Article | Published:

Increased Use of Medications for Erectile Dysfunction in Men With Ulcerative Colitis and Crohn’s Disease Compared to Men Without Inflammatory Bowel Disease: A Nationwide Cohort Study

The American Journal of Gastroenterology (2018) | Download Citation

Subjects

Abstract

BACKGROUND

Men with inflammatory bowel disease (IBD) may have decreased sexual function due to factors related to the underlying disease, medication, and/or surgery. We aimed to examine the use of erectile dysfunction (ED) medications in men with IBD.

Methods

This is a nationwide cohort study based on the Danish registries, comprising all men >18 years old with IBD during 1 January 1995 through December 2016. The cohorts included 31,498 men with IBD and 314,980 age-matched men without IBD. Our main outcome was a first prescription of an ED medication. Cox regression analyses were used to estimate the hazard rate (HR) for use of ED medications, controlled for multiple time-varying covariates.

Results

Overall, 21,966 (69.7%) men had ulcerative colitis (UC) while 9532 (30.3%) had Crohn’s disease (CD). Men with a first ED prescription numbered 3749 (11.9%) (men with IBD) and 30,635 (9.7%) (men without IBD). Adjusting for central nervous system and intestinal anti-inflammatory medications, systemic corticosteroids and co-morbidities, the HR was 1.19 (95% CI: 1.13–1.26) (IBD and no prior IBD operation), and 1.31 (95% CI: 1.20–1.43) (IBD and prior IBD operation). The adjusted HR for UC was 1.17 (95% CI: 1.10–1.24) (no operation) and 1.43 (95% CI: 1.27–1.61) (prior operation), and for CD 1.26 (95% CI: 1.15–1.38) (no operation) and 1.20 (95% CI: 1.06–1.35) (prior operation).

Discussion

Men with IBD are more likely to fill an ED prescription than men without IBD. This result is significant regardless of a history of IBD surgery.

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Author information

Affiliations

  1. Center for Crohn’s and Colitis, Brigham and Women’s Hospital, Chestnut Hill, MA, USA

    • S Friedman MD
    •  & BM Nørgård MD, PhD, DMSc
  2. Harvard Medical School, Boston, MA, USA

    • S Friedman MD
    •  & BM Nørgård MD, PhD, DMSc
  3. Center for Clinical Epidemiology, Odense University Hospital, and Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark

    • S Friedman MD
    • , B Magnussen MSc
    • , MD Larsen MSc, PhD
    •  & BM Nørgård MD, PhD, DMSc
  4. Department of Gastroenterology, Beaumont Hospital and Royal College of Surgeons of Ireland, Dublin, Ireland

    • A O’Toole MD
  5. Centre of Andrology and Fertility Clinic, Department D, Odense University Hospital, and Research Unit of Human Reproduction, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark

    • J Fedder MD, MSc, PhD

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Guarantor of the article

S Friedman.

Specific author contributions

SF, BMN: funding, conception, design, data collection, assistance with data analysis, interpretation of results, manuscript writing and editing, approved the final version. BM: design, data collection, data analysis, interpretation of results, manuscript editing, approved the final version. AOT: conception, interpretation of results, manuscript writing and editing, approved the final version. MDL: design, assistance with data analysis, interpretation of results, manuscript editing, approved the final version. JF: interpretation of results, manuscript editing, approved the final version.

Financial support

The study was supported by a Crohn’s & Colitis Foundation of America (CCFA), Senior Research Award.

Potential competing interests

None

Corresponding author

Correspondence to S Friedman MD.

Appendix

Appendix

Medication Codes: alprostadil (ATC code: G04BE01); sildenafil (ATC code: G04BE03); tadalafil (ATC code: G04BE08); vardenafil (ATC code: G04BE09); avanafil (ATC code: G04BE10); aviptadil (ATC code: G04BE30); intestinal anti-inflammatory agents for IBD (ATC code A07E including all underlying subgroups); corticosteroids for systemic use (ATC code H02A including all subgroups); psychoanaleptics (ATC code N06 with all subgroups); antipsychotics (ATC code N05A); anxiolytics (ATC code N05B with all subgroups); sedative/hypnotics (ATC code N05C with all subgroups); antiepileptics (ATC code N03 with all subgroups); opioids (ATC code N02A with all subgroups; azathioprine (ATC L04AX01); 6-mercaptourine (ATC L01BB02); methotrexate (ATC L01BA01/L04AX03).

Surgical Codes: UC—KJFH; i.e., all types of colectomies; and colectomy codes of 45020, 45060, 45080, 45840, or 45880. CD—KJFB00, KJFB01, KJFB20/21/30/31, KJFB33, KJFB34, KJFB40/41/43/44/46/47/50/51/60/61/63/64, KJFB96, KJFB97, KJFH00/01/10/11/20/96, KJGB00/01/10/11/30/31, KJFA60, 43440, 43460, 43520, 43540, 43680, 43700, 43740, 43760, 43780, 43800, 43820, 43840, 43860, 43880, 44060, 44120, 44150, 44160, 44790, 44900, 44920, 44940, 44960, 44980, 45020, 45060, 45080, 45100, 45120, 45200, 45240, 45320, 45480, 45690, 45840, 45860, 45880, 46290.

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DOI

https://doi.org/10.1038/s41395-018-0177-6