Analysis Of Risk Factors For Erectile Dysfunction in Adult Males

Abstract

Objective
To analyze the risk factors related to the progression of erectile dysfunction (ED) in adult men.

Methods
One hundred and fourteen adult male patients with ED, aged 19 to 84 years old, were analyzed at Nanfang Hospital from January 2019 to January 2021. Among them, 74 cases were diagnosed as mild ED, and 40 as moderate or severe ED. Age, body mass index, living habits, mental health status, education level, and comorbidities were compared between the two groups. Univariate and multivariate logistic regression analysis was used to analyze the risk factors that may lead to the progression of ED.

Results
Univariate analysis showed that monthly income, symptoms of anxiety and depression, frequency of masturbation, and obstructive sleep apnea syndrome (OSAS) had significant effects on the progression of ED. Multivariate logistic regression analysis showed that masturbation frequency (OR = 1.108, P = 0.047) and OSAS (OR = 3.194, P = 0.015) were independent risk factors for the progression of ED.

Conclusion
Excessive masturbation and OSAS are risk factors for the progression of ED from mild to moderate or severe. Therefore, a detailed history should be obtained to recognize these risk factors in patients presenting with ED.

Keywords
male; erectile dysfunction; obstructive sleep apnea syndrome; risk factors

 

 

 

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Introduction
Erectile dysfunction (ED) is the most common male sexual dysfunction disorder [1]. According to the 2018 guidelines of the American Urological Association (AUA) [2], ED is defined as the persistent or recurrent inability to achieve and/or maintain an erection sufficient for satisfactory sexual performance.

There are many causes of ED, including diabetes, hypertension, radical prostatectomy, and others [3]. Epidemiological studies at home and abroad show that the prevalence of ED in middle-aged and elderly men aged 40 to 60 years is approximately 24% to 44% [4-5], with mild ED accounting for 17%-20%, and moderate to severe ED as high as 33%-38% [6-7].

Mild ED can often be treated with oral phosphodiesterase type 5 inhibitors (PDE5i), while moderate to severe ED may require intracavernosal injection of active drugs, vacuum erection devices, or even prosthesis implantation [8]. However, these methods are invasive, complicated to operate, and expensive, which patients often find difficult to accept [9].

In recent years, studies [10-12] have reported the use of hydrogen sulfide (H2S) and stem cells to improve erectile function, but these methods have not yet been applied clinically. This study aims to investigate the risk factors associated with the progression of mild ED to moderate or severe ED, in hopes of developing preventive strategies to stop ED progression.

Materials and Methods

1.1 General Information

A total of 114 adult male patients with erectile dysfunction (ED) who visited the outpatient department of Nanfang Hospital from January 2019 to January 2021 were selected. Based on the International Index of Erectile Function-5 (IIEF-5) score [13], patients were divided into two groups: the mild ED group (n = 74) and the moderate to severe ED group (n = 40). All patients signed informed consent forms, and the study was approved by the Medical Ethics Committee.

Inclusion criteria:

Aged 18–70 years.

Stable sexual partner.

No genetic history of disease.

At least one attempt at sexual intercourse within the past four weeks.

Preliminary diagnosis of ED based on the IIEF-5 score.

Exclusion criteria:

Systemic diseases such as hematological disorders, congestive heart failure, severe liver dysfunction, or malignancies.

Congenital abnormalities of genital organs.

History of prostatectomy, rectal cancer surgery, spinal fractures, paraplegia, pelvic fractures, or penile/urethral injuries.

Primary gonadal insufficiency, thyroid, adrenal, or pituitary dysfunction.

Use of medications affecting erectile function within the past month.

Genital or accessory organ surgeries within the past 3–6 months.

1.2 Methods

Differences in age, body mass index (BMI), city of residence, monthly income, comorbidities, obstructive sleep apnea syndrome (OSAS), smoking and drinking habits, history of prostitution, masturbation history, circumcision, drug abuse, late-night habits, education level, and anxiety/depression status [14] were analyzed between the two groups.

Diagnosis of ED:
The IIEF-5 questionnaire includes the following five questions, with responses scored 0–5 (lower scores indicating worse function, total score = 25):

Confidence in achieving and maintaining an erection.

Frequency of achieving an erection firm enough for penetration when sexually stimulated.

Ability to maintain an erection after penetration.

Difficulty in maintaining an erection until the completion of intercourse.

Satisfaction with attempted intercourse.

Classification based on total score:

≤7: Severe ED.

7–12: Moderate ED.

12–22: Mild ED.

22–25: No ED.

Anxiety evaluation:
Anxiety was assessed using the Self-Rating Anxiety Scale (SAS), which includes 20 items rated on a four-point scale. Patients scored based on their condition over the past week.

≤50: Normal.

50–60: Mild anxiety.

60–70: Moderate anxiety.

70: Severe anxiety.

Depression evaluation:
Depression was assessed using the Self-Rating Depression Scale (SDS):

53–62: Mild depression.

62–72: Moderate depression.

72: Severe depression.

Late-night habits:
Defined as sleeping after 11 PM and having less than 7 hours of sleep. This included late-night habits caused by insomnia. Patients who habitually went to bed late but slept for 7 hours were not classified as having late-night habits [15].

Diagnosis of OSAS:
Based on the American Academy of Sleep Medicine (AASM) criteria:

Meeting either Criterion A (excessive daytime sleepiness without other explanations) or Criterion B (symptoms such as choking or gasping during sleep, frequent awakenings, unrefreshing sleep, fatigue, or impaired attention during the day, with at least two of these symptoms and no other explanations).

Plus Criterion C (overnight monitoring showing ≥5 obstructive respiratory events per hour of sleep, including obstructive apnea, hypopnea, or respiratory effort-related arousals [16]).

1.3 Statistical Analysis

Statistical analysis was performed using SPSS 20.0 software. Measurement data following a normal distribution were expressed as mean ± standard deviation (x̄ ± s) and compared using an independent sample t-test. Count data were expressed as n (%) and compared using the χ² test. Univariate and multivariate logistic regression analyses were conducted to evaluate risk factors for ED. A P-value <0.05 was considered statistically significant.