The Hidden Erection Problem In Young Men

A study in Western Australia on male erectile dysfunction found that one quarter of men had erection problems, and one in twelve had severe erectile difficulty.

The study was conducted by sending postal questionnaires to randomly selected men in the electoral roll. In summary, before we look at the detail of the study, these are the basic facts: 42% of questionnaires were returned to the researchers, so the sample was to some extent self-selected. Among adult men in WA, the occurrence of any erection problem and severe erectile dysfunction was, respectively, 25.0% and 8.5%.

As you might expect, the frequency of erection problems increased with age. Astonishingly, thirty-eight percent of married men and men who had partners experienced erection problems (severe erection problems 19.1%). There was little difference between white collar and blue collar workers; the most disturbing fact of all was that the vast majority of the men had had erection problems for over a year, but only a meagre 14% had asked for or received any treatment.

Erectile dysfunction (erection problems) means that a man is consistently and perhaps recurrently unable to achieve an erection hard enough for penetration and sexual intercourse. The researchers wanted to conduct a survey on erection problems among men in Western Australia, and used the Electoral Roll for June 2001 as the source for the men they questioned.

They selected men by age and location, using 14 random samples of 302 men in and outside Perth. They sent out a reply-paid questionnaire by mail and in it asked questions on medical history and medical treatment, social status, sexual behavior and sexual function. The men were classified as blue or white collar workers and assessed for social deprivation. The data was collected using the International Index for Erectile Function, which is also called the Sexual Health Inventory for Men.

4,228 questionnaires were posted, and 1,580 (89.3%) returned with a full set of answers. These 1,580 men were aged between 20.1 and 99.6 years. For the purpose of this study they were grouped by age. Erection problems occurred in 25% of the whole sample, and and an astonishing 8.5% of these men reported severe erection problems.

Both the frequency of occurrence and the severity of erection problems increased very significantly with age, particularly after a man reached 50 years of age. But even 15% of the young men aged between 20 and 29 years had erectile problems – and surprisingly, this was less than the men in the next older age groups.

Perhaps unsurprisingly, there was a decline in sexual activity in men of 60 years and older; over 70 years of age, sexual activity declined sharply. But a significant number of the men over 60 (42.6%) and over 70 (25.7%) were sexually active.

There are many interesting facts in this survey beyond those related to erection problems. For example, while about three quarters of the men were married or living with sexual partners, only three quarters of these men were sexually active.

Of the ones who were sexually active, just over 60% said they were having sex on a regular basis. Of the other quarter who were not living with a wife or partner, 53.9% were sexually active – and indeed 39.2% of these men said they had sexual intercourse on a regular basis.

A majority of the men were employed, though 36.8% had retired on grounds of age and 6.8% had retired on the grounds of ill-health.

The highest incidence of erectile problems occurred in clerical, sales, and service workers, but the occurrence of erection problems wasn’t really much different between blue collar and white collar workers. What is less surprising is that erection problems occurred most often in men from economically deprived areas. We know stress is a potent factor in causing a loss of a man’s sense of male power, so there is nothing surprising about that.

Most of the men (a massive 89.1%) with erection problems had had  their difficulties for more than 1 year, and a whopping 74.8% had had erection problems for more than two years; unbelievably 12.2% said they had been suffering for more than 10 years. And the longer it went on, the worse it got. Yet only 90 men (a meager 14.1%) had ever looked for and got any treatment.

Most studies on erection problems have looked at men aged between 40 and 70 years, but this study covered a much bigger range. To this extent, then, it represents the entire spectrum of adult men in WA. You have to assume that this is typical of the results in much of the Western World, and it is truly shocking.

When you look at the detail, it seems odd that men in the 20 – 29 age group appeared to have more erection problems than the 30 – 39 years age group. Possible explanations include commonplace stress of early adulthood such as new relationships, new work responsibilities, and stress linked to leaving home. Among men aged between 40 and 69 years, erection problems occurred in 33.0% of men, while sever erection problems occurred in 8.6%. In fact, the age of a man is far more important than any other factor in determining whether a man has an erection problem.

Both the frequency and the severity of erection problems increase with age. And since the older age groups were under-represented in the study, the true frequency of erection problems and of severe erection problems in men may have been higher than the recorded levels of 25.1 and 8.5%.

[These figures are so high they seem hard to believe….but this is what the study found.]

Australian demography is changing rapidly, and the proportion of men aged 65 years and older will increase dramatically in the years to come – which means erection problems will pose huge clinical and socioeconomic burdens on healthcare providers and social support services in the years ahead – if men choose to seek help, which currently they are not doing.

