Results of September survey 2006

Which of the following is not a risk factor for erectile dysfunction?

1) Hypercholesterolemia and diabetes: Percentage of answers: 8,0%
2) Non-steroidal anti-inflammatory drugs (NSAIDs) use: Percentage of answers: 53,0%
3) Lower urinary tract symptoms (LUTS): Percentage of answers: 8,0%
4) None of the previous replies is correct: Percentage of answers: 31,0%

Among the possible replies, hypercholesterolemia and diabetes are two classic risk factors for ED. Lower urinary tract symptoms have been shown, in more recent times, as a risk factor for ED [1]. However, according to a report published in the Journal of Urology by a group from University of Tampere (Finland), also the use of non-steroidal anti-inflammatory drugs (NSAIDs), regardless of the indication, seems to increase the risk of erectile dysfunction in middle-age and elderly men [2]. This study involved 1126 men, between 50 and 70 years of age, without erectile dysfunction in 1994 when they completed a questionnaire that included, among other things, questions about erectile function and medication usage. The questionnaire was then readministered 5 years later. The erectile dysfunction rate per 1000 person-years was 93 cases among NSAID users compared with just 35 cases among nonusers. Arthritis was the most common indication for NSAID use.
In determining if a particular drug causes erectile dysfunction, it is difficult to sort out the effects of the drug from those of the disease for which the drug is taken, a type of bias known as “confounding by indication”. However, in this study, regardless of the indication, NSAID use roughly doubled the risk of erectile dysfunction compared with non use. The presence of arthritis without NSAID use increased the risk by only 30%, suggesting that NSAIDs were more important than the inflammatory disease as a causative factor of ED. Therefore, at the light of these recent findings, it is highly possible that reply n.4 was the most correct.

References

1. Rosen R, Altwein J, Boyle P, Kirby RS, Lukacs B, Meuleman E, O'Leary MP, Puppo P, Robertson C, Giuliano F. Lower urinary tract symptoms and male sexual dysfunction: the multinational survey of the aging male (MSAM-7). Eur Urol 2003;44:637-49.

2. Shiri R, Koskimaki J, Hakkinen J, Tammela TL, Auvinen A, Hakama M. Effect of nonsteroidal anti-inflammatory drug use on the incidence of erectile dysfunction. J Urol 2006;175:1812-5; discussion 5-6.