Epidemiology of Erectile Dysfunction and Key Risk Factors Part 2
The role of medical comorbidities and risk factors has been shown to be increasingly important. Findings from multiple epidemiological studies have also shown convincingly that ED impacts mood state, interpersonal functioning, and overall quality of life (2–8). ED is associated with a wide range of psychosocial consequences and risk factors, such as decreased quality of life (QoL), poor self-esteem and increased incidence of depression and interpersonal relationship problems. Numerous studies have demonstrated that ED can undermine a man’s QoL; for example, Jønler et al.have shown that patients with the loss of erectile function within the past year had significantly lower QoL than men without ED. Similarly, in other recent studies, men with a complaint of ED had poorer QoL than age-matched men from the general population. QoL was also shown to be impaired in men with ED and diabetes who showed significantly higher levels of diabetes-specific health distress, worse psychological adaptation to and acceptance of diabetes, and a less satisfactory sexual life.
Moreover, these men were more easily frustrated and discouraged by their diabetes, which translated into worse metabolic control and higher levels of depressive symptoms. Although not a life-threatening condition, ED is thought to have a profound effect on the quality of life of aging men. Moreover, ED is viewed increasingly as a harbinger or signal of future cardiovascular events. The role of comorbidities has been recognized since the MMAS and other early epidemiologic findings. Among the major comorbidities and risk factors for ED are diabetes, depression, and cardiovascular disease.
This classic trio of risk factors has been implicated in multiple epidemiologic studies, across multiple populations and research settings. Medications for diabetes, hypertension, cardiovascular disease, and depression may also cause erectile difficulties. In addition, there is a substantially higher prevalence of erectile dysfunction among men who have undergone radiation or surgery for prostate cancer, or who have a lower spinal cord injury or other neurological diseases (e.g., Parkinson’s disease, multiple sclerosis). Life style factors, including smoking, alcohol consumption, and sedentary behavior are additional risk factors. Despite its increasing prevalence among older men, erectile dysfunction is not considered a normal or inevitable part of the aging process. It is rarely (in fewer than 5% of cases) due to aging-related hypogonadism, although the relationship between erectile dysfunction and age-related declines in androgen remains controversial.