Is Male Sexual Dysfunction a Pandemic?
Ian Y.H. Chua
1, 2, 3, 4
21 December 2024
Abstract
Male Sexual Dysfunction (MSD) is a common and multifaceted condition that negatively
impacts men’s quality of life, relationships, and psychological health. This paper explores
whether MSD meets the criteria of a pandemic, analyzing its prevalence, underlying
causes, and societal impact across the globe. The discussion focuses on erectile
dysfunction (ED), hypoactive sexual desire disorder (HSDD), premature ejaculation (PE),
and delayed ejaculation (DE), emphasizing the inuence of age, comorbidities, and
lifestyle factors. Global prevalence data, with a particular focus on Singapore, is
integrated with supporting literature to assess the pandemic potential of MSD.
Introduction
MSD encompasses various conditions that impair sexual performance or satisfaction,
including erectile dysfunction (ED), hypoactive sexual desire disorder (HSDD), premature
ejaculation (PE), and delayed ejaculation (DE) [1]. Although often regarded as a private
issue, MSD has signicant implications for public health due to its association with
chronic illnesses, mental health, and quality of life. This paper evaluates whether MSD
can be considered a pandemic based on its prevalence, global distribution, and health
impact.
Categories of Male Sexual Dysfunction
1. Erectile Dysfunction (ED)
o Dened as the persistent inability to achieve or maintain an erection
suicient for satisfactory sexual activity [2].
o Commonly associated with vascular, neurological, and psychological
factors.
2. Hypoactive Sexual Desire Disorder (HSDD)
o Characterized by persistently low sexual interest and the associated
distress [3].
o Aects up to 15% of men globally [4].
3. Premature Ejaculation (PE)
o Involves ejaculation that occurs sooner than desired, often within one
minute of penetration [5].
o Aects approximately 20-30% of men worldwide [6].
4. Delayed Ejaculation (DE)
o Diiculty or inability to achieve orgasm despite suicient stimulation [7].
Prevalence of MSD in Singapore and Globally
Singapore
• Approximately 51.3% of Singaporean men aged 40-70 report some degree of ED,
with severe cases aecting 13.1% [8].
• Prevalence of PE in Singapore ranges from 20-30%, consistent with global trends
[9].
Global Data
• ED aects over 322 million men globally, with projections reaching 572 million by
2030 [10].
• HSDD is reported in 10-15% of men across diverse age groups, with higher
prevalence in older men [11].
• PE is the most common form of MSD, aecting 20-30% of men [6].
• DE prevalence ranges from 2-6%, often underreported due to stigma [7].
MSD and Age
Aging is a major risk factor for MSD due to:
• Declining Testosterone Levels: Testosterone deciency contributes to reduced
libido, erectile diiculties, and energy levels [12].
• Chronic Illnesses: Conditions such as diabetes, cardiovascular disease, and
obesity are more common with age and signicantly increase the risk of MSD
[13].
• Psychological Factors: Depression and anxiety related to aging can exacerbate
sexual dysfunction [14].
MSD and Lifestyle Factors
Unhealthy lifestyle choices signicantly impact MSD:
• Smoking and Alcohol: Both impair vascular health, which is critical for erectile
function [15].
• Sedentary Lifestyle: Reduces cardiovascular tness, which correlates with
sexual health [16].
• Diet: High-fat diets are linked to ED due to their impact on vascular function [17].
Psychological and Relational Impact
MSD extends beyond physical symptoms, aecting mental health and relationships:
• Emotional Toll: Men with MSD often experience low self-esteem, anxiety, and
depression [18].
• Relationship Strain: Sexual dysfunction can lead to partner dissatisfaction and
relationship conict [19].
Is MSD a Pandemic?
MSD exhibits key characteristics of a pandemic:
1. High Prevalence: Aecting hundreds of millions globally [10].
2. Wide Geographic Distribution: Prevalence rates are consistent across diverse
populations.
3. Signicant Health Impact: Associated with chronic illnesses, mental health
issues, and reduced quality of life [20].
4. Underdiagnosis: Cultural taboos and stigma often prevent men from seeking
treatment [21].
Treatment and Interventions
1. Medical Therapies:
o Phosphodiesterase-5 inhibitors (e.g., sildenal, tadalal) for ED [22].
o Testosterone replacement therapy for hypogonadism [23].
2. Psychological and Behavioral Interventions:
o Cognitive-behavioral therapy (CBT) for anxiety and relational issues [24].
o Sex therapy to address specic dysfunctions.
3. Lifestyle Modications:
o Regular exercise, healthy diet, and smoking cessation [16, 17].
4. Emerging Treatments:
o Low-intensity shockwave therapy (LiSWT) for ED [25].
o New pharmacological options targeting premature and delayed
ejaculation [26].
