life and self-esteem in Spanish men with erectile dysfunction during COVID-19 pandemic

Mixed-design cross-sectional study on the impact of quality of life and self-esteem in Spanish men with erectile dysfunction during COVID-19 pandemic | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Mixed-design cross-sectional study on the impact of quality of life and self-esteem in Spanish men with erectile dysfunction during COVID-19 pandemic Carolina Sandoval-Salinas, Jose Benitez, Eugenio Laborda, Juan MartinezP This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4457102/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract A cross-sectional study incorporating quantitative and qualitative analyses was conducted between 2020 and 2022, to evaluate the perception of quality of life and self-esteem in men with erectile dysfunction (ED), exploring factors associated with these psychological constructs. General and sexual-specific quality of life, self-esteem, and confidence, were measured in men with ED in Spain, using the World Health Organization Quality of Life-BREF (WHOQOL-BREF) questionnaire, Sexual Life Quality Questionnaire (SLQQ), and Self-Esteem and Relationship (SEAR) questionnaire. Comprehensive interviews were conducted to deepen the understanding of how ED impacts various aspects of life. 353 men participated in the quantitative phase and 21 in the qualitative phase. 54.9% of participants rated their general quality of life as good or very good. No association was found between the perceived quality of global life and the quality of erection or severity of ED. The median SLQQ score was 33.75 (IQR 22.5), and the median SEAR subscale self-esteem score was 37.5 (IQR 25). It was found that the duration of ED and the frequency of sexual activity influenced self-esteem and confidence in men with ED. In the qualitative assessment, the subjects considered that ED did not influence aspects of their life unrelated to sexual health. Health sciences/Health care/Quality of life Health sciences/Diseases/Urogenital diseases/Erectile dysfunction Erectile dysfunction Quality of Life Self-Esteem Confidence Cross-Sectional Studies Mixed methods research INTRODUCTION Erectile Dysfunction (ED) is defined as the inability to achieve and maintain penile tumescence and rigidity, sufficient for satisfactory sexual intercourse (1). Prevalence rates of ED in men under 40 years of age have been reported to be between 1% and 10% (2), which increase with age, reaching values of 20% to 40% in men between 60 and 69 years of age and 50% to 100% in men over 70 years (3,4). Impairment of erectile capacity affects not only sexual performance but also self-esteem, satisfaction, and quality of life, impacting mental health and relationships with others, which worsens as erectile dysfunction becomes more severe (5-7). Some studies in specific populations illustrate differences in quality of life between men with and without dysfunction, with other pathologies (8-16). For example, in diabetic men, erectile dysfunction is associated with an increase in depressive symptoms and a decrease in sexual quality of life (8,9). In the same way, in men with essential hypertension and ED it has been found low scores in the quality of life assessment with the Medical Outcome Study Short-form 36-Item Health Survey (SF-36) (10). The rising number of patients with erectile dysfunction in Spain is evident, given its association in most cases with prevalent cardiovascular risk factors in this country, such as diabetes, hypertension, hyperlipidemia, and obesity, and its direct correlation with age (17). In clinical practice, it is important to recognize aspects of erectile dysfunction, including its impact on the quality of life and self-esteem of affected men, so that comprehensive management interventions can be proposed and implemented. These interventions aim to improve outcomes that are of great importance to patients and even their partners. The objective of this study is to evaluate the degree of impact and factors associated with self-esteem and general and sexual quality of life in men with erectile dysfunction, consulting for this condition in different cities in Spain. This work was developed in the context of the COVID-19 pandemic. SUBJECTS AND METHODS An observational cross-sectional study with both quantitative and qualitative components was conducted. Men over 18 years of age with a clinical diagnosis of erectile dysfunction, an International Index of Erectile Function-Erectile Function domain (IIEF-EF) score less than 26, who were attending for the first time at a specialized male sexual health clinic in several cities in Spain, between March 2020 and September 2022, were included. Subjects with cognitive or physical illness that prevented them from completing the questionnaires, those who were illiterate, and those who did not sign informed consent for participation in the study were excluded. The protocol was reviewed and approved by the Ethics Committee for Research of the Fundación Jiménez Díaz in Madrid, Spain (Registry number: EO179-19_OTROS). Quantitative Component Sociodemographic and clinical variables were collected using a form created for the study, including information on the participants' sexual life and health. The presence and degree of erectile dysfunction were assessed using the International Index of Erectile Function-Erectile Function domain (IIEF-EF), consisting of 6 questions scored from 0 to 5 for a total of 30 points, where a score of 26 or more suggests no erectile dysfunction (18). The Erection Hardness Score (EHS) was also used to assess the hardness of erection during the four weeks prior to the survey, with 5 response options ranging from 0 to 4: 0= The penis does not enlarge; 1= The penis is larger but not hard; 2= The penis is hard but not hard enough for penetration; 3= The penis is hard enough for penetration but not completely hard; 4= The penis is completely hard and fully rigid (19). Quality of life was evaluated using the World Health Organization Quality of Life-BREF (WHOQOL-BREF) questionnaire, comprising 24 items in four domains: Physical Health, Psychological Health, Social Relationships, and Environment, plus 2 additional questions assessing overall quality of life and general health perception (20). Sexual quality of life was evaluated using the Sexual Life Quality Questionnaire (SLQQ), specifically its sexual quality of life dimension scale with 10 items (21). Finally, self-esteem was assessed with the Self-Esteem and Relationship (SEAR) questionnaire, consisting of 14 items in 2 dimensions: Sexual Relationships and Confidence, the latter subdivided into Self-Esteem and General Relationships (22). Scores for each scale (WHOQOL-BREF, SLQQ and SEAR) were calculated according to the authors' instructions, ranging from 0 to 100, with higher scores indicating better outcomes (20–22). Spanish-validated versions of the questionnaires were used (23-26), except for the IIEF-EF questionnaire. The questionnaires were self-administered either in paper form, digitally, or via telephone by a research assistant during the COVID-19 pandemic, depending on participant preference. For the evaluations of the degree of dysfunction, quality of sexual life, self-esteem, and confidence in men without a current partner or without sexual relations in the last four weeks, the participant was asked to make his evaluation according to his last sexual encounters. Qualitative Component The qualitative study aimed to understand the participants' perceptions of how erectile dysfunction affects different areas of their life beyond sexuality. Semi-structured interviews (27) were conducted based on the following guide questions: What aspects of your everyday life, other than your sexual life, have been affected since you started experiencing symptoms of erectile dysfunction? What customs or habits from your daily life do you think have changed since you developed the condition? From your perspective, what factors or conditions do you believe positively or negatively influence your sexual dysfunction? If you had to describe an emotion related to your current situation, what would it be? The interviews were conducted by a urologist with experience in this method who in turn took notes on the patient's attitude or behavior to complement the analysis. Interviews were audio-recorded and transcribed with patient consent. Sample Size and Sampling For the quantitative component, a sample size of 359 patients was estimated based on the following parameters: Population size: 5254 patients with erectile dysfunction treated during 2018 in this medical center Hypothetical frequency of the outcome factor in the population: 50% Confidence level: 95% A non-probabilistic, consecutive sampling method was used, including all patients who attended the clinic and agreed to participate, until the calculated sample size was reached. For the qualitative component, a sample of 21 patients was selected upon reaching the saturation criterion due to redundancy of information, which means that the new patients repeat what the previous ones had said and there is no new information (28). Subjects in this phase were survey participants who agreed to participate in the in-depth interview, seeking age group representativeness. Statistical Analysis Descriptive analysis of the clinical and demographic characteristics of the participants was performed, estimating measures of central tendency (mean or median) and dispersion (standard deviation or interquartile range) for numerical variables, based on data distribution assessed through graphical and statistical methods. Absolute and relative frequencies were estimated for categorical variables. Bivariate analysis was conducted to explore the relationship between clinical (degree of dysfunction, duration of dysfunction, comorbidities, previous treatment) or sociodemographic (age, educational level, occupation, marital status) variables and quality of life and self-esteem. Chi-square tests were used for categorical variables and t-tests or U-Mann–Whitney tests for numerical variables, depending on data distribution. No parametric regression models were developed to evaluate and quantify the association between different variables and quality of life, sexual quality of life and self-esteem. Variables included in the models were based on two criteria: 1) variables with significant results in the bivariate analysis (p-value <0.05), or 2) clinically relevant variables in the association between erectile dysfunction and quality of life, even if not statistically significant in the bivariate analysis (e.g., age and comorbidity). A 5% significance level and two-tailed hypothesis tests were considered for all tests. Analyses were performed using Stata 15.1 ®. For the analysis of data obtained from the semi-structured interviews, content analysis was used, involving coding and categorization of information to enhance understanding of the research event from the patient's perspective (29,30). RESULTS 353 men met the inclusion criteria and completed the survey for the study. Of these, 48 resided in Madrid and 31 in Barcelona, accounting for 23.02% of the participants. The median age of patients was 59 years old (IQR 16). 146 were retired (41.5%) and 122 were employed (34.6%). Marital status was reported as 169 married (48.0%) and 65 divorced (18.4%). 249 participants (70.5%) had comorbidities associated with erectile dysfunction, with primary hypertension being the most common (n = 152, 43.1%), followed by diabetes (n = 103, 29.1%) and prostate diseases (n = 50, 14.2%). Regarding the history of Covid-19, only 71 patients (20.1%) answered this question, 51 of them affirmatively. Sexual orientation was predominantly heterosexual (n = 346, 98.3%). 