Impact of lifestyle on erectile dysfunction: literature review and educational recommendations
DOI:
https://doi.org/10.12775/QS.2024.22.54687Keywords
erectile dysfunction, risk factors, lifestyle modifications, physical activity, pharmacotherapyAbstract
Introduction: Erectile dysfunction (ED) represents a significant health problem that can have a negative impact on men's quality of life, intimate relationships and self-esteem. ED is a marker of overall health, requiring a comprehensive diagnostic and therapeutic approach. This article highlights the need for an integrated approach, in which lifestyle modifications are key to the successful treatment of erectile dysfunction.
Aim of the study: The aim of this article is to provide a comprehensive review of the literature on erectile dysfunction, with the intention of improving understanding of the condition and providing directions for future research and clinical practice.
Materials and methods: Electronic databases, including PubMed, Scopus, Web of Science, and Google Scholar, were searched to identify studies and literature reviews on erectile dysfunction (ED).
The state of knowledge: This review examines the epidemiology, pathophysiology, and risk factors associated with ED, emphasizing the importance of lifestyle in prevention and treatment. The role of diet, physical activity, weight reduction, smoking cessation, and alcohol restriction in improving erectile function is discussed. The article also presents current diagnostic and therapeutic approaches, including pharmacotherapy, alternative therapies and psychological interventions.
Conclusions: Erectile dysfunction (ED) is a complex health issue that necessitates a comprehensive and interdisciplinary diagnostic and therapeutic approach. Lifestyle plays a pivotal role in the prevention and treatment of ED, and its modification should be an integral component of any treatment plan.
References
Muneer A, Kalsi J, Nazareth I, Arya M. Erectile dysfunction BMJ 2014; 348 :g129 doi:10.1136/bmj.g129
Johansen P.P., Zwisler A.D., Hastrup-Svendsen J.et al. The CopenHeartSF trial—comprehensive sexual rehabilitation programme for male patients with implantable cardioverter defibrillator or ischaemic heart disease and impaired sexual function: protocol of a randomised clinical trial. BMJ Open 2013;311: e003967.
Hehemann M.C., Kashanian J.A.Can lifestyle modification affect men’s erectile function?Transl Androl Urol2016;52: 187- 194.
Miner MM, Kuritzky L. Erectile dysfunction: a sentinel marker for cardiovascular disease in primary care. Cleve Clin J Med. 2007;74(suppl 3):S30-S37.
Liu L.H., Zhang T., Zhang Y.R.et al. Metabolic syndrome and risk for ED: a meta-analysis. Int J Impot Res2014;265: 196- 200
Silva A.B., Sousa N., Azevedo L.F.et al. Physical activity and exercise for erectile dysfunction: systematic review and meta-analysis. Br J Sports Med2017;51: 1419- 1424
Eardley I. The incidence, prevalence, and natural history of erectile dysfunction. Sex Med Rev. 2013;1(1):3-16
Leoni, L. A. B., Fukushima, A. R., Rocha, L. Y., Maifrino, L. B. M. M., & Rodrigues, B. (2014). Physical activity on endothelial and erectile dysfunction: a literature review. The Aging Male, 17(3), 125–130. https://doi.org/10.3109/13685538.2014.923836
Bacon CG, Mittleman MA, Kawachi I, Giovannucci E, Glasser DB, Rimm EB. Sexual function in men older than 50 years of age: results from the health professionals follow-up study. Ann Intern Med. 2003;139(3):161-168.
Kendirci M, Nowfar S, Hellstrom WJ. The impact of vascular risk factors on erectile function. Drugs Today 2005;41:65–74
Panchatsharam PK, Durland J, Zito PM. Physiology, Erection. In: StatPearls. StatPearls Publishing, Treasure Island (FL); 2023. PMID: 30020650.
Annamaria Morelli, Sandra Filippi, Linda Vignozzi, Rosa Mancina, Mario Maggi, Physiology of Erectile Function: An Update on Intracellular Molecular Processes, EAU-EBU Update Series, Volume 4, Issue 3, 2006, Pages 96-108, ISSN 1871-2592, https://doi.org/10.1016/j.eeus.2006.03.003.
