Erectile Dysfunction: Symptoms, Causes, Treatment

Erectile dysfunction (ED) – colloquially called erectile dysfunction – (synonyms: erectio deficiens; erection disorders; erectile dysfunction (ED); impotentia coeundi; impotentia sexualis; impotence; potency; potency disorder; ICD-10-GM F52.2: failure of genital responses) describes a chronic clinical picture of at least 6 months’ duration in which at least 70% of attempts to achieve sexual intercourse are unsuccessful. In other words, erectile dysfunction is not defined by a maximum still achievable tumescence (swelling) or rigidity (rigidity, hardness) of the penis, but is conceived as an unsatisfactory partnered sexual interaction. Because sexuality is an important form of partnership communication, impaired erectile function results in strain on essential personal bonds. For clarification, the term “impotence” must distinguish “impotentia generandi”, i.e. inability to conceive or infertility, from “impotentia coeundi”, i.e. erectile dysfunction (ED) or erectile dysfunction. Peak incidence: the maximum incidence of erectile dysfunction is between the ages of 60 and 80. The most commonly cited study on the prevalence (disease incidence) of erectile dysfunction is the Massachusetts Male Aging Study (MMAS). Using a “calibration sample” of 303 erectile dysfunction patients evaluated in a urology clinic, the degree of erectile dysfunction was calculated in the main nonclinical sample of 1290 men. The results of this study showed that 52% of men aged between 40 and 70 years had erectile dysfunction, in 17% this was minimal dysfunction, in 25% moderate dysfunction, and in 10% complete erectile dysfunction. The prevalence (disease frequency) of erectile dysfunction was strongly age-dependent.

The same study showed that in the total sample, the percentage of men with complete erectile dysfunction increased significantly in an age-correlated manner in the presence of certain comorbidities (concomitant diseases) (total sample: 9.6%, diabetes mellitus 28%, heart disease 39%, hypertension (high blood pressure) 15%). A nationwide study of the prevalence of erectile dysfunction, in which circa 5,000 men from the Cologne metropolitan area were examined, yielded the following results:

• Among 40- to 49-year-olds, the prevalence was 9.5% – assessed as needing therapy: 4.3%.
• Among 50- to 59-year-olds, 15.7% – estimated as needing therapy: 6.8
• Among 60- to 69-year-olds 34.4% – assessed as needing therapy: 14.3%.
• Among those over 70 years 53.4% – assessed as needing therapy: 7.7%.

Overall, 19.2% of men reported the presence of erectile dysfunction. Data on the incidence (frequency of new cases) of erectile dysfunction were also presented in MMAS. From a longitudinal study of 847 men who were followed up with fully scored questionnaires over 10 years, these data were calculated. Age-specific incidence rates of 1.2% for those aged 40 to 49 years, 2.98% for those aged 50 to 59 years, and 4.6% for those aged 60 to 69 years were calculated. The incidence rate was lower in men with higher socioeconomic status and closely associated with overall health status. In particular, patients with diabetes mellitus, treated heart disease, or treated hypertension, have a significantly higher incidence of erectile dysfunction (see Table).

Due to the close correlation of incidence and prevalence of erectile dysfunction with age and due to the aging world population, a significant increase of this clinical picture in Europe by 39% is predicted by 2025. For Germany, the number of men with erectile dysfunction would increase from 5 million to 7 million in 2025. 40 studies on ED from all parts of the world were summarized in a recent study: there were enormous variations in ED prevalence (3-77 %); prevalence in Europe was between 17-65 %. Course and prognosis: The success of therapy depends on whether the cause responsible for erectile dysfunction can be adequately treated or, if necessary, cured. It is also crucial for a successful therapy that the affected person consults a doctor as early as possible, which is often not the case due to the feeling of shame. Comorbidities: Patients with sexual dysfunction often have depression (12.5%) and/or anxiety disorders (23.4%). Furthermore, ED is associated with benign prostatic hypertrophy (BPH; benign prostate enlargement; 1.3-6.2-fold odds) and dementia (1.7-fold odds).Patients with ED and plaque psoriasis are more likely to have hypertension (33.5% vs 19.9%), hyperlipidemia (32.5% vs 23.6%), and diabetes mellitus (11.5% vs 5.2%) compared with controls.