One Patient Out of Four with Newly Diagnosed Erectile Dysfunction Is a Young Man—Worrisome Picture from the Everyday Clinical Practice



      Erectile dysfunction (ED) is a common complaint in men over 40 years of age, and prevalence rates increase throughout the aging period. Prevalence and risk factors of ED among young men have been scantly analyzed.


      Assessing sociodemographic and clinical characteristics of young men (defined as ≤40 years) seeking first medical help for new onset ED as their primary sexual disorder.


      Complete sociodemographic and clinical data from 439 consecutive patients were analyzed. Health‐significant comorbidities were scored with the Charlson Comorbidity Index (CCI). Patients completed the International Index of Erectile Function (IIEF).

      Main Outcome Measure

      Descriptive statistics tested sociodemographic and clinical differences between ED patients ≤40 years and >40 years.


      New onset ED as the primary disorder was found in 114 (26%) men ≤40 years (mean [standard deviation [SD]] age: 32.4 [6.0]; range: 17–40 years). Patients ≤40 years had a lower rate of comorbid conditions (CCI = 0 in 90.4% vs. 58.3%; χ2, 39.12; P < 0.001), a lower mean body mass index value (P = 0.005), and a higher mean circulating total testosterone level (P = 0.005) as compared with those >40 years. Younger ED patients more frequently showed habit of cigarette smoking and use of illicit drug, as compared with older men (all P ≤ 0.02). Premature ejaculation was more comorbid in younger men, whereas Peyronie's disease was prevalent in the older group (all P = 0.03). At IIEF, severe ED rates were found in 48.8% younger men and 40% older men, respectively (P > 0.05). Similarly, rates of mild, mild‐to‐moderate, and moderate ED were not significantly different between the two groups.


      This exploratory analysis showed that one in four patients seeking first medical help for new onset ED was younger than 40 years. Almost half of the young men suffered from severe ED, with comparable rates in older patients. Overall, younger men differed from older individuals in terms of both clinical and sociodemographic parameters. Capogrosso P, Colicchia M, Ventimiglia E, Castagna G, Clementi MC, Suardi N, Castiglione F, Briganti A, Cantiello F, Damiano R, Montorsi F, and Salonia A. One patient out of four with newly diagnosed erectile dysfunction is a young man—worrisome picture from the everyday clinical practice. J Sex Med 2013;10:1833–1841.


      To read this article in full you will need to make a payment
      ISSM Member Login
      Login with your ISSM username and password.
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Purchase one-time access:

