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Prevalence of erectile dysfunction among middle-aged men in a metropolitan area in Germany


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The comparison of results of previous studies on the prevalence of erectile dysfunction is hampered due to differences in study design and research instruments including definitions used. The aim of the study was to determine the prevalence of erectile dysfunction/erectile disorder (ED) using different definitions. An epidemiological cross-sectional study was conducted between May and November 2002 in Berlin, Germany. A total of 6000 men between 40 and 79 years of age were randomly selected by the Berlin Office of Vital Statistics and were sent a questionnaire by mail. The prevalence of ED was determined using five different methods. A total of 1915 questionnaires were eligible for analysis. The five different definitions yielded age-adjusted ED prevalence rates between 18 and 48%. Age was strongly correlated with all five definitions (P<0.001). These results indicate the need for standardized criteria when conducting future studies on ED and may aid in designing public health and clinical management strategies.
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Prevalence of erectile dysfunction among middle-aged men
in a metropolitan area in Germany
H Englert
, G Schaefer
, S Roll
, C Ahlers
, K Beier
and S Willich
-University Medical Center, Institute of Social Medicine, Epidemiology and Health Economics, Berlin, Germany
-University Medical Center, Institute of Sexology and Sexual Medicine, Berlin, Germany
The comparison of results of previous studies on the prevalence of erectile dysfunction is hampered
due to differences in study design and research instruments including definitions used. The aim of
the study was to determine the prevalence of erectile dysfunction/erectile disorder (ED) using
different definitions.An epidemiological cross-sectional study was conducted between May and
November 2002 in Berlin, Germany. A total of 6000 men between 40 and 79 years of age were
randomly selected by the Berlin Office of Vital Statistics and were sent a questionnaire by mail. The
prevalence of ED was determined using five different methods. A total of 1915 questionnaires were
eligible for analysis. The five different definitions yielded age-adjusted ED prevalence rates between
18 and 48%. Age was strongly correlated with all five definitions (Po0.001). These results indicate
the need for standardized criteria when conducting future studies on ED and may aid in designing
public health and clinical management strategies.
International Journal of Impotence Research (2007) 19, 183–188. doi:10.1038/sj.ijir.3901510;
published online 3 August 2006
Keywords: erectile dysfunction; prevalence rates; men and health; epidemiology; public health;
Erectile dysfunction is defined as the inability to
achieve or maintain an erection sufficient for
satisfactory sexual function,
whereas erectile dis-
order (ED) is the recurrent inability to achieve or
maintain an adequate erection until completion of
sexual activity while simultaneously causing dis-
tress and interpersonal problems.
Despite the fact
that investigating erectile dysfunction/ED is diffi-
cult due to the nature of the topic, the amount of
epidemiological research has increased over the past
five decades. However, the prevalence rates found
in these studies have varied widely.
The first
epidemiological study of male sexual behavior was
published in 1948 by Kinsey et al.
They recruited
a total of 15 781 men up to 80 years of age and found
a prevalence of erectile dysfunction ranging from
o1% for young men to 80% in the uppermost age
group. The Massachusetts Male Aging Study, a
community-based observational study of a random
sample of men between 40 and 70 years of age,
showed a 52% overall prevalence rate for impo-
The German ‘Cologne Male Study’
(n ¼ 4489) found an overall prevalence of erectile
dysfunction of 19%, which increased dramatically
with age: while the prevalence in men aged 30–39
years was 2%, it was 53% in men aged 70–79
A recent study in Finland (n ¼ 3787)
reported an overall prevalence of 77% in men
between 50 and 75 years of age.
In other studies,
prevalence rates of erectile dysfunction have ranged
from 61% in Belgium, 69% in Italy to about 80%
in Japan.
The variability in various aspects of
previous investigations such as ED definitions,
questionnaire used, study design, age distribution,
study population and sample size make a compar-
ison of ED prevalence rates difficult. Quantitative
data on the effect of different definitions of ED on
the prevalence are lacking, because precise informa-
tion on the used definition and questionnaire is
often absent. Boer et al.
quantified the effect of
using different questionnaires for ED on the pre-
valence estimates and conducted a difference of
16.8% between International Index of Erectile
Function (IIEF), WHO, KEED and one question.
Received 7 February 2006; revised 5 May 2006; accepted
29 June 2006; published online 3 August 2006
Correspondence: Dr H Englert, Charite
-University Medical
Center, Institute of Social Medicine, Epidemiology and
Health Economics, Luisenstr 57, Berlin 10117, Germany.
International Journal of Impotence Research (2007) 19, 183188
2007 Nature Publishing Group All rights reserved 0955-9930/07 $30.00
In addition, knowing the prevalence of erectile
dysfunction does not provide any information about
the distress experienced by affected patients; nor
does it give any insight into the clinical relevance of
the condition.
In a meta-analysis, Simon and Cary
that previous studies had not taken the DSM-IV
criteria into account, which resulted in a lack of
prevalence data on ED.
Therefore, the aim of the present study was to
determine the prevalence of erectile dysfunction/ED
using five different definitions.
Study design and subjects
This epidemiological cross-sectional study, called
the Berlin Male Study, was conducted in Berlin,
Germany between May and November 2002. The
sample was selected as follows: out of all 680 000
Berlin men between the ages of 40 and 79, 16 210
men were selected randomly. This resulted in the
following distribution, which was representative
(with respect to age) of the general male population
in the city: 40–49 years of age, n ¼ 5000 (31%); 50–
59 years of age, n ¼ 4685 (29%); 60–69 years of age,
n ¼ 4606 (28%); and 70–79 years of age, n ¼ 1919
(12%). From each of these four age groups, 1500
men were selected randomly to guarantee a mini-
mum sample size in each age group. The total
sample (n ¼ 6000) was then contacted by standard
mail. Nonresponders were contacted by standard
mail a second time and asked to return the
questionnaire. The addresses were provided by the
Berlin Office of Vital Statistics. The ethics commit-
tee of the Charite
University Medical Center, Berlin
granted approval for the study, which was con-
ducted according to the stipulation of the German
Data Protection Act.
