Developing Supporting System to Promoting and Enhancing Quality of Life - Research Paper Example

? Developing Supporting System to Promoting and Enhancing Quality of Life In Erectile Dysfunction (ED) After Pro ctomy Lecturer The research Problem One of the most inevitable aspects of the human life span is aging. What makes aging a great issue within the health community is that it brings with it numerous degenerative diseases and conditions. Some of these degenerative diseases include osteoarthritis, Amyotrophic Lateral Sclerosis (ALS), Alzheimer’s disease, atherosclerosis, rheumatoid arthritis, Huntington’s disease, heart diseases and numerous others. Sometimes, some degenerative diseases or conditions affect one gender more than the other. For example, females have to deal with menopause and all the complications such changes in the body bring about. For males, one of the conditions most have to face is erectile dysfunction. Erectile dysfunction (ED) involves the inability to maintain, or even achieve, an erection that is adequate for satisfactory sexual intercourse (Black & Hawks, 2009).Although some temporary cases of erectile dysfunction have been documented in males, these can be attributed to factors other than the degeneration of the human body. What is clinically relevant for healthcare providers as well as researchers is erectile dysfunction that involves a consistent failure to achieve and/or maintain erection which affects around half of all attempts at sexual intercourse. It is a common problem affecting men and thus impacting on the quality of life and their partners. This result into fear, loss of self esteem (self image), self confidence and depression (Aversa et al, 2004).It has been estimated to affect more than 150 million men with only 20% of men seeking medical attention (Aversa et al, 2004). In USA it affects between 20 to 30 million with risks of development being high with increasing age (Hellstrom et al, 2002). Numerous reasons have been provided for erectile dysfunction, including both psychological and physical factors. Psychological causes may involve stress, depression, relationship changes, low self-esteem, fatigue, performance anxiety, and numerous others (Ignatavicius & Workman, 2006). Although psychological causes are sometimes more common in temporary cases of erectile dysfunction, these factors can aggravate the dysfunction brought about by physical causes, especially among older males. On the other hand, physical reasons for erectile dysfunction include diminished testosterone levels, thyroid dysfunction, hyperprolactinemia, cardiovascular diseases, endocrine problems, and even the decrease in penile response to nitric oxide, the neurotransmitter responsible for the erection of the penis (LeMone, Burke, & Bauldoff, 2011). Another well-documented reason attributed to erectile dysfunction is prostatectomy. Prostatectomy involves the removal or resection of a portion of a prostate due to enlargement of the prostate or one of its lobes (Brunner, Smeltzer & Bare, 2010). Studies have established that one of the expected complications of prostatectomy, specifically radical prostatectomy, is erectile dysfunction. Such a complication is most attributed to the damage caused on nerves during the surgery involving the resection of the prostate. These damages can be attributed to actual physical trauma on the nerves involving penile erection, or to complications from the anesthetic used (Lewis, et al., 2011). Still, it must be acknowledged that almost all forms of prostatectomy, even those that aim to spare the nerves (i.e. laparoscopic and robot-assisted prostatectomy), lead to erectile dysfunction, although to varying degrees (Zippe, Nandipati, Agarwal, & Raina, 2006). Identifying problems The identified problems are lack of knowledge about the option treatments, emotional distress anxiety about performance, dissatisfaction, impaired self esteem which affect personal relationships, lack of support and understanding from other significant, spousal dissatisfaction and quality of life affected (Aversa et al, 2004; Shabsigh, Perelman, Laumannn & Lockhart, 2004; Dean et al., 2007). Population characteristics The data was targeting men aged 50 to 75 years. The baseline survey was carried out via phone to assess ED in 20 males who participated in pretest on ED. International Index erectile function assessment (IIEFA), sexual quality of life in men was used as the measurement tool. 12 patients have wives while the remaining 8 have girl friends. 18 of them reported erectile function important to them and affect quality of life. 15 spousal agreed to participate in the group support and the 20 patients had no knowledge of different treatment options. Developing objectives The developing objectives used in this research included the following: 1. Increase general knowledge regarding ED and changing of body composition after prostatectomy after prostatectomy (What it is, how does it occur, the prevalence, options of treatment), 2. Increase patient level of comfortable to express his concerns and worries about ED and anxiety about sexual performance. 