Hypothesis / aims of study
Erectile dysfunction (ED) is defined as the complaint of inability to achieve and sustain an erection firm enough for satisfactory sexual performance and is one of the most common types of sexual dysfunction. Prevalence varies across different age groups, populations, and geographical regions 1. Risk factors associated with ED may include medical conditions (e.g., diabetes, cardiovascular disease), psychological factors (e.g., depression, anxiety), lifestyle factors (e.g., smoking, alcohol consumption), hormonal factors, and medication side effects 2. ED can impact negatively intimate relationships and quality of life.
The aim of this study was to determine the prevalence of ED and the potential risk factors among men from an academic institution.
Study design, materials and methods
Data were collected through an online questionnaire made available from December 2021 to April 2022. The questionnaire comprised several sections, including: 1) sociodemographic, lifestyle, and health condition inquiries, and 2) assessment of urinary and anal incontinence symptoms, identified by affirmative responses to questions such as "Do you experience involuntary loss of urine?" and "Do you experience involuntary loss of gas or feces?", respectively. ED was evaluated using the International Index of Erectile Dysfunction questionnaire. For analysis, only men reporting sexual activity within the past 4 weeks were included.
Results
Out of the 264 individuals who submitted the questionnaire, 75 did not accept the terms of consent. Additionally, 39 questionnaires were excluded due to being incomplete or incorrect, while 3 were excluded due to a history of surgery for malignancies (breast, colorectal, bladder, or genital neoplasms), 2 were excluded due to neuromuscular diseases (Obstetrical Brachial Plexus Palsy and Multiple Sclerosis), and 4 were excluded due to recurrent urinary infections. As a result, 141 questionnaires were enrolled. Among the 141 participants, 20 reported no sexual activity in the last 4 weeks, leading to the analysis of 121 questionnaires.
The male participants had a mean age ± standard deviation of 34 ± 13.5 years, a Body Mass Index of 25 ± 3.2, with more than half (n=62; 51.2%) being single. Most participants had attained a superior level of education (n=83; 68.6%), and the vast majority identified as heterosexual (n=116; 95.9%).
Regarding lifestyle characteristics, almost two-thirds (n=78; 64.5%) reported exercising on a regular basis, and the majority did not have regular consumption of alcoholic beverages or smoking habits (n=90; 74.4% and n=100; 82.6%, respectively). Sample characteristics are presented in Table 1, while Table 2 displays the association between potential risk factors and ED. Furthermore, chi-square tests did not demonstrate any association between ED and urinary or anal incontinence (p=0.272 and p=0.853, respectively).
Interpretation of results
In our sample, 10.7% of men self-reported experiencing erectile dysfunction (ED). Various factors contribute to alterations in the components of the erectile response, encompassing organic, relational, and psychological aspects. However, our study did not identify any significant relationship between ED and traditional risk factors documented in the literature, such as cardiovascular problems, diabetes, hypertension, smoking, and alcohol consumption. It is noteworthy that the relatively low prevalence of these health conditions among participants may have influenced our findings. Additionally, the high proportion of participants who reported regular exercise and attained a superior level of education may have also influenced the results, given that regular physical activity has been shown to reduce the risk of ED, while lower levels of education have been associated with higher rates of ED.
Psychological factors, including depression, anxiety, and partner-related difficulties, are recognized contributors to ED. This study raised questions about psychological issues diagnosed by a physician, which could lead to a underdiagnoses cases. Also, partner-related difficulties were not analyzed in our study.
Concluding message
Further research is warranted to embrace a comprehensive biopsychosocial approach to understanding erectile dysfunction (ED), which encompasses biological, psychological, and social factors. While our study did not identify specific risk factors for men with ED, a more thorough evaluation may help identifying a high-risk subgroup needing a different therapeutic approach. Additionally, other psychosocial stressors, such as chronic stress, anxiety, depression, and work-related stress, should also be assessed to provide a more holistic understanding of the condition.