Condom associated erection problems (CAEP) in heterosexual young men (under 40): A systematic review and qualitative synthesis

Condom associated erection problems (CAEP) interfere with the correct and consistent use of condoms. CAEP, a common form of psychogenic erection problems, have been understudied in heterosexual relationships. We conducted a systematic review and qualitative synthesis of all available studies published before 2019 to examine the prevalence, etiology, effects, prevention, and treatment of CAEP in heterosexual men under 40 years of age. 43 full-text articles were assessed; nine met inclusion criteria. Most studies used self-reported questionnaires, some in combination with measures of physiological arousal. The prevalence of CAEP was 18–36%. CAEP involve attentional, affective, behavioural, cognitive, relational, and sensory processes. CAEP were associated with rushed condom application, condom worry/anxiety, distraction, multiple partners, decreased arousal response to sexual stimuli, self-perpetuating dysfunctional sexual learning, decreased penile sensitivity with erections and condoms, issues with condom 'fit or feel,' and mental health diagnoses, such as depression, anxiety and ADHD. It is important to address CAEP early with sex-positive approaches targeted at men and women that enhance condom self-efficacy, condom confidence, and sexual communication. Men should practice applying condoms in no pressure (solo-sex) situations to discern the condom that fits and feels best and to develop the ease and confidence to apply condoms for partnered sex with less worry and distraction. Further research is needed to confirm which strategies are most effective at reducing CAEP.