Men with erectile dysfunction sicker, less productive

A study spanning over 50,000 men from 8 countries shows that the presence of erectile dysfunction (ED) is a factor in poor productivity at work and decreased quality of life (QoL) with respect to health.

ED in this study was diagnosed based on the self-reported presence of any difficulty in producing or sustaining an erection in the 6 months preceding the survey. The severity was rated on a scale of 1 to 5, and those with a score of 2 or more were classified as having ED, compared to those with 1. The US figures were taken as an arbitrary standard against which the evaluations from other countries were compared.

Image Credit Igorstevanovic / Shutterstock
Image Credit Igorstevanovic / Shutterstock

ED may occur due to low sex hormone levels, reduced blood supply to the penis, impaired nervous stimulation of the organ, or as a result of former surgery or medical treatment of structures in this region. Its incidence was first reported at 52% in the Massachusetts Male Aging Study, supported by several other international surveys. It is known to cause greater loss of workplace productivity, more disruption of activity, and to reduce the health-related QoL by predisposing the person to anxiety and depression, as well as increasing the chances of cardiovascular disease.

The study covered men aged 40 years to 70 years, from the US, Europe (France, Germany, Italy, Spain, the UK), and middle income countries in Asia (China) and South America (Brazil). Overall, almost 50% of men surveyed had ED, with Italy having the highest reported prevalence. Men with ED were more than twice as likely to stay home from work and to report sick to the workplace. The risk of impaired productivity and activity were also twice as high in this group.

With respect to absenteeism, men with and without ED missed 7% and 3% of their work time in the preceding 7 days. Reporting to work while sick (“presenteeism”) resulted in impaired performance of more than 22% and 10% in men with and without ED respectively. Impairment in work productivity (sum of absenteeism and presenteeism) and daily activities led to the loss of about 25% and 29% of work time in men with ED, compared to 11% and 15% of those without ED, respectively.

Health-related QoL assessments were made using Mental Component Summary (MCS) and Physical Component Summary (PCS) scores were significantly reduced in men with ED, by almost 5 points each. Men with ED also were also more likely to be older, obese, smokers, excessive drinkers, and non-exercisers. However, the effects of these on ED and work productivity were compensated for to bring out the unique contribution of ED to impaired work productivity.

The UK showed the strongest linkage between ED and reduced work productivity, more than 2.5 times higher than the next strongest association. The highest association of ED with poorer daily activity was in China, with the highest reduction in MCS and PCS (reduced health-related QoL) being reported from Italy, compared to the US.

In short, the more severe the ED is, the worse is the overall productivity and health-related QoL of the affected individual. Measures to prevent this include earlier identification of the problem and better treatment, which should be emphasized especially in those countries that show a higher linkage between ED and poor outcomes.  

Older studies had already shown that ED causes loss of productivity, but this was an important piece of research in establishing the global prevalence of the condition and its effect on work output. This becomes a still more serious issue in view of the fact that more and more younger men are developing ED. Low testosterone levels as well as increased severity of ED are independent risk factors for reduced QoL in male diabetics, as shown by earlier research. Thus conditions such as obesity and alcoholism could be responsible for both ED and other lifestyle diseases like high blood sugar, high cholesterol levels, depression and hypertension. At the same time, the presence of ED significantly contributes to worse outcomes even after adjusting for these factors.

Summing up, researcher Wing Yu Tang said, “This study shows that ED remains a prevalent concern, one that impacts work productivity and absenteeism.” Senior author Tarek Hassan commented on the global nature of the phenomenon: “Stemming from eight countries, the global coverage of the data also suggests that this issue is pervasive across geographies.”

Journal reference:

Goldstein, I, Goren, A, Li, VW, Maculaitis, MC, Tang, WY, Hassan, TA. The association of erectile dysfunction with productivity and absenteeism in eight countries globally. Int J Clin Pract. 2019;e13384.,

Dr. Liji Thomas

Written by

Dr. Liji Thomas

Dr. Liji Thomas is an OB-GYN, who graduated from the Government Medical College, University of Calicut, Kerala, in 2001. Liji practiced as a full-time consultant in obstetrics/gynecology in a private hospital for a few years following her graduation. She has counseled hundreds of patients facing issues from pregnancy-related problems and infertility, and has been in charge of over 2,000 deliveries, striving always to achieve a normal delivery rather than operative.


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