Recreational Use of Erectile Dysfunction Medication May Decrease Confidence in Ability to Gain and Hold Erections in Young Males

P. Santtila; N. K. Sandnabba; P. Jern; M. Varjonen; K. Witting; B. von der Pahlen


Int J Impot Res. 2007;19(6):591-596. 

In This Article


Recreational use of EDM was more common than medicinal use in this population-based sample of 18 to 44-year-old men. This is in line with previous research showing that a majority of respondents had obtained their EDM from sources other than health-care providers.[9,10] However, Musacchio, Hatrich and Garofalo still reported that a majority of their respondents had used EDM to treat problems with erectile function.[9] In the current study, the proportion of participants reporting recreational use was relatively high 2.6%, suggesting that any adverse psychological effects of recreational use would affect a significant numbers of men. In addition, since the participants were asked to report whether they had used EDM during the previous 4 weeks, the number of users would probably have been even higher with a longer time range. As ED is strongly age-related,[19] these results should be interpreted considering that the mean age of the sample were below 30 years. In an older sample, medicinal use would probably be higher.

One of the issues we wanted to investigate was whether the men who reported using EDM for recreational purposes actually differed from medicinal users. The findings seemed to support the veracity of the participants' self-reports. Recreational users reported less problems with erectile function during their first intercourse compared to both medicinal and non-users. Of course, we cannot be totally certain that the participants had not used EDM already during their first intercourse experience, but we hold this to be unlikely. Especially interesting is the finding that only 16% of recreational users reported fear of erectile problems compared to 40% of medicinal users and 24% of non-users at the time of their first intercourse. This suggests that to begin with, before using EDM, the recreational users were quite confident in their ability to gain and hold their erections. Also, recreational users had best current erectile function whereas medicinal users had the worst functioning. Further, recreational users were sexually more unrestricted compared to non-users and, in terms of the expected number of future partners, also compared to medicinal users. They had also experienced their first intercourse at a younger age. In addition, recreational users reported experiencing more than one ejaculation more often than non-users. This finding probably reflects the fact that prolonging sexual encounters is one of the reasons for recreational use of EDM. Overall, the findings indicate that recreational users differ from both non-users and medicinal users in a way that supports the veracity of their self-report regarding the motivation for their use of EDM. We did not find an overrepresentation of men with homosexual experience among the users probably reflecting the fact that our study was based on a population sample.

The main aim of the present study was to see if recreational use of EDM would adversely affect the confidence the users had in their ability to gain and hold erections. The findings seemed to support this hypothesis although causality cannot be proven in a correlational study. Recreational users had lower levels of confidence compared to non-users. A change seems to have taken place compared to when the participants started their sexual activity as recreational users at that time were the most confident group in terms of their erectile function as pointed out above. Of course, in the present research design, it is not possible to exclude other intervening factors besides recreational use of EDM that might have adversely affected the confidence of this group. However, as all other indicators suggest that this group is enjoying good erectile function and being sexually more active than the other groups, a causal effect created by EDM remains the most logical explanation. The result is also not explained by a general age-related decrease in confidence in maintaining erections as age was not related to the confidence variable. Further, even though having a regular sexual partner was associated with higher confidence, using EDM was not related to this partnership status.

In addition, the more frequent the recreational use of EDM was, the less confident the participants were in their erectile ability. This further supports the possibility that the use of EDM has affected the confidence level of the participants. As lack of confidence in one's ability to gain and hold erections has been identified as an important psychogenic risk factor for ED,[14] the findings have important implications. Recreational users of EDM may be vulnerable for becoming psychologically dependent on pharmacologically induced erection. However, it should be noticed that the associations detected are small in absolute terms. Certainly, the results suggest that there is a need for longitudinal follow-up studies of young men who start using EDM for recreational purposes.

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