madman
Super Moderator
Abstract
Erectile dysfunction (ED) seems to be a widespread sexual issue in men affected by the chronic obstructive pulmonary disease (COPD). Multiple causes appear to be involved such as hormonal imbalance, smoking habit, chronic inflammation, endothelial dysfunction, chronic hypoxia, psychiatric disorders (depression and anxiety), and medications. ED can have a significant impact on COPD men and consequently on their quality of life, which is usually already compromised. Given this situation, however, pneumologists usually do not properly care for the sexuality of COPD patients especially because men can be reluctant to talk about their intimate issues. The aim of this narrative review is to briefly summarize the evidence emerging from literature and to provide a wide point of view about sexual dysfunction in COPD men.
1. Introduction
Chronic obstructive pulmonary disease (COPD) is a common, preventable, and treatable disorder. It is characterized by persistent respiratory symptoms and airflow limitation due to airway and/or alveolar abnormalities [1]. Alarmingly, COPD is now the third leading cause of death globally [2]. This disease occurs as a result of long-term exposure to harmful particles or gases (mainly cigarette smoke) that leads to an increased inflammatory response in the airways [1]. These noxious factors cause chronic lung inflammation that progressively extends to systemic involvement. The natural history of the disease is characterized by progressive worsening of respiratory function. Sometimes disease exacerbations occur, with acute dyspnea and respiratory distress that can accelerate disease progression and result in hospital admission and death [3]. Furthermore, considering COPD is a systemic disease, it is accompanied by impactful comorbidities, such as cardiovascular diseases, cachexia, skeletal muscle dysfunction and loss, osteoporosis, anemia, obstructive sleep apnea, lung cancer, diabetes mellitus, metabolic syndrome, depression, and anxiety [1,4,5]. This overall situation negatively affects the quality of life (QoL) of patients with COPD [6,7].
Erectile dysfunction (ED) is defined as the inability to achieve or maintain an erection that is sufficient for satisfactory sexual performance [8]. It is a common medical disorder that primarily affects men older than 40 years and it progressively worsens with age [8]. In more than 80% of cases, ED is related to an organic etiology. Findings from several cross-sectional and longitudinal studies have linked the development of ED to an unhealthy lifestyle (smoking, obesity, and limited physical exercise [9–11]) and to conditions such as diabetes mellitus, hypertension, hyperlipidemia, metabolic syndrome, depression, and lower urinary tract symptoms [12,13].
In COPD patients, the presence of endothelial dysfunction, smoking, chronic hypoxia, cardiovascular comorbidities, hormonal imbalance, and mood disorders related to status and medications can limit the pursuance of penile erection and subsequently lead to an unsatisfactory sexual life [14,15]. This issue can impair overall QoL, a parameter often compromised in COPD men [16,17].
In a pneumological setting, little time of the examination is dedicated to sexual issues, even though the latest guidelines consider an assessment of sexual activity as a necessary part of the evaluation in COPD men [1]. Unfortunately, these guidelines do not include ED as one of the possible comorbidities of COPD [18]. A previous study demonstrated that 87% of patients with COPD do not discuss their sexual problems with their physicians and that 78% do not share them with their wives [19]. Moreover, sexuality is still a taboo subject, especially in some Asian cultures, where sexual issues are an improper topic. For example, in Korea, only 2% of men discuss their intimate issues [20].
At the present, few studies have investigated ED in patients with COPD, and this topic remains a neglected area of research.
The aim of this narrative review is to investigate sexual function and ED in COPD men.
2. Sexual Function in COPD Patients
3. ED and COPD Men
4. Pathogenesis of ED in COPD
4.1. Hormonal Factor
4.2. Vascular Factor
4.3. Psychological Factor
4.4. Medications: Possible Influence on ED
5. Management of ED in COPD Men
6. Conclusions and Perspectives
Sexual dysfunction is a common finding in COPD men. Hypoxemia, smoking, lower testosterone levels, cardiovascular diseases, limitation of physical activity, and psychological distress are thought to be the foremost mechanisms associated with ED in these patients. The presence of ED negatively affects the functional capacity and QoL in COPD men.
Sexual dysfunctions cannot be treated until a proper history defines the problem. Open communication between the physician and the patient is essential for the successful management of the issue. However, sexual history is usually neglected or avoided as healthcare professionals are poorly trained to obtain it. Greater knowledge of this topic among physicians may help COPD patients to cope with the impact of the disease not only in their daily lives but also in their sexuality. This may improve overall QoL.
Furthermore, additional studies are needed to assess the most appropriate therapeutic strategies to improve sexual function in these men.
