Evaluating Mental Health Risk and Psychiatric Care Access in 18–40 Year Old Men with Erectile Dysfunction

In a cohort of young men with ED and a diagnosed mental health condition, only 6.2% ever had a psychiatry appointment.

Journal: The Journal of Sexual Medicine | Published: 2026-05-11 | Type: Retrospective Chart Review | PMID: 42153742 Authors: Morcos M, Shoeib A, Golrokhian-Sani AA, Breau RH, Witherspoon L (University of Ottawa, Department of Surgery/Urology) Funding/COI: Not reported

Summary

A retrospective review of 535 men aged 18–40 diagnosed with ED at a single Canadian academic hospital found that 15.1% carried a concurrent mental health condition (MHC) within the five-year window around their ED diagnosis. Of those 81 men, fewer than one in three ever received a psychiatry referral, and only 5 actually showed up to a psychiatry appointment — and all 5 of those appointments happened before the ED diagnosis, not after. The data suggest that the ED clinic itself is not generating meaningful mental health follow-through.

Claims

• 535 men met inclusion criteria; median age at ED diagnosis 32.4 years, median BMI 27
• 15.1% (81/535) had a diagnosed MHC within ±5 years of ED index date
• Of the 81 with an MHC: 28.4% (23/81) received a psychiatry referral total
• Of the 81 with an MHC: only 6.2% (5/81) had any psychiatry appointment — all pre-ED diagnosis
• Zero psychiatry appointments occurred after the ED diagnosis in this cohort
• Psychology referrals reached 13.6% (11/81); psychology appointments reached 22.2% (18/81), with 7.4% post-ED
• Diabetes prevalence in the subset with available data: 5.3% uncomplicated, 0.8% complicated

Study Quality

This is a single-center retrospective chart review, which limits both external validity and the ability to capture care received outside The Ottawa Hospital system. The authors acknowledge that a new electronic medical record (EMR) system was implemented in 2019 — the same year the study window opens — meaning earlier psychiatric history may be systematically missing, and MHC diagnoses or referrals predating the EMR cutover would not appear in the data. That's a significant confound: the study may undercount both MHC prevalence and prior psychiatric contact.

The DSM-5 framework was used to define MHCs, which is appropriate, but the methodology section gives minimal detail on how chart codes were mapped to MHC categories or whether unstructured notes were reviewed. With 535 total patients, the MHC subgroup is 81 — small enough that the downstream appointment statistics (n=5 for psychiatry appointments) border on anecdote.

Red Flags

• Single institution (Ottawa Hospital), limiting generalizability
• EMR introduced in 2019 = same as study start; pre-2019 psychiatric history is invisible to the study
• Only 172 of 535 patients had BMI recorded; 355 had diabetes data — substantial missingness in covariates
• Funding and conflicts of interest not disclosed — for a study with "clinical implications" advocating integrated psychiatric care, that omission is notable
• No data on whether patients sought mental health care outside this hospital network (community psychiatrists, GPs, telehealth)
• n=5 psychiatry appointments is too small to draw firm conclusions about rates

Strengths

• Described as one of the largest studies examining MHC access specifically in young (18–40) men with ED
• Six-year data window (2019–2025) is reasonably contemporary
• Temporal framing (before vs. after ED diagnosis) is a useful structure for identifying gaps in the care pathway
• Population focus on young men with ED is underrepresented in the literature, which skews older

Verdict

The core finding — that psychiatric contact essentially stops after an ED diagnosis — is clinically interesting, but this paper is too methodologically thin to carry that weight. Five total psychiatry appointments is not data; it's a case series. The missing EMR history, incomplete covariate capture, and single-site design all compound. The 15.1% MHC prevalence figure is the most credible number here, and it aligns with the broader literature on ED and mental health comorbidity. Worth reading as a hypothesis-generating pilot; worth ignoring if you're looking for anything definitive about psychiatric care access patterns in this population.