The majority of the participants in the Western Australia Men’s Health Study, from where these results are taken, were married or had partners, even though an astonishing 25% or more of these men were not enjoying an active sex life. Of the men aged 70 years and older, a fair proportion remained sexually active.

All these findings matched the results from the Global Study of Sexual Attitudes and Behaviors, a large scale project in which over thirteen thousand men from 30 countries were asked about their sexual behavior. Over 84% of men in this study aged between forty and eighty said they’d had sexual intercourse within the 12 months preceding the study. Among the men who were sexually active, about half said they had sexual intercourse regularly.

When the authors compared men who had never been married with those who were married or had partners, they found, perhaps unsurprisingly, that having never been married was significantly associated with an increased chance of having erection problems; in short, fewer married men have erection problems than non-married men, though which is cause and which effect remains unclear.

Analysis of the results of the study also showed that being separated or divorced may be one of the predisposing factors for erection problems. (Though once again, of course, whether the erection problems were a cause of, or simply unrelated to, separation and divorce, is unclear. In other studies, it has been shown that men with severe erection problems are much more likely to be single, without regular sexual partners.

Erection problems have previously been associated with lower socioeconomic status. The current study demonstrated that erection problems occurred in a smaller proportion of men who were in full- or part-time employment compared to the unemployed.

Clerical, sales and service workers had the highest frequency of erection problems, although there were few other correlations of note between erection problems and occupational group. There was no difference between “blue collar” and “white collar” workers in this respect.

Of the 468 men in the study who reported on the length of time for which they had endured erection problems, 47.9% had had the problem for between one and five years. This matches other studies in the general population, where 55% of men with the problem were found to have had erectile dysfunction of one sort or another for this period. The current authors’ observation that men who had had it for longer also had more severe problems is neither surprising nor novel.

In spite of erection problems being a common and often long-standing condition, only 14.1% of the men with erection problems had ever received any treatment. This suggests that there is an urgent need for sexual education and awareness information at every level. And certainly, if it’s true that the longer the erection problems continue, the worse they get, then men with any erection problem should get professional assistance as soon as possible so that therapeutic intervention can be started in the milder stages of erectile dysfunction.

It’s also important to remember that erection problems may indicate cardiovascular and endothelial disease – so once again, there is a clear incentive for erection problems to be comprehensively investigated. In this study in WA, erectile dysfunction was found to be apparently under-diagnosed and grossly undertreated. Whether or not this is true – and if it is, whether or not it applies to the rest of the world – remains to be seen.
 The Journal of Sexual Medicine

Volume 5 Issue 1 Page 60-69, January 2008

To cite this article: Kew-Kim Chew MBBS, FRCPEdin, FRCPGlasg, Bronwyn Stuckey MBBS, FRACP, Alexandra Bremner BSc(Hons), GradDipAppStats, PhD, Carolyn Earle BSc, PGradDipHithSci, Konrad Jamrozik MBBS, D Phil (2008) Male Erectile Dysfunction: Its Prevalence in Western Australia and Associated Sociodemographic Factors
The Journal of Sexual Medicine 5 (1) , 60–69 doi:10.1111/j.1743-6109.2007.00548.x

Erectile Dysfunction

Erection problems.

And so the demand for effective treatment for erectile dysfunction is going to increase in years to come. One of the major ways to treat ED is  pharmacological agents, i.e., prescription drugs like Viagra and Cialis.

The frequency of erection problems is high: even among normal men it is estimated that about 1 man in 12 has an erection problem. Among diabetic men, the frequency is much higher – up to 50 % of men with diabetes have some kind of erection problem.

What is erectile dysfunction (ED)? How is it treated with drugs?

Erectile dysfunction is defined very simply: a man can’t get an erection hard enough to sustain sexual intercourse. There are other related conditions, such as diminished libido (low sex drive or lack of desire), low testosterone. Also, delayed ejaculation, or DE – see a good book on this here – or premature ejaculation may be associated with erection problems. (Read more about delayed ejaculation here.)

ED or erectile dysfunction increases in frequency in the older age groups. This can be caused by circulation problems, nerve problems, hormonal problems, psychological issues, or prescription drugs.  But most often it is down to a combination of one or more of these factors. (Which are also called, in the order referred to above, vasculogenic, neurogenic, endocrine, psychogenic, and prescription drug induced.)

There’s no hard and fast classification of what constitutes and erection problem, or a definition of erectile dysfunction. The condition itself ranges from an erection that is not firm enough for intercourse to an erection which allows penetration but then fades away. Alternatively and erection may not last long enough for intercourse to be completed.

(By the way, surgery is not such a good option; the implantation of a prosthetic inflatable device is major surgery, with attendant risks, and has a high failure rate.)

