Should We Tailor the Clinical Management of Erectile Dysfunction According to Different Ages?

Paolo Capogrosso MD; Eugenio Ventimiglia MD; Luca Boeri MD; Edoardo Pozzi MD; Francesco Chierigo MD; Nicolò Schifano MD; Costantino Abbate; Rayan Matloob MD; Francesco Montorsi MD; Andrea Salonia MD, PhD

FIRST PUBLISHED: April 30, 2019 – The Journal of Sexual Medicine

DOI:https://doi.org/10.1016/j.jsxm.2019.03.405

Introduction

A man’s chances of developing erectile dysfunction (ED) increase with age. However, research suggests that younger men are also affected, and more men younger than 40 have been seeking help for ED over the last ten years.

Younger men do not usually have comorbidities that can affect erectile function (e.g., diabetes, cardiovascular disease, and obesity) to the same degree as older men. Nevertheless, ED rates in this population are not negligible (22-30%) and younger men may have different needs and expectations of treatment compared to older men.

This study discussed the potential need for an “age-tailored approach” to the diagnosis and treatment of ED, focusing on overall sexual satisfaction and mental health.

Methods

Retrospective data from 765 patients with ED were analyzed. The men completed the International Index of Erectile Function (IIEF) and the Beck Depression Inventory (BDI).

The participants’ ages were categorized as follows:

Results

The men’s median age at their first ED assessment was 50 years. Eighty-five percent of the participants were considered young or middle-aged, and 58% had severe or moderate ED at that time.

Average scores on the IIEF’s intercourse satisfaction and overall satisfaction domains varied for young and middle-aged men. Those with less severe ED tended to have higher satisfaction scores in both domains, indicating more satisfaction. In older men, this difference was not present when comparing normal erectile function and mild ED.

After a linear regression analysis, both IIEF erectile function domain scores and age were significantly associated with sexual satisfaction, and it appeared that the higher a patient’s age, the higher his feeling of sexual satisfaction for the same EF status.

Based on BDI scores, 25% of the men had depressive symptoms and 11% had undiagnosed clinical depression. After comorbidities and body mass index (BMI) were accounted for, symptoms were more common in younger men with worse IIEF-EF scores.

Another trend seen was that the older the patients, the lower the chance of reporting depressive symptoms in each ED category

Discussion

The findings are “a clinically relevant issue that may translate into a different diagnostic workup and therapeutic management of ED according to patients’ age.”

Older men “did not show significant differences in terms of sexual satisfaction for mild ED status vs normal EF.” Past research suggests that older men might be “apparently reconciled to lower levels of sexual activity,” which might explain this result.

Younger men in this study were at higher risk for depressive symptoms than older men. Clinicians might consider psychosocial assessments and support especially for younger men with ED.

The authors acknowledged some limitations:

• The results come from a group of heterosexual men at one medical center and may not apply to other populations.
• It was unclear how more tailored ED treatments might have affected the results.
• Hormonal data were available for just 53% of the participants.
• Information on the patients’ quality of life was not available.

Conclusions

“In this context, for any specific ED severity, older men perceive better sexual satisfaction compared with younger individuals; likewise, younger patients are at higher risk for developing depressive symptoms than older men, despite the same ED severity status.”

Assessment and support for psychological disorders is recommended for younger men with ED and for older men who expect improvements in sexual satisfaction.