Sexual dysfunction ‘ignored in COPD’

Researchers say that physicians should address sexual issues in patients with chronic obstructive pulmonary disease (COPD) as a matter of course, after finding that over three-quarters of men with the condition have some level of erectile dysfunction.

However, despite this having been recognized by several studies, the condition is not listed as a comorbidity in the Global Initiative for Obstructive Lung Disease (GOLD) guidelines.

“The prevalence of sexual dysfunction in patients with COPD is high and its significance has not been sufficiently stressed,” say the researchers, led by Hasan Kahraman (Kahramanmaras Sutcu Imam University, Turkey).

In their sample of 70 male COPD patients and 68 healthy controls, the rate of any erectile dysfunction according to the International Index of Erectile Function questionnaire was 78.6% and 55.8%, respectively.

Furthermore, the degree of severity of erectile dysfunction was greater in COPD patients, at a mean of 3.2 out of 4.0 points versus 2.1 in controls; 25 (35.7%) COPD patients were classified as having severe erectile dysfunction compared with just seven (10.3%) men in the control group.

In COPD patients, there was also a moderate negative correlation between erectile dysfunction and forced expiratory volume in 1 second (FEV1), as well as with oxygen saturation, and a positive correlation with age.

Patients in the COPD group had significantly lower oxygen saturation (93.2 vs 95.8 mmHg), were more likely to be current smokers (48.6 vs 14.7%), and had significantly higher follicle-stimulating hormone (12.5 vs 9.1 mIU/mL), luteinizing hormone (9.8 vs 6.6 mIU/mL), and estradiol levels (39.1 vs 22.8 pg/mL) than men in the control group. They also had lower total testosterone levels, although this difference did not reach statistical significance, and the team did not find any significant relationship between hormone levels and erectile dysfunction.

The researchers also note a high proportion of depression among COPD patients, affecting 48.6% compared with 23.5% in the control group, which they suggest may have contributed to worsening erectile dysfunction.

Writing in Multidisciplinary Respiratory Medicine, the authors say that, owing to the exclusion of erectile dysfunction from the GOLD guidelines, physicians following them may be neglecting to ask patients about an important comorbidity with significant impact on quality of life.

“Sexual dysfunction and depression should be carefully questioned when recording the history of patients with COPD, and this information should be used in therapy planning,” they conclude.

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