275 patients (77.9%) reported being partnered, with a median relationship duration of 4.8 years (IQR 32.3 years). The median frequency of sexual intercourse was 2 times per month (IQR 4), and the median time with erectile dysfunction was 36 months (IQR 60). The median IIEF-EF score was 12 (IQR 10), with 78.5% of participants (n = 277) experiencing moderate to severe levels of the condition. The median score for the EHS was 2 (IQR 1) (Table 1 ). Table 1 Demographic, clinic, and sexual characteristics of the survey respondents Characteristics Mild Mild - Moderate Moderate Severe All patients (n = 21) (n = 55) (n = 125) (n = 152) (n = 353) Sociodemographic characteristics Age (a) 52 ( 13 ) 52 ( 15 ) 59 ( 17 ) 64 ( 15 ) 59 ( 16 ) Marital status Married 11 (52.4%) 24 (44.4%) 64 (51.2%) 70 (46.1%) 169 (48%) Divorced 4 (19.1%) 11 (20.4%) 22 (17.6%) 28 (18.4%) 65 (18.4%) Single 6 (28.6%) 13 (24.1%) 20 (16%) 19 (12.4%) 58 (16.5%) Free Union 0 (0%) 5 (9.7%) 14 (11.2%) 21 (13.8%) 40 (11.3%) Widower 0 (0%) 1 (1.9%) 5 (4%) 14 (9.2%) 20 (5.7%) City of residence Madrid 2 (9.5%) 7 (12.7%) 15 (12%) 24 (15.9%) 48 (13.6%) Barcelona 2 (9.5%) 6 (10.9%) 9 (7.2%) 16 (10.6%) 33 (9.4%) Sevilla 1 (4.8%) 2 (3.6%) 4 (0.8%) 9 (6%) 16 (4.5%) Murcia 0 (0%) 2 (3.6%) 6 (4.8%) 6 (4%) 14 (4%) Valencia 2 (9.5%) 3 (5.5%) 3 (2.4%) 5 (3.3%) 13 (3.7%) Zaragoza 1 (4.8%) 3 (5.5%) 4 (3.2%) 4 (2.7%) 12 (3.4%) Alicante 1 (4.3%) 5 (9.1%) 4 (3.2%) 1 (0.7%) 11 (3.1%) Almería 0 (0%) 1 (1.8%) 3 (2.4%) 3 (1.9%) 7 (1.9%) Bilbao 1 (4.8%) 0 (0%) 0 (0%) 5 (3.3%) 6 (1.7%) Palma de Mallorca 0 (0%) 0 (0%) 1 (0.8%) 3 (2%) 4 (1.1%) La Coruña 0 (0%) 2 (3.6%) 1 (0.8%) 0 (0%) 3 (0.85%) Torremolinos (Málaga) 1 (4.8%) 0 (0%) 1 (0.8%) 1 (5.9%) 3 (0.9%) Oviedo 0 (0%) 1 (1.8%) 1 (0.8%) 0 (0%) 2 (0.56%) Other 10 (47.6%) 23 (41.8%) 73 (58.4%) 74 (49%) 180 (51.1%) Occupation Retired 1 (4.8%) 9 (16.4%) 53 (42.4%) 83 (55%) 146 (41.4%) Employee 12 (57.1%) 29 (52.7%) 38 (30.4%) 43 (28.5%) 122 (34.6%) Independent worker 8 (38.1%) 15 (27.3%) 30 (24.0%) 22 (14.6%) 75 (21.3%) Unemployed 0 (0%) 1 (1.8%) 4 (3.2%) 3 (2%) 8 (2.3%) Student 0 (0%) 1 (1.8%) 0 (0%) 0 (0%) 1 (0.3%) Clinical features Comorbidities Diabetes 1 (4.8%) 9 (16.4%) 35 (28%) 58 (38.2%) 103 (29.1%) Arterial hypertension 5 (23.8%) 16 (29.1%) 48 (38.4%) 83 (54.2%) 152 (43.1%) Cardiovascular disease 0 (0%) 2 (3.6%) 7 (5.6%) 14 (9.2%) 23 (6.5%) Depression 0 (0%) 2 (3.6%) 1 (0.8%) 2 (1.3%) 5 (1.4%) Anxiety 0 (0%) 2 (3.6%) 1 (0.8%) 3 (2%) 6 (1.7%) Apnea 0 (0%) 2 (3.6%) 3 (2.4%) 4 (2.6%) 9 (2.6%) HBP 2 (9.5%) 2 (3.6%) 12 (9.6%) 34 (22.4%) 50 (14.2%) Testosterone 0 (0%) 0 (0%) 1 (0.8%) 3 (2%) 4 (1.1%) Hypothyroidism 1 (4.8%) 9 (16.4%) 38 (30.4%) 52 (34.2%) 100 (28.3%) None 14 (66.7%) 29 (52.7%) 39 (31.2%) 22 (14.7%) 104 (29.5%) Consumption history Tobacco 7 (33.3%) 15 (27.3%) 39 (31.2%) 55 (36.2%) 116 (32.9%) Alcohol 0 (0%) 1 (1.8%) 2 (1.6%) 4 (2.6%) 7 (2%) Recreational drugs 1 (4.8%) 1 (1.8%) 7 (5.6%) 1 (0.7%) 10 (2.8%) Sexual history Sexual orientation Heterosexual 21 (100%) 50 (92.6%) 123 (98.4%) 152 (100%) 346 (98.3%) Homosexual 0 (0%) 3 (5.6%) 2 (1.6%) 0 (0%) 5 (1.4%) Bisexual 0 (0%) 1 (1.8%) 0 (0%) 0 (0%) 1 (0.3%) Whit a partner 17 (81.0%) 44 (80%) 102 (81.6%) 115 (75.6%) 275 (77.9%) Relationship Duration (a) 12.5 ( 26 ) 2.5 (26.5) 7 (35.7) 3.9 (29.8) 4.8 (32.3) Frequency of sexual intercourse (per month) (a) 2 ( 3 ) 3 ( 2 ) 3 ( 3 ) 1 ( 3 ) 2 ( 4 ) Time with ED (months) (a) 24 ( 24 ) 24 (48) 36 ( 36 ) 54 (96) 36 (60) Other sexual dysfunctions 6 (1.7%) 1 (0.2%) Premature ejaculation 1 (4.8%) 1 (1.8%) 2 (1.6%) 2 (0.7%) Low sexual desire 0 (0%) 0 (0%) 1 (0.8%) 0 (0%) Erection Hardness Score - EHS 3 (0) 3 (0) 2 ( 1 ) 2 ( 1 ) 2 ( 1 ) IIEF-EF score (a) 23 ( 1 ) 19 ( 3 ) 14 ( 2 ) 6 ( 7 ) 12 ( 10 ) (a) Median (Interquartile range). ED: Erectile dysfunction In the description on lifestyle factors, 116 participants were tobacco users (32.9%), averaging 19 cigarettes per day. Seven patients (2%) reported consuming more than 4 alcoholic drinks per day, and 10 (2.8%) indicated occasional use of recreational drugs (Table 1 ). Quality of life In the assessment of global quality of life using the WHO-QLQ-BREF questionnaire, for question 1 (How would you rate your quality of life?), on a scale of 1 to 5 where 1 is "very poor" and 5 "very good", 17.6% of the participants considered it very poor or poor and 54.9% considered it good or very good. In the question 2 (How satisfied are you with your health?) the results were 21.5% patients answered "very dissatisfied" or "dissatisfied" and 48.1% answered "satisfied" or "very satisfied". In the evaluation of the 4 domains of this questionnaire, on a scale of 0 to 100, the median scores of the domains were: Physical health 75 (IQR 18), Psychological 75 (IQR 32), Social Relationships 50 (IQR 25), and Environment 75 (IQR 18) (Table 2 ). Table 2 Quality of life questionnaire scores and correlation with the severity of erectile dysfunction. Mild Mild to moderate Moderate Severe Spearman’s Rho p-value WB-Physical health 81 ( 19 ) 75 ( 19 ) 75 ( 18 ) 69 ( 18 ) 0.1173 0.0275 WB-Psychological 81 ( 25 ) 75 ( 32 ) 75 ( 32 ) 81 ( 25 ) -0.0066 0.9011 WB-Social relationships 69 ( 31 ) 56 ( 19 ) 50 ( 12 ) 50 ( 25 ) 0.108 0.0426 WB-Environment 75 ( 19 ) 75 ( 18 ) 69 ( 25 ) 75 ( 18 ) 0.0248 0.6428 SLQQ 40 ( 25 ) 40 ( 25 ) 36.3 ( 20 ) 28.8 (23.8) 0.1501 0.0047 SEAR Total 42.8 (20.9) 41.1 (30.4) 33.9 (19.6) 30.3 (22.3) 0.1492 0.005 SEAR-Confidence 41.7 (18.7) 41.7 ( 25 ) 33.3 ( 25 ) 33.3 ( 25 ) 0.0893 0.094 SEAR-Self-Esteem 37.5 ( 25 ) 37.5 ( 25 ) 37.5 ( 25 ) 37.5 (18.8) 0.0568 0.2876 WB: World Health Organization Quality of Life-BREF. SLQQ: Sexual life quality questionnaire. SEAR: Self-Esteem and Relationship questionnaire. In the evaluation of the sexual quality of life, lower scores were observed: median SLQ questionnaire 33.75 (IQR 22.5), median SEAR questionnaire 33.9 (IQR 23.2), median SEAR-Confidence domain 37.5 (IQR 25), and median SEAR-self-esteem sub-domain 37.5 (IQR 25). When differentiating scores based on the severity of erectile dysfunction, it was observed that more severe cases of the condition had lower scores on the SLQQ and SEAR questionnaires, and the domains Physical health and Social relationships of the WHO-QLQ-BREF scale, becoming evident a mild positive correlation between this variables (Table 2 ). In the multivariate analysis was found that, independent of other evaluated factors, age is associated with the score of domains 2 and 4 of the WHOQOOL-Bref questionnaire, and time with erectile dysfunction is associated with domain 3 score. On the other hand, the frequency of sexual relations is associated with the scores of the SLQQ and SEAR questionnaires, and IIEF score is related with SLQQ score (Table 3 ). Table 3 Multivariate analysis of general and sexual quality of life, self-esteem, and confidence. Coeficient Standard Error CI 95% p-value WHOQOOL-BREF – Domain 1 – Physical Age 0.191 0.116 -0.037 to 0.419 0.1 Comorbidity -0.678 3.144 -0682 to 5.506 0.829 IIEF score 0.382 0.209 -0.30 to 0.793 0.069 Frequency of sexual intercourse 0.215 0.406 -0.584 to 1.014 0.597 Months with erectile dysfunction -0.028 0.021 -0.068 to 0.013 0.183 WHOQOOL-BREF – Domain 2 – Psychological Age 0.339 0.133 0.076 to 0.601 0.012 Comorbidity 2.525 3.615 -4.586 to 9.637 0.485 IIEF score 0.239 0.241 -0.235 to 0.712 0.322 Frequency of sexual intercourse 0.538 0.467 -0.380 to 1.457 0.25 Months with erectile dysfunction -0.013 0.024 -0.060 to 0.034 0.587 WHOQOOL-BREF – Domain 3 – Social relationships Age 0.066 0.093 -0.117 to 0.249 0.478 Comorbidity 3.969 2.524 -0.996 to 8.933 0.117 IIEF score 0.213 0.168 -0.118 to 0.543 0.206 Frequency of sexual intercourse 0.238 0.326 -0.403 to 0.880 0.466 Months with erectile dysfunction -0.043 0.017 -0.076 to -0.011 0.01 WHOQOOL-BREF – Domain 4 – Environment Age 0.17 0.085 0.002 to 0.338 0.047 Comorbidity 0.247 2.313 -4.303 to 4.797 0.915 IIEF score 0.197 0.154 -0.106 to 0.5 0.202 Frequency of sexual intercourse 0.217 0.299 -0.371 to 0.805 0.468 Months with erectile dysfunction 0.01 0.015 -0.020 to 0.040 0.511 Sexual life quality – SLQQ Age -0.037 0.112 -0.258 to 0.183 0.741 Comorbidity 6.145 3.04 0.165 to 12.125 0.044 IIEF score 0.457 0.202 0.059 to 0.855 0.025 Frequency of sexual intercourse 1.088 0.393 0.315 to 1.860 0.006 Months with erectile dysfunction -0.023 0.02 -0.062 to 0.017 0.259 SEAR Total Age 0.194 0.116 -0.03 to 0.421 0.094 Comorbidity 0.863 3.136 -5.30 to 7.031 783 IIEF score 0.393 0.209 -0.01 to 0.803 0.061 Frequency of sexual intercourse 1.266 0.405 0.469 to 2.063 0.002 Months with erectile dysfunction -0.017 0.021 -0.05 to 0.023 0.412 Confidence – SEAR Age -0.02 0.116 -0.25 to 0.204 0.838 Comorbidity 0.582 3.153 -5.61 to 6.785 0.853 IIEF score 0.135 0.209 -0.27 to 0.548 0.52 Frequency of sexual intercourse 0.906 0.407 0.105 to 1.707 0.027 Months with erectile dysfunction -0.0002 0.02 -0.04 to 0.038 0.913 Self-esteem – SEAR Age 0.131 0.08 -0.02 to 0.289 0.103 Comorbidity -0.35 2.178 -4.64 to 3.925 0.869 IIEF-EF score 0.099 0.145 -0.18 to 0.384 0.493 Frequency of sexual intercourse 0.347 0.281 -0.20 to 0.900 0.218 Months with erectile dysfunction -0.01 0.014 -0.04 to 0.014 0.332 WHOQOL-BREF: World Health Organization Quality of Life-BREF. Sexual life quality questionnaire. SEAR: Self-Esteem and Relationship questionnaire. CI: Confidence interval. IIEF-EF: International Index of Erectile Function, Erectile function domain Qualitative Evaluation 21 men were included in in-depth interviews. Their narratives show that in many cases, erectile dysfunction does not impact aspects of their lives beyond sexual activity and relationships with partners. The subjects indicated that they have not experienced problems in other areas of life, such as work or social interactions (with family, friends, or acquaintances) due to this condition. Participant 1: “No, on that issue it has honestly not changed me because the fact that I feel like going one night to be with friends, I have wanted to be with my girlfriend or my wife for a long time because I don't feel like it because of the fear that I won't be able to perform, that is the thing, the rest not at all, not even work, family, or nothing”… Participant 2: “No, just the sexual life, it [erectile dysfunction] hasn't affected me in my daily life.” Patients also reported no changes in their daily routines, customs or habits; they stated that they continued with their lives in a natural way except for one participant who reported increased alcohol consumption. Participant 1: “Honestly, I haven't considered this thing, it's just that I work a lot, I get up at 7 am and I don't stop until 10 pm and sometimes even later, so I practically don't have time to think too much about this aspect.” Participant 2: “Especially anxiety, I drink a lot more alcohol and smoke not because I stopped smoking 6 years ago…” “… Now, what I do, let's say, is that I drink more than I should.” The participants acknowledged that factors such as unhealthy diet, sedentarism, stress, anxiety due to dysfunction, age, and mood, affect erection. It was also identified from their narratives that it has become more challenging to relate with their partners or new women since experiencing ED, with prevailing emotions being frustration, anxiety, and in some cases, profound sadness. Some patients expressed hope for starting treatment for this condition. DISCUSSION Our findings suggest that, in Spanish men who consult for erectile dysfunction, their quality of sexual life, self-esteem and confidence is affected by this condition, independent of other variables such as age or other comorbidities, with median scores below 40 out of a possible 100 on questionnaires assessing this constructs. In our opinion, these results can be explained as 78.4% of patients presented with severe or moderate ED, and 59.7% were unable to achieve an erection hard enough for penetration, emphasizing the significant impact of this factor on the participants' perception of sexual quality of life. Clinically, it is observed that few men seek early consultation for ED, and it is common for them to visit a specialist only after several months of trying self-treatments without satisfactory results. Additionally, lack of control over comorbidities such as diabetes or hypertension worsens their condition at diagnosis. An interesting finding of this study is that in the patients' perception, erectile dysfunction does not affect other areas of their life. Only 17.6% of the participants considered it very poor or poor their quality of life, and the median score of the domains evaluated with the WHOQOOL-BREF questionnaire were over 70 with the exception of the Social relationships domain which include a question about satisfaction with the sexual life. These results are similar from those reported by Ezemenahi et al , in their study in hypertensive men with erectile dysfunction in southern Nigeria (31), but they differ slightly from what was reported by other authors in studies carried out in populations with other comorbidities, as well as in population studies, which can be explained by the