Incidence of erectile dysfunction

Due to the sexual liberalization and enlightenment beginning at the end of the 1960s and the associated detabooization of the sexual sphere, sexual pathology is becoming increasingly important in today's medicine [6]. According to a study by Sulke/Schroer [12], approximately 120,000 patients in the Federal Republic of Germany consult a physician each quarter because of a disorder of erectile function. If an occasional erectile dysfunction is not yet regarded as a pathological finding requiring treatment, erectile dysfunction (ED) is understood as the inability to obtain or maintain an erection strong and lasting enough for the performance of sexual intercourse in the vast majority of attempts [8, 9]. Finkle et al. [4, 5] defined erectile potency as the ability to convert the desire for sexual intercourse into a penile erection strong enough for the performance of satisfactory sexual intercourse. Due to the particular characteristics of erectile dysfunction as a dysfunction associated with the intimate area, occurring passively or permanently, without obligatory recognition symptoms for the social environment [11], only few epidemiological data exist. According to Epple [3], such a disorder is found in an estimated 2-4 million German citizens of reproductive age. Another source even speaks of 3 to 7 million affected men in the Federal Republic of Germany [11]. The incidence rate of erectile dysfunction requiring therapy was also reported to be twice as high as that of coronary heart disease (cited from [11]). In the USA, more than 10% of the adult male population is reported to suffer from erectile dysfunction without taking age into account.

Already in 1948 Kinsey et al. published [7] an increase in erectile dysfunction with increasing age. This again underlines the importance of diagnosis and therapy of sexual dysfunction in Western industrial societies, which are characterized by a reversal of the age pyramid and by increasing life expectancy with a rising proportion of old people [10]. Bowers et al. [2] in their studies of 157 men aged 60–74 years also showed that the incidence of erectile dysfunction increased continuously from 30,070 to 60% with increasing age. This suggests that erectile dysfunction with increasing age should be seen as part of a physiological aging process. On the other hand, Bowers et al. [2] showed that in potent men, there was no decrease in sexual activity with increasing age (mean frequency of coitus about 20 times per year). Furthermore, according to their studies, the impotence rate was independent of the general physical condition of the respective subjects studied. Thus, maintaining an active sexual life is also an important factor in the happiness and satisfaction of the aging person. Over 90% of married men between 60 and 65 years of age and over 70% between 65 and 70 years of age still have sexual relations [14]. Consistently, however, the incidence rate of erectile dysfunction appears to increase sharply at the end of the 6th decade of life. An overview of the incidence rates of erectile dysfunction published in the literature is given in Table 1.1.

Literature

1. Baltimore longitudinal study of aging, taken from USN & WR (1989).
2. Bowers M, Cross RR, Lloyd FA (1963) Sexual function and urologic disease in the elderly male. JAm Geriat Soc 11: 647-652
3. Epple W (1989) Erectile impotence, diagnosis, and possibilities of therapy for general practitioners and specialists. GP 16: 1052-1056
4. Finkle AL, Moyers TO, Thbenkin MI, Karg SJ (1959) Sexual potency in aging males. Frequency of coitus among clinic patients. JAMA 170: 1391-1393
5. Finkle AL, Prian DV (1966) Sexual potency in elderly men before and after prostatectomy. JAMA 196 12: 139-143
6. Haeberle EJ (1985) Human sexuality. Handbook and atlas, 2nd ed. de Gruyter, Berlin.
7. Kinsey AC, Pomeroy WB, Martin CE (eds) (1953) Sexual behavior in the human male. Saunders, Philadelphia
8. Levine LA (1989) Erectile dysfunction: causes, diagnosis and treatment. Compr Ther 15: 54-58
9. Masters WH, Johnson VE, Kolodny RC (1987) Masters and Johnson, love and sexuality.
10. German ed., Ullstein, Berlin to. Munich, M (1991) The corpus cavernosum autoinjection therapy (SKAT): indication, results and patient acceptance. Inaugural dissertation
11. Porst H, Ebeling L (1989) Erectile dysfunction: overview and current status of diagnosis and therapy. In: Fortschr Med 3: 2-6
12. Sulke J, Schroer B (1989) Cavernous autoinjection therapy: potency at any price? Dtsch Med Wochenschr 114: 231-234
13. Virag R (1985) Is impotence an arterial disorder? Lancet 19: 181-184
14. Zohar J, Meiraz D, Maoz B, Durst N (1976) Factors influencing sexual activity after prostatectomy: a prospective study. J Urol 116: 332-334