Research instrument
The developed questionnaire was tested in a pilot
phase and modified for improved feasibility, clarity
and understandability on a group of 30 male
patients above 30 years of age, who had presented
with urological conditions. This research instru-
ment consists of six sections: (1) socio-demo-
graphics (including nationality, age, marital status,
highest level of education, current occupational
status), (2) health history (including medical condi-
tions, medications, operations), (3) health status
(EuroQol Visual Analog Scale), (4) lifestyle vari-
ables, quality of life (SF-12), (5) satisfaction with
current state of relationship and (6) sexuality
(including: sexual orientation, relationship status,
frequency of sexual activity, importance of and
satisfaction with sex life, erectile function).
Every section starts with a brief instruction how to
answer the questions. The sexuality section addi-
tionally begins with the definitions of sexual
intercourse, sexual activity (including sexual inter-
course, caresses and masturbation) and sexual
stimulation (including all stimulating situations
with the partner).
The presence of ED was determined using five
different definitions. The first three definitions used
the erectile function (EF) domain. The EF domain is
comprised of a six-item checklist (five items of the
IIEF, a standard sexual function questionnaire that
includes questions about the ability to achieve and
maintain erections to the completion of sexual
intercourse and one item about the confidence to
achieve and maintain an erection) consistent with
NIH guidelines for the definition of erectile dysfunc-
tion, concerning erectile function over the past 4
The EF domain demonstrates favorable
statistical properties as a diagnostic tool not only
in distinguishing between men without erectile
dysfunction (EF scores between 26 and 30) and with
erectile dysfunction (EF scores between 1 and 25),
but also in categorizing erectile dysfunction into
four levels of severity. An EF score between 25 and
22 indicates ‘mild’ severity, between 21 and 17 ‘mild
to moderate’ severity, and between 16 and 11
‘moderate’ severity of erectile dysfunction.
categorization of the fourth level ‘severe’ erectile
dysfunction is dependent on whether the sexually
inactive men are included in the analysis or not.
When sexually inactive men are included, an EF
score of 10–1 leads to a rating of ‘severe’ erectile
dysfunction and when sexually inactive men are
not included, a rating of ‘severe’ erectile dysfunction
is reached by an EF score between 10 and 6.
Prevalence rates based on the EF domain were
assessed in this study according to the following
three definitions:
Definition 1: includes all men, whether sexually
active (over the last 4 weeks) or not,
and is thus referred to as ED ‘EF all’.
Definition 2: includes only sexually active men
(over the last 4 weeks), and is thus
referred to as ED ‘EF active’.
Definition 3: includes all sexually active men
(over the last 4 weeks) as well as
those sexually inactive men (over
the last 4 weeks) who have low
confidence in their ability to achieve
and/or maintain an erection, and is
thus referred to as ED ‘EF confi-
dence’. (‘Low’ summarizes the cate-
gories ‘moderate’, ‘low’ and ‘very
low’ confidence). Men were classi-
fied as sexually inactive if they
reported ‘no sexual activity’ on all
five questions of the EF domain for
Prevalence of erectile dysfunction and ED in men
H Englert et al
International Journal of Impotence Research
which this answer was possible. The
sixth question of the EF domain
addressed the participants’ confi-
dence in their ability to achieve
and/or maintain an erection and
did not offer the option ‘no sexual
activity’. To be classified as suffering
from ‘severe ED’, a participant’s EF
score had to lie between 1 and 10
according to the ED ‘EF confidence’
The fourth approach was used to determine
prevalence rates based on participant self-assessment:
Definition 4: The participants’ answer to the one-
item question ‘Do you think you have
erectile dysfunction?’ was used to
determine the prevalence of the con-
dition. As the prevalence rates deter-
mined here rely solely on the
participant self-assessment, this group
is referred to as ED ‘subjective’.
The fifth approach was used to determine the
prevalence rates for ED:
Definition 5: ED ‘DSM-IV’ was determined according
to the Diagnostic and Statistical Manual
of Mental Disorder criteria (DSM-IV).
When determining the prevalence of ED
according to DSM-IV, both the lack of
erectile function (criterion A) and the
emotional distress associated with it
(criterion B) must be established before
Criterion A
was met when at least one of the six
items addressing erectile function was
answered with ‘sometimes or less.
Criterion B was met when the presence
of suffering was confirmed, or one of
the six items addressing the frequency
and severity of suffering was answered
with ‘seldom’/‘low’ or more. Indivi-
duals were only assigned to the category
ED in cases where both criteria A and B
were met.
In addition, participants with self-reported ED
were asked to state whether they had at any time
sought treatment. They were given various answers
to choose from: ‘No, I’m not interested’, ‘No, but I
am interested’, ‘Yes, medical’, ‘Yes, psychological’,
‘Yes, alternative’, ‘Yes, with spouse’, ‘Yes, with
success’, and ‘Yes, but I cancelled treatment’.
Data management and statistical analyses
The completed questionnaires were scanned with a
high-speed scanner. To ensure reliability and qual-
ity, all scanned data were checked for plausibility,
verified manually if necessary, and transferred to an
SPSS file. The statistical analyses were performed
with SAS version 8.2 (used for logistic regression)
and SPSS version 11.0 (used for the remaining
analyses). Overall age-adjusted prevalence rates
were weighed according to the general population.
For univariable analyses t-test was used for contin-
uous variables and w
-test for categorical variables.
Statistical significance was stated at the 0.05-level.
Of 6000 mailed questionnaires, 1927 were returned.