differences in the population, the time of application of the survey and the questionnaire used (8,11,32,33). The results of the in-depth interviews confirmed the findings of the quantitative phase. No significant impact was found on other life aspects since experiencing symptoms of ED, contrary to what is reported by Elterman et al ., who show increased work absenteeism and reduced work productivity in men with ED compared to those without (34). This might be explained by partner support or diminished importance attributed to sexual life, seeking satisfaction in other life aspects such as work. Another explanation could be the age of participants, as 49.8% were over 60 years old, a life stage where sexuality, from a reproductive perspective, has mostly fulfilled its purpose and thus loses relevance as a key aspect of life quality. On the other hand, the COVID-19 pandemic could also affect the results because in a situation that generated so much stress, panic and uncertainty, sexuality become a secondary aspect (35,36). However, we do not have a way to verify this hypothesis, since there was very little patient participation in this question. This study presents several limitations: first, the variability in questionnaire administration due to changes in care during the Covid-19 pandemic, which can introduce bias from social desirability when the survey is done by telephone by research assistant. It has been shown that when faced with sensitive topics, participants in research studies change their answers when the questions are asked by an interviewer compared to self-administered questionnaires (37), and sexual health can be a sensitive topic for many men. Second, is its cross-sectional nature without follow-up, not considering changes in perception since starting treatment. Third, we did not evaluate all variables associated with a person's quality of life, such as income level or support from family or friends. Fourth, sampling in the qualitative component was based on different ages but not socioeconomic or education, this has likely affected the sample and that is why there is so much similarity in the responses of the participants. Fifth, we did not use a validate version in Spanish population of the IIEF-EF questionnaire. Sixth, despite the effort to inquire about Covid-19, only 20.1% of the participants responded whether they had had this infection, so it was not possible to evaluate its effect in this study. Strengths include the use of both quantitative and qualitative methodologies providing a broader view of patient perception, the inclusion of men with erectile dysfunction from different regions of Spain, the use of questionnaires validated in the Spanish population (except for the IIEF-EF questionnaire), and the assessment of the self-esteem and the confidence. Although in 2003 an evaluation of the quality of life in men with erectile dysfunction was carried out at a population level in Spain (5), our study makes an evaluation two decades later considering the change in the perspective of quality of life in actual society and complementing it with the evaluation of self-esteem and confidence in this group of patients, in the context of a serious pandemic. From the perspective of physicians and professionals involved in treating men with this pathology, it is necessary to treat their dysfunction comprehensively to cure it where possible or at least improve symptoms, regardless of etiology. This approach aims to enhance overall and sexual quality of life, as well as self-esteem and confidence. In conclusion, the results suggest that ED primarily affects sexual quality of life of Spain men who consult for this condition, without significantly impacting overall quality of life or daily life activities. Further studies are recommended to corroborate these findings, including the perspectives of patients' partners, other populations, and the comparison with men without ED. Declarations Data availability statement The data that support the findings of this study are available from the corresponding author, C.S.S., upon reasonable request. Acknowledgements The authors thank Mercedes Rodriguez who conducted the surveys, Juan Manuel Aguilera for his support in the interviews, and the team of doctors and advisors who supported the inclusion of patients in the study. The authors thank Dr. Manuel Mas Garcia and his research team for providing the SLQQ questionnaire in the version validated in the Spanish population. Author Contributions Statement J.B.M, E.L. and C.S.S conceived the study and wrote the article. C.S.S designed the methodology, did data curation, and formal analysis, J.M.M. supported data curation, and wrote a section of the article. Ethical Approval The protocol was reviewed and approved by the Ethics Committee for Research of the Fundación Jiménez Díaz in Madrid, Spain. Competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Funding The study was funded by Boston Medical Group. References Hackett G, Kirby M, Wylie K, Heald A, Ossei-gerning N, Edwards D, et al. British Society for Sexual Medicine Guidelines on the Management of Erectile Dysfunction in Men — 2017. J Sex Med. 2018;1–28. Lewis RW, Fugl-Meyer KS, Corona G, Hayes RD, Laumann EO, Moreira EDJ, et al. Definitions/epidemiology/risk factors for sexual dysfunction. J Sex Med. 2010;7(4 Pt 2):1598–607. McKinlay JB. The worldwide prevalence and epidemiology of erectile dysfunction. Int J Impot Res. 2000;12 Suppl 4:S6–11. Braun M, Wassmer G, Klotz T, Reifenrath B, Mathers M, Engelmann U. Epidemiology of erectile dysfunction: results of the “Cologne Male Survey”. Int J Impot Res. 2000;12(6):305–11. Sánchez-Cruz JJ, Cabrera-León A, Martín-Morales A, Fernández A, Burgos R, Rejas J. Male erectile dysfunction and health-related quality of life. Eur Urol. 2003;44(2):245–53. Wagner G, Fugl-Meyer KS, Fugl-Meyer AR. Impact of erectile dysfunction on quality of life: Patient and partner perspectives. Int J Impot Res. 2000;12:S144–6. Martínez-Jabaloyas JM, Moncada I, Rodríguez-Vela L, Gutiérrez PR, Chaves J. Evaluation of self-esteem in males with erectile dysfunction treated with viagra. Analysis of a Spanish patients group selected from a multicenter, international study. Actas Urológicas Españolas Ed. 2010;34(8):699–707. De Berardis G, Pellegrini F, Franciosi M, Belfiglio M, Di Nardo B, Greenfield S, et al. Longitudinal assessment of quality of life in patients with type 2 diabetes and self-reported erectile dysfunction. Diabetes Care. 2005;28(11):2637–43. Avasthi A, Grover S, Bhansali A, Dash RJ, Gupta N, Sharan P, et al. Erectile dysfunction in diabetes mellitus contributes to poor quality of life. Int Rev Psychiatry. 2011;23(1):93–9. Erectile Dysfunction and its Influence on Quality of Life in Patients With Essential Hypertension. Kushiro T, Takahashi A, Saito F, et al. Am J Hypertens. 2005; 18:427–430. Montiel-Jarquín ÁJ, Gutiérrez-Quiroz CT, Pérez-Vázquez AL, Ortiz-Agustín JJ, Garciá-Galicia A, Loriá-Castellanos J. Quality of life and erectile dysfunction in patients with benign prostatic hyperplasia. Cir y Cir. 2021;89(2):218–22. Sánchez-Ramos A, Galán-Ruano A, Vargas-Baquero E, Mas M. Sexual life quality of spinal cord-injured men receiving pharmacological treatment for erectile dysfunction and their partners. Rev Int Androl. 2018;16(3):95–101. Wang WG, Li P, Wang YS, Wang G, Wang YT, Zhou HL. The effect of erectile dysfunction on quality of life in male kidney transplant recipients. Pakistan J Med Sci. 2014;30(2):361–5. Rebollo P, Ortega F, Valdés C, Fernández-Vega F, Ortega T, García-Mendoza M, et al. Influence of erectile dysfunction on health related quality of life of male kidney transplant patients. Int J Impot Res. 2004;16(3):282–7. Meyer JP, Gillatt DA, Lockyer R, Macdonagh R. The effect of erectile dysfunction on the quality of life of men after radical prostatectomy. BJU Int. 2003;92(9):929–31. Idung AU, Abasiubong F, Udoh SB, Akinbami OS. Quality of life in patients with erectile dysfunction in the Niger Delta region, Nigeria. J Ment Heal. 2012;21(3):236–43. Grau M, Elosua R, Cabrera De León A, Guembe MJ, Baena-Díez JM, Vega Alonso T, et al. Factores de riesgo cardiovascular en España en la primera década del siglo xxi: análisis agrupado con datos individuales de 11 estudios de base poblacional, estudio DARIOS. Rev Española Cardiol. 2011;64(4):295–304. Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A. The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology. 1997;49(6):822–30. Mulhall JP, Goldstein I, Bushmakin AG, Cappelleri JC, Hvidsten K. Validation of the erection hardness score. J Sex Med. 2007 ;4(6):1626–34. The WHOQOL Group. Development of the World Health Organization WHOQOL-BREF quality of life assessment. The WHOQOL Group. Psychol Med. 1998;28(3):551–8. Woodward JMB, Hass SL, Woodward PJ. Reliability and validity of the sexual life quality questionnaire (SLQQ). Qual Life Res. 2002;11(4):365–77. Cappelleri JC, Althof SE, Siegel RL, Shpilsky A, Bell SS, Duttagupta S. Development and validation of the Self-Esteem and Relationship (SEAR) questionnaire in erectile dysfunction. Int J Impot Res. 2004;16(1):30–8. García-Cruz E, Romero Otero J, Martínez Salamanca JI, Leibar Tamayo A, Rodríguez Antolín A, Astobieta Odriozola A, et al. Linguistic and Psychometric Validation of the Erection Hardness Score to Spanish. J Sex Med. 2011;8(2):470–4. Rejas-Gutiérrez J, Cabello-Santamaria F, Calle-Pascual A, Chantada-Abad V, Fora-Eroles F, García-García M, et al. Validación de la versión española del cuestionario SEAR (Self-Esteem and Relationship Questionnaire) para varones con disfunción eréctil. Med Clin (Barc). 2005;125(15):565–73. Lucas-carrasco R. The WHO quality of life (WHOQOL) questionnaire: Spanish development and validation studies. Qual Life Res. 2012;21(1):161–5. Gutiérrez P, Hernández P, Sanz E, Cardeñosa O, Mas M. Further psychometric validation of the sexual life quality questionnaire for men with erectile dysfunction and their partners on a modified spanish language version. J Sex Med. 2009;6(10):2698–706. Troncoso-Pantoja C, Amaya-Placencia A. Interview: A practical guide for qualitative data collection in health research. Rev Fac Med. 2017;65(2):329–32. Saunders B, Sim J, Kingstone T, Baker S, Waterfield J, Bartlam B, et al. Saturation in qualitative research: exploring its conceptualization and operationalization. Qual Quant. 2018;52(4):1893–907. Kegler MC, Raskind IG, Comeau DL, Griffith DM, Cooper HLF, Shelton RC. Study Design and Use of Inquiry Frameworks in Qualitative Research Published in Health Education & Behavior. Heal Educ Behav. 2019;46(1):24–31. Fernández Núñez L. ¿Cómo analizar datos cualitativos? Butlletí LaRecerca. 2006;(2006):1–13. Ezemenahi SI, Alabi AN, Ogunfowokan O, Nwaneli CU, Aigbokhaode AQ, Eseigbe P. Quality of life of hypertensive men with erectile dysfunction in a tertiary health centre in southern Nigeria. African J Prim Heal Care Fam Med. 2023;15(1):1–7. Fujisawa M, Sawada K, Okada H, Arakawa S, Saito S, Kamidono S. Evaluation of health-related quality of life in patients treated for erectile dysfunction with Viagra (Sildenafil citrate) using SF-36 score. Arch Androl. 2002;48(1):15–21. Wagner G, Fugl-Meyer KS, Fugl-Meyer AR. Impact of erectile dysfunction on quality of life: Patient and partner perspectives. Int J Impot Res. 2000;12:S144–6. Elterman DS, Bhattacharyya SK, Mafilios M, Woodward E, Nitschelm K, Burnett AL. The quality of life and economic burden of erectile dysfunction. Res Reports Urol. 2021;13:79–86. Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, Ho RC. Immediate Psychological Responses and Associated Factors during the Initial Stage of the 2019 Coronavirus Disease (COVID-19) Epidemic among the General Population in China. International Journal of Environmental Research and Public Health. 2020; 17(5):1729. doi.org/10.3390/ijerph17051729 Taylor, S. COVID Stress Syndrome: Clinical and Nosological Considerations. Curr Psychiatry Rep 23, 19 (2021). doi.org/10.1007/s11920-021-01226-y Latkin CA, Edwards C, Davey-Rothwell MA, Tobin KE. The relationship between social desirability bias and self-reports of health, substance use, and social network factors among urban substance users in Baltimore, Maryland. Addict Behav. 2017;73:133-136. doi:10.1016/j.addbeh.2017.05.005 Additional Declarations There is NO conflict of interest to disclose. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4457102","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":306316350,"identity":"4e1a3738-743c-4902-ab14-19af8693a4dd","order_by":0,"name":"Carolina Sandoval-Salinas","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA90lEQVRIiWNgGAWjYLCCBwZgivFBQgUDgwFRWhIgypgNHpwhWguEYpN82EaEFv72sw8fJBTckWfgP/7YIHHeYXlz9uYDDB/+4NYicSbd2CDB4Jlhg0SO4YPEbYcNd/YcS2Cc2YZbiwFDGptEgsFhxgYJHmYDoBbGDTdyDJh5G/Bo4X8G1mLfwH/8mUTinMP2YC1/8DjMQAJiS2IDQ4KZRGLD4USwFgY2PH658YwZ6JfDyUC/AD11LD15w5ljCQd78fiFvz+N8cGHP4dtgQ57+PBHjbXthuPNBx/8wOMwOLA/AKaaweQBIjTAQR0pikfBKBgFo2CEAAA7hVcabXdLLQAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0003-0228-3166","institution":"Elexial Research Limited","correspondingAuthor":true,"prefix":"","firstName":"Carolina","middleName":"","lastName":"Sandoval-Salinas","suffix":""},{"id":306316351,"identity":"a0b24fb0-423b-487f-a2cc-d6738855da55","order_by":1,"name":"Jose Benitez","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Jose","middleName":"","lastName":"Benitez","suffix":""},{"id":306316352,"identity":"4dff47ce-ded4-446e-93c0-df99def1736e","order_by":2,"name":"Eugenio Laborda","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Eugenio","middleName":"","lastName":"Laborda","suffix":""},{"id":306316353,"identity":"abaf0c9c-61fd-4b2f-8dc8-f4f325c8efc8","order_by":3,"name":"Juan MartinezP","email":"","orcid":"","institution":"Boston Medical Group","correspondingAuthor":false,"prefix":"","firstName":"Juan","middleName":"","lastName":"MartinezP","suffix":""}],"badges":[],"createdAt":"2024-05-21 21:25:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4457102/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4457102/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":69334683,"identity":"9b27d15c-643f-47e7-b53d-9c4f6c2eb44e","added_by":"auto","created_at":"2024-11-19 09:49:22","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1021887,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4457102/v1/f3bca439-0ccd-44a3-8e08-7e5a21c45b03.pdf"}],"financialInterests":"There is \u003cb\u003eNO\u003c/b\u003e conflict of interest to disclose.","formattedTitle":"Mixed-design cross-sectional study on the impact of quality of life and self-esteem in Spanish men with erectile dysfunction during COVID-19 pandemic","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eErectile Dysfunction (ED) is defined as the inability to achieve and maintain penile tumescence and rigidity, sufficient for satisfactory sexual intercourse (1). Prevalence rates of ED in men under 40 years of age have been reported to be between 1% and 10% (2), which increase with age, reaching values of 20% to 40% in men between 60 and 69 years of age and 50% to 100% in men over 70 years (3,4).\u003c/p\u003e\n\u003cp\u003eImpairment of erectile capacity affects not only sexual performance but also self-esteem, satisfaction, and quality of life, impacting mental health and relationships with others, which worsens as erectile dysfunction becomes more severe (5-7). Some studies in specific populations illustrate differences in quality of life between men with and without dysfunction, with other pathologies (8-16). For example, in diabetic men, erectile dysfunction is associated with an increase in depressive symptoms and a decrease in sexual quality of life (8,9). In the same way, in men with essential hypertension and ED it has been found low scores in the quality of life assessment with the Medical Outcome Study Short-form 36-Item Health Survey (SF-36) (10). \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe rising number of patients with erectile dysfunction in Spain is evident, given its association in most cases with prevalent cardiovascular risk factors in this country, such as diabetes, hypertension, hyperlipidemia, and obesity, and its direct correlation with age (17). In clinical practice, it is important to recognize aspects of erectile dysfunction, including its impact on the quality of life and self-esteem of affected men, so that comprehensive management interventions can be proposed and implemented. These interventions aim to improve outcomes that are of great importance to patients and even their partners. The objective of this study is to evaluate the degree of impact and factors associated with self-esteem and general and sexual quality of life in men with erectile dysfunction, consulting for this condition in different cities in Spain. This work was developed in the context of the COVID-19 pandemic.\u003c/p\u003e\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n"},{"header":"SUBJECTS AND METHODS","content":"\u003cp\u003eAn observational cross-sectional study with both quantitative and qualitative components was conducted. Men over 18 years of age with a clinical diagnosis of erectile dysfunction, an International Index of Erectile Function-Erectile Function domain (IIEF-EF) score less than 26, who were attending for the first time at a specialized male sexual health clinic in several cities in Spain, between March 2020 and September 2022, were included. Subjects with cognitive or physical illness that prevented them from completing the questionnaires, those who were illiterate, and those who did not sign informed consent for participation in the study were excluded. The protocol was reviewed and approved by the Ethics Committee for Research of the Fundación Jiménez Díaz in Madrid, Spain (Registry number: EO179-19_OTROS).\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eQuantitative Component\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eSociodemographic and clinical variables were collected using a form created for the study, including information on the participants' sexual life and health. The presence and degree of erectile dysfunction were assessed using the International Index of Erectile Function-Erectile Function domain (IIEF-EF), consisting of 6 questions scored from 0 to 5 for a total of 30 points, where a score of 26 or more suggests no erectile dysfunction (18). The Erection Hardness Score (EHS) was also used to assess the hardness of erection during the four weeks prior to the survey, with 5 response options ranging from 0 to 4: 0= The penis does not enlarge; 1= The penis is larger but not hard; 2= The penis is hard but not hard enough for penetration; 3= The penis is hard enough for penetration but not completely hard; 4= The penis is completely hard and fully rigid (19).\u003c/p\u003e\u003cp\u003eQuality of life was evaluated using the World Health Organization Quality of Life-BREF (WHOQOL-BREF) questionnaire, comprising 24 items in four domains: Physical Health, Psychological Health, Social Relationships, and Environment, plus 2 additional questions assessing overall quality of life and general health perception (20). Sexual quality of life was evaluated using the Sexual Life Quality Questionnaire (SLQQ), specifically its sexual quality of life dimension scale with 10 items (21). Finally, self-esteem was assessed with the Self-Esteem and Relationship (SEAR) questionnaire, consisting of 14 items in 2 dimensions: Sexual Relationships and Confidence, the latter subdivided into Self-Esteem and General Relationships (22). Scores for each scale (WHOQOL-BREF, SLQQ and SEAR) were calculated according to the authors' instructions, ranging from 0 to 100, with higher scores indicating better outcomes (20–22).\u003c/p\u003e\u003cp\u003eSpanish-validated versions of the questionnaires were used (23-26), except for the IIEF-EF questionnaire. The questionnaires were self-administered either in paper form, digitally, or via telephone by a research assistant during the COVID-19 pandemic, depending on participant preference. For the evaluations of the degree of dysfunction, quality of sexual life, self-esteem, and confidence in men without a current partner or without sexual relations in the last four weeks, the participant was asked to make his evaluation according to his last sexual encounters.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eQualitative Component\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eThe qualitative study aimed to understand the participants' perceptions of how erectile dysfunction affects different areas of their life beyond sexuality. Semi-structured interviews (27) were conducted based on the following guide questions:\u003c/p\u003e\u003col start=\"1\" style=\"list-style-type: lower-alpha;\"\u003e\n \u003cli\u003eWhat aspects of your everyday life, other than your sexual life, have been affected since you started experiencing symptoms of erectile dysfunction?\u003c/li\u003e\n \u003cli\u003eWhat customs or habits from your daily life do you think have changed since you developed the condition?\u003c/li\u003e\n \u003cli\u003eFrom your perspective, what factors or conditions do you believe positively or negatively influence your sexual dysfunction?\u003c/li\u003e\n \u003cli\u003eIf you had to describe an emotion related to your current situation, what would it be?\u003c/li\u003e\n\u003c/ol\u003e\u003cp\u003eThe interviews were conducted by a urologist with experience in this method who in turn took notes on the patient's attitude or behavior to complement the analysis. Interviews were audio-recorded and transcribed with patient consent.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eSample Size and Sampling\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eFor the quantitative component, a sample size of 359 patients was estimated based on the following parameters:\u003c/p\u003e\u003cul\u003e\n \u003cli\u003ePopulation size: 5254 patients with erectile dysfunction treated during 2018 in this medical center\u003c/li\u003e\n \u003cli\u003eHypothetical frequency of the outcome factor in the population: 50%\u003c/li\u003e\n \u003cli\u003eConfidence level: 95%\u003c/li\u003e\n\u003c/ul\u003e\u003cp\u003eA non-probabilistic, consecutive sampling method was used, including all patients who attended the clinic and agreed to participate, until the calculated sample size was reached.\u003c/p\u003e\u003cp\u003eFor the qualitative component, a sample of 21 patients was selected upon reaching the saturation criterion due to redundancy of information, which means that the new patients repeat what the previous ones had said and there is no new information (28). Subjects in this phase were survey participants who agreed to participate in the in-depth interview, seeking age group representativeness.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eDescriptive analysis of the clinical and demographic characteristics of the participants was performed, estimating measures of central tendency (mean or median) and dispersion (standard deviation or interquartile range) for numerical variables, based on data distribution assessed through graphical and statistical methods. Absolute and relative frequencies were estimated for categorical variables.\u003c/p\u003e\u003cp\u003eBivariate analysis was conducted to explore the relationship between clinical (degree of dysfunction, duration of dysfunction, comorbidities, previous treatment) or sociodemographic (age, educational level, occupation, marital status) variables and quality of life and self-esteem. Chi-square tests were used for categorical variables and t-tests or U-Mann–Whitney tests for numerical variables, depending on data distribution. No parametric regression models were developed to evaluate and quantify the association between different variables and quality of life, sexual quality of life and self-esteem. Variables included in the models were based on two criteria: 1) variables with significant results in the bivariate analysis (p-value \u0026lt;0.05), or 2) clinically relevant variables in the association between erectile dysfunction and quality of life, even if not statistically significant in the bivariate analysis (e.g., age and comorbidity). A 5% significance level and two-tailed hypothesis tests were considered for all tests. Analyses were performed using Stata 15.1 ®.\u003c/p\u003e\u003cp\u003eFor the analysis of data obtained from the semi-structured interviews, content analysis was used, involving coding and categorization of information to enhance understanding of the research event from the patient's perspective (29,30).\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003e353 men met the inclusion criteria and completed the survey for the study. Of these, 48 resided in Madrid and 31 in Barcelona, accounting for 23.02% of the participants. The median age of patients was 59 years old (IQR 16). 