A population-based survey of self-reported and IIEF-defined erectile dysfunction among adult men in the United States in 2021

Abstract Background Erectile dysfunction (ED) is the most common male sexual medical condition worldwide, but assessing its prevalence accurately is made difficult by the diversity of methodologies utilised. This study used the abridged 5-item International Index of Erectile Function (IIEF-5) questionnaire, together with estimates based on self-reported ED and ED treatments, to assess ED prevalence in the US. Methods Analyses were undertaken by age groups: 18–34 years; 35–49 years; 50–64 years; ≥65 years, with further assessments by socioeconomic status (SES), lifestyle and health conditions associated with ED. Continuous variables, categorical variables and multivariate logistic regression models were used. Results Sexually active men aged ≥18 years, from all 50 USA states, Washington, DC, and Puerto Rico, were recruited through the Evidation Health, Inc. (San Mateo, CA, USA; evidation.com) health-tracking platform (n=3,289). ED prevalence was found to increase with age, from 26.0% (18–34 years) to 62.5% (≥65 years) based on the IIEF-5 questionnaire, from 19.3% to 60.0% based on ED self-perception, and from 2.6% to 29.2% based on current treatments. Other factors that were found to increase the risk of ED included low SES; health conditions, such as diabetes, chronic pain, mental health conditions; and being of Black or Asian heritage. Conclusion This study corroborates established knowledge that ED prevalence increases with age, is strongly associated with comorbidities, and is influenced by socioeconomic factors. Importantly, our findings reveal a notable discrepancy between IIEF-5-defined ED and self-reported symptoms, highlighting a critical public health consideration: ED often serves as an early warning sign for more serious underlying health conditions. This underscores the importance of improved screening and awareness in clinical practice.