Chronic obstructive pulmonary disease and erectile dysfunction: a missed relationship

Introduction: Erectile dysfunction (ED) is a common, underappreciated problem in chronic obstructive pulmonary disease (COPD) patients. Physicians should make an effort to diagnose and manage it, in order to improve their patients’ quality of life. Aim: To identify clinical factors associated with ED in COPD patients and to study the impact of COPD symptoms in sexual activity. Methods: During a 6-month period, a cross-sectional study was conducted on sexually active male patients with COPD, followed in a Portuguese Pulmonology Department. The International Index of Erectile Function (IIEF-5) questionnaire was used to evaluate ED and the Respiratory Experiences with Sexuality Profile (RESP) was applied to assess the impact of respiratory symptoms in sexual activity. A logistic regression model was done to identify factors associated to mild-moderate or moderate ED. Results: We identified 84 patients of which 67 were included (median age: 65 years, 13% never-smokers). 22% had COPD 2011-GOLD A, 22% GOLD B, 14% GOLD C and 42% GOLD D. 58 patients (87%) had some degree of ED: 26 (45%) mild, 20 (34%) mild-moderate and 12 (21%) moderate ED. ED occurred in all GOLD stages of COPD, namely in GOLD B and D stages. Higher CAT score was associated to mild-moderate/moderate ED (OR=1.12; 95%CI=1.01-1.25). 85% of patients reported dyspnea during sexual activity, but most of them (72%) never discussed it with their physician. Discussion: This study shows that the majority of COPD patients, namely those with a higher CAT score has ED and dyspnea clearly affects their sexual activity. In everyday clinical practice, physicians’ inexperience and patients’ reluctance to discuss sexual problems should be avoided.