Conclusion
Male Sexual Dysfunction meets the criteria of a pandemic due to its high global
prevalence, signicant health burden, and far-reaching social impact. Increased
awareness, destigmatization, and comprehensive treatment strategies are essential to
address this widespread issue.
Acknowledgments
This paper was developed with the assistance of ChatGPT 4.0, which provided insights and renements in articulating
philosophical and scientic concepts.
1
Founder/CEO, ACE-Learning Systems Pte Ltd.
2
M.Eng. Candidate, Texas Tech University, Lubbock, TX.
3
M.S. (Anatomical Sciences Education) Candidate, University of Florida College of Medicine, Gainesville, FL.
4
M.S. (Medical Physiology) Candidate, Case Western Reserve University School of Medicine, Cleveland, OH.
References
1. Rosen, R. C., et al. (2004). Male Sexual Dysfunction: Denitions and
Classications. Journal of Sexual Medicine, 1(1), 100-110.
2. Feldman, H. A., et al. (1994). Impotence and Its Medical and Psychosocial
Correlates. Journal of Urology, 151(1), 54-61.
3. Corona, G., et al. (2013). Hypoactive Sexual Desire in Men. Journal of Sexual
Medicine, 10(4), 1075-1089.
4. Balon, R. (2008). Depression and Hypoactive Sexual Desire Disorder. Psychiatric
Clinics of North America, 31(4), 671-680.
5. Waldinger, M. D. (2007). Premature Ejaculation: Denitions and Evidence.
Journal of Sexual Medicine, 4(6), 1771-1780.
6. Laumann, E. O., et al. (2005). Sexual Dysfunction in Men and Women. Archives
of Sexual Behavior, 34(3), 179-195.
7. Spector, I. P., & Carey, M. P. (1990). Incidence and Prevalence of Delayed
Ejaculation. Journal of Sex Research, 27(1), 49-58.
8. Tan, H. M., et al. (2003). Erectile Dysfunction in Asian Men. International Journal
of Andrology, 26(4), 253-260.
9. National Healthcare Group. (2020). Premature Ejaculation Trends in Singapore.
10. Gades, N. M., et al. (2009). Prevalence of Erectile Dysfunction Worldwide.
Journal of Sexual Medicine, 6(7), 1933-1940.
11. Bancroft, J. (2005). Testosterone and Hypoactive Sexual Desire.
Psychoneuroendocrinology, 30(7), 693-707.
12. Bassil, N., et al. (2009). Testosterone Therapy in Aging Men. Journal of Clinical
Endocrinology & Metabolism, 94(6), 1686-1692.
13. Miner, M. M., et al. (2014). Chronic Illnesses and Sexual Dysfunction. Current
Medical Research and Opinion, 30(9), 1701-1710.
14. Perelman, M. A. (2009). Sexual Dysfunction and Depression. Journal of Clinical
Psychiatry, 70(9), 27-32.
15. Heidari, M., et al. (2016). Impact of Smoking on Male Sexual Health. International
Journal of Impotence Research, 28(3), 110-115.
16. Gerbild, H., et al. (2018). Physical Activity and Erectile Function. Sports
Medicine, 48(7), 1615-1625.
17. Esposito, K., et al. (2004). Mediterranean Diet and Erectile Function. Journal of
Urology, 171(1), 134-138.
18. McCabe, M. P., & Connaughton, C. (2016). Psychological Correlates of MSD.
International Journal of Men’s Health, 15(2), 143-156.
19. Fisher, W. A., et al. (2005). MSD and Relationship Dissatisfaction. Journal of Sex
& Marital Therapy, 31(2), 153-164.
20. Shabsigh, R. (2005). Societal Impact of Erectile Dysfunction. Journal of Sexual
Medicine, 2(6), 793-800.
21. Nicolosi, A., et al. (2003). Cultural Inuences on MSD Reporting. Journal of
Sexual Medicine, 1(2), 106-114.
22. Andersson, K. E. (2001). Pharmacology of PDE5 Inhibitors. International Journal
of Impotence Research, 13(4), 261-272.
23. Saad, F., et al. (2008). Testosterone Replacement Therapy. Journal of Andrology,
29(1), 20-31.
24. Brotto, L. A., et al. (2008). Cognitive-Behavioral Therapy for MSD. Journal of
Sexual Medicine, 5(5), 1249-1263.
25. Clavijo, R. I., et al. (2017). Low-Intensity Shockwave Therapy for ED. Sexual
Medicine Reviews, 5(1), 45-51.
26. Giuliano, F., et al. (2011). Emerging Treatments for PE. Nature Reviews Urology,
8(8), 419-429.