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Shiri R, Koskimäki J, Häkkinen J, Tammela TL, Auvinen A, Hakata M. Effect of Non-steroidal Anti-Inflammatory Drug Use on the Incidence of Erectile Dysfunction. J Urol 2006;175:1812-1816.

This is an interesting and well-written article, from the Tampere group which has an excellent reputation (The Tampere study is a well-respected, long-term epidemiological study conducted in Finland). Here, the authors look at the influence of NSAIDs, even simple ones, on the incidence of ED. No previous study has looked at the incidence of ED in relation to NSAID use, i.e. studies on the use of NSAIDs recorded before the occurrence of ED.

It may come as a surprise that the idea that analgesic use associates with ED is not unique to this study. In the landmark Massachusetts Male Aging Study, Feldman et al reported that untreated arthritis associated with impotence in 15% compared to 9.6% in the entire cohort. The current population-based follow-up study fills a void in the literature as this relationship has never been adequately explored.

Questionnaires were mailed to 3,143 old men (50, 60 or 70 years) residing in the study area in Finland in 1994, and to 2,864 men 5 years later. The follow-up sample consisted of 1,683 men who responded to baseline and follow-up questionnaires. Erectile dysfunction was assessed by 2 questions on subjects’ erectile capacity: “Have you had problems getting an erection before intercourse begins?” and “Have you had problems maintaining an erection once intercourse has begun?” For both questions 4 response options were “never,” “sometimes,” “quite often” and “intercourse does not succeed.” Moderate or complete ED was defined as frequent failure of intercourse (“quite often” or “does not succeed” in at least 1 of the 2 questions). The effect of NSAIDs on the incidence of ED was estimated in men free from moderate or complete ED at baseline (in 1,126).

The incidence of ED was 93 cases per 1,000 person-years in men who used and 35 in those who did not use NSAIDs. Among men with arthritis, the most common indication for NSAID use, ED incidence was 97 cases per 1,000 in those using and 52 in men who did not use NSAIDs. Compared with men who did not use NSAIDs and were free from arthritis, the relative risk of ED after controlling for the effects of age, smoking, and other medical conditions and medications was higher in men who used NSAIDs but were free of arthritis (IDR 2.0, 95% CI 1.2-3.5) and in those who used NSAIDs and had arthritis (IDR 1.9, 95% CI 1.2-3.1). The relative risk was only somewhat higher in men who had arthritis but did not use NSAIDs (IDR 1.3, 95% CI 0.9-1.8).

This study concludes that the use of nonsteroidal anti-inflammatory drugs increases the risk of ED and the effect is independent of indication. The questions used to assess ED in this study are not validated and the use of IIEF would have been better.