madman
Super Moderator
Abstract
Men with anxiety disorders have been identified as high risk of developing erectile dysfunction (ED). The aim of this review is to define the prevalence and severity of ED in the male anxiety disorder population. A literature search of three electronic databases (PubMed, Embase, and PsychINFO) and a grey literature registry were conducted. Inclusion criteria were studies that investigated adult males, documented diagnosis of anxiety disorders made by a qualified psychiatrist, and use of a validated tool to diagnose ED such as the International Index of Erectile Function or ICD-10/DSM-IV. The search yielded 1220 articles and 12 studies were selected. The anxiety disorders investigated were post-traumatic stress disorder, obsessive–compulsive disorder, social phobia/social anxiety disorder, and panic disorder. We found that the median [IQR] prevalence of ED was 20.0 [5.1–41.2]% and the median [IQR] International Index of Erectile Function-5 scores were 17.62 [13.88–20.88], indicating a mild to moderate severity. Our review suggests a high prevalence of ED in the anxiety disorder population and ED may be more severe in this cohort, therefore advocating this is an important clinical topic. However, the evidence is limited due to the high heterogeneity between the studies and more research is required in this field.
Introduction
Erectile dysfunction (ED) is the inability to achieve or maintain a penile erection satisfactory for sexual intercourse [1]. ED has both organic and psychogenic causes; the mechanism of how psychogenic factors such as anxiety and depression leads to ED is not fully understood. Psychiatric illness has been associated with sexual dysfunctions in both men and women, this could be through the mental health of the disorder itself or the psychotropic medications used to treat them [2].
ED has a substantial effect on the quality of life and patients’ well-being. Many studies have shown that the psychological impact of ED is greater in men with greater erectile impairment [3]. Men with ED tend to have lower self-esteem and poorer satisfaction for sexual activity thereby making them prone to have anxiety and depression [3]. The presence of anxiety disorders in the ED population has been reported to be up to 37%, in addition, ED has also been associated with free-floating anxiety [4]. The role of anxiety in ED has not been clearly established, however, it is proposed that anxiety contributes to a vicious cycle that impairs the sexual relationship between the patient and partner resulting in communication problems, which further impede sexual functioning [5]. It is also suggested that a small level of anxiety contributes to the physiologically normal sexual cycle especially during the arousal stages, this is thought to be because there is an overlap of features between arousal and the typical anxiety response such as tachycardia and excess sweating [6, 7].
There have been other reviews that look at ED and other mental conditions like depression [8], however, there has not been any review evaluating the association between anxiety and ED. Both ED and anxiety disorders have been underdiagnosed in primary care [9, 10]. This makes the patients suffering from these conditions at a higher risk of having a low quality of life, as they are less likely to be identified and be given the care and support they need. Therefore, this review was proposed to explore the link between these conditions.
This systematic review, therefore, aims to (1) define the prevalence of ED in people with anxiety disorders and (2) identify the severity of ED symptoms in this cohort.
Discussion
To our knowledge, this is the first systematic review to evaluate the prevalence of ED in anxiety disorders as a whole. Previous reviews have focused on a single anxiety disorder; however, we provide an overview of the spectrum of anxiety disorders [32, 33]. We identified a high prevalence of ED in patients with anxiety disorders, with a median value of 20%. There was, however, a wide range of estimates identified, likely secondary to the diverse methodology utilized in included studies. Additionally, this reflects the findings in the literature of the prevalence of ED as a whole, which varies widely, depending on age and how the diagnosis is made [33, 34].
*The findings of this review suggest that the anxiety disorder populations are at a higher risk of developing ED. The role of anxiety in sexual functioning in this population has not been clearly established but it is thought that an abnormal anxiety response causes an increase in sympathetic tone, resulting in a distraction from erotic stimuli leading to impaired arousal and erection [4]. Therefore, in psychiatric practice and in primary care clinicians must routinely screen for sexual dysfunction in patients with anxiety disorders and refer them to urology to attain the right support they need, especially if they exhibit some of the common risk factors of both conditions such as using psychotropics. In this case, clinicians should evaluate baseline erectile function before commencing anxiety disorder patients on any psychotropic medications and adjust the dosages appropriately, this could increase adherence to the medication, while not compromising their quality of life [42]. Overall, the significance of the findings in this review is that caring for patients with ED and anxiety requires a multidisciplinary approach requiring psychiatric clinicians to work together with the urology team to attain the best outcomes for the patient.
Conclusion
Our review identified a high prevalence of ED in the anxiety disorder population and evidence that suggest ED may be more severe in this population, therefore this advocates that this is an important clinical topic. However, the evidence is limited because of the high heterogeneity between the study populations of the papers. More research is required to help improve patient care in this population. Literature suggests that men with anxiety disorders may exhibit risk factors for ED, but it is hard to say whether anxiety disorder alone is a risk factor for ED. For future research, it would be good to eliminate potential confounders and risk factors of ED, therefore, using treatment-naive populations with a singular psychiatric diagnosis of an anxiety disorder in a cross-sectional study measuring ED using a validated tool like the IIEF-5 on a large sample of anxiety disorder participants encompassing these factors mentioned earlier will give a good idea about the true prevalence and the severity of ED in this population.