A total of n ¼ 1915 of these were eligible for analysis,
12 having been excluded due to a large amount of
missing data. Thus, the overall response rate was
32%. However, not all 1915 men answered every
question, and not all questionnaires were included
in each of the five approaches. Therefore, the sample
sizes for the various variables varied from n ¼ 1915
(for ‘nationality’) to n ¼ 1233 (for ED ‘EF active’
approach). Table 1 shows the socio-demographic
profile of the sample.
With regard to medical history, 75% reported one
or more conditions (Table 2). The five different
definitions yielded the following overall age-ad-
justed prevalence rates: 48% (ED ‘EF all’), 31% (ED
‘EF active’), 44% (ED ‘EF confidence’), 24% (ED
‘subjective’) and 18% (ED ‘DSM-IV’). Our findings
regarding the prevalence of erectile dysfunction/ED
by age groups are shown in Figure 1. In the ED ‘EF
all’ definition, prevalence ranged from 28% in the
lowest age group to 82% in the uppermost age
group. In the ED ‘EF active’ definition, however, the
prevalence of erectile dysfunction range from only
17 to 63% depending on the age group. The rates in
the ED ‘EF confidence’ definition ranged from 22%
for the lowest to 81% for the uppermost age group.
The lowest prevalence for each age group was found
in the ED ‘DSM-IV’ (between 7 and 26%) and the
ED ‘subjective’ definition (between 9 and 51%).
Important to note, however, is that the rates increased
from age group to age group, regardless of the
approach used to determine the prevalence rate.
Table 3 shows the 490 men who were sexually
inactive over the past 4 weeks and, thus, excluded
from the ED ‘EF active’ definition. Out of these 490
men, 125 (24%) reported their confidence in
achieving and/or maintaining an erection to be high
(62% in the lowest age group, 45% in the second,
25% in the third and 6% in the uppermost age
group). The remaining 365 men (74%) reported their
confidence in achieving and/or maintaining an
erection to be low.
The distribution of the severity levels based on the
ED ‘EF confidence’ approach is shown in Table 4.
The percentage of ‘severe ED’ cases increased from
the lowest to the uppermost age group from 16 to
61%, whereas the amount of ‘mild ED’ cases
decreased from 51 to 18%.
Prevalence of erectile dysfunction and ED in men
H Englert et al
International Journal of Impotence Research
Among those who self-reported having erectile
dysfunction/ED, 39% were not interested in treat-
ment, whereas 26% were interested in treatment
and 35% had obtained treatment previously.
In the Berlin Male study the prevalence rates were
assessed using five different definitions, yielding
overall prevalence rates between 18 and 48%.
Prevalence rates of erectile dysfunction/ED differed
widely depending on the definition used. The main
difference between the three definitions using the
well established and validated EF domain.
the inclusion of the subgroup men who had been
Table 1 Socio-demographic characteristics of the study popula-
Variables n
Nationality (n ¼ 1915)
German 1878 98
Other 37 2
Age categories (n ¼ 1905)
40–49 473 25
50–59 474 25
60–69 478 25
70–79 480 25
Current marital status (n ¼ 1892)
Single 209 11
Married 1287 68
Widowed 85 5
Divorced 311 16
Partnership status (n ¼ 1746)
No partner 271 15
Female partner 1446 83
Male partner 29 2
Sexual orientation (n ¼ 1888)
Heterosexual 1812 96
Homo/bisexual 76 4
Current occupational status (n ¼ 1608)
Employed 737 46
Not employed 871 54
Unemployed 180 18
Retired 634 64
Sick leave 179 18
School/training 4 0.2
Highest level of education (n ¼ 1781)
No graduation 45 3
Graduated 9th grade 554 31
Graduated 10th grade 401 22
Graduated 13th grade (high school) 211 12
University degree 570 32
Total n vary due to missing information.
Table 2 Prevalence of various medical conditions
Conditions (N ¼ 1915)
n %
No condition 486 25
High blood pressure 536 28
Vertebral disease 431 23
Hypercholesterolemia 375 20
Heart disease 224 12
Prostate disease 216 11
Diabetes mellitus 152 8
Depression 87 5
Tumor 75 4
Stroke 60 3
Multiple answers were possible.
Figure 1 Prevalence of erectile dysfunction/ED according to
various approaches and age categories (in percent). ED ‘EF all’:
based on the erectile function (EF) domain (including all men).
ED ‘EF confidence’: based on the EF domain (including only
sexually active men plus inactive men with a low confidence
of achieving and maintaining an erection). ED ‘EF active’: based
on the EF domain including only sexually active men. ED
subjective’: based on participant’s subjective judgment on the
presence of ED. ED DSM-IV’: as defined in the Diagnostic and
Statistical Manual of Mental Disorders-IV (DSM-IV). Confidence
intervals of the proportions.
Table 3 Confidence in achieving and maintaining an erection
among those who reported no sexual activity in the past 4 weeks
Age categories
(n ¼ 490)
(n ¼ 57)
(n ¼ 95)
(n ¼ 139)
(n ¼ 199)
Very high
35 13 6 1
27 32 19 5
26 25 25 20
Very low
Very high and high were summarized to high and excluded in
the ED ‘EF confidence’ approach.
Moderate, low and very low were summarized to low and
included in the ED ‘EF confidence’ approach.
Prevalence of erectile dysfunction and ED in men
H Englert et al
International Journal of Impotence Research
‘sexually inactive’ during the previous 4 weeks.
Simply excluding these men from the analysis
resulted in a decrease in overall prevalence from
48% (ED ‘EF all’) to 31% (ED ‘EF active’). Doing so,
however, is clearly problematic, as clinical experi-
ence has shown that sexual inactivity is often a
consequence of low confidence in achieving and/or
maintaining an erection due to having experienced
a dysfunctional erection in the past.
