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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




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.


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.


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).


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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  1. 1.

    Nørgård BM, Nielsen J, Fonager K, et al. The incidence of ulcerative colitis (1995-2011) and Crohn’s disease (1995-2012)—based on nationwide Danish registry data. J Crohns Colitis. 2014;8:1274–80.

  2. 2.

    O’Toole A, Winter D, Friedman S. Review article: the psychosexual impact of inflammatory bowel disease in male patients. Aliment Pharmacol Ther. 2014;39:1085–94.

  3. 3.

    Mantzouranis G, Fafliora E, Glanztounis G et al. Inflammatory bowel disease and sexual function in male and female patients: an update on evidence in the past ten years. J Crohn Colitis 2015;9:1160–8.

  4. 4.

    Ghazi LJ, Patil SA, Cross RK. Sexual dysfunction in inflammatory bowel disease. Inflamm Bowel Dis. 2015;21:939–47.

  5. 5.

    Doumas M, Lazaridis A, Katsiki N, et al. PDE-5 inhibitors: clinical points. Curr Drug Targets. 2015;16:420–6.

  6. 6.

    Porst H, Hell-Momeni K, Büttner H. Chronic PDE-5 inhibition in patients with erectile dysfunction—a treatment approach using tadalafil once-daily. Expert Opin Pharmacother. 2012;13:1481–94.

  7. 7.

    Tsertsvadze A, Fink HA, Yazdi F, et al. Oral phosphodiesterase-5 inhibitors and hormonal treatments for erectile dysfunction: a systematic review and meta-analysis. Ann Intern Med. 2009;151:650.

  8. 8.

    Burke RM, Evans JD. Avanafil for treatment of erectile dysfunction: review of its potential. Vasc Health Risk Manag. 2012;8:517–23.

  9. 9.

    Timmer A, Bauer A, Dignass A, et al. Sexual function in persons with inflammatory bowel disease: a survey with matched controls. Clin Gastroenterol Hepatol. 2007;5:87–94.

  10. 10.

    Timmer A, Bauer A, Kemptner D, et al. Determinants of male sexual function in inflammatory bowel disease: a survey-based cross sectional analysis in 280 men. Inflamm Bowel Dis. 2007;13:1236–43.

  11. 11.

    Marin L, Manosa M, Garcia-Planella E, et al. Sexual function and patients’ perceptions in inflammatory bowel disease: a case-control survey. J Gastroenterol. 2013;48:713–20.

  12. 12.

    Rivière P, Zallot C, Desobry P, et al. Frequency of and factors associated with sexual dysfunction in patients with inflammatory bowel disease. J Crohns Colitis. 2017;11:1347–52.

  13. 13.

    Knowles SR, Gass C, Macrae F. Illness perceptions in IBD influence psychological status, sexual health and satisfaction, body image and relational functioning: a preliminary exploration using Structural Equation Modeling. J Crohns Colitis. 2013;7:e344–50.

  14. 14.

    Mountifield R, Bampton P, Prosser R, et al. Fear and fertility in inflammatory bowel disease: a mismatch of perception and reality affects family planning decisions. Inflamm Bowel Dis. 2009;15:720–5.

  15. 15.

    Wang JY, Hart SL, Wilkowski KS, et al. Gender-specific differences in pelvic organ function after proctectomy for inflammatory bowel disease. Dis Colon Rectum. 2011;54:66–76.

  16. 16.

    Farouk R, Pemberton JH, Wolff BG, et al. Functional outcomes after ileal pouch-anal anastomosis for chronic ulcerative colitis. Ann Surg. 2000;231:919–26.

  17. 17.

    Lindsey I, George BD, Kettlewell MG, et al. Impotence after mesorectal and close rectal dissection for inflammatory bowel disease. Dis Colon Rectum. 2001;44:831–5.

  18. 18.

    van Balkom KA, Beld MP, Visschers, et al. Long-term results after restorative proctocolectomy with ileal pouch-anal anastomosis at a young age. Dis Colon Rectum. 2012;55:939–47.

  19. 19.

    Rosen RC, Cappelleri JC, Gendrano N 3rd. The International Index of Erectile Function (IIEF): a state-of-the-science review. Int J Impot Res. 2002;14:226–44.

  20. 20.

    Schmidt M, Pedersen L, Sørensen HT. The Danish Civil Registration System as a tool in epidemiology. Eur J Epidemiol. 2014;29:541–9.

  21. 21.

    Schmidt M, Schmidt SAJ, Sandegaard JL, et al. The Danish National Patient Registry: a review of content, data quality, and research potential. Clin Epidemiol. 2015;7:449–90.

  22. 22.

    Pottegård A, Schmidt SA, Wallach-Kildemoes H, et al. Data resource profile: the Danish National Prescription Registry. Int J Epidemiol. 2017;46:798.

  23. 23.

    Rothman KJ . Case-control studies. Modern epidemiology. 3rd edition Philadelphia, PA: LWW; 2008. p. 124–125.

  24. 24.

    Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J Chronic Dis. 1987;40:373–83.

  25. 25.

    O’Toole A, de Silva PS, Marc LG, et al. Sexual dysfunction in men with inflammatory bowel disease: a new IBD-specific scale. Inflamm Bowel Dis. 2018;24:310–6.

  26. 26.

    Rungoe C, Langholz E, Andersson M, et al. Changes in medical treatment and surgery rates in inflammatory bowel disease: A nationwide cohort study 1979-2011. Gut. 2014;63:1607–16.

  27. 27.

    Fonager K, Sorensen HT, Rasmussen SN, et al. Assessment of the diagnoses of Crohn’s disease and ulcerative colitis in a Danish hospital information system. Scand J Gastroenterol. 1996;31:154–9.

  28. 28.

    Szathmari M, Vasarhelyi B, Treszl A, et al. Association of dehydroepiandrosterone sulfate and testosterone deficiency with bone turnover in men with inflammatory bowel disease. Int J Colorectal Dis. 2002;17:1763–6.

  29. 29.

    Schulte CM. Review article: Bone disease in inflammatory bowel disease. Aliment Pharmacol Ther. 2004;20(suppl. 4):43–9.

  30. 30.

    Bokemeyer B, Hardt J, Huppe D, et al. Clinical status, psychosocial impairments, medical treatment and health care costs for patients with inflammatory bowel disease (IBD) in Germany: an online IBD registry. J Crohn’s Colitis. 2013;7:355–68.

  31. 31.

    Cao S, Gan Y, Dong X, et al. Association of quantity and duration of smoking with erectile dysfunction: a dose-response meta-analysis. J Sex Med. 2014;11:2376–84.

  32. 32.

    Verze P, Margreiter M, Esposito K, et al. The link between cigarette smoking and erectile dysfunction: a systematic review. Eur Urol Focus. 2015;1:39–46.

  33. 33.

    Bernstein CN. Review article: changes in the epidemiology of inflammatory bowel disease-clues for aetiology. Aliment Pharmacol Ther. 2017;46:911–9.

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Author information


  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


Corresponding author

Correspondence to S Friedman MD.



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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