146 were retired (41.5%) and 122 were employed (34.6%). Marital status was reported as 169 married (48.0%) and 65 divorced (18.4%). 249 participants (70.5%) had comorbidities associated with erectile dysfunction, with primary hypertension being the most common (n\u0026thinsp;=\u0026thinsp;152, 43.1%), followed by diabetes (n\u0026thinsp;=\u0026thinsp;103, 29.1%) and prostate diseases (n\u0026thinsp;=\u0026thinsp;50, 14.2%). Regarding the history of Covid-19, only 71 patients (20.1%) answered this question, 51 of them affirmatively.\u003c/p\u003e\n\u003cp\u003eSexual orientation was predominantly heterosexual (n\u0026thinsp;=\u0026thinsp;346, 98.3%). 275 patients (77.9%) reported being partnered, with a median relationship duration of 4.8 years (IQR 32.3 years). The median frequency of sexual intercourse was 2 times per month (IQR 4), and the median time with erectile dysfunction was 36 months (IQR 60). The median IIEF-EF score was 12 (IQR 10), with 78.5% of participants (n\u0026thinsp;=\u0026thinsp;277) experiencing moderate to severe levels of the condition. The median score for the EHS was 2 (IQR 1) (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eDemographic, clinic, and sexual characteristics of the survey respondents\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"8\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eCharacteristics\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eMild\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMild - Moderate\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSevere\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAll patients\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;21)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;55)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;125)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;152)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;353)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003e\u003cem\u003eSociodemographic characteristics\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge (a)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e52 (\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52 (\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e59 (\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64 (\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e59 (\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e11 (52.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24 (44.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64 (51.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e70 (46.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e169 (48%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e4 (19.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11 (20.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22 (17.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28 (18.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65 (18.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e6 (28.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13 (24.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20 (16%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19 (12.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58 (16.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFree Union\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (9.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14 (11.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21 (13.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40 (11.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWidower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (1.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14 (9.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20 (5.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eCity of residence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMadrid\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e2 (9.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7 (12.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15 (12%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24 (15.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48 (13.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBarcelona\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e2 (9.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (10.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9 (7.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16 (10.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33 (9.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSevilla\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e1 (4.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (3.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (0.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9 (6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16 (4.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMurcia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (3.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (4.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14 (4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eValencia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e2 (9.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (5.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (2.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (3.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13 (3.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eZaragoza\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e1 (4.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (5.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (3.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (2.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12 (3.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAlicante\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e1 (4.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (9.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (3.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (0.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11 (3.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAlmer\u0026iacute;a\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (1.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (2.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (1.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7 (1.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBilbao\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e1 (4.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (3.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (1.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePalma de Mallorca\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (0.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (1.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLa Coru\u0026ntilde;a\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (3.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (0.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (0.85%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTorremolinos (M\u0026aacute;laga)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e1 (4.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (0.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (5.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (0.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOviedo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (1.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (0.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (0.56%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e10 (47.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23 (41.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e73 (58.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e74 (49%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e180 (51.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOccupation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRetired\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e1 (4.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9 (16.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e53 (42.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e83 (55%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e146 (41.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEmployee\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e12 (57.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29 (52.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38 (30.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43 (28.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e122 (34.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIndependent worker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e8 (38.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15 (27.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30 (24.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22 (14.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75 (21.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (1.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (3.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (2.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStudent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (1.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (0.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003e\u003cem\u003eClinical features\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eComorbidities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDiabetes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e1 (4.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9 (16.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35 (28%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58 (38.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e103 (29.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eArterial hypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e5 (23.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16 (29.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48 (38.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e83 (54.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e152 (43.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCardiovascular disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (3.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7 (5.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14 (9.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23 (6.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDepression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (3.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (0.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (1.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (1.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAnxiety\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (3.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (0.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (1.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eApnea\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (3.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (2.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (2.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9 (2.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHBP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e2 (9.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (3.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12 (9.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34 (22.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50 (14.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTestosterone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (0.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (1.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHypothyroidism\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e1 (4.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9 (16.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38 (30.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52 (34.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100 (28.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e14 (66.