In contrast,
sexually inactive men with high confidence are
presumably inactive for reasons unrelated to sexual
In order to address this subtle
distinction, data from these 490 sexually inactive
men were analyzed with regard to their confidence
in achieving and/or maintaining an erection. The
results showed that only 26% were highly positive,
while 74% had only low confidence in achieving
and maintaining an erection. Boer et al.
stated that
men with erectile dysfunction were less content
with their sexual life and had less confidence in
sexual performance. With this in mind, the third
definition (ED ‘EF confidence’) was designed to
categorize sexually inactive men with low confi-
dence as eligible for analysis, whereas sexually
inactive men with high confidence in achieving
and maintaining an erection were excluded. Report-
ing low confidence justifies the inclusion of respon-
ders when determining the prevalence of erectile
dysfunction, as their inactivity may well be due to
having experienced a dysfunctional erection at some
point in the past. While prevalence following the ED
‘EF all’ definition might be overestimated, preva-
lence rates following the ED ‘EF active’ method
might be underestimated. A fourth method involved
self-assessment of ED (‘ED subjective’). Compared to
the results of all three EF domain approaches, ED
prevalence may be underreported in self-assess-
ment. This finding is consistent with other stu-
Hence, in the authors’ view, the ED ‘EF
confidence’ approach will yield the most realistic
prevalence rates of erectile dysfunction.
However, none of the studies mentioned above
considered DSM-IV criteria when determining pre-
valence of ED. Neither the prevalence rate of erectile
dysfunction reported in this study using the three
different definitions based on the EF domain, nor
the self-reported prevalence rates allow us to
evaluate the clinical relevance of the condition. As
erectile dysfunction is not a life-threatening disease,
the most important reason for possible treatment
might be emotional distress or interpersonal pro-
blems. Research projects investigating the impact of
different chronic diseases on sexuality and partner-
ship based on the DSM-IV criteria clearly reveal that
sexual dysfunctions are not necessarily associated
with emotional distress.
Thus, using a fifth definition based on DSM-IV
criteria, men with erectile dysfunction associated
with emotional distress (measured over the last 6
months) were identified. This approach allows us to
differentiate between erectile dysfunction (without
consideration of emotional distress) and ED (with
consideration of emotional burden).
Following the
DSM-IV criteria, the age-adjusted total was only
18%. The data obtained with the different methods
show a high proportion of men with erectile
dysfunction but without distress and thus without
clinical relevance. This may explain the varying
attitudes towards treatment between men diagnosed
using the EF domain-based approach and those
diagnosed with the DSM-IV-based approach. From a
clinical point of view, it seems essential to incorpo-
rate in a standardized instrument the question of
whether erectile dysfunction is associated with
emotional distress. Further discussion is required
about how long the observation period should be
(e.g. 1, 3 or 6 months) and how to measure emotional
distress in an effective and reliable fashion.
Some general weaknesses of the study should be
pointed out. The reponse rate was only 32%. To
evaluate the different categories of erectile dysfunc-
tion and ED, the questionnaire was quite long,
thereby perhaps reducing the response rate. Boer
et al.
stated that the number of questions appears
to affect the response rate. Therefore, we suggest the
use of shorter instruments for further studies. In
addition, the sensitive nature of the topics in general
may have reduced participation rates. As the
response rate in each age categories was similar
(approximately. 25% in each age group), it was
possible to adjust prevalence rates in each category
for overall prevalence rates. A selection bias cannot
be excluded and no statement can be made regard-
ing the applicability of our data to the German
population and for other populations of the world.
As the study was conducted anonymously, parti-
cipants who did not answer every question could
not be contacted again. Thus, it was impossible to
reduce the amount of missing data. As data was
collected solely via self-completed questionnaire,
the assessment was limited to self-report and, as a
consequence, may have led to some biased results.
Table 4 Severity of ED in age categories (in percent, based on the
ED ‘EF confidence’ definition)
Age categories
Severity 40–49 (%) 50–59 (%) 60–69 (%) 70–79 (%)
Mild 51 44 33 18
Mild–moderate 23 17 16 13
Moderate 10 11 7 8
Severe 16 28 44 61
Prevalence of erectile dysfunction and ED in men
H Englert et al
International Journal of Impotence Research
In this study, we focus on the marked influence of
different definitions on the prevalence rates. As one
data set produced five different prevalence rates
of erectile dysfunction/ED, depending on the defini-
tion used, it is important to agree upon a uniform
way of assessing erectile dysfunction and ED to
make prevalence rates comparable across studies.
There is a need for a standardized concise ques-
tionnaire including the definition of sexual activity,
the timeline investigated (4 weeks or 6 months), the
self-report question, the length of the questionnaire
and the impact of distress. Comparability of pub-
lished prevalence rates will be important to assess
the epidemiological magnitude of the disorder as
well as for designing adequate therapeutic and
public health strategies.
This study was supported by grants from Bayer Vital
GmbH and GlaxoSmithKline, Germany.
None of the authors had competing interests.
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Prevalence of erectile dysfunction and ED in men
H Englert et al
International Journal of Impotence Research
... Auf der Ebene der sexuellen Fantasien, unabhängig von konkret ausgeübten Straftaten, konnte bereits in der Berliner Männerstudie aus dem Jahr 2003 (Schaefer et al., 2003;Englert et al., 2007) Bártová et al., 2021), werden in allen Studien paraphile Inhalte in Sexualfantasien von Frauen deutlich seltener als von Männern berichtet (Bártová et al., 2021;Beier et al., 2021;Hunter & Mathews, 1997). Dieser Unterschied ist für paraphile Interessen, die illegale Verhaltensweisen beinhalten (z.B. ...
