More Common Than You Think: Erectile Dysfunction and Premature Ejaculation in the Arab World

There are a lot of topics that people tend not to discuss openly because they are surrounded by taboo and stigma. One of such topics is men’s reproductive health. Whilst there is growing evidence that problems with men’s reproductive health can be correlated with more serious health problems such as cardiovascular diseases, oncological conditions and much more [1,2], there is still a lot of stigma surrounding this aspect of wellbeing. Some of the most frequently encountered issues that men encounter in their lives are Erectile Dysfunction (ED) and Premature Ejaculation (PE). These problems can have a significant impact on the quality of life and affect millions of men worldwide, including those in the Arab world and Middle East and North Africa (MENA) region. The lack of open discussion can prevent men from seeking the help and treatment they need, leading to prolonged suffering and strained relationships.

In this blog post, we  discuss how frequent these conditions are in the MENA region by exploring the research and statistics on these important issues. We will dive into the prevalence of ED in the region, examine the various risk factors contributing to its development, and discuss the impact it can have on the lives of affected men and their partners.

By shedding light on ED in the Arab world, we hope to encourage more open dialogue, reduce stigma, and ultimately improve the well-being of those affected by this condition. If you want to share your experience with ED and Premature Ejaculation (PE) or leave your opinion - drop us a message on Instagram.

What is ED and PE?

We have discussed the definition of erectile dysfunction and premature ejaculation in separate blogposts, but to briefly reiterate:

• Erectile dysfunction, or impotence, is the inability to achieve or maintain an erection sufficient for satisfactory sexual performance. [3]
• Premature ejaculation occurs when you ejaculate sooner than you or your partner would want for it to happen. [4]

Both of these conditions can occasionally happen to healthy men, but if these become a systematic issue, they might require some attention.

Global prevalence of ED and PE

ED and PE are not rare either. According to the British Journal of Urology, the prevalence of ED amongst men is between 3–76.5%. And whilst traditionally ED is often associated with older age, some research suggests ED is prevalent amongst young men as well. [5] PE is equally common, with around 30% of men suffering from it. [6]

Prevalence of ED in the MENA region

There is limited data available for prevalence of ED and PE in the MENA, but the existing research suggests that it mirrors global trends. This presents a significant concern for the male wellbeing in the region.

For example, according to Hakami et al, in Saudi Arabia the prevalence of ED was about 21%, which means every 1 in 5 men experiences erectile dysfunction. In this study more than half of the respondents were between 18 and 25 years old. That shows that ED affects young men in the region. [7] The real numbers of men struggling with ED are likely even higher, because when Omar and Kamal Sheer used a Global Online Sexuality Survey, 45.1% of respondents expressed various degrees of ED. [8] It is confirmed by other reviewers, that estimate ED in the Arab world to be around 40%. [9] This is closer to one in every two men. In addition to this, a study of married men in Egypt suggests that ED affects underprivileged men and men living in rural areas [10], which makes it a wider socioeconomic problem.

Prevalence of PE in the MENA region

Similar to ED, PE prevalence in the Middle East follows global patterns and is common amongst men of various age groups. In a study of more than 3000 men with the mean age of 37 in Qatar, around 38% of men reported experiencing PE. [11] The numbers were more than double that in a different study that used the Global Online Sexuality Survey: 83.7% Arabic-speaking men reported varying degrees of PE. If we extrapolate it to the whole population, it means 4 out of 5 men in the MENA region struggle with PE.

What is complicating the matters even more, is that ED and PE can often happen together. [12] This requires a comprehensive approach to treating these conditions. To understand how to approach them, we first need to understand what factors can contribute to these conditions.

Risk factors

Several risk factors contribute to the development of ED and PE, and they are of course not specific just the MENA region. Some of the most common risk factors are:

• Age. ED and PE have higher prevalence in older men, even though more and more younger men face these conditions as well
• Chronic diseases such as diabetes, hypertension, and cardiovascular disease
• High rates of obesity
• Unhealthy lifestyle. For example, a study in Saudi Arabia established a higher prevalence of ED amongst smokers of all ages [13]
• Psychological factors like stress, anxiety, and depression

Reproductive health issues can have a significant impact on the quality of life of affected men and their partners. Luckily, numerous treatment options are available for both ED, and PE.

Treatment and Management

The treatment of reproductive health issues should be comprehensive and based on the underlying reasons of ED and PE in this individual patient. In most of the cases going to your GP and performing some tests and blood analysis is a good idea. There are also other options available to the Arab men for managing ED and PE [14, 15]:

• Medications. Most common drugs used to treat ED are Phosphodiesterase Type 5 (PDE5) inhibitors, such as sildenafil (Viagra). It is the first-line pharmacological treatment for ED, and it can help with PE as well if it is caused by ED. There are separate medications that can help you manage PE, but before taking any of them you need to consult your doctor.
• Lifestyle modifications, can help a great deal. Some of possible lifestyle changes include weight loss, exercise, and smoking cessation, can improve ED symptoms
• Psychotherapy and counseling can address psychological factors contributing to ED and PE
• Surgical options, such as penile implants, may be considered in severe cases

However, access to treatment may be limited by factors such as cost, availability, and cultural stigma surrounding sexual health issues. Improving access to care and reducing stigma are important for effective ED management in the region.

