Prevalence of erectile dysfunction among healthy and sexually active Malaysian men aged 18 to 39 years

Background: Erectile dysfunction (ED) is defined as the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual performance, and in Malaysia, ED among the young is poorly understood. Aim: To identify the prevalence of ED in healthy Malaysian men aged 18 to 39 years and factors affecting the presence of ED. Methods: This cross-sectional study was conducted among healthy Malaysian men aged 18 to 39 years, using a standardized questionnaire. The link to the questionnaire was distributed via social media and communication applications. After consent, basic demography and ED was measured via the validated International Index of Erectile Function–15 (IIEF-15) questionnaire. Participants answered the questions in Malay or English. A sample size of 344 participants was needed for the study. Data was analysed using SPSS version 26.0 (IBM). Outcomes: To identify the prevalence of ED among young Malaysian men and its associated factors. Results: A total of 390 men completed the survey, and data from 361 were included in the final analysis. The mean age was 32.89 years (SD, 4.73), 66.5% were Malay, 49.6% were from the M40 group (middle 40% of wage earners in Malaysia), 52.4% were professionals in their fields, 31.3% were from Selangor, 67.6% lived in urban settings, 60.9% were married, 83.9% were heterosexually orientated, and the mean number of children among married men was 1.52 (SD, 1.24). The prevalence of ED was 32.7% (95% CI, 27.8%-37.9%) of the total participants, with 3.9% (95% CI, 2.2%-6.6%) experiencing severe ED. A multivariate regression analysis showed the following as being associated with ED: B40 status (below 40% of wage earners in Malaysia; adjusted odds ratio [AOR], 9.72; 95% CI, 2.43-38.94; P = .001), a homosexual/bisexual orientation (AOR, 11.66; 95% CI, 1.28-105.89; P = .03), and a decreased sexual desire (AOR, 9.02; 95% CI, 2.91-27.95; P .001). Clinical Implications: Because ED was prevalent in younger Malaysians and linked to metabolic diseases, perhaps the screening of non-communicable diseases, including mental health, should also target younger Malaysians. Strengths and Limitations: This study was among the very few in Malaysia that examined ED in the young age group. However, factors such as smoking and psychosocial causes were not taken into account, as there may have been a potential reporting bias. We also included all sexual orientations into the study (i.e., IIEF-15 might have not been suitable for homosexuals — however, analysis removing the homosexual orientated group yielded similar results in the multivariate regression). Conclusion: The prevalence of ED in young healthy Malaysian men was about 1 in 3. Given the psychosocial factors involved, perhaps an insightful look toward mental health and socioeconomic affects to health should be considered for targeted screening programs.