... Greift man den Bereich der Pädophilie heraus, zeigt sich ein noch deutlicherer Unterschied: 9.4 % der Männer und lediglich 1.9 % der Frauen gaben in der Berliner Männerstudie (Schaefer et al., 2003;Englert et al., 2007) sexuelle Fantasien mit Kindern an; pädophiles Verhalten berichteten 3.8 % der Männer und 0.9 % der Frauen. Zahlen die sich auch in anderen Studien im vergleichbaren Rahmen bewegen (z.B. ...
... Ausgangspunkt zum Konzept der reproversen Symptombildung war die bereits erwähnte Berliner Männerstudie (Englert et al., 2007;Schaefer et al., 2003), in der 42.6 % der Frauen von problematisch verarbeiteten Besonderheiten im Bereich der Reproduktion berichteten. Dem Gegenüber standen nur 23.5 % der Männer, was im Prinzip einer Umkehrung der Verhältnisse paraphiler Verhaltensweisen entspricht. ...
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Zusammenfassung Es ist eine verbreitete Annahme, dass Pädophilie eine nahezu ausschließlich bei Männern vorkommende Störung der Sexualpräferenz darstellt. In diesem Artikel werden überblicksartig Befunde und Theorien zu Geschlechtsunterschieden bezüglich der Häufigkeit sexueller Fantasien und paraphiler Interessen (insbesondere Pädophilie) sowie zu sexuellem Kindesmissbrauch dargestellt und kritisch diskutiert, auch hinsichtlich forschungsmethodischer Artefakte. Im Anschluss werden drei Fallbeispiele nicht-männlicher Betroffener mit auf Kindern ausgerichteten sexuellen Fantasien aus dem Präventionsnetzwerk Kein Täter werden vorgestellt. Dabei identifizieren sich zwei der Personen als eindeutig weiblich, eine Person ordnet sich als Frau-zu-Mann-Transsexueller ein. Anhand dieser Beispiele werden Gemeinsamkeiten und Unterschiede nicht-männlicher Personen mit pädophilen Fantasien erörtert und Implikationen für die praktische Arbeit mit weiblichen bzw. nicht-männlichen Betroffenen diskutiert. Schlüsselwörter: Pädophilie, Geschlechtsunterschiede, Frauen, Transsexualität, sexuelle Fantasien Abstract It is a widespread assumption that pedophilia is a sexual preference disorder that almost exclusively affects males. In this article, findings and theories on sex/gender differences regarding the frequency of sexual fantasies and paraphilic interests (especially pedophilia) as well as child sexual abuse are outlined and critically discussed, also with regard to artifacts of research methodology. Subsequently, we present three case studies of non-male participants with sexual fantasies directed at children who attended the prevention network. Two of the participants identify themselves as unambiguously female, one participant classifies himself as a female-to-male transsexual. Based on these examples, similarities and differences of non- male persons with pedophilic fantasies are elaborated and implications for practical work with female (or, more broadly, non-male) participants are drawn. Keywords: Pedophilia, Sex differences, Women, Transsexuality, Sexual fantasies
... In 2 large German studies on ED conducted more than a decade ago, ED prevalence (IIEF-EF <25) was 17%e19.5% in the 40-to 49-year age group. 8,24 Furthermore, previous epidemiologic investigations reported lower prevalences of severe ED than found in our analysis (0.5% and 2.1% vs 3.1%). 8,25 The Berlin Male Study found that prevalence rates including only sexually active men might underestimate the actual prevalence of ED, given that sexual inactivity may result from low confidence in achieving and/or maintaining an erection. ...
... 8,25 The Berlin Male Study found that prevalence rates including only sexually active men might underestimate the actual prevalence of ED, given that sexual inactivity may result from low confidence in achieving and/or maintaining an erection. 24 Because we excluded sexually inactive men from our analysis, the true ED prevalence in 45-year-old German men might be even higher than 25.2%. The high prevalence of severe ED in our study may reflect the increasing prevalence of risk factors with an impact on ED. ...
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Background Erectile dysfunction (ED) is a common public health issue with a significant impact on quality of life. The associations between ED and several risk factors have been reported previously. The continuously increasing incidence of these factors is contributing to the increasing prevalence of ED. Aim To assess ED prevalence and severity in a representative sample of 45-year-old German men and to analyze the association with risk factors (lifestyle risk factors/comorbidities). Methods Data were collected within the German Male Sex-Study. Randomly selected 45-year-old men were invited. A total of 10,135 Caucasian, heterosexual, sexually active men were included in this analysis. The self-reported prevalence of ED was assessed using the Erectile Function domain of the International Index of Erectile Function. Risk factors for ED were ascertained using self-report questionnaires. An anamnesis interview and a short physical examination were performed. Main Outcome Measure ED prevalence and severity were evaluated in a cross-sectional design. The associations of ED with comorbidities (eg, depression, diabetes, hypertension, lower urinary tract symptoms) and lifestyle factors (ie, smoking, obesity, central obesity, physical inactivity, and poor self-perceived health-status) were analyzed by logistic regression. Results The overall prevalence of ED was 25.2% (severe, 3.1%; moderate, 9.2%; mild to moderate, 4.2%; mild, 8.7%). Among the men with ED, 48.8% had moderate or severe symptoms. ED prevalence increased with the number of risk factors, to as high as 68.7% in men with 5–8 risk factors. In multiple logistic regression with backward elimination, the strongest associations with ED were found for depression (odds ratio [OR] = 1.87), poor self-perceived health status (OR = 1.72), lower urinary tract symptoms (OR = 1.68), and diabetes (OR = 1.38). Conclusion One out of 4 men already had symptoms of ED at age 45. Almost one-half of the men with ED had moderate to severe symptoms. ED was strongly associated with each analyzed risk factor, and the prevalence and severity of ED increased with an increasing number of risk factors. Hallanzy J, Kron M, Goethe VE, et al. Erectile Dysfunction in 45-Year-Old Heterosexual German Men and Associated Lifestyle Risk Factors and Comorbidities: Results From the German Male Sex Study. Sex Med 2019;7:26–34.
