Sexual Dysfunction and Erectile Impotence in Chronic Obstructive Pulmonary Disease

doi:10.1378/chest.81.4.413

Chest

Volume 81, Issue 4, April 1982, Pages 413-421

https://doi.org/10.1378/chest.81.4.413 Get rights and content

We studied 20 men (ages 46 to 69, mean 45 years) with chronic obstructive pulmonary disease (FEV₁ of 0.55 to 2.1 L), to determine the relative importance of pulmonary impairment vs other occult physical or psychologic factors in the genesis of sexual dysfunction. Seven subjects had ceased sexual activity concomitant with worsening of their pulmonary symptoms; six because of erectile impotence and one due to dyspnea. Frequency of intercourse for the remaining 13 was 16 percent of prelung disease levels, and libido was decreased to 25 percent of premorbid levels. Nocturnal penile tumescence monitoring disclosed that six subjects had organogenic erectile impotence (OEI). None of the subjects showed signs of peripheral vascular disease as assessed by Doppler examination of peripheral pulses (including penile). The mean bulbocavernosus reflex latency (BCRL) for the OEI group (N = 5) was 40.2 msec, while that for the group with full nocturnal erections (N = 10) was 34.5 msec (P < 0.005). Four subjects had occult diabetes mellitus evident on oral glucose tolerance tests, and one had evidence of an androgen deficit The correlation coefficient for rank by sexual dysfunction vs pulmonary impairment and age was 0.66 (P < 0.005) and 0.24 P > 0.05), respectively. Subjects with OEI tended to have the worst pulmonary function test results and the highest T-scores on the hypochondriasis, depression, and hysteria scales of the Minnesota Multiphasic Personality Inventory. Data suggest that sexual dysfunction worsens as lung disease worsens and that chronic obstructive pulmonary disease may be associated with male impotence in the absence of other commonly known causes.

Section snippets

MATERIALS AND METHODS

Sexual function was evaluated in 20 male subjects with moderate to severe COPD, ages 46 to 69 (mean, 56) years. The subjects were in clinically stable conditions for three weeks prior to the study. Five subjects were self-referred for sexual problems; the remaining 15 were volunteers recruited from a pulmonary disease clinic without our prior knowledge of their sexual function. Seventeen subjects were living with wives or female companions, and three lived alone but claimed having sexual

Subjective Sexual Function

Sexual function histories revealed that seven subjects had ceased sexual activity from three months to nine years before the study, while the remaining 13 continued to engage in coitus with a frequency of 16 percent of the premorbid level (Fig 2). For the entire group, the mean frequency of interest in engaging in sexual intercourse was 25 percent of premorbid levels, and for those still sexually active it was 40 percent. The average time between the onset of severe exertional dyspnea and the

DISCUSSION

Sexual dysfunction has been associated with long-standing diabetes mellitus,6, 16 cerebrovascular disease,¹⁷ after myocardial infarction,¹⁸ and several other chronic diseases.¹⁹ To our knowledge, no prospective studies of sexual dysfunction in COPD have previously been undertaken. The care of patients with COPD has centered on symptomatic treatment of airway infections, bronchospasm, and respiratory failure, while related physical and psychosocial problems have received little attention.²⁰

ACKNOWLEDGMENT

The authors wish to thank Nguyen N. Thong, M.D., for performing the BCRL reflex studies; Robert L. Kane, Ph.D., and George P. Prigatano, Ph.D., for evaluating MMPI results, Paul Costiloe, Ph.D., for statistical analysis, and Mrs. Fern Brandt, R.N., and the nurses of the clinical research unit of the Veterans Administration Medical Center at Oklahoma City for their help in conducting this study.

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Cited by (77)

