Survey: One in 10 Nairobi men struggling with erectile disorder

A graphical image of a depressed man

One in 10 young men in Nairobi is struggling with erectile dysfunction, according to Kemri researchers.

Erectile dysfunction (ED) is when a man has trouble getting or keeping an erection that is strong enough for sex.

The new finding lands hard in a city that prides itself on youth, hustle and bravado.

The findings also challenge the common assumption that erectile problems only affect older men.

“Contrary to traditional belief that ED is solely an issue for older men, recent data indicate a worrying increase in ED among younger males,” the study led by urologist Dr Chrispin Oluoch says.

The study also points to a rising self-prescription of sexual enhancing drugs among young people.

Dr Oluoch and colleagues Benjamin Ngugi and George Makalliwa interviewed 355 young men aged 18 to 35 across Huduma centres at GPO, City Square, Eastleigh, Kibra and Makadara in June last year.

 “Huduma centres were selected because they draw large, diverse walk-in populations seeking administrative services rather than healthcare. This non-clinical setting reduced health-seeking selection bias and facilitated the recruitment of urban young men from diverse socioeconomic and residential backgrounds,” they said.

Most participants reported cigarette smoking, cannabis use, alcohol use and recreational drug use as part of their history.

This is the first known study to quantify ED prevalence among Kenyan men under 35 years outside a clinical setting.

 The authors are affiliated to the Kenya Medical Research Institute (Kemri) and Jomo Kenyatta University of Agriculture and Technology (JKUAT). 

They linked the rampant erectile problems to psychological distress and low levels of physical activity, pointing to a quiet but significant public health issue among young urban men.

“Erectile dysfunction was identified in 10.4 per cent of respondents. Symptoms of depression or anxiety were strongly associated with erectile dysfunction, as was lack of regular physical exercise,” the authors said.

Their report, titled, 'Erectile dysfunction in young men in Nairobi County, Kenya: A community-based study', has not been peer-reviewed but is available on preprint server MedRxiv.

Prof Joachim Osur, Kenya’s leading sexologist and sexual medicine doctor, weighed in on the study.

He told the Star many studies report global prevalence of sexual problems ranging from roughly 10–30 per cent, depending on age group and measurement tools.

“Generally, about 30 per cent of all men have sex problems irrespective of age. If you put everyone together, the commonest problem is premature ejaculation," he said.

"For women, 25 per cent have sexual problems. We don’t have good data for Kenya because it’s not part of the data collected in the Kenya Demographic and Health Surveys.” 

Prof Osur is also a family therapist dealing in relationships and intimacy issues, besides being the vice chancellor of Amref International University.

The average age of respondents in the Kemri study was 27.4 years and most respondents were either working or studying in Nairobi.

 The researchers used the International Index of Erectile Function (IIEF)-5 to assess erectile function.

Total scores range from five to 25, with higher scores indicating better erectile function.

One of the five questions on the index asks: When you had erections with sexual stimulation, how often were your erections hard enough for penetration? The answers are: Almost never/never; A few times (much less than half the time); Sometimes (about half the time); Most times (much more than half the time); and Almost always/always, with scored being one to five.

 “For prevalence and regression analyses, erectile dysfunction was defined as a score of 21 or below, and no erectile dysfunction as 22 to 25,” Oluoch and his colleagues said.

 The scale of the issue became clear when they analysed the results.

 “Out of 355 participants, 37 men were classified as having erectile dysfunction, corresponding to an overall ED prevalence of 10.4 per cent,” the researchers said.

 Most affected men had mild symptoms, but a small number were already dealing with serious difficulties.

Mental health and physical activity were the strongest determinants of having ED.

The study states, “Psychological distress was strongly associated with ED, with approximately fivefold higher odds among men screening positive for anxiety or depression.”

“Regular exercise was protective, with 68 per cent lower odds among men who exercised.”

This suggests that sedentary urban lifestyles are playing a role in young men not rising to the occasion.

Age increased the risk even within this relatively young group. The researchers reported, “Age showed a clear positive association with ED, with a 13 per cent increase in odds per year.”

Prof Osur, who was not involved in the Kemri study, categorises the causes of sexual problems into three.

“It can be a medical problem, such as hypertension and diabetes. It could also be psychological problems such as anxiety and depression," he told the Star.

"Nowadays, mental health problems are common among young people, so this could lead to more sexual problems. The third cause is lifestyle problems such as overweight and obesity.” 

He advised clinicians to conduct a full assessment when a new client shows up with sexual problems.

“Many times, there’s a multiplicity of factors and not one factor. We assess everything to arrive at the problem and treatment.”

He said the International Index of Erectile Function (IIEF) is just a screening tool and medics should go deeper.

“IIEF is a screening tool that’s accepted but beyond that you need to go deeper. If it points to lifestyle, you can go deeper into those issues like obesity and you check what’s causing them.”

The Nairobi findings mirror trends seen elsewhere.

The study explains, “The multinational MALES study reported ED rates of eight per cent among men aged 20–29 years and 11 per cent among those aged 30–39 years, while a population-based survey in São Paulo, Brazil, found a prevalence of 7.3 per cent among men aged 20–29 years.”

One worrying behaviour found in Nairobi is many young men turning to unregulated solutions rather than seeking medical advice.

Dr Stephen Asatsa, a senior lecturer and head of department of psychology at the Catholic University of Eastern Africa, also noted anxiety and depression can significantly affect sexual function among young people.

“The mind and body are closely connected. Mental health struggles don’t just stay in your head; they often show up in sexual performance as well. Addressing emotional wellbeing is just as important as addressing any physical issues,” he said.