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Which Men Develop ED? Here Is Your Definitive Guide

Man in a business suit pointing to the words Erectile dysfunction. An estimated 18 million American men suffer from some degree of erectile dysfunction.

Degree of Erectile Function Among U.S. Men Aged 20 and Older*

Age GroupAlways or Almost AlwaysUsually AbleSometimes AbleNever AbleED Percentage
All ages65.016.512.36.218.5
20-3984.810.14.01.15.1
40-5965.419.812.42.414.8
60-6928.727.52716.743.8
70 and over11.218.633.736.570.2

*Selvin, E., Burnett, A.L., & Platz, E.A. (2007). Prevalence and Risk Factors for Erectile Dysfunction in the US. The American Journal of Medicine, 120(2), 151-157. doi:10.1016/j.amjmed.2006.06.010.

Introduction

In the minds of Americans who have had no personal exposure to erectile dysfunction either as a patient or the close acquaintance of a patient, ED is associated largely with older men. And while it is true that the incidence of ED increases with age, a fair number of younger men — under 40 — also suffer from this common form of male sexual dysfunction. And age is just one of the many factors that figure into the profile of the typical American ED patient.

In a landmark study published in “The American Journal of Medicine,” a team of epidemiological researchers at Johns Hopkins Bloomberg School of Public Health offers a close-up look at the dimensions of the ED problem in the United States. The team analyzed data from more than 2,100 adult males who had participated in the National Health and Nutrition Examination Survey (NHANES).

Their analysis of health data led the researchers to conclude that ED affects roughly 18 million American men who are 20 years of age and older. The range of erectile function among those surveyed varied significantly. While 65 percent of the respondents said they were always or almost always able to get and keep an erection suitable for intercourse, another 16.5 percent said they were usually able to achieve such an erection. The remaining 18.5 percent of the respondents said they were either sometimes or never able to do the same, which means they suffer from some degree of ED.

What Causes ED?

There is no simple answer to this question. Although an estimated 80 percent of all ED stems from insufficient blood flow to the penis, the vascular problems that contribute to this diminished blood flow can arise from a wide array of causes. Very often, underlying medical conditions gradually lead to a buildup of fatty plaque on artery walls or the constriction of blood vessels that in time make it impossible to get and keep an erection suitable for intercourse. Three of the more common medical conditions leading to ED are atherosclerosis, high blood pressure, and type 2 diabetes.

With diminished blood flow accounting for about eight in every 10 ED patients, the causes of the remaining 20 percent of ED are either psychological in origin or stem from a congenital or traumatic injury to the male genitalia. For the latter, surgical repair is usually the only solution, and psychogenic ED most often is treated with psychological counseling. Viagra or one of the other oral ED medications is unlikely to be of much help in these forms of impotence.

Importance of Lifestyle Choices

Apart from the tiny percentage of men who are born with conditions that can compromise blood flow, the most vascular damage is self-inflicted. It’s the lifestyle choices that men make that determine whether they will face an increased risk of ED as they grow older.

An unhealthy diet, excess weight, lack of exercise, and smoking all can lead to medical conditions that decrease blood flow throughout the body, including the penis. So, trading in some of those bad habits for healthy alternatives can jump-start the body’s efforts to repair the earlier damage. Even men who are already suffering from the early stages of diabetes or high blood pressure can minimize vascular damage by working with their doctors to closely manage their disorders.

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ED’s Link to Cardiovascular Disease

The Johns Hopkins research team looked closely at the prevalence of cardiovascular disease (CVD) risk factors among men with and without ED. To no one’s surprise, it found that CVD risk factors were almost always higher in men with ED than in men who were not impotent.

While the average age of men with ED was 63.4 years, the average age of men without ED was more than a decade younger at 51.2 years. The percentage of the men with ED who were also suffering from untreated high blood pressure was 11.7 percent, compared with 17.2 percent among those without ED. However, the percentage of ED patients who were also being treated for hypertension was 38.4 percent, nearly double the 19.7 percent in men without ED.

The percentage of current smokers among ED patients was 27.2 percent, compared with 21.3 for men without ED. A large number of men in both groups suffered from elevated cholesterol levels — 49.4 percent among ED patients versus 45.2 percent in men without ED. At 30.9 percent, diabetes was much more prevalent in men with ED than in men without, with only 9.4 percent suffering from the disease.

The mean body mass index among men with ED was 30.3, compared with 28.2 for men without ED. When asked about their level of physical activity in the 30 days preceding the survey, 45.8 percent of the ED patients said that they had engaged in no physical activity, compared with 31.1 percent of the men without ED. Moderate physical activity was reported by 26.3 percent of the men with ED and 29.8 percent of those without ED, while 28.0 percent of men with ED said they’d engaged in a vigorous physical activity, compared with 39.1 percent of men without ED.

Prevalence of CVD Risk Factors in Men with and Without ED* (Age-Adjusted, Men 40 and Older)

 Men with EDMen without ED
Age (years), mean63.451.2
Hypertension
    Untreated hypertension, %11.717.2
    Treated hypertension, %38.419.7
Current Smoking, %27.221.3
Elevated Cholesterol, %49.445.2
Diabetes, %30.99.4
Hypertension, elevated cholesterol, diabetes, or current smoking, %88.174.0
Body mass index, mean30.328.2
Physical activity in past 30 days
    No physical activity, %45.831.1
    Moderate physical activity, %26.329.8
    Vigorous physical activity, %28.039.1
History of cardiovascular disease, %12.98.7

*Selvin, E., Burnett, A.L., & Platz, E.A. (2007). Prevalence and Risk Factors for Erectile Dysfunction in the US. The American Journal of Medicine, 120(2), 151-157. doi:10.1016/j.amjmed.2006.06.010.

Medication Can Help in Most Cases

The 1998 introduction of Viagra ushered in a whole new era in the treatment of ED. Suddenly men with ED caused by insufficient blood flow to the penis — the most common cause of ED — could pop a pill and be ready for sexual activity in an hour or less. Viagra was followed to market by a handful of similar medications, all of which belong to a family of drugs known as PDE5 inhibitors.

Clinical trials have shown that Viagra and the drugs that followed are safe and effective in more than 80 percent of the men on whom they’ve been tested. Each of these drugs differs slightly from the others in its chemical makeup, and some men have found that one works better than the others and has fewer side effects. A small percentage of men with blood flow-related ED may find that none of the PDE5 inhibitors works for them. In such cases, alternative treatments such as penile injection therapy and vacuum pump devices might offer a solution.

Demographics of Viagra Users

Man smoking a cigarette and drinking a glass of wine.

Smoking and excessive alcohol consumption can lead to erectile dysfunction.

With nearly 10,000 retail outlets, CVS is the largest pharmacy chain in America. Its patient statistics for Viagra show that 50.3 percent of its Viagra customers are between the ages of 40 and 60, followed by 43.6 percent who are over 60 years of age. Just over 6 percent of its Viagra buyers are under the age of 40, according to CVS data.

The data from CVS falls in line with an estimate from Pfizer, Viagra’s developer, that its typical customer for the little blue pill is a man in his early to mid-50s.

While studies have found that African-American and Hispanic-American men have a slightly higher incidence of ED than white American men, those differences are not usually reflected in consumer purchases of the drug.

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About Don Amerman

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Don Amerman has spent more than three decades in the business of writing and editing. During the last 15 years, his focus has been on freelance writing. For almost all of his writing, He has done all of his own research, both online and off, including telephone and face-to-face interviews where possible. Don Amerman on Google+