3. Increase the involvement of other significant in treatment along with patient. 4. Encourage patients and their partner in sharing the concerns about their sexually intimacy, performance and satisfaction. Literature Review In order to help the researcher in carrying out an authoritative research, it was necessary to read a lot of publications on this topic. Hence, a lot of information was sourced from various secondary sources written by people who have carried out a lot of research on this topic. This was preferred because it would give the resaearcher background upon which the data collected would relly on as an academically sound article made up of citations from reputable scholars. According to the National Institutes of Health (NIH), erectile dysfunction in its entirety affects around 30 million males across the United States, a big percentage of which can be found among older males (Jonas, Thon, Stief, & Abicht, 2000). Alivizatos and Skolarikos, (2005) has explained that the incidence of ED after radical prostatectomy has remained higher as compared to other therapies for prostate cancer. The potency rates vary from 11 to 87% with the main contributing factor being the surgical technique used (Alivizatos and Skolarikos, 2005).The variation in potency presercation appears to be dependend on surgeon but it can also be to nonuniformity of data collection. This is also because the criteria used to assess sexual satisfaction or positive erectile responses are not applied universally in each study (Alivizatos and Skolarikos, 2005).The variation in results is also because there is no clear cut between partial and full erection, or rigid erection and attempts.However, potency has shown to be high in young men and where there is preservation of one or both neurovascular bundles (Hellstrom et al, 2002). Erectile dysfunction has been documented as a complication arising after prostatectomy. Different degrees of erectile dysfunction are very much common following prostatectomy, and studies indicate that it may take up to four years for males to recover erectile function (Meuleman & Mulders, 2003 Different underlying mechanisms have been revealed to cause erectile dysfunction after prostatectomy. For one, the nerves leading to the penile area can become damaged or traumatized during surgery. During surgery, arteries and veins may also be damaged, which will reduce and affect the flow of blood into the penis, which will then again affect erection. In addition, the psychological effects of a diagnosis of prostate problems, as well as the psychological effects of the surgery (such as anxiety and depression) can lead to erectile dysfunction (Rabbani, Stapleton, Kattan, et al., 2000). In terms of the arteries, arteriogenic erectile dysfunction can be seen as a result of the transection of the aberrant or accessory pudendal arteries. These arteries serve as sometimes the sole blood supply of the corpora cavernosa, whether bilaterally or unilaterally (Walz, et al., 2010). Rogers, Trock, and Walsh (2004) added the preservation of the said blood vessels can provide greater chances of recovery of penile potency. On the other hand, in terms of erectile dysfunction from damage of the veins, venogenic erectile dysfunction is due to the fibrosis of the smooth muscles of the penile area, with a heightened collagen expression that comes as a result of the increased release of profibriotic cytokines (Leungwattanakij, et al., 2003). The increased release of collagen then in the muscles of the corpora prevents sufficient compression of the venules of the subtunica, causing a leakage in the veins. Based on the study by Mulhall, et al. (2002), the risk of having a venous leakage after prostatectomy, specifically radical prostatectomy is around to 50% among the study participants. A significant characteristic of venogenic erectile dysfunction is that patients with this form of impotency have a higher degree of recovery than those who have arteriogenic erectile dysfunction. Another condition that complicates erectile dysfunction after prostatectomy is the presence of Peyronie’s disease. Ironically, though, Peyronie’s disease has been found to have a higher incidence among males who underwent prostatectomy, especially when compared to the general population. Yet, Peyronie’s disease has been found to further increase the chances of developing erectile dysfunction after prostatectomy by up to 50% (Bella, 2007). Still, although no explicit link between surgery and the development of Peyronie’s disease have been found, it is theorized that the curvature of the penis results from intercourse attempts with a penis