Epidemiology of ED
Epidemiology of Sexual Dysfunction in Men
Sexual dysfunction is a common complaint in men and women, which is associated with a broad range of medical, psychological and interpersonal causes.
Despite significant progress in basic research and clinical therapeutics in recent years, sexual problems remain among the most frequently overlooked and mismanaged patient complaints.
Few physicians are adequately trained in the diagnosis and treatment of sexual dysfunction, and many patients seek assistance from inappropriate or unqualified providers.
Sexual problems frequently impact on patients’ interpersonal functioning and quality of life.
Erectile dysfunction (ED) is a significant and common medical problem.
Approximately 10% of men aged 40-70 have severe or complete erectile dysfunction, defined as the total inability to achieve or maintain erections sufficient for sexual performance.
An additional 25% of men in this age category have moderate or intermittent erectile difficulties.
The disorder is highly age-dependent, as the combined prevalence of moderate to complete erectile dysfunction rises from approximately 22% at age 40 to 49% by age 70.
Although less common in younger men, erectile dysfunction still affects 5%-10% of men below the age of 40.
Findings from these studies show that erectile dysfunction impacts significantly on mood state, interpersonal functioning, and overall quality of life.
Erectile dysfunction is strongly related to both physical and psychological health.
Among the major risk factors are diabetes mellitus, heart disease, hypertension and decreased HDL levels.
Medications for diabetes, hypertension, cardiovascular disease and depression may also cause erectile difficulties.
In addition, there is a higher prevalence of erectile dysfunction among men who have undergone radiation or surgery for prostate cancer, or who have a lower spinal cord injury or other neurological diseases (e.g. Parkinson’s disease, multiple sclerosis).
Life style factors, including smoking, alcohol consumption and sedentary behavior are additional risk factors.
The psychological correlates of erectile dysfunction include anxiety, depression and anger.
Conditions associated with ED are diabetes, hypertension, heart disease, untreated ulcer disease, arthritis, cardiac medications (including vasodilators and antihypertensive agents) in cigarette smokers, hypoglycemic agents and depression.
The prevalence of ED in all diabetics has been estimated between 35 and 75%.
Erectile difficulties may be the harbinger of diabetes, ED occurs in 12% of newly diagnosed diabetics.
Drug associated erectile dysfunction is common and the list of medications that can induce erectile dysfunction is significant.
Medication-induced impotence has been estimated occuring in up to 25% of patients in a medical outpatient clinic. Antihypertensive agents are associated with erectile difficulties, depending upon the specific agents in 4-40% of patients. They induce impotence either by actions at the central level (clonidine), by direct actions at the corporal level (calcium channel blockers) or by purely dropping systemic blood pressure upon which the patient has relied to maintain an intracorporal pressure sufficient for the development of penile rigidity.
Pelvic trauma, in particular injuries to the perineum and pelvic fractures, are associated with erectile dysfunction.