Erectile dysfunction in patients with COPD. A systematic review and meta-analysis
2023, Revista Clinica Espanola
Los estudios sobre sexualidad en pacientes con enfermedad pulmonar obstructiva crónica (EPOC) son escasos y han arrojado resultados contradictorios. Nuestro objetivo fue determinar la prevalencia de disfunción eréctil (DE) y los factores asociados en pacientes con EPOC.
Se buscaron artículos con datos sobre prevalencia de DE en pacientes diagnosticados de EPOC mediante espirometría en las bases de datos PubMed, Embase, Cochrane Library y Biblioteca Virtual de Salud, desde el año desde su creación hasta el 31 de enero de 2021. La prevalencia de DE se valoró con una media ponderada de los estudios. Se realizó un metaanálisis con el modelo de efectos fijos de Peto para valorar la asociación de EPOC con DE.
Se incluyeron finalmente 15 estudios. La prevalencia ponderada de DE fue de 74,6%. Un metaanálisis con cuatro estudios y 519 individuos mostró una asociación de EPOC con DE (odds ratio ponderado estimado de 2,89, IC 95% 1,93-4,32, p < 0,001), con un grado de heterogeneidad no desdeñable (I² 57%). En la revisión sistemática, la edad, el tabaquismo, el grado de obstrucción, la saturación de oxígeno y el estado de salud previo se asociaron con mayor prevalencia de DE.
La DE es frecuente en los pacientes con EPOC y su prevalencia es mayor que en la población general.
Studies on sexuality in patients with chronic obstructive pulmonary disease (COPD) are scarce and have yielded conflicting results. Our aim was to determine the prevalence of erectile dysfunction (ED) and associated factors in patients with COPD.
Articles with data on ED prevalence in patients diagnosed with COPD through spirometry were searched for in the PubMed, Embase, Cochrane Library, and Virtual Health Library databases from the year of their creation until January 31, 2021. The prevalence of ED was assessed with a weighted mean of the studies. A meta-analysis was performed using the Peto fixed-effect model to evaluate the association of COPD with ED.
Fifteen studies were ultimately included. The weighted prevalence of ED was 74.6%. A meta-analysis with four studies and 519 individuals showed an association of COPD with ED (estimated weighted odds ratio 2.89, 95% CI 1.93-4.32, p < 0.001), with a non-negligible degree of heterogeneity (I² 57%). In the systematic review, age, smoking, degree of obstruction, oxygen saturation, and previous health status were associated with a higher prevalence of ED.
ED is common in patients with COPD and its prevalence is higher than in the general population.
Assessment of the impact of pulmonary rehabilitation on sexual activity in patients with chronic obstructive pulmonary disease
2020, Revista Internacional de Andrologia
La enfermedad pulmonar obstructiva crónica (EPOC) limita la calidad de vida, teniendo consecuencias sobre la esfera sexual. Los programas de rehabilitación respiratoria (PRR) ayudan al tratamiento de estos pacientes.
Analizamos la actividad sexual de pacientes con EPOC y los resultados de un PRR.
Estudio prospectivo de cohorte única en varones diagnosticados de EPOC y candidatos a PRR. Evaluación clínica, respiratoria y analítica (T, LH, FSH, estradiol y progesterona). International Index of Erectile Function (IIEF) al inicio y tras 6 meses de PRR. Análisis descriptivo inicial, comparando parámetros respiratorios según actividad sexual. Análisis de cambios tras el PRR mediante IIEF y satisfacción mediante el cuestionario Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS).
Entre 2014 y 2016, 62 varones incluidos. Edad media: 66,5 años (SD 7,2); 52 exfumadores. Diez eran sexualmente activos (16,1%). No detectamos alteraciones hormonales. No apreciamos diferencias significativas en parámetros respiratorios (FEV1, test de marcha de 6 min, número de exacerbaciones, puntuación en CAT) entre pacientes sexualmente activos y no activos.
Puntuación media inicial IIEF: función eréctil 8, función orgásmica 4, deseo sexual 5,6, satisfacción con relaciones 5,3 y satisfacción global 4,5. Tras PRR, aumento significativo en la puntuación total del IIEF: 6,1 (IC95% 1,9-10,3). Mejoría en todos los dominios, con cambio significativo en satisfacción con relaciones: 0,9 (IC95% 0,2-1,6). Moderada satisfacción con el tratamiento según EDITS.
Solo un pequeño porcentaje de pacientes con EPOC incluidos en un PRR son activos sexualmente. No se aprecian diferencias respiratorias entre los pacientes activos y no activos. Los PRR provocan mejoría global en la función sexual, particularmente en la satisfacción con las relaciones.
Chronic obstructive pulmonary disease (COPD) affects life quality, and also sexual activity. Pulmonary rehabilitation (PR) is a helpful treatment in COPD patients.
The aim of this study is to assess sexual activity on COPD patients, and the effect of PR over it.
Single cohort prospective study over male COPD candidates to PR. Clinical, respiratory and biochemical assessment (FSH, LH, T, and progesterone) was performed. Patients were asked to fill baseline International Index of Erectile Function (IIEF) questionnaire, and 6 months after PR. A descriptive initial analysis compared respiratory values between patients with and without sexual activity. Changes in IIEF results were assessed after PR, and satisfaction with treatment using Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS).