that is relatively flaccid, causing injury and scarring. In terms of nerve injury, erectile dysfunction has been found to be caused by damage or injury to the postbilateral cavernous nerve. According to Vignozzi, et al. (2009), the said form of injury involves a hypogonadal-state, which implies possibilities for focusing treatment on the hypogonadal area. Indeed, in a study by the same author conducted among rats, they found that by administering testosterone to the rats with erectile dysfunction from hypogonadal-state post bilateral cavernous nerve injury, certain aspects of the erectile dysfunction improved. Some of these aspects of the erectile dysfunction include the endothelial dysfunction, as well as the penile smooth muscle’s collagenization. In addition, another form of nerve injury that leads to or affects erectile dysfunction is one that was caused by a transection of the cavernous nerve. This transection usually comes with a dissection or nerve traction of the cavernous nerve. Any trauma on the nerves leads to the fibrosis and atrophy of the smooth muscle of the corpora, causing failure of the penis to erect and/or maintain erection. The said neural trauma also leads to the decrease of nerves producing nitric oxide synthase, and enzyme necessary for penile function (Carrier, Zvara, Nunes, Kour, Rehman, & Lue, 1995). Current ED therapies can be divided into 2 categories: non pharmacologic and pharmacologic agents (Zippe, Nandipati, Agarwal & Raina, 2006). There are numerous treatment options available to correct erectile dysfunction and they include penile rehabilitation (Mulhall & Morgentaler, 2007), especially for younger males who have great chances of recovery. However, for some older patients with erectile dysfunction after prostatectomy, rehabilitation may become an impossible ordeal. In such cases, even in those where a successful erection is possible, one intervention that is needed is the provision of a steady support system for the patient. Some recommendations for erectile dysfunction include medication, assistive devices or surgery, penile rehabilitation, and others. Medications for erectile dysfunction are numerous, but some of the most common include phosphodiesterase type 5 (PDE5) inhibitors, which are considered as the first-line of treatment for erectile dysfunction especially after prostatectomy. This medication is given orally, and administration instructions are rather easy to follow. Although different strategies are employed in their use, the user must first have an intact nerve connection to the penis, since the PDE5 works more on the smooth muscles of the penis (Hatzimouraditis, Burnett, Haztichristou, McCullough, Montorsi, & Mulhall, 2009). Other medications and alternatives for erectile dysfunction include intraurethral suppositories of Alprostadil. These Intrauterine Alprostadil Suppositories or IUAs work by providing a direct access of the drug to the area needing erection, and this treatment has been found to be very successful for erectile dysfunctions after prostatectomy. Another treatment for erectile dysfunction is the Intracorporeal Injection (ICI) therapy, which injects alprostadil into the corpora, and it is recommended for males who failed to achieve erection with oral agents (Padma-Nathan, et al., 1997; Ciaro, et al., 2001). Other treatment and management options for erectile dysfunction that does not necessarily involve the use of medication include penile prosthesis and vacuum erection devices. Both of these interventions involve easier means of erection and intercourse, since minimal modifications are really needed once the artificial devices are in place. These devices are also both safe and effective, although they are sometimes only recommended when the patient has failed to respond to the medications, either oral or otherwise (Moskovic, Miles, Lipshultz, & Khera, 2011).Segal and Burnett (2011) also recommended other therapies that are worth looking into in the treatment and management of erectile dysfunction, such as the use of erythropoietin and gene therapy. Psychosocial care for patients with erectile dysfunction is somehow much more complicated that the physical ones because males are almost always ready for alternatives that can help them readily have an erection, rather than opt for alternatives that involve changing their manner of thinking and behavior. Still, in essence, psychosocial interventions for patients with erectile dysfunction involve basic counseling to help the patient cope with the idea of impotence, both reversible and permanent. Counseling should bring out the patient’s feelings and ideas regarding the impotence, to help them come to terms and then deal with it (Wittmann, et al., 2009). Indeed, this concept was explored in the study by Vahlensieck, Sommer, Mathers, Gilbert, and Waidelich (2011), where they looked into the perceptions of erectile