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Reviewed research
Authors Capogrosso P, Colicchia M, Ventimiglia E, et al.
Review Date May 2013
Citation J Sex Med; May 7. doi: 10.1111/jsm.12179 (Epub ahead of print)
Background
Erectile dysfunction (ED) is a common complaint in men over 40 years of age. As age increases, so does the prevalence of ED. Most studies of ED include men over the age of 40 although the presence of ED in younger men has been shown to be associated with a greater relative risk of cardiovascular disease than ED in older men.
Aim
The purpose of this exploratory analysis was to assess the sociodemographic and clinical characteristics of young men (defined as ≤40 years) seeking first medical help for new onset ED as their primary sexual disorder.
Methods
The analyses were based on a cohort of Caucasian-European sexually active patients seeking first medical help for new onset sexual dysfunction between January 2010 and June 2012 at a single academic outpatient clinic. New onset ED as the primary disorder was found in 439 patients (55.6%) out of 790. ED was defined as the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual performance. Patients were comprehensively assessed with a detailed medical and sexual history, including sociodemographic data. Health-significant comorbidities were scored with the Charlson Comorbidity Index (CCI).
Results
Of the 439 patients identified with new onset ED as the primary disorder, 114 (26%) were men ≤40 years (mean age=32.4; Range 17-40 years). Compared to older men, patients ≤40 years had a lower rate of comorbid conditions (CCI=0 in 90.4% vs. 58.3%; p=<0.001), a lower mean body mass index (25.1 vs 26.4 kg/m2; p=0.005); a lower rate of hypertension (5.3% vs 37.5%) and hypercholesterolaemia (3.5% vs 11.7%) and a higher mean circulating testosterone level (5.3 vs 4.5 ng/ml; p=0.005); as compared with those >40 years. Conversely, no significant differences were observed between groups in terms of rates of hypertriglyceridaemia, metabolic syndrome and hypogonadism. Premature ejaculation was more comorbid in younger men (12.4% vs 6.2%; p=0.03) whereas Peyronie’s disease was more prevalent in the older group (11.4% in older vs 4.4% in younger men; p= 0.03). Younger ED patients more frequently reported cigarette smoking and the use of illicit drugs (cannabis and cocaine), as compared with older men (all p≤0.02). Patients completed the International Index of Erectile Function (IIEF) which showed that severe ED rates were found in 48.8% younger men and 40% older men (p= >0.05). Similarly, rates of mild, mild-to-moderate, and moderate ED were not significantly different between the two age groups.
Conclusion
This exploratory analysis showed that one in four patients seeking first medical help for new onset ED was younger than 40 years. Almost half of the young men suffered from severe ED, with comparable rates in older patients. Overall, younger men differed from older individuals in terms of both clinical and sociodemographic parameters.
Points to Note
- This exploratory analysis found that a quarter of patients suffering from ED in everyday clinical practice are men below the age of 40 years. This aligns with previous epidemiological data from population-based studies, outlining that ED is not only a disorder of the aging male and that erectile function impairment in young men should not be clinically underestimated.
- This analysis reports on a small cohort, hence the applicability of findings to the wider population is limited.
- Due to the method of participant selection whereby all participants were selected after being referred to a sexual medicine outpatient clinic, this may substantiate a selection bias in terms of severity of ED.
- These results support the need for healthcare providers to proactively ask about potential sexual complaints, particularly in men younger than 40 years of age
- Additional studies in larger population-based samples are needed to confirm these results and to further characterise the potential role of ED severity as a harbinger of medical disorders in men below the age of 40 years.
- This analysis adds to the debate for further research into causative factors of ED, beside that of age-related sexual decline. On the data from this and other studies, ED has been suggested as a possible means of identifying young and middle-aged men who may benefit from a cardiovascular risk assessment and cardiovascular risk factor monitoring.
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