The number of men seeking treatment for erectile dysfunction has skyrocketed in recent years amid what some have described as a “silent epidemic.”
Viagra – the “little blue pill” – is normally associated with old people, but the most recent figures suggest that an estimated 30 million American men are now living with erectile dysfunction – nearly twice as many in the early 2000s.
However, about a quarter of those under 40 have difficulty getting into bed, which has been linked to an increase in obesity, poor mental health and overconsumption of pornography.
Northeastern states such as Maine, Vermont, and New Hampshire have relatively high median ages. ED is usually more common in older men
Prescription pill rates vary by state, but research shows those leaning politically left tend to have more little blue pills in circulation that, men’s health experts say, could lead to a more open dialogue between patients and doctors about sexual health issues that are taboo in many conservative states.
Dr. Helen Bernie, director of sexual and reproductive medicine at Indiana University said, “What you see on that top 10 list are those your more progressive states, right? New York, New Jersey, Pennsylvania, California, Nevada.
“Those tend to be more progressive states where they have better reproductive rights, so you would assume that maybe people talk a little more about sex, maybe it’s kind of okay to prescribe these drugs.”
In general, southern states had far fewer pill bottles in circulation, with the exception of Florida, where ED prescriptions made up 0.25 percent of the total filled there.
Then you look at the alternative. In the south, the strong Bible Belt, there is a strong religious connection and generally people don’t talk about sex, we can only talk about abstinence or pregnancy.
“So maybe doctors don’t ask their patients about sexual activity, so they don’t prescribe as many drugs. It’s taboo.’
It’s for this reason that Dr. Bernie said the actual number of men with erectile dysfunction is likely much higher than the estimated 30 million.
If a doctor who lives in a conservative area where sex is not freely discussed doesn’t bring up a taboo subject in the safety of the exam room, the patient probably won’t either.
Erectile dysfunction is often a biomarker of a man’s overall health. An inability to get or maintain an erection can be the result of undiagnosed high cholesterol or high blood pressure or even a warning sign of cardiovascular disease.
Dr. Bernie added, “I mean, that’s the simplest question you’re going to have to ask: are you having trouble getting or keeping an erection? And by asking that simple question, you get an answer and it opens up the dialogue between patients to actually ask questions and explore treatment options for preventive health.”
Erectile dysfunction is most often considered in older men because of the many age-related changes the body undergoes, such as naturally declining testosterone levels, weakened pelvic muscles, and a loss of the necessary nerve function that helps the brain communicate with other systems in the body that leads to an erection.
But in younger men, the source of the problem is often psychological. Performance anxiety and high levels of stress can affect the delicate balance of hormones in the body and the functioning of the nervous system.
Testosterone levels usually peak around age 20, followed by a slow decline throughout the rest of adulthood. At their highest, testosterone levels should be somewhere between 300 and 1,200 ng/dL. Once men hit their mid-thirties, testosterone levels begin to drop by at least one percent per year.
Pornography use and overuse can also contribute to ED. Constant exposure to explicit images and videos desensitizes the viewer, making the brain less responsive to sexual stimuli, such as your partner standing naked in front of you.
And repeated exposure to porn can lead to the same disturbances in the brain like hard drugs.
The brain’s reward system releases dopamine whenever something that feels good happens, whether it’s finding food in the middle of a desert, snorting cocaine, or watching hardcore porn.
Over time, the brain gets used to the images and videos and doesn’t get the same heavy dose of dopamine when the person presses play. This hinders the brain’s reward system and makes it more difficult for the brain to get excited about the real thing.
But people’s penchant for porn is unlikely to change any time soon. Internet viewing has constantly checked over the past two decades, suggesting that the pool of young men with ED will expand.
And as the US population grows grayer by the year, the prevalence of erection problems could potentially increase even further, translating into even bigger profit margins for the companies behind blockbuster drugs like Viagra and Cialis.