Reviewed research

Slayday et al., 2022. Erectile Function, Sexual Satisfaction, and Cognitive Decline in Men From Midlife to Older Adulthood, The Gerontologist


If a man has erectile dysfunction, it’s likely he has at least one accompanying comorbidity. Recent data from the United Kingdom show a prevalence of self-reported erectile dysfunction above 40% for men aged 18 years and older1, consistent with international and Australian figures2. In addition to confirming the high prevalence of ED, the UK study shows almost three out of four men with ED had at least one accompanying health problem.

The presence of comorbidities in men with ED is not surprising, because there’s many associated health problems that are well known. Associations between erectile dysfunction and cardiovascular disease are well established enough for some specialty groups to include ED in models predicting risk of heart attack or stroke.

If ED is indeed a canary in a coal mine when it comes to cardiovascular disease, what other associated health problems might it help to predict?

Like erectile function, problems with cognition are associated with cardiovascular disease3, suggesting ED and cognitive decline might be related4.


Erectile dysfunction and cognitive decline

The cognitive performance of male United States Vietnam War veterans (most of whom did not have combat roles, and who are broadly representative of the US male population; although they are all twins) was associated with erectile dysfunction in a cross-sectional study5, and the risk of developing Alzheimer’s disease and non-Alzheimer’s dementia over a seven-year period was 2/3 higher in Taiwanese men with newly diagnosed ED than in those without, based on national insurance records4.

More recently, data from twin pairs of US Vietnam war veterans was used for a longitudinal study of erectile and sexual function and cognitive performance6. Beginning at ages from 51-61, 818 men underwent assessments of erectile function, sexual satisfaction, and cognitive function on three occasions until they were 61-71 years old (by which time there were 589 subjects). Statistical analyses included adjustment for potentially confounding variables.

In general, erectile function, sexual satisfaction and cognitive function (focusing on domains vulnerable to aging: episodic memory, executive function and processing speed) declined over the 10-year period of the study, as would be expected for men of this age group. At baseline, lower erectile function was associated with lower episodic memory, executive function and processing speed, but sexual function was not. Men with lower baseline erectile function also had faster declines in processing speed over the course of the study.

Men whose erectile function declined during the study had accompanying falls in episodic memory; those whose erectile function improved had slower declines. The same relationship was observed for sexual satisfaction, and the authors suggest this association might be mostly mediated by erectile function.


Implications for practice

The most recent Australian and New Zealand clinical guidelines on the management of erectile dysfunction7 recommend cardiovascular risk stratification of patients presenting with erectile dysfunction, with further cardiovascular testing and/or cardiology referral where necessary.

Accumulating evidence that erectile dysfunction may be accompanied by cognitive impairment and future cognitive decline may aid health professionals in identifying patients at risk. It should also further motivate heath professionals and the general public to use erectile function as an indicator of men’s physical and mental well-being.

  1. Slayday et al., 2022. Erectile Function, Sexual Satisfaction, and Cognitive Decline in Men From Midlife to Older Adulthood, The Gerontologist
  2. Kessler et al., 2019. The global prevalence of erectile dysfunction: a review. BJU International
  3. Gorelick et al., 2011. Vascular Contributions to Cognitive Impairment and Dementia. Stroke
  4. Yang et al., 2015. Increased Risk of Dementia in Patients With Erectile Dysfunction: A Population-Based, Propensity Score-Matched, Longitudinal Follow-Up Study. Medicine
  5. Moore et al., 2014. Erectile Dysfunction, Vascular Risk, and Cognitive Performance in Late Middle Age. Psychology and Aging
  6. Slayday et al., 2022. Erectile Function, Sexual Satisfaction, and Cognitive Decline in Men From Midlife to Older Adulthood, The Gerontologist
  7. Chung et al., 2022. Urological Society of Australia and New Zealand (USANZ) and Australasian Chapter of Sexual Health Medicine (AChSHM) for the Royal Australasian College of Physicians. Medical Journal of Australia