Results of September survey 2007

A healthy patient worried about a “possible worsening” of his erectile function asks for counseling on alcohol consumption. Which of the following suggestions is more appropriate?

1. He should avoid any alcohol consumption at all, if he wants to be on the safe side!: Percentage of answers: 65%
2. He should take 1-7 drinks/week that are beneficial on ED.: Percentage of answers: 35%
3. He should take 8 or more drinks/week that are beneficial on ED.: Percentage of answers: 0%
4. Alcohol consumption is totally unrelated to ED and should be unrestricted.: Percentage of answers: 0%

Comments

This survey deals with a classic prejudice about the effect of alcohol on sexual function. Most responders selected answer 1. However, although it is quite worldwide recognized that an acute alcohol intoxication can “increase sexual desire but inhibits sexual performance” (Macbeth, Act 2, Scene 3) the effects of a chronic alcohol assumption are poorly understood and epidemiological evidences are conflicting. Erectile Dysfunction shares many risk factors with cardiovascular diseases (CVD), being endothelial dysfunction a common pathogenetic step. The beneficial effect of a moderate, chronic assumption of alcoholic beverages, especially red wine, on cardiovascular risk has been widely advocated, and confirmed in several large epidemiological studies.[1,2]
Due to such background, it is reasonable to hypothesize that a certain amount of alcohol in the diet might be beneficial on erectile function, but differently from studies on CVD, available studies on ED risk factors lack the power needed to demonstrate any conclusive positive affect.
A recent paper by JYW Cheng [3] showed, through a metaanalysis of cross-sectional studies, a protective association of alcohol on ED: consuming 1–7 drinks/week appeared to confer the lowest risk (OR = 0.73; P = 0.101) but it was not statistically significant (too little sample?), and only 8 or more drinks/week was significant (OR = 0.85; P = 0.007). It appeared that alcohol consumption, much similar to its relationship with cardiac survival, was related to sexual function in a J-shaped manner, with moderate consumption conferring highest protection and higher consumption conferring less benefit. This observation would explain why alcohol addiction is associate to ED while moderate alcohol consumption can be protective for both endothelial and erectile dysfunction.
However, the same paper also outlines the result of two cohort studies that did not demonstrate any significant findings (neither negative nor positive effect) for alcohol consumption.
It is remains questionable if alcohol can have a protective affect on ED and, in that case, if 8 or more drinks/week (answer 3) could be the optimal threshold of alcohol intake were benefits outline damages.
However, if not protective, a regular, moderate alcohol assumption should not be considered a risk factor for ED and patients should be discouraged from abundant, acute alcohol assumption, but not from a moderate, regular consume. At the light of such data, both answers 2 and 3 could be adopted in a clinical contest.

References

Agewall S, Wright S, Doughty RN, Whalley GA, Duxbury M, Sharpe N. Does a glass of red wine improve endothelial function? Eur Heart J 2000; 21:74-8.
Spaak J, Merlocco AC, Soleas GJ, Tomlinson G, Morris BL, Picton P, Notarius CF, Chan CT, Floras JS. Dose-related effects of red wine and alcohol on hemodynamics, sympathetic nerve activity and arterial diameter. Am J Physiol Heart Circ Physiol. 2007 Nov 30
Cheng JY, Ng EM, Chen RY, Ko JS. Alcohol consumption and erectile dysfunction: meta-analysis of population-based studies. Int J Impot Res 2007; 19:343-52.