... Erectile dysfunction (ED) is the second most prevalent sexual dysfunction affecting men (1) just after premature ejaculation, with incidence ranging from 2% in the 40-49 years old group, to 44.9% in the 70-79 years, according to a real-life, general medicine setting study (2). Psychogenic ED is one of the most challenging types of ED, given that there are men with some grade of organic ED worsened by psychogenic factors (3), which can hinder its proper assessment. Accordingly, a recent systematic review found that as much as 20% (5.1-41.2%) of patients with anxiety disorders suffered some grade of ED (4). ...
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Background: Erectile dysfunction (ED) is the second sexual dysfunction affecting men. Penile duplex ultrasound (PDU) with intracavernous injection of a vasoactive agent as alprostadil or papaverine, may play an important role in differentiating psychogenic from vasculogenic ED (arterial or venooclusive) and may also have an important role in the secondary prevention of cardiovascular events. The aim of this study is to investigate the relationship between the vascular parameters and sexual satisfaction as established by a questionnaire. Methods: Prospective, multicenter analysis of all patients who underwent a PDU between September 2018 and April 2021 in four centers, including patients who were >18 years old and underwent a PDU for ED, Peyronie's disease (PD) or other reasons, signed informed consent and completed an adapted version of the Brief Sexual Symptom Checklist (BSSC). All the patients underwent a standard technique, and from a total of 325 patients, 16 were excluded because of low testosterone levels, and 15 due to missing data. Results: A total of 294 patients were included for the analysis. Significant differences were found between patients with and without ED defined by their score in the Sexual Health Inventory for Men (SHIM) questionnaire in the PSV at 10', adjusted for age (38.07 vs. 44.95 cm/s; P=0.016), and in the PSV and the EHS at 10' for sexually satisfied and non-satisfied patients, and a significant correlation with those parameters and the probability of being sexually satisfied (r=0.147, P=0.011; r=0.132, P=0.023; respectively). Conclusions: In our clinical practice we used the cut-off of >35 cm/s, that seems to be quite low looking at our results. The 10' measurement may be more sensitive in order to establish a diagnosis. BSSC questionnaire is a simple, easy-to perform tool to screen those patients at risk of developing sexual dysfunctions.
... Our study suggests that long-term OMT patients, even those younger than the ones in the previous studies, also suffer from a range of somatic problems. Sexual dysfunction, reported by 30% of our patients, may also be experienced by OMT patients at lower ages than non-OMT populations [29]. ...
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Objectives To describe and explore somatic disease burdens of ageing long-term patients in opioid maintenance treatment (OMT), a unique population emerging in countries offering OMT as a long-term treatment. Methods We used data from the Norwegian Cohort of Patient in Opioid Maintenance Treatment and Other Drug Treatment Study (NorComt). 156 patients enrolled for at least three of the past five years provided data during structured interviews, including on chronic conditions, somatic treatment received, mental distress (SCL-25), and treatment satisfaction. A somatic disease burden was calculated from a list measuring the recent severity of 16 somatic complaints. A hierarchical multiple linear regression analysis identified correlates of somatic disease burden. Results Over half of patients reported at least seven somatic complaints. Reported somatic disease burden was associated with higher mental distress, more chronic conditions, fewer years in OMT, and treatment dissatisfaction. Age was unrelated, and there were few gender differences. These five variables explained 43.6% of the variance in disease burden. Conclusion Long-term OMT patients experience a large range of somatic complaints, and at non-acute levels. As OMT secures longevity for opioid-dependent persons, the clinical focus must be adjusted from acute to chronic care. Providers must address how to optimize health and quality of life while in treatment, as treatment may last for many years.
... It is no normative statistical questionnaire but contents cover the whole range of sexual disorders. The FSEV was for example used in the Berlin male study to assess erectile dysfunction (Englert et al., 2006). The prevalence rate for erectile dysfunction ranged from 18 -48% in different age-adjusted subgroups, prevalence increased with age. ...
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Partnership quality is associated with physical and psychological health. The Questionnaire on Sexual Experience and Partnership Quality (Q-SEx-PaQ) was constructed as a part of the Berlin Aging Study (BASE-II). It allows the assessment of the main dimensions of sexuality and partnership quality. Aims were to analyze factorial validity including measurement invariance across age and to examine hypotheses regarding test criterion correlations as part of a validation strategy. We also wanted to estimate the test scores’ reliability in a large survey setting. A combination of exploratory and confirmatory factor analyses was used to first explore and then test factorial validity. We analyzed baseline cross-sectional data from 233 younger (28.3 ± 3.0 years) and 767 older (68.2 ± 3.7 years) participants from the BASE-II. The EFA showed two-factor-solutions for the scales partnership satisfaction and changes of meaning ascribed to partnership and four-factor-solutions for meaning ascribed to partnership and partner selection. CFAs confirmed these structures. Reliability estimates were satisfactory with few exceptions. The empirical findings support the reliability and factorial validity of the Q-SEx-PaQ scores. The questionnaire provides a short yet comprehensive instrument to assess sexual experiences and partnership quality of same age groups using factor scores and is not appropriate for individual diagnostics.
... For instance, it was reported that 41.3% of adult men (above 18 years old) in France have ED, 33.2% in Brazil and 41.8% in China [79]; 18.0%-48.0% among middle-aged men in Germany [80] and about 50.0% of aging diabetic men (aged have ED in the United States [81]. ...