      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Glina S.
        • Sharlip I.D.
        • Hellstrom W.J.
        Modifying risk factors to prevent and treat erectile dysfunction.
        J Sex Med. 2013; 10: 115-119
        • Corona G.
        • Lee D.M.
        • Forti G.
        • O'Connor D.B.
        • Maggi M.
        • O'Neill T.W.
        • Pendleton N.
        • Bartfai G.
        • Boonen S.
        • Casanueva F.F.
        • Finn J.D.
        • Giwercman A.
        • Han T.S.
        • Huhtaniemi I.T.
        • Kula K.
        • Lean M.E.
        • Punab M.
        • Silman A.J.
        • Vanderschueren D.
        • Wu F.C.
        • EMAS Study Group
        Age‐related changes in general and sexual health in middle‐aged and older men: Results from the European Male Ageing Study (EMAS).
        J Sex Med. 2010; 7: 1362-1380
        • Salonia A.
        • Castagna G.
        • Saccà A.
        • Ferrari M.
        • Capitanio U.
        • Castiglione F.
        • Rocchini L.
        • Briganti A.
        • Rigatti P.
        • Montorsi F.
        Is erectile dysfunction a reliable proxy of general male health status? The case for the International Index of Erectile Function‐Erectile Function domain.
        J Sex Med. 2012; 9: 2708-2715
        • Montorsi F.
        • Briganti A.
        • Salonia A.
        • Rigatti P.
        • Margonato A.
        • Macchi A.
        • Galli S.
        • Ravagnani P.M.
        • Montorsi P.
        Erectile dysfunction prevalence, time of onset and association with risk factors in 300 consecutive patients with acute chest pain and angiographically documented coronary artery disease.
        Eur Urol. 2003; 44: 360-364
        • Guo W.
        • Liao C.
        • Zou Y.
        • Li F.
        • Li T.
        • Zhou Q.
        • Cao Y.
        • Mao X.
        Erectile dysfunction and risk of clinical cardiovascular events: A meta‐analysis of seven cohort studies.
        J Sex Med. 2010; 7: 2805-2816
        • Dong J.Y.
        • Zhang Y.H.
        • Qin L.Q.
        Erectile dysfunction and risk of cardiovascular disease: Meta‐analysis of prospective cohort studies.
        J Am Coll Cardiol. 2011; 58: 1378-1385
        • Feldman H.A.
        • Goldstein I.
        • Hatzichristou D.G.
        • Krane R.J.
        • McKinlay J.B.
        Impotence and its medical and psychosocial correlates: Results of the Massachusetts Male Aging Study.
        J Urol. 1994; 151: 54-61
        • Laumann E.O.
        • Paik A.
        • Rosen R.C.
        Sexual dysfunction in the United States: Prevalence and predictors.
        JAMA. 1999; 281: 537-544
        • Prins J.
        • Blanker M.H.
        • Bohnen A.M.
        • Thomas S.
        • Bosch J.L.
        Prevalence of erectile dysfunction: A systematic review of population‐based studies.
        Int J Impot Res. 2002; 14: 422-432
        • Roth A.
        • Kalter‐Leibovici O.
        • Kerbis Y.
        • Tenenbaum‐Koren E.
        • Chen J.
        • Sobol T.
        • Raz I.
        Prevalence and risk factors for erectile dysfunction in men with diabetes, hypertension, or both diseases: A community survey among 1,412 Israeli men.
        Clin Cardiol. 2003; 26: 25-30
        • Hyde Z.
        • Flicker L.
        • Hankey G.J.
        • Almeida O.P.
        • McCaul K.A.
        • Chubb S.A.
        • Yeap B.B.
        Prevalence and predictors of sexual problems in men aged 75–95 years: A population‐based study.
        J Sex Med. 2012; 9: 442-453
        • Gacci M.
        • Eardley I.
        • Giuliano F.
        • Hatzichristou D.
        • Kaplan S.A.
        • Maggi M.
        • McVary K.T.
        • Mirone V.
        • Porst H.
        • Roehrborn C.G.
        Critical analysis of the relationship between sexual dysfunctions and lower urinary tract symptoms due to benign prostatic hyperplasia.
        Eur Urol. 2011; 60: 809-825
        • Parazzini F.
        • Menchini Fabris F.
        • Bortolotti A.
        • Calabrò A.
        • Chatenoud L.
        • Colli E.
        • Landoni M.
        • Lavezzari M.
        • Turchi P.
        • Sessa A.
        • Mirone V.
