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Erectile dysfunction (and other sexual difficulties) are common, distressing and treatable

A couple of recent research papers caught my attention - Kashdan & colleagues' "Sexuality leads to boosts in mood and meaning in life with no evidence for the reverse direction: A daily diary investigation" and Gerbild et al's "Physical activity to Improve erectile function: A systematic review of intervention studies".  The two papers are a good reminder of how sex can often be an important contributor to wellbeing, that sexual difficulties are common, and that much can be done to help this kind of problem. 

It was about thirty years ago that I became increasingly aware of something rather odd in my work with distressed patients.  Although I knew that sexual difficulties occur frequently in the general population and even more commonly amongst people attending health professionals, very few of those coming to see me seemed to be troubled by such problems.  The blindingly obvious insight then occurred to me.  A major reason why so few of my patients talked about sexual distress was that I simply didn't ask them about it.  And a major reason I didn't ask them was because I didn't know how to help if they said they did have difficulties in this important area of their lives.  That lead me - back in 1991 - to enrol on a one-year part time psychosexual training.  Looking back at the 'log book of case records' I kept back then, I see a long list of classic difficulties: low sexual desire, vaginismus, sexual abuse & arousal disorder, erectile dysfunction, chronic vaginal pain, premature ejaculation, sexual aversion, and sexual anxiety.  A lot of suffering.  Embarrassment, shame, pain, isolation, sadness, relationship strains ... and the probable loss or diminishment of a major source of closeness & pleasure.

The Journal of Sexual Medicine published updated British Society for Sexual Medicine guidelines on management of erectile dysfunction earlier this year, and coincidentally the American Urological Society also published their evidence-based guideline on erectile dysfunction as well.  The British paper states "ED (erectile dysfunction) has been defined as the persistent inability to attain and/or maintain an erection sufficient for sexual performance.  Although ED is not usually perceived as a life-threatening condition, it is closely associated with many important physical conditions and may affect psychosocial health.  As such, ED has a significant impact on the quality of life of patients and their partners.  Several large epidemiological studies have shown a high prevalence and incidence of ED worldwide." 

"In the Massachusetts Male Aging Study, the prevalence of ED was 52% in non-institutionalized 40- to 70-year-old men in the Boston area: 17.2%, 25.2%, and 9.6% for minimal, moderate, and complete ED, respectively ... A large European study of men aged 30-80 years reported a prevalence of 19%.  In the Men’s Attitude to Life Events and Sexuality Study, which included 20- to 75-year-old men from 8 countries (United States, United Kingdom, Germany, France, Italy, Spain, Mexico, and Brazil), the ED prevalence, assessed by International Index of Erectile Function (IIEF), ranged from 22% in the United States to 10% in Spain.  All studies showed a steep age-related increase (in the Massachusetts study 40% had some degree of ED at age 40 and this increased to 66% by age 70 - with complete ED increasing from 5 to 15% and moderate from 17 to 34%).  These epidemiological studies provide different estimates of the prevalence of ED, which can be explained by the methodological designs in the different surveys.  In particular, the estimates were influenced by the development of the IIEF and similar assessment tools in 1998 (here is a downloadable version of the widely used short IIEF-5 ED assessment questionnaire), and minor changes in the definition of the condition."  Although it's true that ED tends to become considerably more of a problem as men age, there is worrying evidence that younger men too are becoming increasingly troubled by this condition - last year's paper "Erectile dysfunction in young men - A review of the prevalence and risk factorsreported "Large multinational studies have estimated the prevalence of ED in young men to be as high as 30%".

So erectile dysfunction is common and distressing - but so too are many other sexual problems.  The 2017 paper "A place for sexual dysfunctions in an empirical taxonomy of psychopathology" starts with the paragraph "Symptoms of sexual dysfunctions1 - or low sexual function - broadly include low or absent sexual desire, difficulty becoming and/or staying sexually aroused, difficulty attaining orgasm, or experiencing rapid orgasm, and sexual pain (American Psychiatric Association [APA], 2013).  Low sexual function is not only common—with an estimated prevalence of about 40–45% for women and 20–30% for men (Lewis et al., 2010) —it is often associated with marked personal distress (Hayes et al., 2008; Lewis et al., 2010), relationship distress (e.g., Bossini et al., 2014), low self-esteem (e.g., McCabe & Althof, 2014), and decreased quality of life (e.g., Bossini et al., 2014; Laurent & Simons, 2009)."

Further details "Incidence and prevalence of sexual dysfunction in women and men: A consensus statement from the Fourth International Consultation on Sexual Medicine 2015" ...

More to follow ...

It reminds me of Debrot's touching paper last year - "More than just sex: affection mediates the association between sexual activity and well-being" - with its abstract reading "Positive interpersonal interactions such as affection are central to well-being. Sex is associated with greater individual well-being, but little is known about why this occurs. We predicted that experienced affection would account for the association between sex and well-being. Cross-sectional results indicated that affection mediated the association between sex and both life satisfaction (Study 1) and positive emotions ... In Study 3, an experience sampling study with 106 dual-earner couples with children, affection mediated the association between sex and increased positive affect in daily life. Cross-lagged analyses in Study 3 to 4 supported the predicted direction of the associations. Moreover, the strength of the daily association between sex and positive affect predicted both partners’ relationship satisfaction 6 months later."

The link between having an active and satisfying sexual life and individual well-being has received strong support. In a large nationally representative U.S. sample, sexual frequency was associated with greater general happiness (Blanchflower & Oswald, 2004). In a large international study, sexual frequency and sexual satisfaction were associated with greater life happiness in older adults (Laumann et al., 2006). In addition, Muise, Schimmack, et al. (2016) underscore the relevance of these basic findings: the size of the difference in well-being for people having sex once a week, compared with those having sex less than once a month, was greater than the size of the difference in well-being for those making US$75,000 compared with US$25,000 a year—a US$50,000 difference.”  [See too the excellent BPS Digest discussion of this article at https://digest.bps.org.uk/2017/02/27/its-all-the-cuddling-psychologists-explore-why-people-who-have-more-sex-are-happier/].


More to follow ...


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