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Infertility is prevalent in about 10%-25% of couples in their reproductive age, analogous to 60-80 million infertile couples globally. Of these infertility cases, 10%-30% are exclusively attributed to a problem of the male. Several diseases have been implicated as contributors to deteriorating male fertility and diabetes mellitus (DM) is included. DM, a chronic non-communicable disease, has been considered as one of the most appreciable health threats, as it affects 9% (422 million) of the world’s population as of 2014. It is characterised by hyperglycaemia, which can result from the inability of the pancreatic β-cells to secrete insulin or from the target tissue becoming insensitive to insulin. DM has been reported to influence male reproductive function through diverse pathways and mechanisms. The adverse effects of reactive oxygen species and successive development of oxidative stress that occur due to DM have been investigated and implicated by several studies. The products of non-enzymatic glycosylation are reported to be widely distributed in the reproductive tract of diabetic men. Additionally, DM has been implicated to impair the processes of male sexual acts. Data reported in this review were extracted from PubMed, Google Scholar, Science Direct and Scopus with diabetes and male infertility as the key search words. In light of the aforementioned, the aim of this review is to provide brief background information on DM as well highlight and explain the likely mechanisms of male fertility which DM impacts.
... Bei Frauen wird von einer Prävalenz aller sexuellen Funktionsstörungen zusammengenommen von etwa 38 % in Deutschland ausgegangen [6]. Bei Männern schwanken die Angaben der Prävalenz für Erektionsstörungen in Deutschland zwischen 9 und 48 % [7][8][9]. Für Erektionsstörungen zeigt sich eine deutliche Zunahme der Prävalenz mit steigendem Alter (<40 Jahre: 1-10 %; 60-69 Jahre: 20-40 %; [5]). Die große Varianz der Prävalenzangaben findet sich nicht allein bei den Erektionsstörungen, sondern auch bei den anderen sexuellen Funktionsstörungen (vgl. ...
Background. Patients with the ICD-10 sexual disorders F52, F64, F65, and F66 are treated by a variety of medical disciplines. Until now, there has been a paucity of data regarding which sexual disorders are treated by means of in-patient hospital care and whether changes have occurred over time. Objectives. The aim of this study is to examine how many patients with sexual disorders that are classified by ICD-10 chapter V (F) as “mental” are treated as in-patients. Methods. Diagnosis data regarding German hospital care, which have been published annually since 2000 by the German Federal Statistical Office (Destatis), are analysed. Results. Since 2000, the number of in-patients with disorders of gender identity (F64) has increased 2.6-fold. Hospital treatment of sexual dysfunctions (F52) as a primary diagnosis is decreasing, whereas a significantly higher number of in-patients are treated with F52 as a secondary diagnosis. In-patients with F64 are mostly treated in urology and gynaecology departments or by surgeons, and 76.0–81.1% of F52 cases in urology. In-patients with paraphilic disorders (F65) or psychological and behavioral disorders associated with sexual development and orientation (F66) are rarely but almost exclusively treated in psychiatric or psychotherapeutic departments. Discussion. The data indicate that most in-patient hospital treatment for primary diagnoses of sexual disorders are somatic treatments for erectile dysfunction (F52.2) and transsexualism (F64.0). Owing to a steady increase in cases with F64.0 diagnoses, a growth in demand for competence in sexual medicine can be noted, especially in the surgical disciplines. Causes of the distribution and the increase in in-patient numbers are discussed. Further research is required, particularly concerning the treatment of in-patients with F52 and F64 secondary diagnoses.
Zusammenfassung Fragestellung: Die Studie untersucht, (1) ob sich die Inanspruchnahme stationärer Krankenhausbehandlung aufgrund der Hauptdiagnose Geschlechtsidentitätsstörungen (ICD-10 F64) in den Jahren zwischen 2000 und 2015 verändert hat und (2) welchen Anteil psychiatrische, psychotherapeutische und psychosomatische Behandlungen ausmachen. Methode: Aus der Krankenhausstatistik des Statistischen Bundesamtes wurden die F64-Diagnosedaten analysiert. Ergebnisse: Die Fallzahlen von stationär behandelten Krankenhauspatienten mit einer F64 Hauptdiagnose haben sich von 2000 bis 2015 mehr als verdreifacht. Dieser Anstieg ist in den somatischen Fächern, insbesondere der Chirurgie, Gynäkologie und Urologie, zu verzeichnen. Die Behandlung von stationär aufgenommenen Patienten aufgrund einer F64 Hauptdiagnose in den psychosozialen Krankenhausabteilungen hat im gleichen Zeitraum abgenommen. Schlussfolgerung: Die Daten geben keinen Aufschluss über die Bedeutung der psychosozialen Fächer für die Versorgung von Transgender Personen, da diese hauptsächlich ambulant erfolgen dürfte. Die Ergebnisse zeigen jedoch, dass stationäre psychiatrische oder psychotherapeutische Behandlungen sehr selten sind, wohingegen in anderen Krankenhausabteilungen ein erheblicher Anstieg zu verzeichnen ist. Letzteres dürfte den Wandel sozialer Einstellungen und eine stärkere Integration von Transgender Gesundheitsversorgung widerspiegeln.
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Context While recent pharmacological advances have generated increased public interest and demand for clinical services regarding erectile dysfunction, epidemiologic data on sexual dysfunction are relatively scant for both women and men. Objective To assess the prevalence and risk of experiencing sexual dysfunction across various social groups and examine the determinants and health consequences of these disorders. Design Analysis of data from the National Health and Social Life Survey, a probability sample study of sexual behavior in a demographically representative, 1992 cohort of US adults. Participants A national probability sample of 1749 women and 1410 men aged 18 to 59 years at the time of the survey. Main Outcome Measures Risk of experiencing sexual dysfunction as well as negative concomitant outcomes. Results Sexual dysfunction is more prevalent for women (43%) than men (31%) and is associated with various demographic characteristics, including age and educational attainment. Women of different racial groups demonstrate different patterns of sexual dysfunction. Differences among men are not as marked but generally consistent with women. Experience of sexual dysfunction is more likely among women and men with poor physical and emotional health. Moreover, sexual dysfunction is highly associated with negative experiences in sexual relationships and overall wellbeing. Conclusions The results indicate that sexual dysfunction is an important public health concern, and emotional problems likely contribute to the experience of these problems.
