The current state of men’s health is marked by a perplexing increase in life expectancy and the looming threat of erectile dysfunction. This debilitating condition, also known as ED, is characterized by the failure to achieve and/or maintain an erection suitable for sexual intercourse. According to a survey of 600 men between the ages of 40 and 70 conducted across four different countries, the incidence of ED varies widely: 15% in Brazil, 17% in Italy, 22% in Malaysia, and a whopping 34% in Japan. These alarming statistics indicate that ED is a growing concern for men worldwide.
Recent research suggests that ED is closely linked to cardiovascular disease, and the prevalence of the condition increases with age. Depending on the study design, the prevalence of ED ranges from 10% to 52%, with some countries experiencing 25-30 new cases per 1,000 inhabitants per year. Mild ED affects 17.2% of men, moderate ED affects 25.2%, and severe ED affects 9.6%.
The mechanics of an erection are complex and involve a combination of neurovascular changes in the cavernous bodies of the penis, resulting in the relaxation of smooth muscle elements in the walls of the arteries, arterioles, and sinusoids. The parasympathetic nervous system is activated with sexual stimulation, leading to the release of neurotransmitters like nitric oxide, which accumulates cGMP in the cavernous tissue, further relaxing smooth muscle cells, and filling the lacunae with arterial blood, resulting in compression of the venules and blockage of blood outflow.
Psychogenic and organic ED are two types, though in most cases, both factors contribute to its development. Depression, relationship issues, sexual ignorance, fear of failure, etc., are some psychological factors that contribute to ED. Organic ED can develop due to various somatic diseases such as diabetes mellitus, arterial hypertension, hypercholesterolemia, hypogonadism, hypothyroidism, and smoking. Numerous studies show a significant association of ED with metabolic syndrome and cardiovascular disease, indicating that ED is an early marker of these diseases.
In persons without somatic pathology, the prevalence of ED is 15.4%, but in individuals with concomitant cardiovascular diseases, ED is detected almost ten times more often, accounting for 66.4%. For example, ED is detected in every third man with arterial hypertension, every second man with coronary heart disease, and in two-thirds of patients with both conditions. Diabetes mellitus is also a disease that negatively affects sexual function, with the prevalence of ED and decreased libido in type 2 diabetes being 60.9% and 46.4%, respectively.
It is important to note that 80% of ED cases are organic and arise as a complication of somatic diseases. Various mechanisms, such as neurogenic and vascular, may be involved in its development, and its treatment should primarily be pathogenetic. With the increase in life expectancy among men, the detection and treatment of ED is now more crucial than ever to ensure their overall health and well-being.
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