Erectile dysfunction (ED) seems to be a widespread sexual issue in men affected by the chronic obstructive pulmonary disease (COPD). Multiple causes appear to be involved such as hormonal imbalance, smoking habit, chronic inflammation, endothelial dysfunction, chronic hypoxia, psychiatric disorders (depression and anxiety), and medications. ED can have a significant impact on COPD men and consequently on their quality of life, which is usually already compromised. Given this situation, however, pneumologists usually do not properly care for the sexuality of COPD patients especially because men can be reluctant to talk about their intimate issues. The aim of this narrative review is to briefly summarize the evidence emerging from literature and to provide a wide point of view about sexual dysfunction in COPD men.
1. Introduction
Chronic obstructive pulmonary disease (COPD) is a common, preventable, and treatable disorder. It is characterized by persistent respiratory symptoms and airflow limitation due to airway and/or alveolar abnormalities [1]. Alarmingly, COPD is now the third leading cause of death globally [2]. This disease occurs as a result of long-term exposure to harmful particles or gases (mainly cigarette smoke) that leads to an increased inflammatory response in the airways [1]. These noxious factors cause chronic lung inflammation that progressively extends to systemic involvement. The natural history of the disease is characterized by progressive worsening of respiratory function. Sometimes disease exacerbations occur, with acute dyspnea and respiratory distress that can accelerate disease progression and result in hospital admission and death [3]. Furthermore, considering COPD is a systemic disease, it is accompanied by impactful comorbidities, such as cardiovascular diseases, cachexia, skeletal muscle dysfunction and loss, osteoporosis, anemia, obstructive sleep apnea, lung cancer, diabetes mellitus, metabolic syndrome, depression, and anxiety [1,4,5]. This overall situation negatively affects the quality of life (QoL) of patients with COPD [6,7].
Erectile dysfunction (ED) is defined as the inability to achieve or maintain an erection that is sufficient for satisfactory sexual performance [8]. It is a common medical disorder that primarily affects men older than 40 years and it progressively worsens with age [8]. In more than 80% of cases, ED is related to an organic etiology. Findings from several cross-sectional and longitudinal studies have linked the development of ED to an unhealthy lifestyle (smoking, obesity, and limited physical exercise [9–11]) and to conditions such as diabetes mellitus, hypertension, hyperlipidemia, metabolic syndrome, depression, and lower urinary tract symptoms [12,13].
In COPD patients, the presence of endothelial dysfunction, smoking, chronic hypoxia, cardiovascular comorbidities, hormonal imbalance, and mood disorders related to status and medications can limit the pursuance of penile erection and subsequently lead to an unsatisfactory sexual life [14,15]. This issue can impair overall QoL, a parameter often compromised in COPD men [16,17].
In a pneumological setting, little time of the examination is dedicated to sexual issues, even though the latest guidelines consider an assessment of sexual activity as a necessary part of the evaluation in COPD men [1]. Unfortunately, these guidelines do not include ED as one of the possible comorbidities of COPD [18]. A previous study demonstrated that 87% of patients with COPD do not discuss their sexual problems with their physicians and that 78% do not share them with their wives [19]. Moreover, sexuality is still a taboo subject, especially in some Asian cultures, where sexual issues are an improper topic. For example, in Korea, only 2% of men discuss their intimate issues [20].
At the present, few studies have investigated ED in patients with COPD, and this topic remains a neglected area of research.
The aim of this narrative review is to investigate sexual function and ED in COPD men.
2. Sexual Function in COPD Patients
3. ED and COPD Men
4. Pathogenesis of ED in COPD
4.1. Hormonal Factor
4.2. Vascular Factor
4.3. Psychological Factor
4.4. Medications: Possible Influence on ED
5. Management of ED in COPD Men
6. Conclusions and Perspectives
Sexual dysfunction is a common finding in COPD men. Hypoxemia, smoking, lower testosterone levels, cardiovascular diseases, limitation of physical activity, and psychological distress are thought to be the foremost mechanisms associated with ED in these patients. The presence of ED negatively affects the functional capacity and QoL in COPD men.
Sexual dysfunctions cannot be treated until a proper history defines the problem. Open communication between the physician and the patient is essential for the successful management of the issue. However, sexual history is usually neglected or avoided as healthcare professionals are poorly trained to obtain it. Greater knowledge of this topic among physicians may help COPD patients to cope with the impact of the disease not only in their daily lives but also in their sexuality. This may improve overall QoL.
Furthermore, additional studies are needed to assess the most appropriate therapeutic strategies to improve sexual function in these men.
