Erectile dysfunction may be twice as common in men with AS

Review study suggests problem is prevalent and quality research is needed

Patricia Inacio PhD avatar

by Patricia Inacio PhD |

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Men with ankylosing spondylitis (AS) are at a higher risk of erectile dysfunction than are healthy men in the general population, according to a meta-analysis of data covering nearly 400 people with AS.

“Conflicting results” are evident across the reviewed work, however, and “more high-quality studies are needed in the future to elicit the underlying mechanisms of ED [erectile dysfunction] in AS patients,” the researchers wrote.

The study, “Erectile dysfunction in ankylosing spondylitis: a systematic review and meta-analysis,” was published in the journal Sexual Medicine.

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AS is a type of arthritis characterized by inflammation of the sacroiliac joints, where the base of the spine (the sacrum) meets the pelvis (iliac bone). The disease is more common in men than women and symptoms typically begin in early adulthood, a period when people are sexually more active.

Past studies suggest a likelihood of problems with sexual function in men with AS. But the prevalence of erectile dysfunction, defined as a persistent or recurrent inability to achieve and/or maintain an erection, rarely has been reported. Existing reports involved small numbers of patients and lacked validated instruments to assess erectile function.

Researchers in China sought to address this knowledge gap by conducting a systematic review of studies published across several databases through late 2022.

From an initial pool of 351 studies, eight studies — covering a total of 393 AS patients — were included in the meta-analysis, after removing duplicated and unrelated studies. A meta-analysis is a type of study where data are pooled from multiple studies and analyzed collectively.

The overall prevalence of erectile dysfunction was 44%. Statistical analysis showed that men with AS were at significantly higher risk — 2.04 times higher — of developing erectile dysfunction when compared with healthy men.

These findings were confirmed with the International Index of Erectile Function (IIEF), a tool designed to assess erectile function.

Men with AS showed significantly lower IIEF scores than men in the general population, suggesting “that men with AS more frequently experienced ED than men without AS,” the researchers wrote.

Since reported results varied across studies, the researchers also compared them based on location (developing country vs. developed country), sample size, publication year, patients’ age, disease duration, and Bath ankylosing spondylitis disease activity index (BASDAI) score — a measure where higher scores indicate greater disease activity.

A study’s location, sample size (less than 50 patients versus 50 or more patients), and publication year (before or after 2010) did not affect the results.

The prevalence of erectile dysfunction was significantly higher in men ages 40 and older than in younger men, 53% vs. 41%, and in men living with AS for less than 10 years compared with men whose disease was diagnosed 10 or more years ago, 51% vs. 42%.

By disease activity, erectile dysfunction was significantly more prevalent among patients with less severe AS (BASDAI scores below 3) than in those with higher BASDAI scores, 58% vs. 36%.

Further analysis taking into account all these factors, however, did not show statistically significance differences, meaning findings could be due to chance.

Overall, these findings suggest a “high prevalence of ED in men with AS and that AS is a potential risk factor for ED,” the researchers wrote.

“Future studies with large samples and well-designed studies are needed to continue to explore this issue,” the team concluded.