Erectile Difficulty/Dysfunction

Erectile Difficulty (ED) has been broadly defined as the inability of the male to attain and/or maintain an erection sufficiently rigid for satisfactory sexual activity.  To the extent that sexual activity form the core of the physical and emotional being, the inability to perform can have a devastating impact.

The paper Epidemiology of erectile dysfunction provides information on the prevalence of ED in the general populations of many countries.  We will now cite some survey data from the MARS OTC/DTC Pharmaceutical Study.  This study includes responses from 6,896 male adults collected during the first quarter of 2003.  Among these survey respondents, 5.9% said that they have suffered from erectile difficulty/dysfunction over the past 12 months.

In the chart below, we show the incidence of ED among various age groups.  The incidence of ED rises with age.  As for the apparent dip after 75 years of age, we need to remember that an ED episode occurs during an attempted sexual act, and the dip is in fact due to fewer attempts after that age.  The higher incidence of ED among older men occurs not necessarily due to the deterioration of the sexual organ, but there are often concomitant medical conditions such as diabetes, vascular diseases and the side-effects of medications.

ED can have a profound negative impact on the quality of life and life satisfaction of the patient (and his partner), resulting in fear, loss of self-image and self-confidence, and depression.  This is the reason why ED has a much larger impact on the collective psyche than other more insidious and fatal ailments such as hypertension and cardio-vascular disease.  Within the MARS study, the survey respondents were shown a statement "Medical conditions limit my lifestyle to some extent."  The incidence of ED among the various response categories to this statement is shown in the next chart.  

From a study in the Annals of Internal Medicine:

"There's a clear increased risk of erectile dysfunction as people age," confirms study author Eric Rimm, an associate professor of nutrition and epidemiology at the Harvard School of Public Health in Boston. "There is a way to delay the onset of ED, and that's pretty significant."

These ways coincide strongly with ways to prevent or delay other health problems, such as cardiovascular disease and diabetes. That means men need to rely on the old stalwarts of exercising, keeping your body lean and not smoking.

"There is an age-dependent increase but, also, modification of risk factors can affect sexual function. Losing weight, stopping smoking, doing more exercise are associated with better sexual health," says Dr. Andrew McCullough, director of Male Sexual Health, Fertility and Microsurgery at New York University Medical Center in New York City. "We talk so much about treating, treating, treating. Here we're beginning to see an increasing body of evidence that we can modify the appearance of this by changing lifestyle."


The bottom line is that risk factors for ED were about the same as those for heart disease. "One could almost say that erectile dysfunction may be a good marker for cardiovascular disease because of the tie-in with these factors," Rimm says.

Rimm hopes that this news may help change behavior. "A lot of people have known about exercise and obesity and cardiovascular disease and the message is not getting through. The population is getting more overweight," he says. "Maybe people think of cardiovascular disease as too far off, but ED is much more immediate and affects the quality of life. It's something that could affect you every day."

McCullough says, "Since ED is intimately associated with the health of the vascular system, a man needs to have his cardiovascular risk factors thoroughly examined so that maybe we can do some prevention. This clearly shows that prevention can affect erectile function.

"If you ask most people about their erectile function, even if they're overweight, hypertensive and smokers, they'll say 'It's all in my head,' but their body is screaming out to them. The public message is that the penis is a barometer of the health of the vascular system and when it's not working right, you need to listen to that," McCullough says.

But whereas it is not always clear about the effects of cardio-vascular problems until a major episode has occurred, ED is impossible to ignore because there was a failure in a situation where more than one party is participating.  When an ED problem is identified, the search may begin for a quick and effective treatment.  Exercise and diet are long-term projects which may or may not deliver relevant results.

The next chart below shows the treatment options that the ED people have sought over the past 12 months.  It should be noted that the sum of these incidences add up to more than 100% because multiple options may have been pursued.  More than half of the people did not seek treatment.  Of those who did, the majority of them took some branded prescription medicine.

Here we see the anatomy of the social/health conditions that have created an industry whose total revenue exceeds the operating budgets of many countries in the world as well as overwhelming everyone's email in-box with spam mail.  First, a significant number of men have experienced ED, which is an extremely embarrassing condition.  Secondly, the best known treatment are branded prescription pills of which Viagra is the most famous.  Thirdly, these prescription drugs are not one-time-only treatments.  Rather, they are taken each time before sexual activity begins so that this is a recurrent revenue stream.  Fourthly, while these prescription drugs are not physically addictive, they do engender psychological dependency from the fear of failure without them.

(posted by Roland Soong, 8//10/2003)

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