dysfunction patients in relation to their experience with impotence, as well as their rehabilitation after surgery. The study found that older males and more sexually active males found erectile dysfunction a greater burden or problem. However, for those undergoing rehabilitation and counseling, the ordeal of facing erectile dysfunction was much more bearable and easier to tolerate as compared to the group not undergoing rehabilitation. Similarly, the study by Wittmann, et al. (2009) looked into the psychosocial aspects of sexual recovery among males with, and who underwent treatment for, prostate cancer. The said treatment involved prostatectomy, and recovery involved dealing with erectile dysfunction. The study found that the availability of education as well as psychosocial care for patients with erectile dysfunction helps reassure patients that there is a support system available for them, and this could then encourage them to seek help to restore sexuality and intimacy for a couple’s life. By seeking help, the patients can be assured of greater chances of recovery or if not, at least of acceptance of their condition. Despite the availability of all these treatment options, erectile dysfunction has remained to be a serious clinical issue especially in prostatectomy patients, where recovery is sometimes difficult, if not impossible. This is especially true among patients aged 50 to 76, where erectile dysfunction after prostatectomy is most common (White & Duncan, 2002).Indeed, among patients who underwent prostatectomy, five to ten percent experience erectile dysfunction after their surgery. This statistic is most especially concentrated among the elderly male population, wherein almost around 90% of patients who underwent prostatectomy experience erectile dysfunction (Mulhall & Morgentaler, 2007). In fact, McCullough (2005) added that more than 50% of males with prostate cancer, especially those who have undergone prostatectomy, are at a high risk of erectile dysfunction. Indeed, erectile dysfunction after prostatectomy becomes such a serious issue because of the fact that after every surgery involving the prostate, almost all males experience erectile dysfunction. According to (Padma-Nathan, McCullough, Guiliano, et al., 2003), psychogenic, morning, and nocturnal erections disappear almost immediately after erectile dysfunction. Although recovery is possible for some males, erectile dysfunction becomes a persistent problem for others, especially those belonging to older populations. As stated earlier, these cases especially involve support from their significant others and healthcare professionals. For many communities and hospitals they have support groups for people with various ailments such as ED. These support groups can be national groups or local groups trained or who have undergone through a similar health condition. They can be family members, friends and health care professionals. They play an essential role by offering moral, physical care, emotional, psychotherapy and motivational support (Shreard & Maguire, 1999). Psychotherapy support is very vital especially if the patients find it hard to cope with diagnosis, treatment and changes in life and their relationships. Psychotherapy can take the form of individual therapy or group therapy and addresses the feelings that arise due to changes in life, financial constraints and self esteem. Support groups have been found to be useful in preventing symptoms of anxiety (Shreard &Maguire, 1999). It is not all men who find such groups useful. Barriers to support systems in improving quality of life stem from social, religion, interpersonal and cultural factors (Shreard &Maguire, 1999). Findings Lack of knowledge about available therapies Lack of knowledge on the available treatment options on ED and on the effects of aging on sexual response is a major impediment to improvement of life quality. Based on US department of education survey, it is only 36% of US population that has either basic or below basic health education literacy (Andreus &Roth, 2002). This implies that they have difficulties in finding hospitals, doctor’s office, filling hospital and insurance forms. Due to poor levels of education this affects access to medical care as education make general population better aware of pathological causes of ED. Disparity in health care seeking is because the patients may have misconceptions which may preclude them from adopting such medications as viable forms of treatment (Schnittker, 2004). Lack of education and awareness is very important in making decisions about health. All men ought to learn about physiology, morphology of prostate, sexual function and their anatomy. Prostate glands play a significant role in the reproductive system. The complexity of sexual function rotates around erection, ejaculation and achieving organism. For this lifecycle to be