Irritable Bowel Syndrome Is Associated Not Only With Organic but Also Psychogenic Erectile Dysfunction

C-Y Hsu; C-L Lin; C-H Kao


Int J Impot Res. 2015;27(6):233-238. 

In This Article


A total of 15 533 IBS patients and 62 124 controls without IBS were enrolled in our study. Among the study participants, 48.2% of the patients were 49 years of age or younger (Table 1). The mean age in the non-IBS and IBS cohorts was 51.7±17.1 years and 52.2±16.9 years, respectively. Both cohorts tended to have lower income levels (23.3% vs 23.3%) and reside in urbanized areas (56.4% vs 56.4%). The IBS cohort included more cases of CAD, COPD, CKD, hypertension, diabetes, hyperlipidemia, depression, anxiety, antihypertensive drug, antidepressants drug and benzodiazepines than did the non-IBS cohort (all P<0.001). The overall incidence of OED was 2.30-fold greater in the IBS cohort than in the non-IBS cohort (26.6 vs 10.1 per 10 000 person-years), with an adjusted hazards ratio (AHR) of 2.12 (95% CI: 1.80–2.50; Table 2). Figure 1a shows that the cumulative incidence of OED was higher in the IBS cohort than that in the non-IBS cohort by 1.50% (log-rank test P<0.001) at the end of follow-up. The OED incidence increased with age in both cohorts, but the age-specific IBS to non-IBS relative risk was the greatest for the youngest group (crude HR=3.12; 95% CI: 2.40–4.07). The corresponding AHR reduced to 1.84 (95% CI: 1.33–2.55) for the oldest group. The OED incidence increased with comorbidities in both cohorts.

Figure 1.

Cummulative incidence comparison of organic erectile dysfunction (a) and psychogenic erectile dysfunction (b) for patients with (dashed line) or without (solid line) irritable bowel syndrome.

The Kaplan–Meier graph shows that the cumulative incidence of PED was higher for the IBS cohort than for the non-IBS cohort (Figure 1b, the log-rank test P <0.001). In total, 32 IBS patients were diagnosed with PED, yielding an incidence of 3.17 per 10 000 person-years, whereas 43 cases of PED occurred in the non-IBS cohort, yielding an incidence of 1.08 per 10 000 person-years. The crude HR of PED in the IBS cohort was 2.94 (95% CI: 1.86–4.65), and the AHR of PED was 2.38 (95% CI: 1.47–3.85), indicating that the IBS patients were at increased risk of PED. The age-specific IBS cohort to the non-IBS cohort AHR of PED was significant for aged ≤49 years. IBS patients with or without comorbidity were associated with significantly higher risk of PED than the non-IBS patients were.

The results of multivariable Cox proportional hazard analyses for the OED association risk factor in patients with IBS are shown in Table 3. The risk of developing OED was 1.01-fold (95% CI: 1.01–1.02) increased with age (every year), higher income (AHR=1.66, 95% CI: 1.34–2.05), living in urbanized areas, and comorbidity of CKD (AHR=1.35, 95% CI: 1.07–1.72), diabetes (AHR=1.32, 95% CI: 1.04–1.67), hyperlipidemia (AHR=1.41, 95% CI: 1.16–1.70), antihypertensive drug (AHR=1.39, 95% CI: 1.12–1.72), antidepressants drug (AHR=1.45, 95% CI: 1.12–1.88), and benzodiazepines (AHR=1.29, 95% CI: 1.07–1.56) was associated with increased risk of OED. In the multivariable model, higher income (AHR=2.29, 95% CI=1.19–4.40), and living in urbanized areas were significantly associated with increased PED risk.

Furthermore, relative to the non-IBS cohort without any comorbidity, the IBS patients with any comorbidity were at much higher risk of OED (AHR=3.81, 95% CI: 3.02–4.81; Table 4). Compared with patients without IBS and any comorbidity, patients with IBS and with any comorbidity were 3.05-fold more likely to develop PED (95% CI: 1.52–6.09), followed by patients with IBS and without any comorbidity (AHR=2.37, 95% CI: 1.31–4.28).

In addition, NHIRD covers a highly representative sample of Taiwan's general population because the reimbursement policy is universal and operated by a single-buyer, the government of Taiwan. All insurance claims should be scrutinized by medical reimbursement specialists and peer review. The diagnoses of ED were based on the ICD-9 codes, which were assessed and determined by related specialists and physicians according to the standard clinical criteria. If these specialists or physicians misdiagnosed diseases or miscoded diagnoses, they would be subject to punitive action. Therefore, the diagnoses and codes for ED used in this study should be correct and reliable.