Prevalence of ED

In the United States as well as the rest of the world, ED is highly prevalent. The Massachusetts Male Aging Study (MMAS) particularly has documented the high prevalence, which reaches 52% in men over age 40 yr. MMAS was the first large population-based study of ED in the United States. The initial data were collected during 1987–1989 and established a cohort of 1709 men, of whom 1156 were re-interviewed during 1995–1997. The baseline study included questions related to erectile function, such as frequency and quality of erections. The follow-up questionnaire included items related to erectile function plus a single question subjective global self-assessment that classified ED as ranging from none to complete.

The MMAS found that the combined prevalence of mild, moderate, and severe ED was 52% among this cohort of men aged 40 to 70 yr.
This prevalence increases with age and exceeds 70% in men over age 65 yr. The MMAS recorded depression, unhappiness with life, and pessimistic attitudes as significant risk factor predictors for ED cheap Nolvadex online in Canada. With increasing age, there was an increase in ED but, surprisingly, also a significant decrease in libido or desire for sexual activity. Nonmarried men appear to be at higher risk. A subsequent follow-up study of these same men 8 yr later showed that the incidence and prevalence of ED increases with age and that not smoking and regular exercise are factors that predict maintenance of erections as men age. With extrapolation of these data, it is estimated that more than 30 million men in the United States suffer from some degree of ED. The results of a large scale epidemiological study of sexual dysfunction in men throughout the United States demonstrated a high prevalence of ED in men of all ages, with as many as 31% of men complaining of some degree of ED.

Laumann et al. studied 1410 men and 1749 women ages 18–59 yr through analysis of the data from the National Health and Social Life Survey. Overall, ED occurred in 5% of men, low sexual desire in 5% of men, and 21% of men, most often in the younger age group, suffered from premature ejaculation. The study demonstrated that sexual dysfunction is a significant public health concern and is widespread in Western society, influenced by health-related and psychological factors. Stress-inducing events influence and increase sexual dysfunction. There is a strong association between sexual dysfunction and impaired quality of life on quality-of-life questionnaires. The Men’s All Race Sexual Health Study investigated the differences among racial groups and the prevalence of ED. Early data from this study confirm that white, black, and Hispanic Americans are equally at risk for ED and that risk factors for the three groups are similar.

Worldwide, epidemiological studies have confirmed the high prevalence rates in men of all ages. Aytac et al. calculated that the worldwide prevalence of ED will probably increase from 152 million men in 1995 to 322 million in 2025. Much of this increase of 170 million will occur in the developing world, that is, Asia, Africa, and South America, and is associated with the aging world population. Other related changes may be contributing to the increase of ED because it is associated with other diseases that are reaching epidemic proportions, such as obesity and diabetes.

Aytac et al. concluded that this likely increase in the prevalence of moderate to severe ED combined with newly available drug treatments will pose a major challenge for healthcare policy makers to develop and implement policies to alleviate ED. This will be a major problem, particularly in countries in which national health systems are already under stress from existing government funding priorities. Despite this high prevalence, fewer than 10% of men have received therapy for ED.

Despite these revolutions in the understanding and treatment of ED, there are many men who have not sought help for ED and many physicians who are uneasy and resistant to investigation and treatment of ED. Part of the problem includes the issues of men’s health. It is estimated that in the United States, men have more than 150 million fewer doctor visits then women, even excluding prenatal visits. This partially accounts for not only the reluctance for ED treatment but also the lower life expectancy for men compared with women. Marwick surveyed patient’s expectations and experiences in discussion of sexual issues with their physicians and found that 71% of patients stated that they believed that physicians would not recognize ED as a medical problem, whereas 68% of patients feared that discussing sexuality with their physicians would embarrass their physicians.

Since the introduction of sildenafil in 1998, there has been a revolution in the treatment of ED throughout the world. The scientific and marketing efforts of physicians and the pharmaceutical industry have increased the presentation rates of ED by 250, 55, 103, 279, and 90% in the United States, Germany, UK, Mexico, and Spain, respectively, compared with the pre-sildenafil launch period. Similarly, prescriptions for the treatment of ED before the introduction of sildenafil were slightly greater than 4 million with the majority of men with ED being treated with intracavernous alprostadil. Shortly after the introduction of sildenafil in the United States, the prescriptions for ED increased 438% to more than 19 million between April 1998 and December 1999. This increase was led by physicians and media who educated the public on the importance of ED and the ability to treat ED effectively.

Numerous studies have demonstrated the improvement in quality of life for patients with ED treatment. In 1999, Parkerson et al. studied 1073 men in the United States and Europe with ED who were treated with intracavernous alprostadil. These patients were followed for 19 month, and there was a demonstrated improvement in mental status in all groups despite a decrease in physical status associated with increasing age. Interestingly, social status also increased in Europe whereas it did not in the United States. In 1999, Litwin et al. reviewed the quality of life of 438 men undergoing treatment for carcinoma of the prostate with X-ray therapy or radical prostatectomy.

These patients included not only nerve-sparing but also non-nerve-sparing radical prostatectomy patients. An evaluation was conducted using the UCLA prostate cancer index. Sexual function during follow-up increased in the first year for all groups whereas function decreased slightly for radiation therapy patients in the second year. However, sexual function improved in all patients, but response was related to age, prediagnosis ED, and non-nervesparing radical prostatectomy. It has been estimated that 1 in 10 men worldwide have ED and that it is the most common chronic medical disorder in men over the age of 40 yr.
Patients and their partners must be educated in lifestyle issues that preserve erectile function and, indeed, optimize the response to agents for the treatment of ED Viagra in New Zealand – http://www.viagra-online.co.nz best place to order viagra online. Smoking is one of the most important lifestyle issues that can impact on erectile function. In its follow-up publication, the MMAS reported an increase in ED with smoking in addition to other risk factors such as diabetes, heart disease, and hypertension. Indeed, the incidence of ED increased among smokers with some stability in onset if men stopped smoking. The Health Professions Follow-Up Study reported by Bacon et al. examined 32,287 men and demonstrated a relative risk of ED of 2.2 (95% CI, 1.9–2.5) in men who smoked. Indeed, the effects of smoking in the laboratory, and in clinical research, have been widely published. Smoking appears to enhance prostacyclin production, increase platelet vessel wall interaction, and reduce endothelium-mediated forearm vessel dilation in chronic human smokers. Smoking has also been demonstrated to decrease endothelial nitric oxide synthase (NOS) activity and impair the release of NO. Finally, there has been a demonstrated increase in superoxide ion-mediated endothelium-derived relaxing factor degradation in smokers.

Therefore, it is important to educate patients that ED can be treated in greater than 80% of men and that lifestyle changes may improve erections or at least stabilize ED. Expectations of excellent outcomes and success with low morbidity and risks are the norm. Patients should also be educated and instructed that lifestyle counseling may assist their longevity and healthiness and may also improve not only erectile function but response to ED treatment. These counseling points should include smoking cessation, moderate alcohol intake, reduction in fat and cholesterol, exercise, improvement and compliance with cardiovascular and diabetic medications, stress reduction, depression treatment, and an optimism of ED treatment outcomes and resolution with appropriate management.

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