Prevalence and risk factors of erectile dysfunction in patients with hepatitis B virus or hepatitis C virus or chronic liver disease: results from a prospective study
Ivan Gentile A , Ferdinando Fusco B , Antonio Riccardo Buonomo A C , Riccardo Scotto A , Emanuela Zappulo A , Biagio Pinchera A , Francesco Persico B , Gianluigi Califano B , Guglielmo Borgia A and Nicola Longo B
+ Author Affiliations
- Author Affiliations
A Department of Clinical Medicine and Surgery - Section of Infectious Diseases, University of Naples Federico II, Naples 80131, Italy.
B Urology Unit, Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, Naples 80131, Italy.
C Corresponding author. Email: antonioriccardobuonomo@gmail.com
Sexual Health 15(5) 408-412 https://doi.org/10.1071/SH17168
Submitted: 5 September 2017 Accepted: 22 May 2018 Published: 26 July 2018
Abstract
Background: Approximately 300 million people are affected by hepatitis B virus (HBV) or hepatitis C virus (HCV) infection worldwide. Erectile dysfunction (ED) is a frequent condition that impairs the quality of life and can be associated with several chronic disorders (type 2 diabetes mellitus, atherosclerosis, depression). Few studies have evaluated the prevalence of ED in patients with HBV and HCV chronic infection. The aim of this study was to evaluate the prevalence and the risk factors of ED in a cohort of patients with HBV or HCV-related chronic liver diseases. Methods: Consecutive patients with HCV and HBV chronic infection were enrolled. Results: In total, 89 out (49 with cirrhosis, 21 with HBV and 68 with HCV infection) were included in this study. ED was diagnosed in 76.4% of patients. The use of phosphodiesterase type 5 inhibitors was reported by 21.3% of patients. Patients with ED were older and had a higher rate of cirrhosis and diabetes mellitus compared with patients without ED. At multivariate analysis, diabetes mellitus and stage of liver disease (cirrhosis vs chronic hepatitis) were the only independent predictors of ED. Conclusion: Due to the high rate of ED in outpatients with viral-related liver disease and the underuse of phosphodiesterase type 5 inhibitors, a larger study focussed on these patients is needed.
Additional keywords: Erectile dysfunction, chronic viral infection, cirhhosis, liver disease.
References
[1] World Health Organization. Hepatitis B Fact Sheet July 2015. Available online at: http://www.who.int/mediacentre/factsheets/fs204_Jul2014/en/ [verified July 2017].[2] World Health Organization. Hepatitis C Fact Sheet April 2017. Available at: http://www.who.int/mediacentre/factsheets/fs164/en/ [verified July 2017].
[3] Morisco F, Stroffolini T, Lombardo FL, Guarino M, Camera S, Cossiga V, Donnarumma L, Loperto I, Caporaso N. Prevalence of and risk factors for HBV infection in a metropolitan Southern Italian area: evidence for the effectiveness of universal Hepatitis B vaccination. Dig Liver Dis 2017; 49 1257–1261.
| Prevalence of and risk factors for HBV infection in a metropolitan Southern Italian area: evidence for the effectiveness of universal Hepatitis B vaccination.Crossref | GoogleScholarGoogle Scholar |
[4] Buonomo AR, Scotto R, Pinchera B, Coppola N, Monari C, Macera M, Borgia G, Gentile I. Epidemiology and risk factors for hepatitis C virus genotypes in a high prevalence region in Italy. New Microbiol 2018; 41 26–9.
[5] NIH Consensus Conference Impotence. NIH Consensus Development Panel on Impotence. JAMA 1993; 270 83–90.
| Impotence. NIH Consensus Development Panel on Impotence.Crossref | GoogleScholarGoogle Scholar |
[6] Feldman HA, Goldstein . Feldman HA, Goldstein . Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol 1994; 151 54–61.
| Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study.Crossref | GoogleScholarGoogle Scholar |
[7] Broderick GA. Oral pharmacotherapy and the contemporary evaluation and management of erectile dysfunction. Rev Urol 2003; 5 S9–S20.
[8] Gentile I, Viola C, Graf M, Liuzzi R, Quarto M, Cerini R, Piazza M, Borgia G. A simple noninvasive score predicts gastroesophageal varices in patients with chronic viral hepatitis. J Clin Gastroenterol 2009; 43 81–7.
| A simple noninvasive score predicts gastroesophageal varices in patients with chronic viral hepatitis.Crossref | GoogleScholarGoogle Scholar |
[9] Lok AS, Ghany MG, Goodman ZD, Wright EC, Everson GT, Sterling RK, Everhart JE, Lindsay KL, Bonkovsky HL, Di Bisceglie AM, Lee WM, Morgan TR, Dienstag JL, Morishima C. Predicting cirrhosis in patients with hepatitis C based on standard laboratory tests: results of the HALT-C cohort. Hepatology 2005; 42 282–92.
| Predicting cirrhosis in patients with hepatitis C based on standard laboratory tests: results of the HALT-C cohort.Crossref | GoogleScholarGoogle Scholar |
[10] New Zealand Ministry of Health. Definitions of smoking status. Available online at: http://www.health.govt.nz/our-work/preventative-health-wellness/tobacco-control/tobacco-control-guidance-practitioners/definitions-smoking-status [verified July 2017].
