The natural progression and regression of erectile dysfunction: follow-up results from the MMAS and MALES studies

Introduction: Using the Massachusetts Male Aging Study (MMAS) data from the years 1987-1995, we previously demonstrated high rates of both progression (33%) and regression (35%) of self-reported severity of erectile dysfunction (ED). These results have not been replicated using more recent data-relevant in light of the introduction of phosphodiesterase type 5 inhibitors (PDE5i) to treat ED-nor compared with those from other populations.

Aim: To estimate age-specific progression and regression of ED severity among subjects with at least mild self-reported ED.

Methods: We used the two most recent data collection waves from the MMAS (baseline in 1995-1997 and follow-up in 2002-2004, approximately 7 years of follow-up) and data from the Men's Attitudes to Life Events and Sexuality (MALES) study (baseline in 2001 and follow-up in 2004, approximately 3 years of follow-up); 367 MMAS and 617 MALES subjects contributed data. MMAS participants were a population-based sample of men living in Boston, Massachusetts, United States. MALES subjects were obtained from a multinational convenience sample.

Main outcome measures: ED was measured using the validated single-question self-report of ED severity ("none,""minimal,""moderate," or "complete"). ED progression was defined as worsening of ED over time, whereas regression was defined as a lessening of ED severity. Logistic regression analyses were adjusted for age, body mass index (MMAS only), and use of PDE5i.

Results: In MMAS and MALES, 21% (confidence interval [CI]: 17%, 25%) and 25% (22%, 29%) of subjects, respectively, exhibited regression; 51% (45%, 57%) in MMAS and 28% (23%, 33%) in MALES exhibited ED progression. A minority of subjects (14% in MMAS and 28% in MALES) reported use of PDE5i. The proportion of subjects reporting progression increased with age. The higher rate of progression in MMAS may be due in part to the shorter follow-up time (∼3 years) in MALES.

Conclusions: Among subjects with some level of self-reported ED, progression and regression are common over a several-year period. Strategies for therapy and intervention for ED should acknowledge this basic evolution with time.