Alcohol Consumption and Erectile Dysfunction: Meta-Analysis of Population-Based Studies

J Y W Cheng; E M L Ng; R Y L Chen; J S N Ko

Disclosures

Int J Impot Res. 2007;19(4):343-352. 

In This Article

Abstract and Introduction

Alcohol is long regarded as a risk factor for erectile dysfunction (ED), but epidemiological evidence has been equivocal. We aimed to investigate the ED risk associated with various levels of alcohol consumption by meta-analysis. We searched for population-based studies on ED through Medline, PubMed, PsychInfo, and scanned through reference lists. Eleven cross-sectional studies were included and analyzed with random effects model. We reviewed the results from one cross-sectional study and two cohort studies. Regular alcohol consumption was negatively associated with ED (odds ratio (OR) = 0.79; 99% confidence interval (CI), 0.67–0.92; P<0.001). Consumption of 8 or more drinks/week significantly reduced the risk of ED (OR = 0.85; 99% CI, 0.73–0.99; P = 0.007), but consumption of less alcohol (1–7 drinks/week) was not significant (OR = 0.73; 99% CI, 0.44, 1.20; P = 0.101). Begg's test and Egger's test detected no significant publication bias. Our estimates (in sensitivity analyses) were rendered nonsignificant when International Index of Erectile Function definition was used and when statistical adjustment was made only for age. Meta-analysis of cross-sectional studies yielded a protective association of alcohol on ED, but the two cohort studies did not demonstrate any significant findings for alcohol consumption. More research is needed to confirm whether alcohol is protective or is unrelated to ED development.

Alcohol is long regarded as a risk factor for erectile dysfunction (ED), whether in textbooks,[1,2] review articles[3,4] or clinical teachings. It was a long-held empirical observation that acute alcohol intoxication increases sexual desire but inhibits sexual performance (Macbeth, Act 2, Scene 3, 'What three things does drink especially provoke... lechery, sir, it provokes, and unprovokes; it provokes the desire, but it takes away the performance'). The scientific explanation is that alcohol is a central nervous system depressant[2], but it also leads to disinhibition and increases sexual desire.

Epidemiological studies have demonstrated numerous risk factors for ED, such as age,[5] variables related to diabetes,[6] depression,[7] hypertension[6] and smoking.[8] With more accumulating evidence, the risk of alcohol consumption in ED seemed more equivocal. ED has also been said to be the harbinger of cardiovascular events.[9] Endothelial dysfunction has been hypothesized to result from cardiovascular risk factors such as hypertension or diabetes, which in turn leads to ED, myocardial infarction and stroke.[10] As evidence accumulates to support the similarity in cardiovascular risk factor profiles[11] of ED and cardiovascular diseases, it was fair to hypothesize that alcohol may demonstrate a J-shaped (or inverse) relationship with ED, with moderate alcohol consumption conferring the lowest risk of ED. Furthermore, considering the scale of the studies done on cardiovascular diseases and that of ED, it was not surprising that perhaps ED studies were simply not large enough to delineate the risk of ED associated with alcohol consumption.

It was the aim of this paper to use meta-analysis to pool the risk of regular alcohol consumption associated with ED.

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