Erectile dysfunction (ED) is not considered a normal part of the aging process. Nonetheless, it is associated with certain physiologic and psychological changes related to age. In the Massachusetts Male Aging Study (MMAS), a community-based survey of men between the ages of 40 and 70, 52% of responders reported some degree of ED. Complete ED occurred in 10% of respondents, moderate ED occurred in 25%, and minimal ED in 17%. The incidence of moderate or severe ED more than doubled between the ages of 40 and 70. In the National Health and Social Life Survey (NHSLS), which was a nationally representative sample of men and women ages 18–59, 10% of men reported being unable to maintain an erection (corresponding to the proportion of men in the MMAS reporting severe ED). Incidence was highest among men in the 50–59 age group (21%) and among men who were poor (14%), divorced (14%), and less educated (13%).
The incidence of ED is also higher among men with certain medical disorders such as diabetes mellitus, obesity, lower urinary tract symptoms secondary to benign prostatic hyperplasia (BPH), heart disease, hypertension, and decreased HDL levels. Smoking is a significant risk factor in the development of ED. Medications used to treat diabetes or cardiovascular disease are additional risk factors (see below). There is a higher incidence of ED among men who have undergone radiation or surgery for prostate cancer and in those with a lower spinal cord injury. Psychological causes of ED include depression, anger, or stress from unemployment or other causes.
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