Where Are Men Struggling to Get (and Keep) It Up?

Studies show that one-third of all men are affected by erectile dysfunction (ED), and Americans are no exception.1 In fact, one study on the prevalence of ED specifically in the U.S. adult male population found that 18.4% of men ages 20 and older are impacted by the condition — that’s 18 million people.2 To put that into perspective, the entire state of New York has a population of around 19.8 million. This means that the number of men with ED in the U.S. is nearly enough to equal the population of the fourth-most-populous state in the country.3

ED is a common concern in the United States, but are there certain areas of the country where erectile dysfunction is more prevalent than others? To investigate, we analyzed a year’s worth of data on the geographic popularity of 40 ED-related search queries and applied weighting to account for the magnitude of search volumes and the clarity and acuteness of search intent in order to rank all 50 states (plus the District of Columbia).

• Mississippi ranks number one for ED-related searches. The state also ranks high for obesity prevalence and low for mental health support — both of which can contribute to erectile dysfunction.
• Men in the District of Columbia may be the least likely to struggle with erectile dysfunction.
• Ten out of the top 15 states where search data indicates men are struggling the most are located in the South and West South Central regions.
• Eight out of the top 15 states (Mississippi, Alabama, West Virginia, Arkansas, Oklahoma, Kentucky, Louisiana, and Tennessee) are in an area dubbed “Tobacco Nation” due to a nearly 50% higher rate of smoking, a habit that can cause or worsen ED.
• Many of the states with the lowest expression of ED-related issues in search are those with cooler climates.
• Both the top and bottom states in our list underscore that the picture of erectile health can’t be reduced to something as simple as age.

Before delving into our rankings, let’s first go over some important information on ED and a few of its risk factors. As explained by the Cleveland Clinic, there are four main causes or types of ED:4

• Vascular erectile dysfunction: This is the most common variety of ED, and it’s caused by issues with penile blood vessels or valves. Vascular ED is “closely related” to conditions like cardiovascular disease and can be caused by obesity, smoking, diabetes, hypertension, or a lack of exercise.5
• Neurogenic erectile dysfunction: This form of ED occurs due to nerve-related issues, such as trauma, radiation therapy, stroke, multiple sclerosis (MS), or some surgeries.
• Hormonal erectile dysfunction: If your ED is related to a hormone issue, it’s likely due to either a testosterone deficiency or a problem with your thyroid gland.
• Psychogenic erectile dysfunction: As the name implies, psychogenic ED involves a psychological cause, like depression or anxiety.

Additionally, erectile dysfunction can sometimes be caused by certain medications — like antidepressants, antihistamines, diuretics, and chemotherapy, among others — or even a poor diet.6 Consuming too much alcohol or foods high in saturated fats, refined carbohydrates, sodium, or added sugar can increase your risk of developing diabetes, heart disease, or obesity, all of which can increase your chance of developing ED.7

According to the results of our search data analysis, these are the top 15 states in the U.S. struggling the most with erectile dysfunction:

Something you may notice about the above list is that most of these states are either in the South or West South Central regions of the U.S. In fact, the only three states that aren’t in either region are Delaware, New Mexico, and Nevada.

Interestingly, many of these same 15 states ranked pretty high for various ED risk factors, too. For example:

• According to the CDC, Alabama, Arkansas, Delaware, and Florida are among the top ten states with the highest prevalence of obesity.9
• Nevada, Oklahoma, Mississippi, and Texas rank among the bottom ten states for adequate mental health support.10
• Alabama, Arkansas, Kentucky, Louisiana, Mississippi, Oklahoma, Tennessee, and West Virginia are all located in a region dubbed “Tobacco Nation” due to a nearly 50% higher prevalence of smoking.11
• Florida, West Virginia, Delaware, and South Carolina are among the top ten states with the largest populations of adults aged 65 and older.12
• Oklahoma, Mississippi, Alabama, Louisiana, and Arkansas are the top five states in the U.S. with the highest heart disease mortality rates.13

However, it’s also important to point out that some of these high-ranking states conversely ranked low for certain ED risk factors.

• Tennessee, Texas, and West Virginia are among the top ten states with the lowest obesity rates.9
• Delaware and Kentucky rank fairly well in terms of access to mental health support.10
• Texas, Georgia, Oklahoma, Louisiana, and Nevada have some of the lowest percentages of citizens 65 and older, further demonstrating that ED isn’t only something older men deal with.12

Let’s now take a look at states that ranked lowest in our analysis, indicating the least amount of struggle with ED.

