18 Million American Men With Erectile Dysfunction

BALTIMORE, Feb. 1 -- Eighteen million American men ages 20 or older have erectile dysfunction, generally attributed to the effects of diabetes, hypertension, or physical inactivity, researchers here reported.

Using data from the 2001-2002 National Health Nutrition Examination Survey (NHANES), Elizabeth Selvin, Ph.D., M.P.H. of Johns Hopkins Bloomberg School of Public Health, and colleagues, determined that the overall prevalence of erectile dysfunction was 18.4% (95% CI, 16.2-20.7) in these men.

That estimate was based on a cross-sectional analysis of data from 2,126 men who participated in the NHANES survey, Dr. Selvin reported in the February issue of the American Journal of Medicine.

Not surprisingly, prevalence of erectile dysfunction increased with age-just 5% in men 20 to 40 versus 70% in men 70 or older, Dr. Selvin reported in the February issue of the American Journal of Medicine.

Likewise, diabetes was a marker for erectile dysfunction and after adjusting for other risk factors, men with diabetes were three times more likely to erectile dysfunction than men without diabetes.

The age-adjusted prevalence of erectile dysfunction among men with diabetes was 38.6% (95 CI 28.7-49.5) and for men with treated hypertension it was 27.7 (95% CI 21.4-35.0), she said.

Erectile dysfunction was assessed using a single question during a computer-assisted, self-interview, which was conducted in a private room.

Men who said they were "sometimes able" or "never able" to get and keep an erection were identified as having erectile dysfunction. Men who said they were always or usually able to get and sustain an erection were categorized as not having erectile dysfunction.

Watching three or more hours of television daily-a marker for sedentary life style-was also associated with an increased risk of erectile dysfunction compared with men who maintained physically active lifestyles.

Dr. Selvin said that the "association physical activity with erectile dysfunction suggests that life style changes, especially exercise, may be an effective non-pharmacologic treatment for erectile dysfunction."

Aggressive management of hypertension as well as diabetes might also reduce symptoms, she said.

Other findings:

• Men with a history of benign prostate enlargement had an age-adjusted prevalence of 19.6% (95% CI 13.9-26.8) while men with a history of prostate cancer had an age-adjusted prevalence of 70.2 (95% CI 45.7-86.9), but Dr. Selvin noted that the latter estimate was based on only 68 cases.
• Age-adjusted prevalence of erectile dysfunction among current smokers was 21.1% (95% CI, 16.5-26.6).
• A history of cardiovascular disease was associated with an age-adjusted prevalence of 24.7% (95% CI, 18.1-32.7)

Dr. Selvin said the high prevalence of cardiovascular disease risk factors in men with erectile dysfunction suggested that screening for those risk factors was warranted. The reverse would also be true, that men with hypertension and diabetes should be screened for erectile dysfunction, she added.

Several limitations of the study were noted by the authors. Data on erectile dysfunction were self-reported, and some men may have been receiving treatment for the condition, they said. As a result, the estimates may underestimate the magnitude of the problem and associations in the U.S. population. Also, the cross-sectional nature of the NHANES limits conclusions about direction or causality of associations.