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In 2001–2002, it was administered to 13,618 sexually active men in 29 countries [5]. Based on the findings of historical studies cited earlier, older men would be expected to have far higher ED rates than the negligible rates of younger men [2,7].

A decade later, in 2011, the same (yes/no) question from the GSSAB was administered to 2737 sexually active men in Croatia, Norway and Portugal [6]. However, in just a decade, things changed radically.

However, none of the familiar correlative factors suggested for psychogenic ED seem adequate to account for a rapid many-fold increase in youthful sexual difficulties.

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A 2013 Italian study reported one in four patients seeking help for new onset ED were younger than 40, with rates of severe ED nearly 10% higher than in men over 40 [9].

A 2014 study on Canadian adolescents reported that 53.5% of males aged 16–21 had symptoms indicative of a sexual problem [10].

Yet these lifestyle risks have not changed proportionately, or have decreased, in the last 20 years: Obesity rates in U. men aged 20–40 increased only 4% between 19 [19]; rates of illicit drug use among US citizens aged 12 or older have been relatively stable over the last 15 years [20]; and smoking rates for US adults declined from 25% in 1993 to 19% in 2011 [21]. Yet, how likely is it that anxiety and depression account for the sharp rise in youthful sexual difficulties given the complex relationship between sexual desire and depression and anxiety?

Some depressed and anxious patients report less desire for sex while others report increased sexual desire [22,23,24,25].

Clinical reports suggest that terminating Internet pornography use is sometimes sufficient to reverse negative effects, underscoring the need for extensive investigation using methodologies that have subjects remove the variable of Internet pornography use.

In the interim, a simple diagnostic protocol for assessing patients with porn-induced sexual dysfunction is put forth.

Rates of psychogenic ED increased more than organic ED, while rates of unclassified ED remained relatively stable [12].

A 2014 cross-sectional study of active duty, relatively healthy, male military personnel aged 21–40 employing the five-item IIEF-5 found an overall ED rate of 33.2% [13], with rates as high as 15.7% in individuals without posttraumatic stress disorder [14].

Traditionally, ED has been seen as an age-dependent problem [2], and studies investigating ED risk factors in men under 40 have often failed to identify the factors commonly associated with ED in older men, such as smoking, alcoholism, obesity, sedentary life, diabetes, hypertension, cardiovascular disease, and hyperlipidemia [16].

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