Impact on the quality of life

Reproductive health issues can have a significant impact on the quality of life of affected men and their partners:

Recognizing the broader impact of ED is essential for providing comprehensive care and support to affected individuals. [3-5]

Conclusion

To better understand the specifics of prevalence, risk factors, and impact of ED and PE in the MENA region further comprehensive and evidence-based research is needed. But we can already say, that erectile dysfunction and premature ejaculation are the issues that a lot of Arab men face starting from a relatively young age. It has a significant impact on the quality of the lives of these men and their wives. But what it means for you, is you are not alone with your problems. There are millions of people around that are like you, facing similar struggles. It is not a shame to acknowledge that you experience ED and/or PE. It actually takes strength and courage to go and address your reproductive health challenges. It will help you to feel more confident, and to create a stronger relationship with your partner.

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References:

[1]  Belladelli F, Muncey W, Eisenberg ML. Reproduction as a window for health in men. Fertility and Sterility, Volume 120, Issue 3, Part 1, 2023, Pages 429-437, ISSN 0015-0282, https://doi.org/10.1016/j.fertnstert.2023.01.014.

[2] Tabassam Latif, Tina Kold Jensen, Jesper Mehlsen, Stine Agergaard Holmboe, Louise Brinth, Kirsten Pors, Sven Olaf Skouby, Niels Jørgensen, Rune Lindahl-Jacobsen, Semen Quality as a Predictor of Subsequent Morbidity: A Danish Cohort Study of 4,712 Men With Long-Term Follow-up, American Journal of Epidemiology, Volume 186, Issue 8, 15 October 2017, Pages 910–917, https://doi.org/10.1093/aje/kwx067

[3] https://www.nhs.uk/conditions/erection-problems-erectile-dysfunction/

[4] https://www.webmd.com/sex/what-is-premature-ejaculation

[5] Kessler A, Sollie S, Challacombe B, Briggs K, Van Hemelrijck M. The global prevalence of erectile dysfunction: a review. BJU Int. 2019 Oct;124(4):587-599. doi: 10.1111/bju.14813. Epub 2019 Jul 2. PMID: 31267639.

[6] Carson, C., Gunn, K. Premature ejaculation: definition and prevalence. Int J Impot Res 18 (Suppl 1), S5–S13 (2006). https://doi.org/10.1038/sj.ijir.3901507

[7] Hakami BO, Alhazmi AA, Kariri AM, Zaybi FA, Hadadi AW, Mahzara NK, Ageeli FA, Aqeel AA, Mahzari FH, Alzahrani MA. Prevalence, Risk Factors, and Awareness of Erectile Dysfunction in the Saudi Arabian Population. Cureus. 2024 May 28;16(5):e61233. doi: 10.7759/cureus.61233. PMID: 38939275; PMCID: PMC11210442.

[8] Shaeer O, Shaeer K. The Global Online Sexuality Survey (GOSS): erectile dysfunction among Arabic-speaking internet users in the Middle East. J Sex Med. 2011 Aug;8(8):2152-60; quiz 2160-3. doi: 10.1111/j.1743-6109.2011.02297.x. Epub 2011 May 13. PMID: 21569214.

[9] El-Sakka AI. Erectile dysfunction in Arab countries. Part I: Prevalence and correlates. Arab J Urol. 2012 Jun;10(2):97-103. doi: 10.1016/j.aju.2012.01.004. Epub 2012 Feb 28. PMID: 26558010; PMCID: PMC4442907.

[10] Seyam RM, Albakry A, Ghobish A, Arif H, Dandash K, Rashwan H. Prevalence of erectile dysfunction and its correlates in Egypt: a community-based study. Int J Impot Res. 2003 Aug;15(4):237-45. doi: 10.1038/sj.ijir.3901000. PMID: 12934050.

[11] Albakr A, Arafa M, Elbardisi H, ElSaid S, Majzoub A. Premature ejaculation: An investigative study into assumptions, facts and perceptions of patients from the Middle East (PEAP STUDY). Arab J Urol. 2021 Jul 9;19(3):303-309. doi: 10.1080/2090598X.2021.1948159. PMID: 34552781; PMCID: PMC8451653.

[12] Tsai WK, Chiang PK, Lu CC, Jiann BP. The Comorbidity Between Premature Ejaculation and Erectile Dysfunction-A Cross-Sectional Internet Survey. Sex Med. 2019 Dec;7(4):451-458. doi: 10.1016/j.esxm.2019.06.014. Epub 2019 Sep 17. PMID: 31540883; PMCID: PMC6963126.

[13] Abdulaziz A. Alamri, Faisal Saeed Al-qahtani, Awad Saeed Alsamghan, Faisal Saeed Alahmari, Saad Abdullah Alahmari, Naif Murayh Alsharif, Abdulelah Mohammed Aljamaan, Abdulaziz Baazeem. Prevalence of erectile dysfunction among smokers in southwestern Saudi Arabia. Journal of Men's Health. 2022. 18(4);1-4.

[14] Ahmed I. El-Sakka. Erectile dysfunction in Arab countries. Part II: Diagnosis and treatment. Arab Journal of Urology, Volume 10, Issue 2, 2012, Pages 104-109, ISSN 2090-598X, https://doi.org/10.1016/j.aju.2012.02.001.

[15] 11. Montorsi, F., et al. (2010). Summary of the recommendations on sexual dysfunctions in men. The Journal of Sexual Medicine, 7(11), 3572-3588. https://doi.org/10.1111/j.1743-6109.2010.02062.x

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