Here are the areas of the country that appear to be suffering the least from erectile dysfunction, based on our analysis of a year’s worth of search data trends.

In contrast to the states with the highest ED-related search volume, many of the places in this list are in regions with relatively cooler climates. Though the evidence isn’t particularly strong, some animal research suggests that higher temperatures can have an adverse effect on sexual behavior, including fertility and erectile function.14 Additionally, some experts note that outcomes from excessive heat exposure — like dehydration and fatigue — can impact testosterone production or alter blood pressure, both of which can negatively impact proper erectile functioning.15

Several of the states with lower related search volume also ranked well in separate analyses of various factors contributing to the prevention or treatment of erectile dysfunction. For instance:

• Minnesota, Massachusetts, and Colorado are three of the top five states with the lowest heart disease mortality rates.13
• New York, New Jersey, Maine, Maryland, and Virginia are among the top ten states with both the lowest prevalence of mental illness and the highest rates of access to mental health care.10

However, there are also notable instances where some of these states rank particularly high for certain erectile dysfunction risks.

• In terms of obesity rates, for example, California, Colorado, and the District of Columbia have some of the highest in the country.9
• Adequate access to mental health resources is relatively limited in Colorado, Oregon, and Washington.10

Perhaps one of the most interesting data points is that Maine, Vermont, and Oregon are among the states where men appear least impacted by ED despite having some of the largest percentages of adult citizens over age 65.12

So, with all of this in mind, we feel it’s important to point out that — no matter the state rankings — much of this data simply supports the fact that erectile dysfunction is a concern felt nationwide by men of all ages. As an indication of where the struggle with ED is greatest, our geographic analysis, alongside other analyses of associated health concerns, illustrates that the picture of men’s sexual health is complex.

Though our analysis thus far focuses on the top and bottom 15 states in our rankings, we didn’t forget about the remaining 21 regions. (There are 51 rankings in total with the inclusion of DC.) If you’re wondering how your state ranked, check out the table below.

There’s no one “cure” for erectile dysfunction, but the good news is that there are effective treatment options, from prescription PDE5 inhibitors and mental health care to over-the-counter testosterone-boosting supplements, shockwave devices, ED pumps, and more. Talking to your primary care physician is the best first step. An effective treatment path may involve lifestyle and nutritional changes, a prescription, counseling, a device, or a combined approach to the problem.

Helpful links to learn more:

• Symptoms and causes of ED (NIDDK)
• Diagnosis and tests for ED (Cleveland Clinic)

We analyzed 12 months of data about the geographic popularity of 40 prominent, diverse, and relevant search queries that collectively amount to over 1.25 million monthly searches in the United States. Our objective in selecting search queries was to capture the fullest possible breadth of ED-related search activity with a very diverse group of phrases. This selection includes queries related to:

• Branded and unbranded medications
• Specific telemedical platforms that focus on offering ED services
• Specific ED products themselves
• Widely discussed but less trustworthy products that people often seek
• Nutritional approaches that avoid prescriptions
• Clear efforts to compare and identify the best treatment options
• Phrases that contain slang or common misspellings

Using Ahrefs, we determined the queries’ monthly search volumes and then explored their geographic distribution trends over the past 12 months at the state level using Google Trends.

We weighted the terms to account for the wide variation in search volume from phrase to phrase. Then, we applied weighting based on the clarity of intent, with more weight given to queries with the most obvious intent (e.g., “buy Cialis online” or “where can I buy Viagra?”) and less weight applied to broader phrases that are used both at times of acute need and in less specific instances such as when searching due to academic interest (e.g., “erectile dysfunction,” “sildenafil,” or “what causes erectile dysfunction?”). By analyzing popularity and accounting for volumes and intent, we arrived at a ranking of states based on the apparent magnitude of their struggle with ED.

Innerbody Research is committed to providing objective, science-based suggestions and research to help our readers make more informed decisions regarding health and wellness. We invested the time and effort into creating this report to explore where men across the United States are suffering the most from erectile dysfunction. We hope to reach as many people as possible by making this information widely available. As such, please feel free to share our content for educational, editorial, or discussion purposes. We only ask that you link back to this page and credit the author as Innerbody.com.