Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Comment
  • Published:

Erectile dysfunction drugs are essential and probably life-saving and should be provided to all men who need them just as birth control should be provided to all women who need them

International Journal of Impotence Research (2023)Cite this article

Subjects

Phosphodiesterase 5 inhibitors are commonly used to treat erectile dysfunction. While these drugs are often effective [1, 2] and relatively rarely have severe adverse effects [1, 2], their cost often limits their use [3]. I believe that these drugs should be provided to all men who need them not only for their sexual benefits for them and their partners, but also for their probable role in significantly reducing mortality and severe morbidity among users.

A recent Kloner et al. retrospective cohort study involved 72,498 men with erectile dysfunction of which 23,816 were treated with erectile function related phosphodiesterase 5 inhibitors [4]. Treatment with phosphodiesterase 5 inhibitors were associated with significantly lower rates of major adverse cardiovascular events (Hazard Ratio or HR = 0.87, 95% Confidence Interval or CI 0.79–0.95, p = 0.001), significantly lower cardiovascular death rates (HR = 0.61, 95% CI 0.41–0.90, p = 0.014), and significantly lower overall mortality (HR = 0.75, 95% CI 0.65–0.87, p < 0.001) [4].

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Data availability

All data comes from earlier published papers and no original research was used.

References

  1. Wang CM, Wu BR, Xiang P, Xiao J, Hu XC. Management of male erectile dysfunction: from the past to the future. Front Endocrinol. 2023;14:1148834.

    Article  Google Scholar 

  2. Madeira CR, Tonin FS, Fachi MM, Borba HH, Ferreira VL, Leonart LP, et al. Efficacy and safety of oral phosphodiesterase 5 inhibitors for erectile dysfunction: a network meta-analysis and multicriteria decision analysis. World J Urol. 2021;39:953–62.

    Article  CAS  PubMed  Google Scholar 

  3. Bakr AM, El-Sakka AA, El-Sakka AI. Considerations for prescribing pharmacotherapy for the treatment of erectile dysfunction. Expert Opin Pharmacother. 2021;22:821–34.

    Article  CAS  PubMed  Google Scholar 

  4. Kloner RA, Stanek E, Crowe CL, Singhal M, Pepe RS, Bradsher J, et al. Effect of phosphodiesterase type 5 inhibitors on major adverse cardiovascular events and overall mortality in a large nationwide cohort of men with erectile dysfunction and cardiovascular risk factors: a retrospective, observational study based on healthcare claims and national death index data. J Sex Med. 2023;20:38–48.

    Article  PubMed  Google Scholar 

  5. Barnes H, Brown Z, Burns A, Williams T. Phosphodiesterase 5 inhibitors for pulmonary hypertension. Cochrane database Syst Rev. 2019;1:Cd012621.

    PubMed  Google Scholar 

  6. Bhogal S, Khraisha O, Al Madani M, Treece J, Baumrucker SJ, Paul TK. Sildenafil for pulmonary arterial hypertension. Am J Ther. 2019;26:e520–e6.

    Article  PubMed  Google Scholar 

  7. Samidurai A, Xi L, Das A, Kukreja RC. Beyond erectile dysfunction: cGMP-specific phosphodiesterase 5 inhibitors for other clinical disorders. Annu Rev Pharmacol Toxicol. 2023;63:585–615.

    Article  PubMed  Google Scholar 

  8. Guazzi M, Vicenzi M, Arena R, Guazzi MD. PDE5 inhibition with sildenafil improves left ventricular diastolic function, cardiac geometry, and clinical status in patients with stable systolic heart failure: results of a 1-year, prospective, randomized, placebo-controlled study. Circ Heart Fail. 2011;4:8–17.

    Article  CAS  PubMed  Google Scholar 

  9. Kim KH, Kim HK, Hwang IC, Cho HJ, Je N, Kwon OM, et al. PDE 5 inhibition with udenafil improves left ventricular systolic/diastolic functions and exercise capacity in patients with chronic heart failure with reduced ejection fraction; A 12-week, randomized, double-blind, placebo-controlled trial. Am Heart J. 2015;169:813–22.e3.