        Frequency and determinants of erectile dysfunction in Italy.
        Eur Urol. 2000; 37: 43-49
        • Ponholzer A.
        • Temml C.
        • Mock K.
        • Marszalek M.
        • Obermayr R.
        • Madersbacher S.
        Prevalence and risk factors for erectile dysfunction in 2869 men using a validated questionnaire.
        Eur Urol. 2005; 47: 80-85
        • Mialon A.
        • Berchtold A.
        • Michaud P.A.
        • Gmel G.
        • Suris J.C.
        Sexual dysfunction among young men: Prevalence and associated factors.
        J Adol Health. 2012; 51: 25-31
        • Martins F.G.
        • Abdo C.H.
        Erectile dysfunction and correlated factors in Brazilian men aged 18–40 years.
        J Sex Med. 2010; 7: 2166-2173
        • Pescatori E.S.
        • Giammusso B.
        • Piubello G.
        • Gentile V.
        • Farina F.P.
        Journey into the realm of requests for help presented to sexual medicine specialists: Introducing male sexual distress.
        J Sex Med. 2007; 4: 762-770
      1. NIH consensus development panel on impotence.
        JAMA. 1993; 270: 83-90
        • Charlson M.E.
        • Pompei P.
        • Ales K.L.
        • MacKenzie C.R.
        A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation.
        J Chronic Dis. 1987; 40: 373-383
        • National Institutes of Health, National Heart, Lung, and Blood Institute
        Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults—The Evidence Report.
        Obes Res. 1998; 6: 51-210S
        • Grundy S.M.
        • Cleeman J.I.
        • Daniels S.R.
        • Donato K.A.
        • Eckel R.H.
        • Franklin B.A.
        • Gordon D.J.
        • Krauss R.M.
        • Savage P.J.
        • Smith Jr, S.C.
        • Spertus J.A.
        • Costa F.
        • American Heart Association; National Heart, Lung, and Blood Institute
        Diagnosis and management of the metabolic syndrome: An American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement.
        Circulation. 2005; 112: 2735-2752
        • American Association of Clinical Endocrinologists
        Medical guidelines for clinical practice for the evaluation and treatment of hypogonadism in adult male patients—2002 update.
        Endocr Pract. 2002; 8: 440-456
        • Rosen R.C.
        • Riley A.
        • Wagner G.
        • Osterloh I.H.
        • Kirkpatrick J.
        • Mishra A.
        The International Index of Erectile Function (IIEF): A multidimensional scale for assessment of erectile dysfunction.
        Urology. 1997; 49: 822-830
        • Cappelleri J.C.
        • Rosen R.C.
        • Smith M.D.
        • Mishra A.
        • Osterloh I.H.
        Diagnostic evaluation of the erectile function domain of the International Index of Erectile Function.
        Urology. 1999; 54: 346-351
        • Kaye J.A.
        • Jick H.
        Incidence of erectile dysfunction and characteristics of patients before and after the introduction of sildenafil in the United Kingdom: Cross sectional study with comparison patients.
        Br Med J. 2003; 22: 424-425
        • Braun M.
        • Wassmer G.
        • Klotz T.
        • Reifenrath B.
        • Mathers M.
        • Engelmann U.
        Epidemiology of erectile dysfunction: Results of the “Cologne Male Survey”.
        Int J Impot Res. 2000; 12: 305-311
        • Martin‐Morales A.
        • Sanchez‐Cruz J.J.
        • Saenz de Tejada I.
        • Rodriguez‐Vela L.
        • Jimenez‐Cruz J.F.
        • Burgos‐Rodriguez R.
        Prevalence and independent risk factors for erectile dysfunction in Spain: Results of the Epidemiologia de la Disfunction Erectil MAsculina Study.
        J Urol. 2001; 166: 569-574
        • De Berardis G.
        • Pellegrini F.
        • Franciosi M.
        • Pamparana F.
        • Morelli P.
        • Tognoni G.
        • Nicolucci A.
        • EDEN Study Group
        Management of erectile dysfunction in general practice.
        J Sex Med. 2009; 6: 1127-1134
        • Akre C.
        • Michaud P.A.
        • Suris J.C.
        “I'll look it up on the web first”: Barriers and overcoming barriers to consult for sexual dysfunction among young men.