By contrast, one of the main avenues of treatment over the past ten years has been by drugs such as Viagra. The rapid response and effective action of these drugs is important. They represent an instant treatment for a man who is unable to have sex, and thereby provide a rapid boost to self-esteem and sexual self-confidence. This will reduce the feelings of anger, depression and low self-esteem so common among men with ED.

How does drug treatment for Erectile Dysfunction (ED) work?

The erectile chambers of the penis consist of two longitudinal structures (each called a corpus cavernosum) which run along the length of the penis from its base to the coronal ridge. These corpora cavernosa are made up of spongy tissues surrounded by smooth muscle.

Normally, a degree of muscle tone keeps the muscles fibres slightly tense, thereby preventing blood flowing into the expandable tissues. When the muscles relax, blood may enter, and the tissues swell, which has the effect of squeezing the veins leading blood away from the penis.

(The veins are squeezed between the rather inelastic tunica albuginea which surrounds the whole of the erectile tissue and the corpora cavernosa.) With blood unable to drain away, the penis becomes erect. This process is far from simple, and involves many chemicals, nerve impulses and interacting somatic and chemical factors. Disruption to any part of the process may cause a man to develop erectile dysfunction.

Causes of erectile dysfunction


The most common factor is vascular: a problem with either the veins or the arteries of the penis. Clearly either impaired arterial function (arterial insufficiency) or a leaking vein (veno-occlusive erectile failure) may contribute to erection problems. Such problems originate in conditions such as hypertension, hyperlipidemia, diabetes and smoking.


But neurological problems are also a common cause of impotence. Nerve impulses resulting from sexual stimulation cause the release of nitric oxide and prostaglandins in the base of the penis. These substances then cause the smooth muscles of the penis to relax and allow blood to flow in, thereby causing an erection to develop. Injury to any part of the nerve network that promotes these chemical actions can render a man impotent. Such damage can result from groin injury, prostate surgery, MS, and neuropathy associated with diabetes.


Testosterone declines with age – as most men over 50 years of age will know – and this reduction in blood testosterone may result in fewer night-time erections and a lower level of libido. There are also a number of medications which may produce high prolactin levels, which antagonizes the action of testosterone. See below for more on this.


These include SSRIs (prescribed for mood disorders) and ranitidine (prescribed for stomach acid problems). In addition, some antihistamines, antidepressants, antihypertensives, sedatives and anxiolytics (anti-anxiety drugs) have been all been blamed for causing erection problems.

Stress, anxiety and other psychological factors 

Stress and anxiety can produce erectile dysfunction by raising blood catecholamine levels – these stress hormones oppose smooth muscle relaxation.

Purely psychological factors may include fear of sex, fear of women, fear of pregnancy, fear of failure and so forth. The inability to get erect causes much anxiety, which in itself is likely to cause erectile failure at the next sexual situation, thereby perpetuating and compounding the erectile dysfunction.

Treatment Options for Erectile Dysfunction 

Treatment may involve both the man and his partner: ED is generally not a problem that occurs in isolation.

You can enjoy a better erection by engaging with your partner in a series of exercises which resemble those prescribed by the professional sex therapists. These are described in this book on erectile dysfunction, which you can get from and

Penile prostheses and erectile dysfunction

These are inflatable or semi-rigid devices which are implanted into a man’s penis in place of his own erectile tissue. There has historically been a fairly high failure and infection rate. A more modern form of surgery for impotence is surgery to improve the flow of blood to the penis. This can be successful when the surgeon is experienced and the patient is properly selected.

A penile support sleeve to improve erectile firmness

A support sleeve may allow penetration of a soft penis into the vagina but who knows how much pleasure it gives either partner? Read more here.

Pharmacologic agents and the treatment of ED

Vasoactive agents like Viagra and Cialis will relax the blood vessels of the penis and permit the accumulation of more blood in the corpora cavernosa.

Other drugs used from time to time to treat ED have included Yohimbine, which is an alpha-2-adrenergic blocking agent. The effectiveness of Yohimbine as a treatment for erectile dysfunction has not been proven, and as it tends to promote anxiety and high pulse rates in susceptible men. It is really a treatment of limited benefit, especially now that Viagra has been proven safe and successful.

Psychological or physical erectile dysfunction?

Psychological issues are probably involved in all cases of erectile dysfunction: if not before it develops, certainly after it has done so! But for erectile problems that have a purely psychological origin (e.g. anxiety, nervousness, anger), the onset of erectile dysfunction is sudden and unexpected. In the case of physical erectile dysfunction, in other words that caused by an underlying physiological problem, the onset may be more gradual.