[11] Parazzini F, Menchini Fabris F, Bortolotti A, Calabro A, Chatenoud L, Colli E, Landoni M, Lavezzari M, Turchi P, Sessa A, Mirone V. Frequency and determinants of erectile dysfunction in Italy. Eur Urol 2000; 37 43–9.
| Frequency and determinants of erectile dysfunction in Italy.Crossref | GoogleScholarGoogle Scholar |
[12] Burke JP, Jacobson DJ, McGree ME, Nehra A, Roberts RO, Girman CJ, Lieber MM, Jacobsen SJ. Diabetes and sexual dysfunction: results from the Olmsted County study of urinary symptoms and health status among men. J Urol 2007; 177 1438–42.
| Diabetes and sexual dysfunction: results from the Olmsted County study of urinary symptoms and health status among men.Crossref | GoogleScholarGoogle Scholar |
[13] McCulloch DK, Campbell IW, Wu FC, Prescott RJ, Clarke BF. The prevalence of diabetic impotence. Diabetologia 1980; 18 279–83.
| The prevalence of diabetic impotence.Crossref | GoogleScholarGoogle Scholar |
[14] De Berardis G, Franciosi M, Belfiglio M, Di Nardo B, Greenfield S, Kaplan SH, Pellegrini F, Sacco M, Tognoni G, Valentini M, Nicolucci A, Quality of Care and Outcomes in Type 2 Diabetes (QuED) Study Group Erectile dysfunction and quality of life in type 2 diabetic patients: a serious problem too often overlooked. Diabetes Care 2002; 25 284–91.
| Erectile dysfunction and quality of life in type 2 diabetic patients: a serious problem too often overlooked.Crossref | GoogleScholarGoogle Scholar |
[15] Fedele D, Coscelli C, Santeusanio F, Bortolotti A, Chatenoud L, Colli E, Landoni M, Parazzini F. Erectile dysfunction in diabetic subjects in Italy. Gruppo Italiano Studio Deficit Erettile nei Diabetici. Diabetes Care 1998; 21 1973–7.
| Erectile dysfunction in diabetic subjects in Italy. Gruppo Italiano Studio Deficit Erettile nei Diabetici.Crossref | GoogleScholarGoogle Scholar |
[16] Bacon CG, Hu FB, Giovannucci E, Glasser DB, Mittleman MA, Rimm EB. Association of type and duration of diabetes with erectile dysfunction in a large cohort of men. Diabetes Care 2002; 25 1458–63.
| Association of type and duration of diabetes with erectile dysfunction in a large cohort of men.Crossref | GoogleScholarGoogle Scholar |
[17] Siu SC, Lo SK, Wong KW, Ip KM, Wong YS. Prevalence of and risk factors for erectile dysfunction in Hong Kong diabetic patients. Diabet Med 2001; 18 732–8.
| Prevalence of and risk factors for erectile dysfunction in Hong Kong diabetic patients.Crossref | GoogleScholarGoogle Scholar |
[18] Cho NH, Ahn CW, Park JY, Ahn TY, Lee HW, Park TS, Kim IJ, Pomerantz K, Park C, Kimm KC, Choi DS. Prevalence of erectile dysfunction in Korean men with Type 2 diabetes mellitus. Diabet Med 2006; 23 198–203.
| Prevalence of erectile dysfunction in Korean men with Type 2 diabetes mellitus.Crossref | GoogleScholarGoogle Scholar |
[19] Giuliano FA, Leriche A, Jaudinot EO, de Gendre AS. Prevalence of erectile dysfunction among 7689 patients with diabetes or hypertension, or both. Urology 2004; 64 1196–201.
| Prevalence of erectile dysfunction among 7689 patients with diabetes or hypertension, or both.Crossref | GoogleScholarGoogle Scholar |
[20] Malavige LS, Jayaratne SD, Kathriarachchi ST, Sivayogan S, Fernando DJ, Levy JC. Erectile dysfunction among men with diabetes is strongly associated with premature ejaculation and reduced libido. J Sex Med 2008; 5 2125–34.
| Erectile dysfunction among men with diabetes is strongly associated with premature ejaculation and reduced libido.Crossref | GoogleScholarGoogle Scholar |
[21] El-Sakka AI, Tayeb KA. Erectile dysfunction risk factors in noninsulin dependent diabetic Saudi patients. J Urol 2003; 169 1043–7.
| Erectile dysfunction risk factors in noninsulin dependent diabetic Saudi patients.Crossref | GoogleScholarGoogle Scholar |
[22] Sasaki H, Yamasaki H, Ogawa K, Nanjo K, Kawamori R, Iwamoto Y, Katayama S, Shirai M. Prevalence and risk factors for erectile dysfunction in Japanese diabetics. Diabetes Res Clin Pract 2005; 70 81–9.