        Swiss Med Wkly. 2010; 140: 348-353
        • Angst J.
        Sexual problems in healthy and depressed persons.
        Int Clin Psychopharmacol. 1998; 13: S1-4
        • Gratzke C.
        • Angulo J.
        • Chitaley K.
        • Dai Y.T.
        • Kim N.N.
        • Paick J.S.
        • Simonsen U.
        • Uckert S.
        • Wespes E.
        • Andersson K.E.
        • Lue T.F.
        • Stief C.G.
        Anatomy, physiology, and pathophysiology of erectile dysfunction.
        J Sex Med. 2010; 7: 445-475
        • Aversa A.
        • Rossi F.
        • Francomano D.
        • Bruzziches R.
        • Bertone C.
        • Santiemma V.
        • Spera G.
        Early endothelial dysfunction as a marker of vasculogenic erectile dysfunction in young habitual cannabis users.
        Int J Impot Res. 2008; 20: 566-573
        • Shamloul R.
        • Bella A.J.
        Impact of cannabis use on male sexual health.
        J Sex Med. 2011; 8: 971-975
        • Mannino D.M.
        • Klevens R.M.
        • Flanders W.D.
        Cigarette smoking: An independent risk factor for impotence?.
        Am J Epidemiol. 1994; 140: 1003-1008
        • Nicolosi A.
        • Moreira Jr, E.D.
        • Shirai M.
        • Bin Tambi M.I.
        • Glasser D.B.
        Epidemiology of erectile dysfunction in four countries: Cross‐national study of the prevalence and correlates of erectile dysfunction.
        Urology. 2003; 61: 201-206
        • Rosen R.C.
        • Wing R.
        • Schneider S.
        • Gendrano N.
        Epidemiology of erectile dysfunction: The role of medical comorbidities and lifestyle factors.
        Urol Clin North Am. 2005; 32: 403-417
        • Harte C.B.
        • Meston C.M.
        Acute effects of nicotine on physiological and subjective sexual arousal in nonsmoking men: A randomized, double‐blind, placebo‐controlled trial.
        J Sex Med. 2008; 5: 110-121
        • Gades N.M.
        • Jacobson D.J.
        • McGree M.E.
        • St Sauver J.L.
        • Lieber M.M.
        • Nehra A.
        • Girman C.J.
        • Jacobsen S.J.
        Longitudinal evaluation of sexual function in a male cohort: The Olmsted county study of urinary symptoms and health status among men.
        J Sex Med. 2009; 6: 2455-2466
        • Deveci S.
        • O'Brien K.
        • Ahmed A.
        • Parker M.
        • Guhring P.
        • Mulhall J.P.
        Can the International Index of Erectile Function distinguish between organic and psychogenic erectile function?.
        BJU Int. 2008; 102: 354-356
        • Schouten B.W.
        • Bohnen A.M.
        • Bosch J.L.
        • Bernsen R.M.
        • Deckers J.W.
        • Dohle G.R.
        • Thomas S.
        Erectile dysfunction prospectively associated with cardiovascular disease in the Dutch general population: Results from the Krimpen Study.
        Int J Impot Res. 2008; 20: 92-99
        • Chew K.K.
        • Finn J.
        • Stuckey B.
        • Gibson N.
        • Sanfilippo F.
        • Bremner A.
        • Thompson P.
        • Hobbs M.
        • Jamrozik K.
        Erectile dysfunction as a predictor for subsequent atherosclerotic cardiovascular events: Findings from a linked‐data study.
        J Sex Med. 2010; 7: 192-202
        • Kupelian V.
        • Shabsigh R.
        • Araujo A.B.
        • O'Donnell A.B.
        • McKinlay J.B.
        Erectile dysfunction as a predictor of the metabolic syndrome in aging men: Results from the Massachusetts Male Aging Study.
        J Urol. 2006; 176: 222-226
        • Brotons F.B.
        • Campos J.C.
        • Gonzalez‐Correales R.
        • Martín‐Morales A.
        • Moncada I.
        • Pomerol J.M.
        Core document on erectile dysfunction: Key aspects in the care of a patient with erectile dysfunction.
        Int J Impot Res. 2004; 16: S26-39
        • Travison T.G.
        • Hall S.A.
        • Fisher W.A.
        • Araujo A.B.
        • Rosen R.C.
        • McKinlay J.B.
        • Sand M.S.
        Correlates of PDE5i use among subjects with erectile dysfunction in two population based surveys.
        J Sex Med. 2011; 8: 3051-3057