Between 2014 and 2016, 62 male COPD patients enlisted. Mean age: 66.5 years (SD 7.2). 52 Ex-smokers. 10 declared being sexually active (16.1%). No hormonal levels alterations. No significant differences on respiratory parameters between sexually active and non-active patients (FEV1, 6-minutes walking test, number of exacerbations, CAT score).
Baseline mean IIEF values: Erectile function 8, orgasmic function 4, sexual desire 5.6, intercourse satisfaction 5.3, and overall satisfaction 4.5. After PR, significant increase in mean IIEF value: 6.1 (CI95% 1.9-10.3). Improvement was found in all domains, with statistical significance on intercourse satisfaction 0.9 (CI95% 0.2-1.6). Moderate satisfaction with treatment was achieved according to EDITS.
Only a low percentage of COPD males included in PR is sexually active. No pulmonary differences were found between sexually active and non-active patients. PR improves sexual function, particularly intercourse satisfaction domain.
Risk Factors for Sexual Dysfunction Among Women and Men: A Consensus Statement From the Fourth International Consultation on Sexual Medicine 2015
2016, Journal of Sexual Medicine
This article presents a review of previous research concerning risk factors for sexual dysfunction in women and men.
The aim is to evaluate past research studies to determine the contribution of all risk factors to the development and maintenance of sexual dysfunction among women and men.
Studies were organized under a biopsychosocial framework, with the bulk of studies of women and men having investigated the role of biological factors.
The outcome measures were the data on factors for sexual dysfunction.
Many more studies investigated risk factors for sexual dysfunction in men than in women. For women and men, diabetes, heart disease, urinary tract disorders, and chronic illness were significant risk factors for sexual dysfunction. Depression and anxiety and the medications used to treat these disorders also were risk factors for sexual dysfunction in women and men. In addition, substance abuse was associated with sexual dysfunction. Many other social and cultural factors were related to sexual dysfunction in women and men.
Psychosocial factors are clearly risk factors for sexual dysfunction. Women and men with sexual dysfunction should be offered psychosocial evaluation and treatment, if available, in addition to medical evaluation and treatment. The impact of social and cultural factors on sexual function requires substantially more research. The evidence that erectile dysfunction is a harbinger of other forms of cardiovascular disease is strong enough to recommend that clinical evaluation for occult cardiovascular disease should be undertaken in men who do not have known cardiovascular disease but who develop organic erectile dysfunction, especially in men younger than 70 years.
Erectile Dysfunction is Associated with Subsequent Cardiovascular and Respiratory Mortality in Cohort of 1,436 Chinese Elderly Men
2015, Journal of Sexual Medicine
Erectile dysfunction (ED) is commonly shown to be associated with subsequent cardiovascular mortality, but not respiratory mortality, despite respiratory disease being highly prevalent among ED patients.
We aim to examine associations of ED with all‐cause and cause‐specific (i.e., cardiovascular and respiratory) mortality in a prospective cohort of 1,436 Chinese men, followed up from 2001 for a median of 11.5 years.
ED measurement was based on a single question of four categories at the 4‐year follow up.
Outcome measures include all‐cause and cause‐specific mortality (i.e., cardiovascular and respiratory mortality, classified according to the International Classification of Disease‐version 10 [ICD‐10]). Multivariable regression models estimated associations between ED and all‐cause and cause‐specific mortality, adjusting for the presence of chronic conditions, and socio‐demographics and lifestyle factors. For each category of disease‐specific mortality, subjects with the corresponding diseases and death cases from other causes were excluded. Cancer mortality was included for comparison.
Participants who were completely impotent had significantly increased risk of all‐cause (HR = 1.63, 95% CI = 1.20–2.23), cardiovascular (HR = 3.94, 95% CI = 1.77–8.76) and respiratory mortality (HR = 3.16, 95% CI = 1.46–6.81) compared with non‐impotent participants, adjusting for chronic conditions, and socio‐demographics and lifestyle factors.
ED is significantly associated with subsequent all‐cause mortality, possibly via its association with cardiovascular and respiratory mortality. Primary care practitioners should pay attention to ED patients' cardiovascular and respiratory risk profiles, which may benefit their prognosis. Chung RY, Chan D, Woo J, Kwok T, Leung JCS, Lai JTT, and Wong SYS. Erectile dysfunction is associated with subsequent cardiovascular and respiratory mortality in cohort of 1,436 Chinese elderly men. J Sex Med 2015;12:1567–1575.
Is erectile dysfunction a reliable indicator of general health status in men?
2013, Arab Journal of Urology
Citation Excerpt :
Furthermore, some cardiovascular drugs can contribute to impaired EF [67]. Besides the important link between ED and CVD, a significant but incompletely known correlation between ED and other comorbid conditions has been outlined, with an impressive direct effect on men’s overall health [12,31,68–74]. In this context, several epidemiological surveys have highlighted the association between ED and conditions like respiratory disorders, connective tissue disorders, kidney and liver impairment and neurological diseases.