complete one should mentally competent, function well anatomically, physiologically and have biologically active sexual organs (Lunelli, Rabello, Stein, Goldmeier, and Moraes, 2008). Loosing of sexual function can lead to stress, confusion, anxiety and depression. Regular screening of prostate cancer at early stages and awareness about the condition is very vital. Early diagnosis help to prevent risks which may arise due to treatment options adopted. Lack of information about ED and sexual activity is not only related to schooling as both partners and healthcare provider often term sex as a hard topic due to surrounded taboo in our society and surrounded prejudice (Lunelli, Rabello, Stein, Goldmeier, and Moraes, 2008).The strategy for solving this barrier is by educating patients on the available ED therapies together with their advantages and disadvantages. This will help them understand the pathological causes of ED and correct beliefs that sexual activity among the old people is not desirable or seeking medical help is an embarrassment (Shabsigh, Perelman, Laumann and Lockhart, 2004). Impaired self esteem Diminished capacities to perform physical and sexual acts can cause disappointment and depression (Harden, Northouse and Mood, 2006) .Lack of sexual capacity may lead to reduced self esteem and if coupled with anxiety it may hamper restoration of normal erectile function. Impaired self esteem accounts for 10 to 20 % causes of erectile dysfunction (Harden, Northouse and Mood, 2006).Impaired self esteem is a common problem among young men and it forces them to use drugs such as alcohol which is a predisposing factor to ED (Harden, Northouse and Mood, 2006). Patients with low self esteem should be encouraged to voice their concern about ED. Encouraging the patient to join support groups will also help in building their self esteem, self motivation and confidence (Shreard & Maguire, 1999; Munn- Giddings & McVicar, 2006). The intervention for addressing this barrier is by counseling of the patient and having one-on-one discussion with a primary care provider. In this discussion the health care provider will investigate any physical problems, possible fears, anxiety of sexual performance and predisposing diseases. He/she will also try to uncover any history of previous sexual trauma. Life styles such as smoking should also be discussed as they are predisposing factors. Where the health care provider doesn’t have enough knowledge and skills to deal with the emerging concerns, he will offer referral services (Lunelli, Rabello, Stein, Goldmeier, and Moraes, 2008). Family dynamics/ family influence /Lack of spousal support/Relationship problems In situations where family members had a member whose quality of life didn’t improve after medication, this is likely to make future patients to be reluctant in seeking medical help or changing life style in case of ED (Shabsigh, Perelman, Laumannn & Lockhart, 2004). Recent studies have shown that the best long lasting term therapy outcomes are realized when both partners are willing to be involved (Dean et al., 2007).However lack of support may occur when the woman beliefs that ED is purely a man’s responsibility or when there are unresolved relationship problems or feelings of embarrassment or shame. In such situations, the relationship barriers should be addressed through counseling (Dean et al, 2007). Studies have shown that for successful long term ED treatment, there should be good communication between the partners and the physician (Aversa, 2004). With good communication major challenges such as treatment rejection are broken, early diagnosis and treatment are initiated reducing the progression of associated comorbids and changes in lifestyle which is predisposing factor Early diagnosis will also lower the long lasting negative psychological effects on the couples which may arise dues to ignoring sexual problem for years (Aversa, 2004). Fear or emotional concerns and anxiety about sexual performance The daily fears of dealing with ED can make the patient hopeless. This may prevent him from adhering to treatment regimens. The patient may become overwhelmed on how the condition will change his life. Lack of patient’s motivation can make him become accustomed to being sick (Shabsigh, Perelman, Laumannn & Lockhart, 2004). Anxiety has been shown to play a role in the development of the problems linked to ED. It is a common problem among young men who put a lot of emphasize on their ability to satisfy their partners. This pushes them to use alcohol and other drugs which cause erectile dysfunction (Ignatavicius & Workman, 2006).Sometimes it may overlap with other sexual disorders or depression due to response to health and personal issues. Depression interferes with sexual neurobiology of sexual desires thus causing loss of sexual desire and a lowered mental arousal (Aversa et al, 