Erectile Dysfunction Waxes and Wanes

WATERTOWN, Mass., Jan. 17 -- Instead of popping pills, men with erectile dysfunction may be able to improve their performance through weight loss and getting in shape, but long-term cigarette smokers may be out of luck.

That's the conclusion of investigators in the ongoing Massachusetts Male Aging Study, who found that changing some modifiable risk factors may reverse or prevent the progression of erectile dysfunction.

"The lack of knowledge about prognosis following erectile dysfunction onset may have created the impression that remission of symptoms through nonpharmacological treatment, a path many patients prefer, is not possible," Thomas G. Travison, Ph.D., of the New England Research Institutes here, and colleagues, wrote in the January issue of the Journal of Urology.

"The results presented here, by contrast, suggest that erectile dysfunction severity following onset is influenced by modifiable factors," they wrote.

The findings suggest that a significant number of men experience the ebb and flow of erectile dysfunction remission and progression, and point to possible non-drug approaches to coping with the condition.

The authors found that body mass index was associated with remission and progression of erectile dysfunction, while smoking, age and health status were associated with progression of impotence. Smoking doubled the risk for progression of erectile dysfunction, a magnitude of effect similar to that of aging.

The investigators looked at data on 401 men with some degree of erectile function at baseline who were part of the Massachusetts Male Aging Study, a longitudinal follow-up study of 1,709 men who ranged in age from 40 to 70 at study enrollment in 1987-89.

The investigators evaluated data only from the enrollment period and from the first interim follow-up at about the nine-year mark (1995-97) to avoid potential confounding from the widespread use of Viagra (sildenafil, approved in 1998), and other phosphodiesterase-5 inhibitors.

They analyzed the data to determine the severity of erectile dysfunction at initial presentation of symptoms, and used logistic regression to estimate the odds of the progression and/or remission in association with variable factors.

The variables included demographics, BMI, co-morbidities, lifestyle factors, frequency of sexual intercourse, and satisfaction with recent sexual experiences. They also evaluated self-reported medical history, depression, current smoking status, alcohol consumption, education, marital status, household income, hours of sleep per day, physical activities, diet, and general health status.

They found that remission of erectile dysfunction occurred in 141 of the 401 men (35%) studied (95% confidence interval, 30%-40%). Of the 323 men who were determined to have had minimal or moderate erectile dysfunction at baseline, 107 (33%, 95% CI 28%-38%) had progression of dysfunction,

Of the 78 men who had complete erectile at baseline, 45 (58%) still had complete dysfunction at follow-up.

In the logistic regression analysis, age and body mass index were associated with progression and remission, while smoking and self-assessed health status were associated with progression only.

The odds ratio for erectile dysfunction progression in the multivariate model was 2.3 (95% CI, 1.6-3.3, P<0.001). The odds ratio for smoking was 2.1 (95% CI, 1.16-3.68, P=0.01).

The lack of association between smoking and disease regression suggests that the damage to erectile function from cigarettes, once manifest, may not be reversible, the authors implied.

They also found that comorbidities and demographic factors other than age had little or no association with ED progression or remission when age effects were controlled for.

"Likewise, measures of sexual satisfaction were not predictive. Sexual desire displayed a significant age adjusted association with progression, but was also strongly associated with general health and BMI and, therefore, was not significant in multivariate models," they wrote.

They said the association of body mass index with remission and progression, plus the association of smoking and health status with progression, "offer potential avenues for facilitating remission and delaying progression using nonpharmacological intervention. The benefits of such interventions for overall men's health may be far-reaching."

Physicians can use the findings from the study as a basis for evaluation and treatment of men with erectile dysfunction, suggested Michael A. Perelman, M.S., M.Phil., Ph.D., of the departments of psychiatry, reproductive medicine, and urology at Weill Cornell Medical College in New York, in an accompanying editorial comment.

"How to evaluate and when to treat are timely questions," Dr. Perelman wrote. "Developing a dialogue with patients regarding the issues surrounding sexual function is critical. Not all patients want immediate and/or exclusive pharmaceutical treatment. Conclusions from this article can be integrated into an assessment algorithm in a manner which facilitates patient compliance, and leads to increased respect and rapport between patient and urologist."

The study was supported by grants from the National Institute of Diabetes and Digestive and Kidney Diseases and the National Institute on Aging.