Epidemiology of Erectile Dysfunction in .NET

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Epidemiology of Erectile Dysfunction
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The scale and potential social impact of erectile dysfunction may be best understood by an appreciation of its international frequency In 1995, it is estimated that there were 152 000 000 men worldwide suffering from erectile dysfunction Because of the accelerating aging of the world population, coupled with the high prevalence of erectile dysfunction in men over 50, the world population of men with erectile dysfunction is expected to increase to 322 000 000 by the year 2025 [21] With this high prevalence, erectile dysfunction will become a progressively more common and compelling public health problem throughout the world Many studies on the prevalence of erectile dysfunction have been published in recent years but their conclusions vary widely The reasons for the varying results include differences in the design and methodology of the studies, the methods of selecting subjects for the study, the age and health of the cohort studied, the questions that are asked, how the questions are asked, cultural characteristics of the cohort under study, the prevailing attitudes about what constitutes a normal and an abnormal erection in the cohort under study, and prejudices of the investigators A review of 15 large-scale prevalence studies from
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History and Epidemiology of Male Sexual Dysfunction 1994 to 2004, reporting men with erectile dysfunction as a percentage of the studied population shows that the prevalence of erectile dysfunction has varied from a low of 102% in Laumann s US study of men aged 18 59 years, to a high of 64% in Akkus Turkish study of men over 40 (Table 41) [22 36] Among all 15 studies, the Massachusetts Male Aging Study is the one that is most often referenced [22] This study demonstrated an overall prevalence of erectile dysfunction of 52% in men aged 40 70 Of these 52%, 172% had minimal erectile dysfunction, 252% had
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moderate erectile dysfunction and 96% had complete erectile dysfunction Prevalence studies have produced much practical information of clinical importance Across all prevalence studies, when controlling for other factors, increasing age is a strong risk factor for erectile dysfunction This effect becomes especially prominent after about age 50 years For example, in 11 prevalence studies which report erectile dysfunction by decade of life, the prevalence of erectile dysfunction for men in their 30s is 2 159%, in their 40s is 9
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Table 41 Prevalence of erectile dysfunction Total (%) 52 Mild (%) 172 Moderate (%) 252 Complete (%) 96 ( 54)
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Author Feldman [22]
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Year 1994
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Country US
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N 1290
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Age 40 70 ( 54) 18 75 50 18 59 30 80 18 91 ( 56) >40 >40 >40 30 70 ( 39) 50 70 35 70 ( 43) >25 ( 40) 25 70 20 75 40 80 18 80 20 80
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Dunn [23]
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Laumann [24] Braun [25] Chew [26]
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1999 2000 2000
Recognizing UPC Code In Visual Studio .NET
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US Germany Australia
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1249 4489 1240
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102 192 394 96 89 186
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Akkus [27] Vaaler [28] Meuleman [29] Mahmoud [30]
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2000 2000 2000 2000
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Turkey Norway Netherlands Egypt
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1982 1182 1215 594
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643 33 13 549
357 NA
23 20
56 13
204 ( 39) 14 99
Koskimaki [31] Dogunro [32]
2000 2000
Finland Nigeria
2128 917
48 507
22 405
12 02
Kadiri [33]
Morocco
M-Morales [34] Rosen [35] Laumann [36] deBoer [37] Ponholzer [38]
2001 2004 2005 2004 2005
Spain Multinational Multinational Netherlands Austria
2476 27839 13618 2117 2869
121 16 129 281* 168 323
59 237
36 72
69 13
* Variation of prevalence depends on the region under investigation
4 studies, the variances in study design, methodology and subject recruitment prevent the conclusion that the prevalence of erectile dysfunction is discernibly more or less common in any one country Even though erectile dysfunction increases signi cantly with increasing age, there is evidence of continued sexual activity in men over 70, and even beyond age 80 For men in the age range 70 to 79, a study conducted in Germany [25] reported that 71% of men were sexually active, and a study in Japan [41] reported that 55% to 70% of men were sexually active [41] The Japanese study also reported that 44% of men over age 80 were sexually active Another study showed that, for men aged 50 to 80 in the United States and six European countries, the number of sexual activities per month was consistently between 54 and 65 (Fig 41) [42] These epidemiologic studies strongly suggest that a large percentage of men remain sexually active into their 70s and beyond Another important concept in epidemiologic studies of erectile dysfunction is that the overall preva-
39%, in their 50s is 16 67%, in their 60s is 27 76%, and in their 70s is 37 83% [22 26,29 31,33,34, 36 38] (Table 42) Other major risk factors for erectile dysfunction include hypertension, hyperlipidemia, diabetes, cardiovascular disease, and probably smoking The common element, which links these risk factors and erectile dysfunction, is endothelial dysfunction Epidemiologic studies are producing the very important new concepts that erectile dysfunction may be an early manifestation of endothelial dysfunction, that erectile dysfunction may be a harbinger of generalized endothelial dysfunction, and that erectile dysfunction may be a precursor for various forms of cardiovascular disease [40] These concepts, if true, will have powerful implications for strategies to promote cardiovascular health and to prevent catastrophic cardiovascular diseases such as stroke and coronary thrombosis Many of the erectile dysfunction prevalence studies have been done in populations from speci c nations While there are large variations among these