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29 (52.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39 (31.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22 (14.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e104 (29.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003e\u003cem\u003eConsumption history\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTobacco\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e7 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15 (27.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39 (31.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55 (36.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e116 (32.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAlcohol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (1.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (1.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (2.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7 (2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRecreational drugs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e1 (4.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (1.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7 (5.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (0.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (2.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003e\u003cem\u003eSexual history\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eSexual orientation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHeterosexual\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e21 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50 (92.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e123 (98.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e152 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e346 (98.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHomosexual\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (5.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (1.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (1.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBisexual\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (1.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (0.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWhit a partner\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e17 (81.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44 (80%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e102 (81.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e115 (75.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e275 (77.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRelationship Duration (a)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e12.5 (\u003cspan class=\"CitationRef\"\u003e26\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.5 (26.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7 (35.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.9 (29.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.8 (32.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFrequency of sexual intercourse (per month) (a)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e2 (\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTime with ED (months) (a)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e24 (\u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24 (48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36 (\u003cspan class=\"CitationRef\"\u003e36\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e54 (96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36 (60)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOther sexual dysfunctions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e6 (1.7%)\u003c/p\u003e\n \u003cp\u003e1 (0.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePremature ejaculation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e1 (4.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (1.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (1.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (0.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eLow sexual desire\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (0.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eErection Hardness Score - EHS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e3 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIIEF-EF score (a)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e23 (\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19 (\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14 (\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12 (\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"8\"\u003e(a) Median (Interquartile range). ED: Erectile dysfunction\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eIn the description on lifestyle factors, 116 participants were tobacco users (32.9%), averaging 19 cigarettes per day. Seven patients (2%) reported consuming more than 4 alcoholic drinks per day, and 10 (2.8%) indicated occasional use of recreational drugs (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003eQuality of life\u003c/h2\u003e\n \u003cp\u003eIn the assessment of global quality of life using the WHO-QLQ-BREF questionnaire, for question 1 (How would you rate your quality of life?), on a scale of 1 to 5 where 1 is \u0026quot;very poor\u0026quot; and 5 \u0026quot;very good\u0026quot;, 17.6% of the participants considered it very poor or poor and 54.9% considered it good or very good. In the question 2 (How satisfied are you with your health?) the results were 21.5% patients answered \u0026quot;very dissatisfied\u0026quot; or \u0026quot;dissatisfied\u0026quot; and 48.1% answered \u0026quot;satisfied\u0026quot; or \u0026quot;very satisfied\u0026quot;. In the evaluation of the 4 domains of this questionnaire, on a scale of 0 to 100, the median scores of the domains were: Physical health 75 (IQR 18), Psychological 75 (IQR 32), Social Relationships 50 (IQR 25), and Environment 75 (IQR 18) (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eQuality of life questionnaire scores and correlation with the severity of erectile dysfunction.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"7\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMild\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMild to moderate\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSevere\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSpearman\u0026rsquo;s Rho\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWB-Physical health\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e81 (\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75 (\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75 (\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e69 (\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.1173\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.0275\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWB-Psychological\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e81 (\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75 (\u003cspan class=\"CitationRef\"\u003e32\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75 (\u003cspan class=\"CitationRef\"\u003e32\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e81 (\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.0066\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.9011\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWB-Social relationships\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e69 (\u003cspan class=\"CitationRef\"\u003e31\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e56 (\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50 (\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50 (\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.108\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.0426\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWB-Environment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75 (\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75 (\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e69 (\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75 (\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.0248\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.6428\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSLQQ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40 (\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40 (\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36.3 (\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28.8 (23.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.1501\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.0047\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSEAR Total\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42.8 (20.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41.1 (30.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33.9 (19.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30.3 (22.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.1492\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.005\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSEAR-Confidence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41.7 (18.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41.7 (\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33.3 (\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33.3 (\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.0893\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.094\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSEAR-Self-Esteem\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37.5 (\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37.5 (\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37.5 (\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37.5 (18.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.0568\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.2876\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\"\u003eWB: World Health Organization Quality of Life-BREF. SLQQ: Sexual life quality questionnaire. SEAR: Self-Esteem and Relationship questionnaire.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eIn the evaluation of the sexual quality of life, lower scores were observed: median SLQ questionnaire 33.75 (IQR 22.5), median SEAR questionnaire 33.9 (IQR 23.2), median SEAR-Confidence domain 37.5 (IQR 25), and median SEAR-self-esteem sub-domain 37.5 (IQR 25). When differentiating scores based on the severity of erectile dysfunction, it was observed that more severe cases of the condition had lower scores on the SLQQ and SEAR questionnaires, and the domains Physical health and Social relationships of the WHO-QLQ-BREF scale, becoming evident a mild positive correlation between this variables (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003eIn the multivariate analysis was found that, independent of other evaluated factors, age is associated with the score of domains 2 and 4 of the WHOQOOL-Bref questionnaire, and time with erectile dysfunction is associated with domain 3 score. On the other hand, the frequency of sexual relations is associated with the scores of the SLQQ and SEAR questionnaires, and IIEF score is related with SLQQ score (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eMultivariate analysis of general and sexual quality of life, self-esteem, and confidence.