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NSAID Use Tied to Men's Sexual Performance
By Todd Neale, Staff Writer, MedPage Today
March 05, 2011

MedPage Today Action Points

Explain that the regular use of NSAIDs is associated with higher odds of
erectile dysfunction, according to a cross-sectional study.

Note that the study does not prove a cause-and-effect relationship between
NSAIDs and erectile dysfunction.

Review
The regular use of nonsteroidal anti-inflammatory drugs (NSAIDs) is associated with
higher odds of erectile dysfunction, a cross-sectional study showed.

In a large healthcare system, the rate of erectile dysfunction was 35.2% among
middle-age men who regularly took NSAIDs and 24% among those who did not
(P<0.001), according to Steven Jacobsen, MD, PhD, director of research at Kaiser
Permanente Southern California in Los Angeles, and colleagues.

After adjustment for age, race, ethnicity, smoking, body mass index, and various
comorbidities, that worked out to a 1.22-fold greater likelihood of erectile dysfunction
in NSAID users (OR 1.22, 95% CI 1.18 to 1.27), the researchers reported online in
the Journal of Urology.

"While this raises the question of the role of inflammation and COX pathways in
erectile dysfunction etiology, we cannot exclude alternative explanations," they
wrote.

Those alternatives included confounding by factors not captured in the study, like
subclinical disease and the severity of various comorbid conditions, and the
possibility that NSAID use was itself an indicator of other conditions causing erectile
dysfunction.

"If it's a true association then I think that it needs to enter into discussions about the
risks and benefits of using NSAIDs -- whether for prevention or treatment," Jacobsen
told MedPage Today.

"But I think probably the more important thing is that [by] bringing this to men's
attention, that it may actually stimulate some conversation with their care provider
about, first, erectile dysfunction, and, second, about some of the other risk factors
for erectile dysfunction," he said.

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Medical News: NSAID Use Tied to Men's Sexual Performance - Pri... http://www.medpagetoday.com/tbprint.cfm?tbid=25204

Jacobsen stressed that the study does not prove a cause-and-effect relationship
between NSAIDs and erectile dysfunction.

"People should not stop taking these if it's been recommended by their provider," he
said, "and if they are concerned about it, they really should have a discussion with
their provider about those risks and benefits."

Because previous studies had suggested a possible relationship between

inflammation and erectile dysfunction, the researchers thought the use of NSAIDs
might lower the chances of developing the condition.

To explore the issue, Jacobsen and his colleagues turned to the California Men's
Health Study, which included an ethnically diverse group of men ages 45 to 69 who
were enrolled in Kaiser Permanente managed care plans.

The presence of erectile dysfunction was self-reported. Those who said they were
sometimes or never able to achieve and maintain an erection were classified as
having either moderate or severe dysfunction.

NSAID use was assessed using both electronic pharmacy data and self-report.
Regular NSAID users were defined as men who received more than a 100-day
supply of at least one NSAID, had any prescription for three or more NSAID doses
per day, or reported using the drugs at least five days a week.

Of the 80,966 men included in the analysis, 47.4% used NSAIDs regularly and
29.3% reported some level of erectile dysfunction. Both rates were lowest in the
youngest men and increased with age.

Even after adjustment for demographics, lifestyle, and several comorbidities --

including diabetes, hypertension, hyperlipidemia, peripheral vascular disease, and
coronary artery disease -- regular NSAID use was associated with greater odds of
both moderate and severe erectile dysfunction (ORs 1.09 and 1.38, respectively).
Both were significant at P<0.001.

The findings were consistent with a small, observational Finnish study.

Jacobsen and his colleagues acknowledged some limitations of their study,

including the inability to establish the temporal relationship between NSAID
exposure and the development of erectile dysfunction using a cross-sectional
analysis, potential participation bias, and a low participation rate.

The study was supported by the California Cancer Research Program and Kaiser Foundation Community
Benefit Program.

Jacobsen reported a financial interest and/or other relationship with Kaiser Permanente and Merck. One of his
co-authors reported relationships with Takeda and GlaxoSmithKline.

This article was developed in collaboration with ABC News.

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Medical News: NSAID Use Tied to Men's Sexual Performance - Pri... http://www.medpagetoday.com/tbprint.cfm?tbid=25204

Primary source: Journal of Urology

Source reference:
Gleason J, et al "Regular nonsteroidal anti-inflammatory drug use and erectile
dysfunction" J Urol 2011; 185: 1388-1393.

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