Effect of non-steroidal anti-inflammatory drug use on the incidence of erectile dysfunction

Arthritis and erectile dysfunction (ED) affect men more as they age.

In this article, R. Shiri and colleagues of the Tampere School of Public Health of Tampere Finland first list several prior articles that show that the occurrence of these two diseases correlates well. They then correlate the use of non-steroidal anti-inflammatory drugs (NSAID) used for treatment of arthritis and other ailments with their effects on ED. Their study used a sub-set of the Tampere Aging Male Urological Study and involved data derived from 1,126 men who began the study without evidence of ED. Of these, 101 used NSAIDs and most (58%) also reported arthritis symptoms. However, of 256 men who separately reported arthritis symptoms, only 23% used NSAIDS. After multivariate adjustment, the relative increased risk for ED amongst those using NSAIDs versus not using, was 1.8. Also, ED risk was low in men without arthritis and who used no NSAIDs. When age adjustment was applied, the relative risk of ED with NSAIDs climbed to 2.4. In men without arthritis who still used NSAIDs, the relative risk of ED was 2.0, still elevated when compared to non-NSAID users. The authors conclude that use of NSAIDs increased risk of ED and could not be correlated directly with the presence or absence of arthritis. They suggest that NSAIDs compete with arachidonic acid and inhibit the synthesis of prostaglandins and thromboxane. NSAIDS may therefore interfere with the nitric oxide pathway that is essential for the erectile process. They believe that their stratification of the results shows that increased risk of ED was related to NSAID use but not to the disease arthritis itself. They estimate that the "population etiological fraction of ED due to NSAID drug use was 16.7%".

In an editorial comment, Kevin T. McVary of Northwestern University, Chicago, USA, notes that for their 2 questions used to estimate ED, "the question of validation remains." He then suggests more elaborate questionnaires (Short Form 30) that might better estimate the relationship between ED, arthritis and NSAID use. Finally, he calls on use of more stringent epidemiologic principles (Hill's causality method) that might be able to verify a stronger relationship. Clearly, "additional confirmatory studies" are needed.

By George W. Drach, MD


J Urol 2006;175:1812-16


Shiri R, Koskimaki J, Hakkinen J, Tammela TL, Auvinen A, Hakama M

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