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"5\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCoeficient\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eStandard Error\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCI 95%\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cem\u003eWHOQOOL-BREF \u0026ndash; Domain 1 \u0026ndash; Physical\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.191\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.116\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.037 to 0.419\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eComorbidity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.678\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.144\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0682 to 5.506\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.829\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIIEF score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.382\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.209\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.30 to 0.793\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.069\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFrequency of sexual intercourse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.215\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.406\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.584 to 1.014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.597\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMonths with erectile dysfunction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.028\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.068 to 0.013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.183\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eWHOQOOL-BREF \u0026ndash; Domain 2 \u0026ndash; Psychological\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.339\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.133\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.076 to 0.601\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.012\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eComorbidity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.525\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.615\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-4.586 to 9.637\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.485\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIIEF score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.239\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.241\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.235 to 0.712\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.322\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFrequency of sexual intercourse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.538\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.467\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.380 to 1.457\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMonths with erectile dysfunction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.060 to 0.034\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.587\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eWHOQOOL-BREF \u0026ndash; Domain 3 \u0026ndash; Social relationships\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.066\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.093\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.117 to 0.249\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.478\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eComorbidity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.969\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.524\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.996 to 8.933\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.117\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIIEF score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.213\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.168\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.118 to 0.543\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.206\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFrequency of sexual intercourse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.238\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.326\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.403 to 0.880\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.466\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMonths with erectile dysfunction\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e-0.043\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.017\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e-0.076 to -0.011\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.01\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eWHOQOOL-BREF \u0026ndash; Domain 4 \u0026ndash; Environment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.17\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.085\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.002 to 0.338\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.047\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eComorbidity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.247\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.313\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-4.303 to 4.797\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.915\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIIEF score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.197\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.154\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.106 to 0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.202\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFrequency of sexual intercourse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.217\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.299\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.371 to 0.805\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.468\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMonths with erectile dysfunction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.020 to 0.040\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.511\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSexual life quality \u0026ndash; SLQQ\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.037\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.112\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.258 to 0.183\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.741\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eComorbidity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e6.145\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e3.04\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.165 to 12.125\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.044\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eIIEF score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.457\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.202\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.059 to 0.855\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.025\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency of sexual intercourse\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.088\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.393\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.315 to 1.860\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.006\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMonths with erectile dysfunction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.062 to 0.017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.259\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSEAR Total\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.194\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.116\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.03 to 0.421\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.094\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eComorbidity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.863\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.136\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-5.30 to 7.031\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e783\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIIEF score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.393\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.209\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.01 to 0.803\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.061\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency of sexual intercourse\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.266\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.405\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.469 to 2.063\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.002\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMonths with erectile dysfunction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.05 to 0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.412\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eConfidence \u0026ndash; SEAR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.116\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.25 to 0.204\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.838\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eComorbidity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.582\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.153\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-5.61 to 6.785\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.853\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIIEF score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.135\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.209\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.27 to 0.548\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency of sexual intercourse\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.906\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.407\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.105 to 1.707\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.027\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMonths with erectile dysfunction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.0002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.04 to 0.038\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.913\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSelf-esteem \u0026ndash; SEAR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.131\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.02 to 0.289\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.103\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eComorbidity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.178\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-4.64 to 3.925\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.869\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIIEF-EF score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.099\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.145\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.18 to 0.384\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.493\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFrequency of sexual intercourse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.347\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.281\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.20 to 0.900\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.218\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMonths with erectile dysfunction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.04 to 0.014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.332\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003eWHOQOL-BREF: World Health Organization Quality of Life-BREF. Sexual life quality questionnaire. SEAR: Self-Esteem and Relationship questionnaire. CI: Confidence interval. IIEF-EF: International Index of Erectile Function, Erectile function domain\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e\n \u003ch2\u003eQualitative Evaluation\u003c/h2\u003e\n \u003cp\u003e21 men were included in in-depth interviews. Their narratives show that in many cases, erectile dysfunction does not impact aspects of their lives beyond sexual activity and relationships with partners. The subjects indicated that they have not experienced problems in other areas of life, such as work or social interactions (with family, friends, or acquaintances) due to this condition.\u003c/p\u003e\n \u003cul\u003e\n \u003cli\u003e\n \u003cp\u003eParticipant 1: \u003cem\u003e\u0026ldquo;No, on that issue it has honestly not changed me because the fact that I feel like going one night to be with friends, I have wanted to be with my girlfriend or my wife for a long time because I don\u0026apos;t feel like it because of the fear that I won\u0026apos;t be able to perform, that is the thing, the rest not at all, not even work, family, or nothing\u0026rdquo;\u0026hellip;\u003c/em\u003e\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eParticipant 2: \u003cem\u003e\u0026ldquo;No, just the sexual life, it [erectile dysfunction] hasn\u0026apos;t affected me in my daily life.