In a cross-section study the influence of Parkinson's Disease (PD) on sexuality and partnership in 2099 affected members of the German Parkinson Organization (DPV) were investigated. At an average age of 65, 330 women and 1008 men had been living in a partnership for an average of 37 years. Not only sexual dysfunctions occurred both in affected women and men as well as in healthy partners but also an evident reduction of sexual contentment on the whole. The affected patients mentioned specific symptoms of PD and medication as the deciding factors of influence on their sexuality. It was impressing that one single group of substances could influence sexual functions by increasing as well as decreasing them or having no influence at all. Furthermore different effects in different genders became obvious. The information concerning their partnership situation given by both men and women shows that communication in general, especially caressing and showing feelings, are reduced since diagnosis, whereas a desire for mutual intimicy prevails on the same level as before.
Ten years of research that has provided data regarding the prevalence of sexual dysfunctions is reviewed. A thorough review of the literature identified 52 studies published in the 10 years since an earlier review by Spector and Carey (Arch. Sex. Behav. 19(4): 389–408, 1990). Community samples indicate a current prevalence of 0%–3% for male orgasmic disorder, 0%–5% for erectile disorder, and 0%–3% for male hypoactive sexual desire disorder. Pooling current and 1-year figures provides community prevalence estimates of 7%–10% for female orgasmic disorder and 4%–5% for premature ejaculation. Stable community estimates of the current prevalence of other sexual dysfunctions remain unavailable. Prevalence estimates obtained from primary care and sexuality clinic samples are characteristically higher. Although a relatively large number of studies has been conducted since the earlier review, the lack of methodological rigor of many studies limits the confidence that can be placed in these findings.
In order to assess the prevalence and associated factors for erectile dysfunction (ED) in primary care, a cross-sectional study was undertaken by questionnaire distributed to consecutive adult male attendees at 32 family practices. ED was assessed by the Korean five-item version of the International Index of Erectile Function (IIEF-5). In total, 3501 completed questionnaires were available for analysis. The prevalence of ED was severe (IIEF-5 score: 5–9) in 1.6% of cases, moderate (10–13) in 10.2%, mild (14–17) in 24.7%, and normal (18–25) in 63.4%. The prevalence of ED increased with age, lower educational status, heavy job-related physical activity, and lower income. ED prevalence was significantly higher in patients with chronic diseases such as diabetes, depression, and anxiety. These results suggest that the age-adjusted prevalence of ED among Korean men can be estimated as 32.2% (95% CI 30.6–33.7). Low socioeconomic status and several diseases such as diabetes, anxiety, and depression, as well as age, were associated with ED.
The goal of this study was threefold: to determine the point prevalence of erectile disorder amongst 40 to 79 year old Berlin men as well as its connection with their age, general health status and last but not least with their quality of life. An epidemiological cross-sectional study was conducted, in which a questionnaire was developed and supplemented by other already validated measures, then tested in a pilot phase on 30 male out-patients (aged 30 and above) of the Charite's urology department, and finally mailed to a representative sample of 6.000 men. The age span 40-79 was divided into four categories of ten years each, and within each category 1.500 men were sent a questionnaire. Erectile Disorder was assessed by using a self-devised measure, in which the criteria of the Diagnostic and Statistical Manual of Mental Disorders DSM-IV (APA, 1994) had been operationalised, hence, burden had to be associated with dysfunctional erection. As reference period the past six months were chosen. Furthermore, self-reported presence of dysfunctional erection yielded a second prevalence rate for each age category. Prevalence rates were also assessed by using the Erectile Function Domain (EF-Domain), which constitutes one of the five domains of the International Index of Erectile Function IIEF (Rosen et al., 1997). The focus of this paper, however, is on the DSM-IV approach to assessing erectile disorder; all results pertaining to the EF-Domain approach will be published separately. General Health Status was assessed by means of a checklist containing numerous conditions, amongst other things. Quality of Life was assessed using the SF-12 (Ware et al., 1998) and the Visual Analog Scale of the EuroQoL (EQ-VAS) (Schulenburg et al., 1998), amongst other things. Results, which are all based on self-reported data, are presented with respect to the distribution of various sociodemographic variables and various conditions, prevalence rates of erectile disorder (DSM-IV) for each age category, and the connection of erectile disorder with quality of life (results regarding the connection of erectile disorder with general health will be published in due time). Amongst the 1.915 returned questionnaires suitable for analysis (response rate=32%) the four age categories were represented almost equally. The findings regarding the prevalence of erectile disorder are of particular interest from both a public health and scientific perspective: when considering the internationally acknowledged DSM-IV criteria not only the age adjusted prevalence of 17,8% is lower than compared with other studies on men of similar age. Furthermore, the increase with age is far less prominent as consistently reported in the literature. In conjunction with the higher self-reported prevalence rates, i.e. where burden is not taken into consideration, the data suggest the need to differentiate between a burden bearing disorder and a dysfunction or malfunction that is not associated with any burden and, therefore, does not require treatment. Apart from some operational aspects the authors suggest to continue using the international established abbreviation "ED", but to differentiate between "EDy" when referring to erectile dysfunction and "EDi" when referring to erectile disorder, i.e. when the dysfunctional erection is accompanied by suffering. This would not only benefit the (improvement of) comparability of future research, above all, it would also reflect the experience of clinical practice. (PsycINFO Database Record (c) 2012 APA, all rights reserved)