| Prevalence and risk factors for erectile dysfunction in Japanese diabetics.Crossref | GoogleScholarGoogle Scholar |
[23] Lewis RW, Fugl-Meyer KS, Corona G, Hayes RD, Laumann EO, Moreira ED, Rellini AH, Segraves T. Definitions/epidemiology/risk factors for sexual dysfunction. J Sex Med 2010; 7 1598–607.
| Definitions/epidemiology/risk factors for sexual dysfunction.Crossref | GoogleScholarGoogle Scholar |
[24] Gratzke C, Angulo J, Chitaley K, Dai YT, Kim NN, Paick JS, Simonsen U, Uckert S, Wespes E, Andersson KE, Lue TF, Stief CG. Anatomy, physiology, and pathophysiology of erectile dysfunction. J Sex Med 2010; 7 445–75.
| Anatomy, physiology, and pathophysiology of erectile dysfunction.Crossref | GoogleScholarGoogle Scholar |
[25] Kim M, Kim SY, Rou WS, Hwang SW, Lee BS. Erectile dysfunction in patients with liver disease related to chronic hepatitis B. Clin Mol Hepatol 2015; 21 352–7.
| Erectile dysfunction in patients with liver disease related to chronic hepatitis B.Crossref | GoogleScholarGoogle Scholar |
[26] Hunter SS, Gadallah A, Azawi MK, Doss W. Arab J Gastroenterol 2014; 15 16–20.
| Crossref | GoogleScholarGoogle Scholar |
[27] Toda K, Miwa Y, Kuriyama S, Fukushima H, Shiraki M, Murakami N, Shimazaki M, Ito Y, Nakamura T, Sugihara J, Tomita E, Nagata C, Suzuki K, Moriwaki H. Erectile dysfunction in patients with chronic viral liver disease: its relevance to protein malnutrition. J Gastroenterol 2005; 40 894–900.
| Erectile dysfunction in patients with chronic viral liver disease: its relevance to protein malnutrition.Crossref | GoogleScholarGoogle Scholar |
[28] Wang YJ, Wu JC, Lee SD, Tsai YT, Lo KJ. Gonadal dysfunction and changes in sex hormones in postnecrotic cirrhotic men: a matched study with alcoholic cirrhotic men. Hepatogastroenterology 1991; 38 531–4.
[29] Wu F, Mao S, Yu T, Jiang H, Ding Q, Xu G. Elevated plasma aldosterone is an independent risk factor for erectile dysfunction in men. World J Urol 2016; 34 999–1007.
| Elevated plasma aldosterone is an independent risk factor for erectile dysfunction in men.Crossref | GoogleScholarGoogle Scholar |
[30] Simsek I, Aslan G, Akarsu M, Koseoglu H, Esen A. Assessment of sexual functions in patients with chronic liver disease. Int J Impot Res 2005; 17 343–5.
| Assessment of sexual functions in patients with chronic liver disease.Crossref | GoogleScholarGoogle Scholar |
[31] Pircher J, Czermak T, Merkle M, Mannell H, Krotz F, Ribeiro A, Vielhauer V, Nadjiri J, Gaitzsch E, Niemeyer M, Porubsky S, Gröne HJ, Wörnle M. Hepatitis C virus induced endothelial inflammatory response depends on the functional expression of TNFalpha receptor subtype 2. PLoS One 2014; 9 e113351
| Hepatitis C virus induced endothelial inflammatory response depends on the functional expression of TNFalpha receptor subtype 2.Crossref | GoogleScholarGoogle Scholar |
[32] Blick C, Ritchie RW, Sullivan ME. Is erectile dysfunction an example of abnormal endothelial function? Curr Vasc Pharmacol 2016; 14 163–7.
| Is erectile dysfunction an example of abnormal endothelial function?Crossref | GoogleScholarGoogle Scholar |
[33] Ferri C, Bertozzi MA, Zignego AL. Erectile dysfunction and hepatitis C virus infection. JAMA 2002; 288 698–9.
| Erectile dysfunction and hepatitis C virus infection.Crossref | GoogleScholarGoogle Scholar |
[34] Hatzimouratidis K, Amar E, Eardley I, Giuliano F, Hatzichristou D, Montorsi F, Vardi Y, Wespes E, European Association of Urology Guidelines on male sexual dysfunction: erectile dysfunction and premature ejaculation. Eur Urol 2010; 57 804–14.
| Guidelines on male sexual dysfunction: erectile dysfunction and premature ejaculation.Crossref | GoogleScholarGoogle Scholar |
[35] Chung SD, Chen YK, Kang JH, Keller JJ, Huang CC, Lin HC. Population-based estimates of medical comorbidities in erectile dysfunction in a Taiwanese population. J Sex Med 2011; 8 3316–24.
| Population-based estimates of medical comorbidities in erectile dysfunction in a Taiwanese population.Crossref | GoogleScholarGoogle Scholar |
[36] Chung SD, Keller JJ, Liang YC, Lin HC. Association between viral hepatitis and erectile dysfunction: a population-based case-control analysis. J Sex Med 2012; 9 1295–302.
| Association between viral hepatitis and erectile dysfunction: a population-based case-control analysis.Crossref | GoogleScholarGoogle Scholar |