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n \u003c/li\u003e\n \u003c/ul\u003e\n \u003cp\u003ePatients also reported no changes in their daily routines, customs or habits; they stated that they continued with their lives in a natural way except for one participant who reported increased alcohol consumption.\u003c/p\u003e\n \u003cul\u003e\n \u003cli\u003e\n \u003cp\u003eParticipant 1: \u003cem\u003e\u0026ldquo;Honestly, I haven\u0026apos;t considered this thing, it\u0026apos;s just that I work a lot, I get up at 7 am and I don\u0026apos;t stop until 10 pm and sometimes even later, so I practically don\u0026apos;t have time to think too much about this aspect.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eParticipant 2: \u003cem\u003e\u0026ldquo;Especially anxiety, I drink a lot more alcohol and smoke not because I stopped smoking 6 years ago\u0026hellip;\u0026rdquo; \u0026ldquo;\u0026hellip; Now, what I do, let\u0026apos;s say, is that I drink more than I should.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n \u003c/li\u003e\n \u003c/ul\u003e\n \u003cp\u003eThe participants acknowledged that factors such as unhealthy diet, sedentarism, stress, anxiety due to dysfunction, age, and mood, affect erection. It was also identified from their narratives that it has become more challenging to relate with their partners or new women since experiencing ED, with prevailing emotions being frustration, anxiety, and in some cases, profound sadness. Some patients expressed hope for starting treatment for this condition.\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eOur findings suggest that, in Spanish men who consult for erectile dysfunction, their quality of sexual life, self-esteem and confidence is affected by this condition, independent of other variables such as age or other comorbidities, with median scores below 40 out of a possible 100 on questionnaires assessing this constructs. In our opinion, these results can be explained as 78.4% of patients presented with severe or moderate ED, and 59.7% were unable to achieve an erection hard enough for penetration, emphasizing the significant impact of this factor on the participants' perception of sexual quality of life. Clinically, it is observed that few men seek early consultation for ED, and it is common for them to visit a specialist only after several months of trying self-treatments without satisfactory results. Additionally, lack of control over comorbidities such as diabetes or hypertension worsens their condition at diagnosis.\u003c/p\u003e\n\u003cp\u003eAn interesting finding of this study is that in the patients' perception, erectile dysfunction does not affect other areas of their life. Only 17.6% of the participants considered it very poor or poor their quality of life, and the median score of the domains evaluated with the WHOQOOL-BREF questionnaire were over 70 with the exception of the Social relationships domain which include a question about satisfaction with the sexual life. These results are similar from those reported by Ezemenahi \u003cem\u003eet al\u003c/em\u003e, in their study in hypertensive men with erectile dysfunction in southern Nigeria (31), but they differ slightly from what was reported by other authors in studies carried out in populations with other comorbidities, as well as in population studies,\u0026nbsp;which can be explained by the differences in the population, the time of application of the survey and the questionnaire used (8,11,32,33).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe results of the in-depth interviews confirmed the findings of the quantitative phase. No significant impact was found on other life aspects since experiencing symptoms of ED, contrary to what is reported by Elterman \u003cem\u003eet al\u003c/em\u003e., who show increased work absenteeism and reduced work productivity in men with ED compared to those without (34). This might be explained by partner support or diminished importance attributed to sexual life, seeking satisfaction in other life aspects such as work. Another explanation could be the age of participants, as 49.8% were over 60 years old, a life stage where sexuality, from a reproductive perspective, has mostly fulfilled its purpose and thus loses relevance as a key aspect of life quality. On the other hand, the COVID-19 pandemic could also affect the results because in a situation that generated so much stress, panic and uncertainty, sexuality become a secondary aspect (35,36). However, we do not have a way to verify this hypothesis, since there was very little patient participation in this question.\u003c/p\u003e\n\u003cp\u003eThis study presents several limitations: first, the variability in questionnaire administration due to changes in care during the Covid-19 pandemic, which can introduce bias from social desirability when the survey is done by telephone by research assistant. It has been shown that when faced with sensitive topics, participants in research studies change their answers when the questions are asked by an interviewer compared to self-administered questionnaires (37), and sexual health can be a sensitive topic for many men. Second, is its cross-sectional nature without follow-up, not considering changes in perception since starting treatment. Third, we did not evaluate all variables associated with a person's quality of life, such as income level or support from family or friends. Fourth, sampling in the qualitative component was based on different ages but not socioeconomic or education, this has likely affected the sample and that is why there is so much similarity in the responses of the participants. Fifth, we did not use a validate version in Spanish population of the IIEF-EF questionnaire. Sixth, despite the effort to inquire about Covid-19, only 20.1% of the participants responded whether they had had this infection, so it was not possible to evaluate its effect in this study.\u003c/p\u003e\n\u003cp\u003eStrengths include the use of both quantitative and qualitative methodologies providing a broader view of patient perception, the inclusion of men with erectile dysfunction from different regions of Spain, the use of questionnaires validated in the Spanish population (except for the IIEF-EF questionnaire), and the assessment of the self-esteem and the confidence. Although in 2003 an evaluation of the quality of life in men with erectile dysfunction was carried out at a population level in Spain (5), our study makes an evaluation two decades later considering the change in the perspective of quality of life in actual society and complementing it with the evaluation of self-esteem and confidence in this group of patients, in the context of a serious pandemic.\u003c/p\u003e\n\u003cp\u003eFrom the perspective of physicians and professionals involved in treating men with this pathology, it is necessary to treat their dysfunction comprehensively to cure it where possible or at least improve symptoms, regardless of etiology. This approach aims to enhance overall and sexual quality of life, as well as self-esteem and confidence.\u003c/p\u003e\n\u003cp\u003eIn conclusion, the results suggest that ED primarily affects sexual quality of life of Spain men who consult for this condition, without significantly impacting overall quality of life or daily life activities. Further studies are recommended to corroborate these findings, including the perspectives of patients' partners, other populations, and the comparison with men without ED.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the corresponding author, C.S.S., upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank Mercedes Rodriguez who conducted the surveys, Juan Manuel Aguilera for his support in the interviews, and the team of doctors and advisors who supported the inclusion of patients in the study. The authors thank Dr. Manuel Mas Garcia and his research team for providing the SLQQ questionnaire in the version validated in the Spanish population.\u003c/p\u003e\n\u003cp\u003e \u003ch2\u003eAuthor Contributions Statement\u003c/h2\u003e \u003cp\u003eJ.B.M, E.L. and C.S.S conceived the study and wrote the article. C.S.S designed the methodology, did data curation, and formal analysis, J.M.M. supported data curation, and wrote a section of the article.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eEthical Approval\u003c/h2\u003e \u003cp\u003eThe protocol was reviewed and approved by the Ethics Committee for Research of the Fundaci\u0026oacute;n Jim\u0026eacute;nez D\u0026iacute;az in Madrid, Spain.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCompeting interest\u003c/strong\u003e \u003cp\u003eThe authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThe study was funded by Boston Medical Group.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eHackett G, Kirby M, Wylie K, Heald A, Ossei-gerning N, Edwards D, et al. 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Res Reports Urol. 2021;13:79\u0026ndash;86. \u003c/li\u003e\n\u003cli\u003eWang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, Ho RC. Immediate Psychological Responses and Associated Factors during the Initial Stage of the 2019 Coronavirus Disease (COVID-19) Epidemic among the General Population in China. International Journal of Environmental Research and Public Health. 2020; 17(5):1729. doi.org/10.3390/ijerph17051729\u003c/li\u003e\n\u003cli\u003eTaylor, S. COVID Stress Syndrome: Clinical and Nosological Considerations. Curr Psychiatry Rep 23, 19 (2021). doi.org/10.1007/s11920-021-01226-y\u003c/li\u003e\n\u003cli\u003eLatkin CA, Edwards C, Davey-Rothwell MA, Tobin KE. The relationship between social desirability bias and self-reports of health, substance use, and social network factors among urban substance users in Baltimore, Maryland. Addict Behav. 2017;73:133-136. doi:10.1016/j.addbeh.2017.05.005\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Erectile dysfunction, Quality of Life, Self-Esteem, Confidence, Cross-Sectional Studies, Mixed methods research","lastPublishedDoi":"10.21203/rs.3.rs-4457102/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4457102/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eA cross-sectional study incorporating quantitative and qualitative analyses was conducted between 2020 and 2022, to evaluate the perception of quality of life and self-esteem in men with erectile dysfunction (ED), exploring factors associated with these psychological constructs. General and sexual-specific quality of life, self-esteem, and confidence, were measured in men with ED in Spain, using the World Health Organization Quality of Life-BREF (WHOQOL-BREF) questionnaire, Sexual Life Quality Questionnaire (SLQQ), and Self-Esteem and Relationship (SEAR) questionnaire. Comprehensive interviews were conducted to deepen the understanding of how ED impacts various aspects of life. 353 men participated in the quantitative phase and 21 in the qualitative phase. 54.9% of participants rated their general quality of life as good or very good. No association was found between the perceived quality of global life and the quality of erection or severity of ED. The median SLQQ score was 33.75 (IQR 22.5), and the median SEAR subscale self-esteem score was 37.5 (IQR 25). It was found that the duration of ED and the frequency of sexual activity influenced self-esteem and confidence in men with ED. In the qualitative assessment, the subjects considered that ED did not influence aspects of their life unrelated to sexual health.\u003c/p\u003e","manuscriptTitle":"Mixed-design cross-sectional study on the impact of quality of life and self-esteem in Spanish men with erectile dysfunction during COVID-19 pandemic","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-05 17:46:58","doi":"10.21203/rs.3.rs-4457102/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ea64b791-e53e-4f9a-aefd-888c83a62bf4","owner":[],"postedDate":"June 5th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":32354380,"name":"Health sciences/Health care/Quality of life"},{"id":32354381,"name":"Health sciences/Diseases/Urogenital diseases/Erectile dysfunction"}],"tags":[],"updatedAt":"2024-11-19T09:41:15+00:00","versionOfRecord":[],"versionCreatedAt":"2024-06-05 17:46:58","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4457102","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4457102","identity":"rs-4457102","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}