Erection problems in young men

A study in Western Australia on male erectile dysfunction found that one quarter of men had erection problems, and one in twelve had severe erectile difficulty.

The study was conducted by sending postal questionnaires to randomly selected men in the electoral roll. In summary, before we look at the detail of the study, these are the basic facts: 42% of questionnaires were returned to the researchers, so the sample was to some extent self-selected. Among adult men in WA, the occurrence of any erection problem and severe erectile dysfunction was, respectively, 25.0% and 8.5%.

As you might expect, the frequency of erection problems increased with age. Astonishingly, thirty-eight percent of married men and men who had partners experienced erection problems (severe erection problems 19.1%). There was little difference between white collar and blue collar workers; the most disturbing fact of all was that the vast majority of the men had had erection problems for over a year, but only a meagre 14% had asked for or received any treatment.

Erectile dysfunction (erection problems) means that a man is consistently and perhaps recurrently unable to achieve an erection hard enough for penetration and sexual intercourse. The researchers wanted to conduct a survey on erection problems among men in Western Australia, and used the Electoral Roll for June 2001 as the source for the men they questioned.

They selected men by age and location, using 14 random samples of 302 men in and outside Perth. They sent out a reply-paid questionnaire by mail and in it asked questions on medical history and medical treatment, social status, sexual behavior and sexual function. The men were classified as blue or white collar workers and assessed for social deprivation. The data was collected using the International Index for Erectile Function, which is also called the Sexual Health Inventory for Men.

4,228 questionnaires were posted, and 1,580 (89.3%) returned with a full set of answers. These 1,580 men were aged between 20.1 and 99.6 years. For the purpose of this study they were grouped by age. Erection problems occurred in 25% of the whole sample, and and an astonishing 8.5% of these men reported severe erection problems.

Both the frequency of occurrence and the severity of erection problems increased very significantly with age, particularly after a man reached 50 years of age. But even 15% of the young men aged between 20 and 29 years had erectile problems – and surprisingly, this was less than the men in the next older age groups.

Perhaps unsurprisingly, there was a decline in sexual activity in men of 60 years and older; over 70 years of age, sexual activity declined sharply. But a significant number of the men over 60 (42.6%) and over 70 (25.7%) were sexually active.

There are many interesting facts in this survey beyond those related to erection problems. For example, while about three quarters of the men were married or living with sexual partners, only three quarters of these men were sexually active.

Of the ones who were sexually active, just over 60% said they were having sex on a regular basis. Of the other quarter who were not living with a wife or partner, 53.9% were sexually active – and indeed 39.2% of these men said they had sexual intercourse on a regular basis.

A majority of the men were employed, though 36.8% had retired on grounds of age and 6.8% had retired on the grounds of ill-health.

The highest incidence of erectile problems occurred in clerical, sales, and service workers, but the occurrence of erection problems wasn’t really much different between blue collar and white collar workers. What is less surprising is that erection problems occurred most often in men from economically deprived areas. We know stress is a potent factor in causing a loss of a man’s sense of male power, so there is nothing surprising about that.

Most of the men (a massive 89.1%) with erection problems had had  their difficulties for more than 1 year, and a whopping 74.8% had had erection problems for more than two years; unbelievably 12.2% said they had been suffering for more than 10 years. And the longer it went on, the worse it got. Yet only 90 men (a meager 14.1%) had ever looked for and got any treatment.

Most studies on erection problems have looked at men aged between 40 and 70 years, but this study covered a much bigger range. To this extent, then, it represents the entire spectrum of adult men in WA. You have to assume that this is typical of the results in much of the Western World, and it is truly shocking.

When you look at the detail, it seems odd that men in the 20 – 29 age group appeared to have more erection problems than the 30 – 39 years age group. Possible explanations include commonplace stress of early adulthood such as new relationships, new work responsibilities, and stress linked to leaving home. Among men aged between 40 and 69 years, erection problems occurred in 33.0% of men, while severe erection problems occurred in 8.6%. In fact, the age of a man is far more important than any other factor in determining whether a man has an erection problem.

Both the frequency and the severity of erection problems increase with age. And since the older age groups were under-represented in the study, the true frequency of erection problems and of severe erection problems in men may have been higher than the recorded levels of 25.1 and 8.5%.

Australian demography is changing rapidly, and the proportion of men aged 65 years and older will increase dramatically in the years to come – which means erection problems will pose huge clinical and socioeconomic burdens on healthcare providers and social support services in the years ahead – if men choose to seek help, which currently they are not doing.

The majority of the participants in the Western Australia Men’s Health Study, from where these results are taken, were married or had partners, even though an astonishing 25% or more of these men were not enjoying an active sex life. Of the men aged 70 years and older, a fair proportion remained sexually active.

All these findings matched the results from the Global Study of Sexual Attitudes and Behaviors, a large scale project in which over thirteen thousand men from 30 countries were asked about their sexual behavior. Over 84% of men in this study aged between forty and eighty said they’d had sexual intercourse within the 12 months preceding the study. Among the men who were sexually active, about half said they had sexual intercourse regularly.

Analysis of the results of the study also showed that being separated or divorced may be one of the predisposing factors for erection problems. (Though once again, of course, whether the erection problems were a cause of, or simply unrelated to, separation and divorce, is unclear. In other studies, it has been shown that men with severe erection problems are much more likely to be single, without regular sexual partners.

Erection problems have previously been associated with lower socioeconomic status. The current study demonstrated that erection problems occurred in a smaller proportion of men who were in full- or part-time employment compared to the unemployed.

Of the 468 men in the study who reported on the length of time for which they had endured erection problems, 47.9% had had the problem for between one and five years. This matches other studies in the general population, where 55% of men with the problem were found to have had erectile dysfunction of one sort or another for this period. The current authors’ observation that men who had had it for longer also had more severe problems is neither surprising nor novel.

In spite of erection problems being a common and often long-standing condition, only 14.1% of the men with erection problems had ever received any treatment.

This suggests that there is an urgent need for sexual education and awareness information at every level. And certainly, if it’s true that the longer the erection problems continue, the worse they get, then men with any erection problem should get professional assistance as soon as possible so that therapeutic intervention can be started in the milder stages of erectile dysfunction.

It’s also important to remember that erection problems may indicate cardiovascular and endothelial disease – so once again, there is a clear incentive for erection problems to be comprehensively investigated. In this study in WA, erectile dysfunction was found to be apparently under-diagnosed and grossly undertreated. Whether or not this is true – and if it is, whether or not it applies to the rest of the world – remains to be seen.

The Journal of Sexual Medicine

Volume 5 Issue 1 Page 60-69, January 2008

To cite this article: Kew-Kim Chew MBBS, FRCPEdin, FRCPGlasg, Bronwyn Stuckey MBBS, FRACP, Alexandra Bremner BSc(Hons), GradDipAppStats, PhD, Carolyn Earle BSc, PGradDipHithSci, Konrad Jamrozik MBBS, D Phil (2008) Male Erectile Dysfunction: Its Prevalence in Western Australia and Associated Sociodemographic Factors
The Journal of Sexual Medicine 5 (1) , 60–69 doi:10.1111/j.1743-6109.2007.00548.x