Erectile dysfunction (ED) is a common risk factor in men and its incidence increases with age. Ageing and older men frequently have comorbidities such as cardiovascular diseases (CVD), diabetes mellitus (DM), hypertension, chronic obstructive pulmonary disease and dyslipidaemia; likewise, they concurrently refer to a clinician for impairments in sexual function, mostly for ED. The association of ED and other organic, multi-organic or even systemic diseases is widely described, with a specific emphasis on the fact that they often share common pathophysiological factors and mechanisms. Thus we reviewed previous reports assessing the role of ED as a sentinel marker of overall men’s health.
ED is considered an important sentinel marker for CVD. Numerous studies have highlighted the predictive role of ED for subsequent CV events in patients with a silent history of coronary artery disease. Indeed, ED might be considered as a clinical manifestation of a generalised vascular disease, and it should provoke clinicians to check for CVDs in those patients complaining of impaired erectile function. This concept appears to be even more important for men with DM, where ED has already been shown to have a significant predictive ability for major vascular complications. Moreover, data from large population-based studies showed that ED is a significant predictor of all-cause mortality, in addition to CV outcomes. The severity of erectile function is assessed with the International Index of Erectile Function-Erectile Function domain score, and this has emerged as a proxy for men’s general health status, as assessed with the Charlson Comorbidity Index score.
Patients complaining of ED should be evaluated with a comprehensive medical and sexual history, and a thorough physical examination, regardless of their age, considering ED as an opportunity to screen for the presence of health-threatening concomitant comorbidities.
Effects of Hypoxia on Nocturnal Erection Quality: A Case Report from the Manaslu Expedition
2011, Journal of Sexual Medicine
Citation Excerpt :
Heavy smoking men with erectile dysfunction (ED) have less penile rigidity, lower total tumescence time, and more rapid detumescence during sleep, in comparison to nonsmokers [6]. Similar SRE‐related alterations are found in patients with chronic obstructive pulmonary disease (COPD) [7]. ED is a highly prevalent condition in patients affected by obstructive sleep apnea syndrome (OSAS), characterized by chronic intermittent hypoxia [8,9], and some researchers have demonstrated that OSAS‐related pathophysiological events may have an important role in the occurrence of ED [8,10].
High altitude environment represents a fine model to study physiological and pathophysiological effects of oxygen availability on sleep‐related erections (SREs).
To describe altitude‐dependent effects on quality of SREs in order to estimate the role of hypoxia in erection physiology.
A healthy 37‐year‐old male mountain climber underwent a chronic high altitude‐related hypoxia experience during the 43 days of the Manaslu expedition (Nepal). SREs were recorded by RigiScan (Timm Medical Technologies, Inc., Eden Prairie, MN, USA) at altitudes ranging from 0 to 5,800 m above sea level. The erection‐related parameters assessed were: number, duration, event duration (% of session), event rigidity %, time rigidity %, tumescence and rigidity activated unit, and event tum % > bline (%).
SREs were recorded by RigiScan at altitudes ranging from 0 to 5,800 m above sea level.
Erectile parameters showed an altitude‐related reduction during the hypoxic exposure, although all functional alterations were reverted by the return to sea level.
Our case report supports the hypothesis that oxygen availability and delivery could play an important role in the regulation of local penile erection‐related mechanisms and that low oxygen levels might be considered an etiological cofactor in erectile dysfunction. Verratti V, Falone S, Fanò G, Paoli A, Reggiani C, Tenaglia R, and Di Giulio C. Effects of hypoxia on nocturnal erection quality: A case report from the Manaslu expedition. J Sex Med 2011;8:2386–2390.

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: This work was supported in part by funds from the Veterans Administration and US Public Health Service, National Institutes of Health, grant HL07210-05.

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Chest

Clinical InvestigationsSexual Dysfunction and Erectile Impotence in Chronic Obstructive Pulmonary Disease

Section snippets

MATERIALS AND METHODS

Subjective Sexual Function

DISCUSSION

ACKNOWLEDGMENT

J Urol

J Neurol Sci

J Urol

Urology

Chest

Fertil Steril

Chest

Chest

Sex in chronic obstructive pulmonary disease

Med Aspects Human Sexuality

Psychologic aspects of chronic obstructive pulmonary disease

Med Clin North Am

The etiology, diagnosis and surgical treatment of erectile impotence

J Reprod Med

A manual of standardized terminology, techniques, and scoring system for sleep stages of human subjects. Bethesda, Md: US Dept of HEW, Public Health Service, NIH, National Institute of Neurologic Disease and Stroke, Neurological Information Network

Clinical Investigations
Sexual Dysfunction and Erectile Impotence in Chronic Obstructive Pulmonary Disease