Dear Sir,
    
    Erectile dysfunction (ED) is a worldwide problem whose prevalence is projected to rise sharply due to increasing age in Europe and North America and to population growth in other continents, especially Asia [Giuliano F. Eur Urol 2002; 1 (Supp l): 1]. The recent development, promotion and acceptance of effective and well-tolerated oral ED therapies, have encouraged many men with ED to seek medical consultation. Herein we briefly review epidemiological studies conducted in the European Union (EU), that were published in MEDLINE since 2000.
    
    In the UK, in 2002 men (aged 55 years ~ 70 years) ED was reported in 6.9 % aged 55 years ~ 60 years, in 12.5 % aged 61 years ~ 65 years and in 22.2 % aged 66 years ~ 70 years, while the prevalence of complete ED was 12.8 % [Green JS, et al. BJU Int 2001; 88: 551]. Moreover, recorded diagnoses of ED more than doubled in the UK after sildenafil was licensed in 1998 [Kaye JA & Jick H. BMJ 2003; 326: 424]. In Germany, in the 'Cologne Male Survey' it was found that among 4489 men (aged 30~80 years) the prevalence of ED was 19.2 %, with a steep age-related increase (2.3 % ~ 53.4 %) [Braun M, et al. Int J Impot Res 2000; 12: 305]. In France, a study in 1004 men (aged > 40 years) found that 31.6 % had ED of mild or moderate severity [Giuliano F, et al. Eur Urol 2002; 42: 382]. In Italy, among 2010 men (aged > 18 years), 12.8 % reported ED and the prevalence increased from 2 % in men aged 18 years ~ 39 years to 48 % in those >70 years [Parazzini F, et al. Eur Urol 2000; 37: 43]. In another study, the age-adjusted prevalence of moderate or complete ED was 17 % in 600 men aged 40 years~70 years [Nicolosi A, et al. Urology 2003; 61: 201]. In Spain, the EDEM study found that in 2476 men (aged 25~70 years), the overall prevalence of ED was 18.9 % [Martin-Morales A, et al. J Urol 2001; 166: 569]. In Belgium, among 799 men (aged 40~70 years) the overall age-adjusted prevalence of ED was 10.1 % for severe, 24.7 % for moderate, and 26.6 % for mild ED [Mak R, et al. Eur Urol 2002; 41: 132]. In Finland, in the TAMU study it was found that in 1983 men (aged 50 years ~ 70 years), ED was reported in 45 % as minimal, in 11 % as moderate and in 7 % as complete [Koskimaki J, et al. J Urol 2000; 164: 367]. In the Netherlands, in the 'Krimpen' study in 1688 men (aged 50 years ~ 78 years) it was found that 17 % reported ED and that the prevalence of significant ED increased from 3 % in men 50~54 years to 26 % in men 70 years ~ 78 years [Blanker MH, et al. Urology 2001; 57: 763].
    
    Different definitions of ED and various study methods, age distributions and concomitant medical conditions may explain much of the variance in reported prevalence rates. Despite national variations in prevalence, uniform associations were found between ED and ageing, medical conditions and lifestyle habits. ED was increased in subgroups with diabetes, depression, chronic renal failure, pelvic surgery and cardiovascular and neurological diseases. Moreover, ED was inversely associated with physical activity and education and positively with heavy smoking and alcohol consumption.
    
    This brief review suggests that the prevalence range of ED in EU is 20 % ~ 45 %. ED needs to be more accurately evaluated by standardized methods, especially as effective oral treatments and diagnostic/therapeutic guidelines are now available. Societies facing substantial increases in ED will need to allocate resources to deal with this serious health problem in terms of research and clinical studies.
    
    A.G. Papatsoris, A. Triantafyllidis, A. Gekas
    Department of Urology
    "Agios Andreas" Regional Hospital
    26335 Patras
    Greece
    Tel/Fax: +30-2610-993 058
    E-mail: agpapatsoris@hotmail.com

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