2004).Depression therefore affects quality of sexual life among couples as well as the positive response to sexual cues. The end result of this neuropsychiatric disorder is a vicious cycle of elevated uneasiness, intimacy avoidance, reduced frequency of sexual life, reduced time spent together among couples and reduced communication among couples in terms of relationship (Aversa et al, 2004).Anxiety is managed through psychological counseling of the patient and the spouse on sexual barriers. Sex therapy can also be offered if required (Moskovic, Miles, Lipshultz, & Khera, 2011). Patient-based Program: Interpersonal, supportive, and behavioural therapy will be initiated. Education will be done using brochure about ED and detailed brochure of different type of treatments including their advantage and disadvantages. Group therapy will also be used where patients will share their experiences with one another. In addition to this, psychological counselling of the patients and their spouse about sexual barriers of uncertainty, embarrassment, and privacy concerns will be done. Sex therapy if needed will be offered. Data analysis The results were tested and evaluated using the T-test method. This would be considered the best alternative in evaluating both the pre test and the post test results to help the researcher to come up with the good analyses that can be relied on as the correct and accurate information for this kind of research. More importantly, the use of Welsch’s T test would be very useful particularly when analyzing the results of samples with a great possibility of having unequal variance as was the case in this research. Identifying Outcomes and measurement of Outcomes: (1) Process outcome:- Participation on ED assessment, pretest, (IIEFA), sexual quality of life in men, number of spouse participate (Letwin, Nied and Dhanani, 1998) (2) Shorterm outcome:- gain knowledge of ED and different treatments, improved confidence to share their concerns (3) intermediate outcome:- utilizing the treatment brochure and participation in group support (4) ultimate outcome:-promote and enhance quality of life for Erectile Dysfunction after (Andreus &Roth, 2002). Identification of measurement tools Those who participated in the support group among men comprised of 7African American, 4 Caucasians and 1 Hispanic. 4 of the spousal and 1 girl friend also showed up at the group support. 12 did post test about the knowledge of ED option treatment and it showed that they had gained more understanding about ED after prostatectomy and different treatments. The prevalence of ED was 90% while the overall participation in the support group was recorded as 48.57%.Men participation in support groups was 34.28% while spousal participation was 14.29%. On the other hand, percentage increase in knowledge was 60%. Fig.1 This study shows a high ED prevalence of 90% and a low overall participation in support groups of 48.57%.This study is in agreement with other studies which have shown that out the estimated150 million people with ED, its less than 50% who participate in support groups or seek medical help (Aversa et al, 2004). This means that mortality and morbidity due to ED and the associated cormobids will continue to be high.This is because participating in support groups has been found to help in building self confidence, self esteem and motivating ED patients to seek medical help (Munn-Giddings & McVicar, 2006).A low spousal outcome of14.29% was recorded and this means that a long lasting term therapy outcome may not be realized.This is because studies have shown that for successful ED treatment, spousal support is required (Aversa et al, 2004).Lack of support may occur when the woman beliefs that ED is purely a man’s responsibility or when there are unresolved relationship problems (Dean et al, 2007). However,gained knowledge about ED and treatment therapies available was recorded at 60% among the support group participants.The implication of increased knowledge is that more ED patients will be in a position to seek medical help as they are better aware of the pathological causes of ED and option treatments available (Andreus & Roth, 2002).Gained knowledge will also help in correcting beliefs that sexual activity among the old is not desirable or seeking medical help is an embarrssment especisally in male dominated societies (Shabsigh, Perelman, Laumann & Lockhart, 2004). The end result of all this is a reduced mortality and morbidity due to ED and its cormobids and this will consequently improve the quality of life. Methods or tools to measure outcomes: Measurement of the outcomes is achieved by using pre/post test about ED and treatments options available, international Index erectile function assessment (IIEFA), sexual quality of life in men. International index of erectile function assessment (IIEF) is an internationally recognized tool used