Correlation Between Gut Microbiota Diversity and Psychogenic Erectile Dysfunction

Qiang Geng; Shaofeng Chen; Yuan Sun; Yu Zhao; Zhong Li; Fu Wang; Guojin Yu; Xiuchuan Yan; Jiwei Zhang


Transl Androl Urol. 2021;10(12):4412-4421. 

In This Article

Abstract and Introduction


Background: To analyze the distribution of gut microbiota in erectile dysfunction (ED) patients and explore the relationship between the diversity of gut microbiota and psychogenic ED.

Methods: Stool specimen were collected from 30 patients with ED and 30 healthy persons (healthy donors, HDs) and analyzed Paired end (PE) 300 sequencing on V3-V4 region sequences of bacterial 16S rRNA gene by using Illumina's Miseq platform, whereby sequencing results were analyzed to assess differences in species composition and diversity. The analysis comprised five modules: sequencing data quality control, operational taxonomic units (OTU) species clustering and annotation, alpha diversity, beta diversity and the use of t-tests and analysis of linear discriminant analysis effect size (LEfSe) differences.

Results: The International Index of Erectile Function (IIEF-5) score ranged between 8 and 21. The scores of ED patients were ≥11 and ≤20, and the mean value was 15.67±2.94. The flora diversity in the group of ED patients was significantly different from that of HDs (P<0.01), with the ED group having low bacterial diversity. There were no significant differences in the genus level between the ED and HD group, and abundant bacteria (TOP10) and core flora (90%). Comparison of total flora (the abundance >1%) display, Alloprevotella genera showed differences, whereby Alloprevotella was only be identified in the HD group. Erectile dysfunction and HD showed good separation and clustering respectively in principal component analysis, showing significant differences in two kinds of microflora. T-tests showed that six species were significantly different, and that in the ED group, streptococci and Subdoligranulum were significantly increasing, and Prevotella sp.9, Blautia, Lachnospiraceae NK4A136 groups and Roseburia were significantly lower. Analysis using LEfSe analysis revealed 24 species were significantly different between ED and HD groups.

Conclusions: When gene sequencing was performed of ED and HD specimens, the microbial community structure and diversity showed significant differences, suggesting that ED specimen had lower gut microbiota diversity.


A large number of microorganisms live in the human intestinal tract. The normal gut microbiota is the natural barrier of the human body and plays an important part in maintaining human health.[1] The normal gut microbiota in the human body is mainly composed of firmicutes, Bacteroidetes, proteobacteria, and actinomycetes. According to the impact on human health, gut microbiota can be divided into three categories: symbiotic bacteria, opportunistic bacteria, and pathogenic bacteria, which are dynamically balanced to maintain the homeostasis of the intestinal environment.[2] Intestinal beneficial bacteria (i.e., probiotics) include bifidobacteria, lactobacillus, and so on. Harmful bacteria include Escherichia coli and enterococcus.[3] Changes in the internal and external environment of the body can affect the structure of gut microbiota, resulting in gut microbiota imbalance,[4] which can lead to inflammatory bowel disease,[5] irritable bowel syndrome,[6] non-alcoholic liver disease,[7] viral hepatitis,[8] metabolic syndrome,[9] and other diseases, aggravation, and rapid progression. Sexual function is a complex phenomenon affected by sex hormones, psychological and neurological factors, hemodynamics, hormonal disorders, obesity, stress, anxiety, hypertension, diabetes and so on. It had been reported that gut microbiota was related to endocrine, psychological factors and metabolic syndrome. The causes of ED was generally believed as vascular, neurologic, psychological, and hormonal factors. Conditions commonly associated with ED include diabetes mellitus, hypertension, hyperlipidemia, obesity, testosterone deficiency. Performance anxiety and relationship issues are common psychological causes.[10,11] Therefore, it might be hypothesized that there is a correlation between ED and gut microbiota distribution, and the distribution of gut microbiota was different between the HD and ED populations. To test this hypothesis, this study compared the gut microbiota diversity of patients with ED to that of a normal control group. We present the following article in accordance with the MDAR reporting checklist (available at