Erectile Dysfunction in Cirrhosis: Its Prevalence and Risk Factors

Rakesh K Jagdish; Ahmed Kamaal; Saggere M Shasthry; Jaya Benjamin; Rakhi Maiwall; Ankur Jindal; Ashok Choudhary; Vijayaraghavan Rajan; Vinod Arora; Ankit Bhardwaj; Guresh Kumar; Manoj Kumar; Shiv K Sarin

doi:10.1016/j.jceh.2022.05.001

Erectile Dysfunction in Cirrhosis: Its Prevalence and Risk Factors

J Clin Exp Hepatol. 2022 Sep-Oct;12(5):1264-1275. doi: 10.1016/j.jceh.2022.05.001. Epub 2022 May 10.

Authors

Affiliations

¹ Department of Hepatology and Liver Transplantation, Institute of Liver and Biliary Sciences, New Delhi, India.
² Department of Urology, Institute of Liver and Biliary Sciences, New Delhi, India.
³ Department of Clinical Nutrition, Institute of Liver and Biliary Sciences, New Delhi, India.
⁴ Department of Clinical Research, Institute of Liver and Biliary Sciences, New Delhi, India.
⁵ Department of Biostatistics, Institute of Liver and Biliary Sciences, New Delhi, India.

Abstract

Background: Erectile dysfunction (ED) is common in men with cirrhosis. The aim of this study was to assess the prevalence of ED and the factors associated with ED in men with cirrhosis.

Methods: 400 men with cirrhosis [Child-Turcotte-Pugh (CTP) class A, 44.0%; CTP class B, 41.0%; and CTP class C, 15.0%] having high Karnofsky performance score, and living in a stable monogamous relationship with a female partner were included in the study. International Index of Erectile Function (IIEF) questionnaire, and Short-Form (36) Health Survey (SF-36) were used to assess erectile function and the health-related quality of life (HRQOL), respectively.

Results: ED was found in 289 (72.3%) patients. Patients with ED reported significantly lower SF-36 scores across all the eight domains of SF-36 (i.e., physical functioning score, role physical score, bodily pain score, general health perception score, vitality score, social functioning score, role emotional score, and mental health score); physical component summary score, and mental physical component summary score, compared with those without ED. On multivariate analysis, factors associated with ED were older age, longer duration of cirrhosis, CTP-C (vs. CTP-A), higher hepatic venous pressure gradient (HVPG), presence of generalized anxiety disorder (GAD), presence of major depression, and lower appendicular skeletal muscle index measured by dual-energy X-ray absorptiometry (DEXA ASMI).

Conclusion: ED is common in men with cirrhosis, and men with ED have poor HRQOL compared with those without ED. Older age, longer duration of cirrhosis, CTP-C (vs. CTP-A), higher HVPG, presence of GAD, presence of major depression, and lower DEXA ASMI are associated with ED.

Keywords: ASMI, Appendicular skeletal muscle mass index; CTP, Child–Turcotte–Pugh; DEXA, Dual-energy x-ray absorptiometry; ED, Erectile dysfunction; GAD, Generalized anxiety disorder; HRQOL, Health-related quality of life; IIEF, International Index of Erectile Function; PHQ, Patient Health Questionnaire; cirrhosis; erectile dysfunction; health-related quality of life; q ADAM, Quantitative androgen deficiency in the aging male questionnaire.