for epidemiological studies and addresses domains of male sexuality such as libido, satisfaction with sexual encounters, orgasm and erection. It is a 5 questionnaire and the answers to these questions are rated as either very low, low, moderate, very high or high with scores of 1, 2, 3, 4 and 5 respectively (Rosen, Cappelleri, Smith, Lipsky & Pena, 1999). A score of 26-30 denotes no ED while score of 17-25 denotes mild condition. On the other hand, a score of 11-16 shows moderate ED while a score of 6-10 denotes severe ED (Rosen, 1999). IIEF is mainly used in favour of self assessment questionnaires as the later involves individual perception (Rosen, Cappelleri, Smith, Lipsky & Pena, 1999). Strengths and limitations in the interventions In this study the use of brochures on ED led to an increase of knowledge by 60% percent. When it is combined with other interventions such as one-on-one discussions better outcomes can be realized. One-on-one method allows the participant to explore areas of personal interest and which motivates them. However, limitation can occur when there are insufficient materials. The low overall participation in support groups can be increased by offering transportations to the participants. Another limitation in this study is the sample size. A small sample was used and it may not be a true reflection of prevalence condition in the entire population. However it was obtained randomly from the population through phone call. Recommendations In addition to addressing barriers to support systems it is recommended that the physician should provide accurate and responsible preparations of the patients prior to prostatectomy. This is by providing the couples with full information on the potential side effects of surgery. Optimizing of treatment options will also help in reducing side effects and it should therefore be encouraged. This means that those treatment options with minimal side effects such as nerve sparing technique should be adopted in order to preserve sexual function (Brewer & Kim, 2008) Referral services should also be used to help couples adjust to changes in sexual functions. This will allow screening of men to determine risk of psychological distress. Adherence to principles of sexual rehabilitation should be encouraged in order to help couples discuss options to maintaining sexual life. This will also help them to cultivate attitudes of persistent and optimism. Other recommendations are individualizing medical and psychological care. This is done by encouraging counselling for partners to who value their sexuality, informing all people about the benefits of keeping penile health and building boldness in patients to help them withstand disappoints from treatment failure (Elliot, Latini, Walker,Wassersug and Robinson, 2010). Conclusion Sexual function is an important part of quality of life. Although ED is a common complication following prostatectomy, various treatment options are available and they can help restore sexual function in order to maximize life quality irrespective of age and other co-infections. This study demonstrates a prevalence of 90% with low overall participation of 48.57% in the support groups. Emphasizes should be made to address barriers such as lack of knowledge, impaired self esteem, family dynamics, lack of spousal support, fears, emotions and anxiety surrounding sexual performance. References Andreus, M.R. and Roth, M.T. (2002). Health literacy. A review. Pharmacotherapy , 22 (3), 282. 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Albany, NY: Delmar Thomson Learning. Wittmann, D., Northouse, L., Foley, S., Gilbert, S., Wood, D. J., Balon, R., et al. (2009). The Psychosocial Aspects of Sexual Recovery After Prostate Cancer. Int J Impot Res , 21 (2), 99–106. Doi:10.1038/ijir.2008. Zippe, C., Nandipati, K., Agarwal, A., & Raina, R. (2006). Sexual Dysfunction after Pelvic Surgery. Int J Impot Res , 1-18, 1-18.Retrieved from https://www.clevelandclinic.org Appendix 1. Are you familiar with oral agent treatments of ED?  Yes or No 2. oral agent and nitrate as well as apha-blocker are contraindicate and can not take at the same time? Yes or No 3. Are you familiar with urethral suppository alprostadil? Yes or NO 4. Do you know the important of walking or standing for 10 mins after inserting MUSE into urethra? Yes and NO 5. Are you familiar with Penile injection? Yes or No 6. Do you know it is a medical emergency if erection last more than 4 hours with penile injection? Yes or No? 7. Are you familiar with VED? Yes or No 8. Do you know VED should not be worn for more than 30 mins? Yes or No 9. Are you familiar with penile inplant? Yes or No 10. Do you know penile implant last treatment and irrversitble? Yes r No 11. What is the likely that you will seek other option treatments? (1) strongly unlikely, (2) unlikely (3) not sure (4) likely (5) strongly likely. Read More