Shamloul R, Ghanem H. Erectile dysfunction Lancet. 2013;381:153–65
Calogero, A. E., Burgio, G., Condorelli, R. A., Cannarella, R., & La Vignera, S. (2018). Epidemiology and risk factors of lower urinary tract symptoms/benign prostatic hyperplasia and erectile dysfunction. The Aging Male, 22(1), 12–19. https://doi.org/10.1080/13685538.2018.1434772
Meldrum DR, Gambone JC, Morris MA, Meldrum DA, Esposito K, et al The link between erectile and cardiovascular health: the canary in the coal mine Am J Cardiol. 2011;108:599–606
Doumas M, Douma S. Sexual dysfunction in essential hypertension: myth or reality? J Clin Hypertens 2006;8:269–74
Montague DK, Jarow JP, Broderick GA, et al.; for the Erectile Dysfunction Guideline Update Panel. Chapter 1: The management of erectile dysfunction: an AUA update. J Urol. 2005;174(1):230-239
McVary KT. Clinical practice. Erectile dysfunction. N Engl J Med. 2007;357(24):2472
Jardin A, Wagner G, Khoury S, et al. Recommendations of the 1st International Consultation on Erectile Dysfunction. In: Jardin A, Wagner G, Khoury S, et al., eds. Erectile Dysfunction. Plymouth, U.K.: Health Publication Ltd, 2000:711–726.
Rosen RC, Cappelleri JC, Smith MD, Lipsky J, Peña BM. Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction. Int J Impot Res. 1999;11(6):319-326.
Carson CC, Lue TF. Phosphodiesterase type 5 inhibitors for erectile dysfunction. BJU Int. 2005;96(3):257-280
Esposito K, Giugliano F, Di Palo C, et al. Effect of lifestyle changes on erectile dysfunction in obese men: a randomized controlled trial. JAMA. 2004;291(24):2978-2984
Vardi M, Nini A. Phosphodiesterase inhibitors for erectile dysfunction in patients with diabetes mellitus. Cochrane Database Syst Rev. 2007;1:CD002187.
Goldstein I, Lue TF, Padma-Nathan H, Rosen RC, Steers WD, Wicker PA for the Sildenafil Study Group. Oral sildenafil in the treatment of erectile dysfunction [published correction appears in N Engl J Med. 1998;239(1):59]. N Engl J Med. 1998;338(20):1397-1404
Raja SG, Nayak SH. Sildenafil: emerging cardiovascular indications. Ann Thorac Surg 2004;78:1496–506
Kontaras K, Varnavas V, Kyriakides ZS. Does sildenafil cause myocardial infarction or sudden cardiac death? Am J Cardiovasc Drugs 2008;8:1–7
Lee TM, Chen CC, Chung TH, Chang NC. Effect of sildenafil on ventricular arrhythmias in post-infarcted rat hearts. Eur J Pharmacol 2012;690:124–32
Vlachopoulos C, Terentes-Printzios D, Ioakeimidis N, et al. PDE5 inhibitors in non-urological conditions. Curr Pharm Des 2009;15:3521–39
DeLay KJ, Haney N, Hellstrom WJ. Modifying risk factors in the management of erectile dysfunction: a review. World J Mens Health. 2016;34:89–100.
Jain P, Rademaker AW, McVary KT. Testosterone supplementation for erectile dysfunction: results of a meta-analysis. J Urol. 2000;164(2):371-375
Earle CM, Stuckey BG. Biochemical screening in the assessment of erectile dysfunction: what tests decide future therapy?. Urology. 2003;62(4):727-731
Boloña ER, Uraga MV, Haddad RM, et al. Testosterone use in men with sexual dysfunction: a systematic review and meta-analysis of randomized placebo-controlled trials. Mayo Clin Proc. 2007;82(1):20-28
Leisegang, K., & Finelli, R. (2021). Alternative medicine and herbal remedies in the treatment of erectile dysfunction: A systematic review. Arab Journal of Urology, 19(3), 323–339. https://doi.org/10.1080/2090598X.2021.1926753
Hong B, Ji YH, Hong JH, Nam KY, Ahn TY. A double-blind crossover study evaluating the efficacy of korean red ginseng in patients with erectile dysfunction: a preliminary report. J Urol. 2002;168(5):2070-2073
Rosen RC. Psychogenic erectile dysfunction. Classification and management. Urol Clin North Am. 2001;28(2):269-278
Melnik T, Soares BGO, Nasselo AG. Psychosocial interventions for erectile dysfunction. Cochrane Database Syst Rev. 2007;3:CD004825
Makhlouf A, Kparker A, Niederberger CS. Depression and erectile dysfunction. Urol Clin North Am. 2007;34(4):565-574
Larsen SH, Wagner G, Heitmann BL. Sexual function and obesity Int J Obes (Lond). 2007;31:1189–98
Esposito K, Giugliano D. Obesity, the metabolic syndrome, and sexual dysfunction in men Clin Pharmacol Ther. 2011;90:169–73
