U-Shaped Age Pattern of Erectile Dysfunction with Elevated Prevalence in Men in Their 20s Independent of Marital Status: Results from a National Survey in Japan.

PURPOSE: To investigate differences in erectile dysfunction (ED) prevalence between unmarried and married men and to determine whether the high prevalence of ED among young men is independent of marital status.

MATERIALS AND

METHODS

We analyzed data from a nationwide, internet-based cross-sectional survey conducted by the Japanese Society for Sexual Medicine in 2023, including 6,228 men aged 20 to 79 years. ED was defined as an Erection Hardness Score ≤2. Participants were stratified by marital status and age. Multivariable analyses adjusted for comorbidities, including obesity, diabetes, hypertension, dyslipidemia, chronic kidney disease, cardiovascular disease, and smoking. Restricted cubic spline regression was used to evaluate age-related trends. Sexual behaviors and desire were assessed using validated questionnaires.

RESULTS

Unmarried men were younger and had fewer comorbidities than married men. Despite this, the prevalence of ED was significantly higher among unmarried men in younger age groups. In men aged 20 to 29 years, ED prevalence was 25.5% in unmarried men and 17.8% in married men (adjusted prevalence difference 7.3%, p<0.05). Similar trends were observed in men aged 30 to 39 and 40 to 49 years. After adjusting for marital status and comorbidities, ED prevalence followed a U-shaped distribution across age, with the lowest prevalence around 40 years. Notably, ED prevalence in men in their 20s remained significantly higher than in those in their 30s. Unmarried men also had lower sexual intercourse frequency and sexual desire but higher masturbation frequency.

CONCLUSIONS

Unmarried status is associated with impaired sexual function, particularly in younger men. However, the elevated prevalence of ED among men in their 20s persists independently of marital status, raising the possibility of a substantial contribution of psychosocial and lifestyle factors. These findings highlight young adulthood as a vulnerable period for male sexual health and underscore the need for early intervention strategies.