Fallen flag: Why erectile dysfunction is no longer just an older men's problem

For many men, it remains one of the most difficult conversations to have, often buried in silence, masked by humour, or dismissed as a temporary setback. Yet behind that silence, doctors warn, lies a potentially life-threatening signal.

Erectile dysfunction (ED) is increasingly being reframed not merely as a sexual health concern, but as an early warning sign of deeper medical conditions, including heart disease, stroke, and metabolic disorders.

Globally, the numbers are striking. More than 150 million men are estimated to be living with erectile dysfunction, a figure projected to rise to over 300 million as populations age and lifestyle diseases increase. Studies further show that up to 52 percent of men aged between 40 and 70 years will experience some form of ED.

Yet despite its prevalence, ED remains largely underreported, especially in African societies, where stigma and cultural expectations discourage open discussion.

At its core, erectile dysfunction is not simply about sexual performance. It is about circulation, nerves, hormones, and the complex interplay between physical and psychological health.

According to David Kimani, a consultant urologist at Kenyatta National Hospital, the condition should be viewed as a “window” into a man’s overall health.

“Erectile dysfunction precedes cardiovascular disease by about five to ten years,” he explains. “It is often the first clinical sign that something is wrong within the blood vessels.”

An erection depends on the ability of blood vessels to dilate and allow sufficient blood flow into the penis. When those vessels are narrowed, due to plaque buildup, high blood pressure, or diabetes, the process is disrupted.

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“These are the same blood vessels that supply the heart and brain,” Dr Kimani says. “So if they are affected, the implications go far beyond sexual health.”

This biological link explains why ED is closely associated with hypertension, diabetes, and cardiovascular disease. 

In many cases, men presenting with erectile dysfunction are later diagnosed with these underlying conditions, sometimes for the first time.

In Kenya, comprehensive national data on erectile dysfunction remains limited. However, hospital-based evidence and clinical observations point to a growing burden, closely tied to the rise of non-communicable diseases.

At major referral facilities such as Kenyatta National Hospital, doctors report increasing cases of ED among men with hypertension, diabetes, and heart disease.

“As these conditions increase in the population, erectile dysfunction follows the same trend,” says Dr Kimani. “It is not isolated; it reflects what is happening in the broader health system.”

Urbanisation has intensified the problem. Sedentary lifestyles, processed diets, reduced physical activity, and heightened stress levels are contributing to a perfect storm of risk factors.

“People no longer walk as they used to. Even children are driven everywhere,” he notes. “That lack of physical activity contributes to obesity, diabetes, and ultimately erectile dysfunction.”

While the link between ED and physical disease is well established, experts emphasise that not all cases are medical in origin.

“In fact, about 95 percent of erectile dysfunction is psychogenic,” Dr Kimani explains. “That means it is related to stress, anxiety, emotional factors, or relationship issues.”

This distinction is critical. A single episode does not necessarily indicate a medical disorder.

“If you have a disagreement with your partner, or you are under stress, you may not perform that night,” he says. “That does not mean you have erectile dysfunction.”

Doctors classify ED into two broad categories: temporary (situational) and persistent (chronic).

Situational ED may arise due to fatigue, alcohol use, stress, or emotional tension, and often resolves without medical intervention.

Persistent ED, however, is recurring and may signal deeper physiological issues.

A key diagnostic clue is the presence of morning erections.

“If a man still experiences morning erections, it suggests the physical system is intact,” Dr Kimani explains. “The issue is likely psychological.”

Young Men, Anxiety, and Unrealistic Expectations

Although erectile dysfunction is more common in older men, clinicians are increasingly seeing younger patients seeking help.

However, many of these cases are not disease-related but driven by anxiety, misinformation, and unrealistic expectations.

“Some young men believe they have erectile dysfunction when they don’t,” says Dr Kimani. “They are comparing themselves to unrealistic standards.”

Exposure to pornography, peer pressure, masturbation, and social myths about sexual performance have contributed to rising “performance anxiety.”

“A young man may come in saying he cannot perform, but when you ask, he is lasting 20 minutes,” he says. “That is not dysfunction, it is perception.”

Still, emerging local data suggest that erectile dysfunction among younger men is not insignificant. According to a 2026 community-based study by KEMRI on erectile dysfunction in young men in Nairobi County, about one in ten young men suffer from erectile dysfunction, with strong links to psychological distress and physical inactivity. 

The study conducted in men between the ages of 18 and 35 further highlights that while ED is commonly perceived as a condition affecting older men, it is increasingly present among younger populations, even as community-level data in sub-Saharan Africa remains limited.

Symptoms of depression or anxiety were strongly associated with ED, as was lack of regular physical exercise. 

Still, genuine cases among younger populations are rising due to alcohol use, smoking, and drug consumption.