    Article  CAS  PubMed  Google Scholar 

  10. Redfield MM, Chen HH, Borlaug BA, Semigran MJ, Lee KL, Lewis G, et al. Effect of phosphodiesterase-5 inhibition on exercise capacity and clinical status in heart failure with preserved ejection fraction: a randomized clinical trial. JAMA. 2013;309:1268–77.

    Article  CAS  PubMed  Google Scholar 

  11. Martin EA, Barresi R, Byrne BJ, Tsimerinov EI, Scott BL, Walker AE, et al. Tadalafil alleviates muscle ischemia in patients with Becker muscular dystrophy. Sci Transl Med. 2012;4:162ra55.

    Article  Google Scholar 

  12. Giannetta E, Isidori AM, Galea N, Carbone I, Mandosi E, Vizza CD, et al. Chronic Inhibition of cGMP phosphodiesterase 5A improves diabetic cardiomyopathy: a randomized, controlled clinical trial using magnetic resonance imaging with myocardial tagging. Circulation. 2012;125:2323–33.

    Article  CAS  PubMed  Google Scholar 

  13. Nawras M, Beran A, Yazdi V, Hecht M, Lewis C. Phosphodiesterase inhibitor and selective serotonin reuptake inhibitor combination therapy versus monotherapy for the treatment of major depressive disorder: a systematic review and meta-analysis. Int Clin Psychopharmacol. 2023;38:261–8.

  14. Cao C, Yang L, Xu T, Cavazos-Rehg PA, Liu Q, McDermott D, et al. Trends in sexual activity and associations with all-cause and cause-specific mortality among US adults. J Sex Med. 2020;17:1903–13.

  15. Jian Z, Ye D, Chen Y, Li H, Wang K. Sexual activity and risk of prostate cancer: a dose-response meta-analysis. J Sex Med. 2018;15:1300–9.

    Article  PubMed  Google Scholar 

  16. Chavez AC, Coffield KS, Rajab MH, Jo C. Inicidence rate of prostate cancer in ment treated for erectile dysfyunction with phosphodiesterase type 5 inhibitors: retrospective analysis. Asian J Androl. 2013;15:246–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Mishra K, Bukavina L, Mahran A, Bobrow A, Buzzy CA, Jain N, et al. Variability in prices for erectile dysfunction medications-are all pharmacies the same? J Sex Med. 2018;15:1785–91.

    Article  PubMed  Google Scholar 

  18. Rew KT, Heidelbaugh JJ. Erectile dysfunction. Am Fam Physician. 2016;94:820–7.

    PubMed  Google Scholar 

  19. Cherney KH, T. 7 Effective erectile dysfunction medications and how they work. 2023:1–14. https://www.healthline.com/health/erectile-dysfunction/medication-list. Accessed 4 May 2023.

  20. Manalew WS, Hale N, Leinaar E, Sen B, Smith M, Khoury A. Medicaid cost savings from provision of contraception to beneficiaries in South Carolina, 2012–2018. Popul Health Manag. 2022;25:542–50.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

All of the data are from published articles. I thank the authors and participants of these studies.

Author information

Authors and Affiliations

  1. East Carolina University, Hazelwood, MO, USA

    Luke Curtis

Authors
  1. Luke Curtis
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

LC researched and wrote the entire commentary/paper by himself.

Corresponding author

Correspondence to Luke Curtis.

Ethics declarations

Competing interests

The author declares no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Curtis, L. Erectile dysfunction drugs are essential and probably life-saving and should be provided to all men who need them just as birth control should be provided to all women who need them. Int J Impot Res (2023). https://doi.org/10.1038/s41443-023-00736-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1038/s41443-023-00736-y

Search

Advanced search

Quick links