• Boris W V Schouten, Arthur M Bohnen, Frans P M J Groeneveld, Gert R Dohle, Siep Thomas, and J L H Ruud Bosch.
• Erasmus MC, Department of General Practice, Rotterdam, the Netherlands. b.schouten@erasmusmc.nl
• J Sex Med. 2010 Jul 1;7(7):2547-53.

IntroductionIn the general population, erectile dysfunction (ED) is surrounded by a "taboo." Epidemiologists studying this problem have to be aware of the phenomenon of the "tip-of-the-iceberg."AimsOur aim is to describe the iceberg phenomenon for ED and their help-seeking behavior in the general population during a period when public interest in ED heightened and waned after the introduction of the drug sildenafil.MethodsThe data were obtained as part of a large longitudinal community-based study, i.e., the Krimpen study. With four rounds of data collection with an approximate 2.1 years interval, the local pharmacists provided data on medication use, whereas abstracts from the medical record and history were provided by the local general practitioners (GPs). The data from the questionnaires were entered into the Krimpen study database but were not communicated to the GPs.Main Outcome MeasuresED: according to the ICS-questionnaire, GP consultation: search of electronic medical dossier for ED or reports from any specialist, use of ED medication as delivered by the pharmacy.ResultsThe age-standardized prevalence of ED is stable, i.e., around 40%. During the period 1995 to 2000, the incidence increased from 5% to 6.5%, then it stabilizes around 5% per year. The first-time use of ED medication increases exponentially between 1995 and 2000, then it stabilizes at about 3.5% per year. The number of GP consultations by men with ED increases up to 1999, after which it stabilizes at about 1.8% per year.ConclusionWe suggest that the availability and awareness of a new pharmacological option induced a change of behavior among GPs and their patients.

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