PREVALENCE AND RISK FACTORS OF ERECTILE DYSFUNCTION

1.1       BACKGROUND

Erectile Dysfunction(ED) was defined in 1992 by the National institute of Health Consensus panel on ED as the repeated inability to develop or maintain erection of penis sufficient for a satisfactory sexual intercourse or activity in the absence of an ejaculatory disorder such as premature ejaculation.[1]

Erectile dysfunction is a common public health problem that is said to affect 152 million men worldwide. It was initially called impotence but was reversed due to set backs incurred as it causes confusion and lead to inability to interpret result in both clinical and basic science investigations.[2] It is more prevalent in patients with associated medical conditions such as diabetes and hypertension and among cigarette smokers.[3] For many men, erectile dysfunction creates mental stress that affects their interactions with their family members and associates. However, its various aspects remain poorly understood by the general population and by most health care professionals. The fact that results have not been effectively communicated to the public has compounded this situation.⁴

1.2       STATEMENT OF THE PROBLEM

Prevalence varies according to individual characteristics- age, race, ethnicity, socioeconomic status, and concomitant disease conditions.

It was estimated in 1995 that over 152 Million men worldwide have experienced erectile dysfunction and was projected that by the year 2005, about 322 Million men would be affected with the largest projected increase in the developing world i.e. Asia, Africa, and South America.

In France, the estimated prevalence of ED is 32%; 56% in West Virginia, USA; 37.55% of men ranging from 40-70 years in Thailand; 37% in Korea; 52% among men with chronic disease in Japan; 49% of men with chronic prostration in Anhui, China;  88% of men with end-stage renal disease in Ontario, Canada; 69% of  men with Peyroni’s disease in Porto Alegre, Brazil; 47% of men with hypertension in Valencia, Spain; 68% of men with Diabetes Mellitus in Japan; and 48% of men with Rheumatoid arthritis in USA and Canada⁵.

Prevalence of ED in developing countries is largely unknown. However, the age adjusted prevalence rates of ED among men attending primary health care clinic is 57.4% in Nigeria, 63.5% in Egypt, 80.8% in Pakistan and 47% in Burkina Faso.⁶

An assessment of andropause (also known as androgen decline in ageing male) and erectile dysfunction awareness among married men with diabetes mellitus in Ile-Ife, Nigeria has a prevalence of 51.3%.⁷

Andropause has implications on the reproductive health and quality of life in older males. However, very few studies have been recorded among the Nigerian populace on andropause related issues.

In Nigeria, sufferers are unable to freely discuss the problem of ED with their doctors because of the fear of stigmatization. Also, data on the issue of erectile dysfunction is generally scarce on the scientific literatures and studies on clinical roles in the diagnosis and management of ED are extremely limited.

In USA, it has been established that ED affects 50% of males older than 45 years with various degrees of dysfunction. Approximately 152 million men worldwide suffer from the disease and the prevalence may be as high as 30 million in USA alone.  An increase in prevalence in ED in ageing male is well documented in studies such as Massachusetts male aging study and others. Several recent studies have looked at the prevalence of ED. The Massachusetts male aging study ,conducted from 1987-1989 in areas around Boston , was a cross- sectional random sampling community based survey of 1290 men ages from 40- 70. ED was self reported and the condition was classified as mild, moderate or complete. The combined prevalence of mild, moderate and complete ED was 52%; the study demonstrated that ED increases in prevalent with age, at age 40, there is an approximately 40% prevalence rate, increasing to almost 70% in men at age 70. The prevalence of moderate ED increases from 17% to approximately 34% the prevalence of complete ED increases from 5% to 15% as age increases from 40 to 70 years⁸.

The prevalence in an Italian Study increased from 2% for men aged 18-39 years to 48% in those over 70 years.