Men With ED: 25% Are Aged 40 Years or Younger

Norra MacReady

June 10, 2013

Traditionally considered the bane of aging men, erectile dysfunction (ED) is surprisingly common in younger men as well, the authors of a new study report.

Of 439 men visiting a sexual medicine outpatient clinic complaining of new-onset ED, 114 (26%) were 40 years old or younger, lead author Paolo Capogrosso, MD, from the Department of Urology, University Vita-Salute San Raffaele, Milan, Italy, and colleagues write in an article published online May 7 in the Journal of Sexual Medicine.

Moreover, the rate of severe ED was similar in younger and older men, and scores on the International Index of Erectile Function (IIEF) also were similar between the age groups. "Therefore, the observation as a whole appeared to us as a worrisome picture from the everyday clinical practice," the authors write.

For this retrospective analysis, which included men visiting the clinic between January 2010 and June 2012, the authors defined ED as "the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual performance." In addition to undergoing a comprehensive medical evaluation, including a detailed medical and sexual history and measurement of circulating testosterone levels, the men completed the IIEF, a 5-item questionnaire covering various aspects of sexual performance and satisfaction. Each item is scored from 1 to 5, with overall scores from 22 to 25, indicating no ED, and from 5 to 7, indicating severe ED.

Compared with men older than 40 years, younger men had fewer comorbidities, a lower mean body mass index, lower rates of hypertension and hypercholesterolemia, and higher mean levels of circulating testosterone (P ≤ .02 for all comparisons). Premature ejaculation was more common in younger men, whereas older men had higher rates of Peyronie disease (P = .03 for both comparisons). Low libido was reported by 10 younger patients (8.8%) and 23 (7.1%) older patients (P = .55). Older patients were more likely to be taking medications such as antihypertensive or antidiabetic agents, drugs for uricosuria and lower urinary tract symptoms, and proton pump inhibitors (P ≤ .03 for all comparisons). Younger men, however, were more likely to smoke cigarettes and to use marijuana or cocaine (P ≤ .02 for both comparisons). There was no difference in the rates of alcohol use between the groups.

On the IIEF, 56 (48.8%) of the younger men and 132 (40.6%) of the older men had scores indicating severe ED (P = .73).

Potential limitations of this research include the relatively small cohort of men studied and their presence at a sexual medicine clinic, suggesting a possible selection bias for patients with more serious cases of ED. "However, we consider that this methodological flaw would be equally present in both age groups, thus not undermining the value of these findings," the researchers write. In addition, they did not assess the patients for depression or anxiety, they did not delve into the men's adolescent sexual history, and they did not account for socioeconomic differences among the patients.

These findings underscore the importance of taking a comprehensive medical and sexual history and performing a thorough physical examination in all men with ED, regardless of age, the authors conclude. "Likewise, given the low rate of seeking medical help for disorders related to sexual health, these results express even more the need that healthcare providers may proactively ask about potential sexual complaints, once more even in men younger than 40 years of age."

The authors have disclosed no relevant financial relationships.

J Sex Med. Published online May 7, 2013. Abstract

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