Recreational use of erectile dysfunction medications and its adverse effects on erectile function in young healthy men: the mediating role of confidence in erectile ability

Introduction: Oral erectile dysfunction medications (EDMs) have become an increasingly popular drug of abuse among young men without a medical indication. In addition to being associated with increased sexual risk behaviors, recreational EDM use may adversely impact psychological aspects of sexual function, primarily by affecting one's confidence in pharmacologically unaided erectile ability. To date, these associations have not been investigated empirically.

Aim: This study examined the mediating role of confidence in erectile ability on the concurrent relationship between recreational EDM use and erectile function among young healthy men. A secondary aim was to examine erectile function characteristics among recreational users, prescribed users, and nonusers to control for the possibility that recreational users were using EDMs to treat ED.

Methods: The sample comprised 1,207 sexually active men (mean age = 21.9 years; standard deviation = 4.48) who were recruited from undergraduate institutions within the United States.

Main outcome measures: Participants completed an online survey assessing frequency of EDM use, as well as levels of sexual function (erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall sexual satisfaction) and levels of confidence in ability to gain and maintain erection, as per the International Index of Erectile Function.

Results: Recreational users (N = 72) reported similar erectile function levels compared with nonusers (N = 1,111), and both groups differed from prescribed users (N = 24). Recreational users also reported lower erectile confidence and lower overall satisfaction compared with nonusers. Results were consistent with mediation, in that more frequent EDM use was inversely associated with erectile confidence, which in turn showed negative relations with erectile function.

Conclusions: Confidence in erectile abilities mediates the inverse relationship between recreational EDM use and erectile function. Results underscore the possibility that recreational EDM use among healthy young men may lead to psychogenic ED. Additional longitudinal research is necessary to establish a causal link between these variables.