“Alcohol increases desire but reduces performance,” Dr. Kimani explains. “It is one of the most common contributors.”

Despite its prevalence, erectile dysfunction remains one of the least openly discussed medical conditions among men.

“Men are driven by ego,” Dr. Kimani says. “Very few will openly admit they have a problem.”

Cultural expectations around masculinity reinforce silence, while fear of judgment keeps many away from clinics.

In some cases, men only seek help when relationships begin to break down.

“Sometimes it is the partner who pushes them to come,” he says. “Otherwise, they would remain silent.”

This silence carries serious consequences. Without diagnosis, underlying conditions such as diabetes or hypertension may go undetected until complications become severe.

Treatment Options: From Lifestyle Changes to Surgical Implants

Treatment for erectile dysfunction depends on the underlying cause, with most patients responding well to non-invasive approaches.

“The first step is lifestyle adjustment exercise, managing blood pressure, controlling diabetes, and addressing stress,” says Dr Kimani. “In many cases, that alone can resolve the problem.”

He emphasises a critical link between cardiovascular and sexual health:

“If you take care of your heart, you maintain your penis,” he says.

For psychological causes, counselling, sometimes involving both partners, can be highly effective.

“Sexual health is not just an individual issue; it involves relationships,” he notes.

Medication is often introduced when lifestyle changes are not enough. Drugs such as Viagra improve blood flow but must be used under medical supervision.

“These drugs are safe for the right patient, but dangerous if misused, especially in people with underlying heart conditions,” Dr Kimani warns.

More advanced treatments include injectable therapies and vacuum erection devices.

At the highest level are penile implants, surgical devices inserted into the penis to create controlled erections.

“We implant cylinders into the penis, connected to a fluid reservoir and a small pump. When activated, it produces an erection on demand,” he explains.

However, cost remains a major barrier.

“The device alone costs about two million shillings. With surgery and hospital care, the total can go up to around 2.5 million,” he says.

Despite the cost, the implant offers a permanent solution.

“Once inserted, it is for life. It allows a patient to have an erection whenever needed,” he adds.

Increasingly, medical experts are calling for erectile dysfunction to be treated as a public health issue rather than a private concern.

By identifying ED early, clinicians can detect and manage underlying conditions before they become life-threatening.

“It is not just about sex,” Dr Kimani says. “It is about survival.”

Erectile dysfunction, he adds, offers a critical window for early intervention in cardiovascular disease.

“If you treat erectile dysfunction early, you can prevent heart attacks and strokes,” he says.

Ultimately, addressing erectile dysfunction requires a cultural shift in how men perceive health and vulnerability.

Doctors are urging men to treat ED as a medical condition no different from diabetes or hypertension.

“It should be discussed openly,” Dr Kimani says. “There is no shame in seeking help.”

He stresses that awareness, early diagnosis, and open conversation are key to reducing both medical and psychological burden.

A Warning the Body Should Not Be Ignored

Erectile dysfunction is often seen as a private issue, but its implications are far broader.

It is a signal. A warning. A window into a man’s overall health.

Ignoring it may mean missing early signs of serious disease. Addressing it, however, could save lives.

As Dr Kimani puts it, “If your body is telling you something is wrong, listen. Erectile dysfunction may be the first sign, but it should not be the last.” 

UTILITYGlobal burden• ED affects an estimated 150–200 million men worldwide.• Projections suggest it could rise to over 300 million by 2025 due to aging populations and lifestyle diseases.Age breakdown• Men 40–49 years: ~10–15% report some degree of ED• Men 50–59 years: ~20–40%• Men 60+ years: up to 50–70%But increasingly, cases are rising in men under 40, linked to stress, obesity, diabetes, and pornography overuse debates. 

 Health connections• ED is strongly associated with:o Heart diseaseo Metabolic syndromeo Low testosterone (in some cases)o Neurological disorders (e.g., Parkinson’s disease, multiple sclerosis)

Mental health angle (often missed)• Up to 1 in 3 men with ED report anxiety or depression symptoms• Performance anxiety can worsen or trigger ED → creating a vicious cycle

Treatment realityED is treatable in most cases• Options include:o Lifestyle change (first-line intervention)o Oral medications (PDE5 inhibitors like sildenafil)o Therapy (especially for psychological ED)o Hormone treatment (in selected cases)o Devices or surgery (severe cases)

Kenya / Africa insight (important contextual angle)• ED is underreported due to stigma• Doctors estimate the prevalence is likely higher than recorded hospital data shows• Increasing association with:o Rising diabetes caseso Hypertension in younger meno Stress and alcohol use among urban populations

“Erectile dysfunction is not just a bedroom issue. It is often a silent signal of heart disease, diabetes, or psychological distress’, Dr Kimani concludes.