Men with anxiety disorders have been identified as high risk of developing erectile dysfunction (ED). The aim of this review is to define the prevalence and severity of ED in the male anxiety disorder population. A literature search of three electronic databases (PubMed, Embase, and PsychINFO) and a grey literature registry were conducted. Inclusion criteria were studies that investigated adult males, documented diagnosis of anxiety disorders made by a qualified psychiatrist, and use of a validated tool to diagnose ED such as the International Index of Erectile Function or ICD-10/DSM-IV. The search yielded 1220 articles and 12 studies were selected. The anxiety disorders investigated were post-traumatic stress disorder, obsessive–compulsive disorder, social phobia/social anxiety disorder, and panic disorder. We found that the median [IQR] prevalence of ED was 20.0 [5.1–41.2]% and the median [IQR] International Index of Erectile Function-5 scores were 17.62 [13.88–20.88], indicating a mild to moderate severity. Our review suggests a high prevalence of ED in the anxiety disorder population and ED may be more severe in this cohort, therefore advocating this is an important clinical topic. However, the evidence is limited due to the high heterogeneity between the studies and more research is required in this field.
Introduction
Erectile dysfunction (ED) is the inability to achieve or maintain a penile erection satisfactory for sexual intercourse [1]. ED has both organic and psychogenic causes; the mechanism of how psychogenic factors such as anxiety and depression leads to ED is not fully understood. Psychiatric illness has been associated with sexual dysfunctions in both men and women, this could be through the mental health of the disorder itself or the psychotropic medications used to treat them [2].
ED has a substantial effect on the quality of life and patients’ well-being. Many studies have shown that the psychological impact of ED is greater in men with greater erectile impairment [3]. Men with ED tend to have lower self-esteem and poorer satisfaction for sexual activity thereby making them prone to have anxiety and depression [3]. The presence of anxiety disorders in the ED population has been reported to be up to 37%, in addition, ED has also been associated with free-floating anxiety [4]. The role of anxiety in ED has not been clearly established, however, it is proposed that anxiety contributes to a vicious cycle that impairs the sexual relationship between the patient and partner resulting in communication problems, which further impede sexual functioning [5]. It is also suggested that a small level of anxiety contributes to the physiologically normal sexual cycle especially during the arousal stages, this is thought to be because there is an overlap of features between arousal and the typical anxiety response such as tachycardia and excess sweating [6, 7].
There have been other reviews that look at ED and other mental conditions like depression [8], however, there has not been any review evaluating the association between anxiety and ED. Both ED and anxiety disorders have been underdiagnosed in primary care [9, 10]. This makes the patients suffering from these conditions at a higher risk of having a low quality of life, as they are less likely to be identified and be given the care and support they need. Therefore, this review was proposed to explore the link between these conditions.
This systematic review, therefore, aims to (1) define the prevalence of ED in people with anxiety disorders and (2) identify the severity of ED symptoms in this cohort.
Discussion
To our knowledge, this is the first systematic review to evaluate the prevalence of ED in anxiety disorders as a whole. Previous reviews have focused on a single anxiety disorder; however, we provide an overview of the spectrum of anxiety disorders [32, 33]. We identified a high prevalence of ED in patients with anxiety disorders, with a median value of 20%. There was, however, a wide range of estimates identified, likely secondary to the diverse methodology utilized in included studies. Additionally, this reflects the findings in the literature of the prevalence of ED as a whole, which varies widely, depending on age and how the diagnosis is made [33, 34].
*The findings of this review suggest that the anxiety disorder populations are at a higher risk of developing ED. The role of anxiety in sexual functioning in this population has not been clearly established but it is thought that an abnormal anxiety response causes an increase in sympathetic tone, resulting in a distraction from erotic stimuli leading to impaired arousal and erection [4]. Therefore, in psychiatric practice and in primary care clinicians must routinely screen for sexual dysfunction in patients with anxiety disorders and refer them to urology to attain the right support they need, especially if they exhibit some of the common risk factors of both conditions such as using psychotropics. In this case, clinicians should evaluate baseline erectile function before commencing anxiety disorder patients on any psychotropic medications and adjust the dosages appropriately, this could increase adherence to the medication, while not compromising their quality of life [42]. Overall, the significance of the findings in this review is that caring for patients with ED and anxiety requires a multidisciplinary approach requiring psychiatric clinicians to work together with the urology team to attain the best outcomes for the patient.
Conclusion
Our review identified a high prevalence of ED in the anxiety disorder population and evidence that suggest ED may be more severe in this population, therefore this advocates that this is an important clinical topic. However, the evidence is limited because of the high heterogeneity between the study populations of the papers. More research is required to help improve patient care in this population. Literature suggests that men with anxiety disorders may exhibit risk factors for ED, but it is hard to say whether anxiety disorder alone is a risk factor for ED. For future research, it would be good to eliminate potential confounders and risk factors of ED, therefore, using treatment-naive populations with a singular psychiatric diagnosis of an anxiety disorder in a cross-sectional study measuring ED using a validated tool like the IIEF-5 on a large sample of anxiety disorder participants encompassing these factors mentioned earlier will give a good idea about the true prevalence and the severity of ED in this population.
