Age at First Presentation for Erectile Dysfunction: Analysis of Changes over a 12-yr Period

Background: The awareness regarding erectile dysfunction (ED) may have increased over the past decade due to the widespread availability of phosphodiesterase type 5 inhibitors and the growing knowledge of a link between ED and men's overall health. Objective: We examined whether the increased awareness of ED has led to observable changes in patient characteristics among first-time assessments for ED. Design, setting, and participants: Data was collected from 1586 men seeking their first medical attention for ED at a single academic center during 2005–2017. Intervention: Patients completed the International Index of Erectile Function (IIEF) to assess ED. Outcome measurements and statistical analysis: Local polynomial regression models explored the relationship between patient characteristics and the year of first-time assessment. Linear and logistic regression models estimated the association between the time at first assessment and the investigated outcomes. Restricted cubic splines tested the nonlinearity for continuous variables. Results and limitations: We observed a nonlinear correlation between age and year of assessment (p = 0.0003); the probability that a patient aged <40 yr presented for ED increased from 13.5% in 2006 to 21.7% in 2017 (p = 0.002). Patients assessed over the last period were significantly healthier (Charlson Comorbidity Index ≥ 1; odds ratio [OR]: 0.96; 95% confidence interval [CI]: 0.92–0.99, p = 0.02). We observed an increase in the rate of smokers (OR: 1.19, 95% CI: 1.14–1.23, p < 0.0001) and in regularly physically active men (OR: 1.05; 95% CI: 1.01–1.08, p = 0.008) over the same period. No changes were observed in terms of baseline IIEF-Erectile function scores over time. The single center design is the main limitation of the study. Conclusions: Age at first presentation for ED significantly decreased over the past decade. Physicians should carefully assess EF even at younger age groups, suggesting lifestyle modifications and relevant treatments for comorbid conditions as soon as possible. Patient summary: Patients presenting for erectile dysfunction (ED) are younger than they were 10 yr ago. These findings may suggest an increase in ED awareness. Likewise, this age reduction could represent a worrisome increase in terms of ED incidence in young men.