Usually regarded as a sign of getting old, an analysis from Italy has been published in the Journal of Sexual Medicine which shows that one in four men seeking help for newly-developed erectile dysfunction was younger than 40.

Paolo Capogrosso of the University Vita-Salute San Raffaele in Milan Italy, and colleagues assessed 439 men who visited a single outpatient clinic between January 2010 and June 2012 seeking help for their ED. They note that 114 (26%) were aged 40 or younger.

Compared with older patients, the sufferers had a lower body mass index and a higher level of testosterone in the blood, while only 9.6% had one or more concomitant medical conditions compared with 41.7% among the more elderly. However, the younger ED patients smoked cigarettes and used illicit drugs more frequently and premature ejaculation was more common in that group.

The researchers added that severe erectile dysfunction was found in 48.8% of younger patients and 40% of older ones, while there was no difference in the rates of mild to moderate symptoms. They conclude that while larger studies are needed, the findings suggest that ED in young men may be more prevalent and more serious than previously thought.

Dr Capogrosso said the data, taken together with those of other studies showing ED as a potential marker of major diseases, "outline the importance of taking a comprehensive medical and sexual history and to perform a thorough physical examination in all men with ED". Irwin Goldstein, editor-in-chief of the Journal of Sexual Medicine, said that "we have in the past had a bias that ED [in younger men] was primarily psychologic-based and vascular testing was not needed. We now need to consider regularly assessing the integrity of arterial inflow in young patients [which] may be very relevant to their overall long-term health".