The Temporal Association of Depression and Anxiety in Young Men With Erectile Dysfunction - Beyond the Abstract

While erectile dysfunction (ED) has been studied extensively in older men, there is growing interest in understanding the underlying causes and risk factors of ED in younger men. Studies of men under 40 years old have estimated a prevalence of ED as high as 30%.1–5  While the etiology is multifactorial, involving biological, psychiatric, and sociocultural factors, ED among young men has been largely classified as psychogenic.6–13  Several studies have examined the effects of ED on depression and anxiety and conversely the risk of ED from these psychiatric conditions.7,10,14,15  However, the temporal relationship between mental health and erectile dysfunction in young men is not well understood. How long after a diagnosis of ED is a young man at increased risk of mental illness? Could an ED diagnosis precipitate or perhaps uncover underlying depression or anxiety? Importantly, should mental health screening be normalized in this population?

We performed a case control study on men under 40 using a large U.S. claims database to investigate temporal associations between ED and depression and anxiety. We found the prevalence of mental illness to be 17.1% in young men with ED compared to 12.9% in men without ED in the 12-month period before an ED diagnosis. This supports a large base of literature establishing depression and anxiety as risk factors for ED. Interestingly, in each of the three years following their diagnosis of ED, young men were increasingly more likely to receive a new mental health diagnosis than their matched controls. The incidence of new mental illness was 11.7%, 14.5%, and 15.9% for men with ED in the 36 months following their diagnosis compared to 6.3%, 9.0%, and 10.6% respectively in controls. These findings not only highlight the significant effects ED can have on mental health but also the potential of streamlined mental health screenings to benefit young men with newly diagnosed ED. Further study is needed to elucidate this potential bidirectional association, as well as better, characterize these findings in the context of one’s socioeconomic status.

Written by: Henry Biermann & Tad Manalo, Department of Urology, Emory University School of Medicine, Atlanta, GA


  1. Weber MF, Smith DP, O’Connell DL, et al. Risk factors for erectile dysfunction in a cohort of 108 477. Australian men. Med J Aust. 2013;199(2). doi:10.5694/mja12.11548
  2. Mykletun A, Dahl AA, O’Leary MP, Fosså SD. Assessment of male sexual function by the Brief Sexual Function Inventory. BJU Int. 2006;97(2). doi:10.1111/j.1464-410X.2005.05904.x
  3. Nguyen HMT, Gabrielson AT, Hellstrom WJG. Erectile Dysfunction in Young Men—A Review of the Prevalence and Risk Factors. Sex Med Rev. 2017;5(4):508-520. doi:10.1016/j.sxmr.2017.05.004
  4. Capogrosso P, Colicchia M, Ventimiglia E, et al. One patient out of four with newly diagnosed erectile dysfunction is a young man-worrisome picture from the everyday clinical practice. J Sex Med. 2013;10(7):1833-1841. doi:10.1111/jsm.12179
  5. Mialon A, Berchtold A, Michaud PA, Gmel G, Suris JC. Sexual dysfunctions among young men: Prevalence and associated factors. J Adolesc Heal. 2012;51(1):25-31. doi:10.1016/j.jadohealth.2012.01.008
  6. Hedon F. Anxiety and erectile dysfunction: A global approach to ED enhances results and quality of life. In: International Journal of Impotence Research. Vol 15. ; 2003. doi:10.1038/sj.ijir.3900994
  7. Pozzi E, Capogrosso P, Chierigo F, et al. Clinical Profile of Young Patients with Erectile Dysfunction: Preliminary Findings of a Real-life Cross-sectional Study. Eur Urol Focus. 2020;6(1):184-189. doi:10.1016/j.euf.2018.10.003
  8. Akre C, Berchtold A, Gmel G, Suris JC. The evolution of sexual dysfunction in young men aged 18-25 years. J Adolesc Heal. 2014;55(6):736-743. doi:10.1016/j.jadohealth.2014.05.014
  9. Kaufman MR, Milam DF, Johnsen N V., et al. Prior Radiation Therapy Decreases Time to Idiopathic Erosion of Artificial Urinary Sphincter: A Multi-Institutional Analysis. J Urol. 2018;199(4):1037-1041. doi:10.1016/j.juro.2017.11.046
  10. Araujo AB, Durante R, Feldman HA, Goldstein I, Mckinlay JB. The relationship between depressive symptoms and male erectile dysfunction: Cross-sectional results from the Massachusetts male aging study. Psychosom Med. 1998;60(4). doi:10.1097/00006842-199807000-00011
  11. Hale VE, Strassberg DS. The role of anxiety on sexual arousal. Arch Sex Behav. 1990;19(6). doi:10.1007/BF01542466
  12. McCabe MP, Sharlip ID, Lewis R, et al. Risk Factors for Sexual Dysfunction Among Women and Men: A Consensus Statement From the Fourth International Consultation on Sexual Medicine 2015. J Sex Med. 2016;13(2):153-167. doi:10.1016/j.jsxm.2015.12.015
  13. Velurajah R, Brunckhorst O, Waqar M, McMullen I, Ahmed K. Erectile dysfunction in patients with anxiety disorders: a systematic review. Int J Impot Res. Published online 2021. doi:10.1038/s41443-020-00405-4
  14. Shim YS, Pae CU, Cho KJ, Kim SW, Kim JC, Koh JS. Effects of daily low-dose treatment with phosphodiesterase type 5 inhibitor on cognition, depression, somatization and erectile function in patients with erectile dysfunction: A double-blind, placebo-controlled study. Int J Impot Res. 2014;26(2):76-80. doi:10.1038/ijir.2013.38
  15. Dryman A, Eaton WW. Affective symptoms associated with the onset of major depression in the community: findings from the US National Institute of Mental Health Epidemiologic Catchment Area Program. Acta Psychiatr Scand. 1991;84(1):1-5. doi:10.1111/j.1600-0447.1991.tb01410.x
Read the Abstract 
email news signup