Wang F, Dai S, Wang M, Morrison H. Erectile dysfunction and fruit/vegetable consumption among diabetic Canadian men Urology. 2013;82:1330–5
Giugliano F, Maiorino MI, Bellastella G, Autorino R, De Sio M, et al Adherence to Mediterranean diet and erectile dysfunction in men with type 2 diabetes J Sex Med. 2010;7:1911–7
Esposito K, Giugliano F, De Sio M, Carleo D, Di Palo C, et al Dietary factors in erectile dysfunction Int J Impot Res. 2006;18:370–4
Lopez-Garcia E, Hu FB. Nutrition and the endothelium Curr Diab Rep. 2004;4:253–9
Esposito K, Giugliano D. Diet and inflammation: a link to metabolic and cardiovascular diseases Eur Heart J. 2006;27:15–20
Johannes CB, Araujo AB, Feldman HA, Derby CA, Kleinman KP, McKinlay JB. Incidence of erectile dysfunction in men 40 to 69 years old: longitudinal results from the Massachusetts male aging study. J Urol. 2000;163(2):460-463
Polsky JY, Aronson KJ, Heaton JP, Adams MA. Smoking and other lifestyle factors in relation to erectile dysfunction BJU Int. 2005;96:1355–9
Kupelian V, Link CL, McKinlay JB. Association between smoking, passive smoking, and erectile dysfunction: results from the Boston Area Community Health (BACH) Survey Eur Urol. 2007;52:416–22
Harte CB, Meston CM. Association between smoking cessation and sexual health in men BJU Int. 2012;109:888–96
Kalter-Leibovici O, Wainstein J, Ziv A, Harman-Bohem I, Murad H, et al Clinical, socioeconomic, and lifestyle parameters associated with erectile dysfunction among diabetic men Diabetes Care. 2005;28:1739–44
Cheng JY, Ng EM, Chen RY, Ko JS. Alcohol consumption and erectile dysfunction: meta-analysis of population-based studies Int J Impot Res. 2007;19:343–52
Meldrum DR, Gambone JC, Morris MA, Esposito K, Giugliano D, et al Lifestyle and metabolic approaches to maximizing erectile and vascular health Int J Impot Res. 2012;24:61–8
Meldrum DR, Burnett AL, Dorey G, Esposito K, Ignarro LJ. Erectile hydraulics: maximizing inflow while minimizing outflow J Sex Med. 2014;11:1208–20
Esposito K, Ciotola M, Giugliano F, Maiorino MI, Autorino R, et al Effects of intensive lifestyle changes on erectile dysfunction in men J Sex Med. 2009;6:243–50
Van Craenenbroeck EM, Conraads VM. Endothelial progenitor cells in vascular health: focus on lifestyle Microvasc Res. 2010;79:184–92
Cooney GM, Dwan K, Greig CA, Lawlor DA, Rimer J, et al Exercise for depression Cochrane Database Syst Rev. 2013;9:CD004366 doi: 10.1002/14651858
Cornelissen VA, Fagard RH. Effects of endurance training on blood pressure, blood pressure-regulating mechanisms, and cardiovascular risk factors. Hypertension. 2005; 46: 667–675.
Durstine JL, Grandjean PW, Davis PG, Ferguson MA, Alderson NL, DuBose KD. Blood lipid and lipoprotein adaptations to exercise: a quantitative analysis. Sports Med. 2001; 31: 1033–1062.
Hamer M.. The relative influences of fitness and fatness on inflammatory factors. Prev Med. 2007; 44: 3–11.
Nelson ME, Rejeski WJ, Blair SN, Duncan PW, Judge JO, King AC, Macera CA, Castaneda-Sceppa C.; American College of Sports Medicine; American Heart Association. Physical activity and public health in older adults: Recommendation from the American College of Sports Medicine and the American Heart Association. Circulation. 2007; 116: 1094–105.
Autenrieth C., Schneider A., Döring A., Meisinger C., Herder C., Koenig W., Huber G., Thorand B.. Association between different domains of physical activity and markers of inflammation. Med Sci Sports Exerc. 2009; 41: 1706–1713.
Cheng JY, Ng EM, Ko JS, Chen RY. Physical activity and erectile dysfunction: meta-analysis of population-based studies Int J Impot Res. 2007;19:245–52
Feldman HA, Johannes CB, Derby CA, Kleinman KP, Mohr BA, et al Erectile dysfunction and coronary risk factors: prospective results from the Massachusetts male aging study Prev Med. 2000;30:328–38
Bacon CG, Mittleman MA, Kawachi I, Giovannucci E, Glasser DB, et al A prospective study of risk factors for erectile dysfunction J Urol. 2006;176:217–21
Ponholzer A, Temml C, Mock K, Marszalek M, Obermayr R, et al Prevalence and risk factors for erectile dysfunction in 2869 men using a validated questionnaire Eur Urol. 2005;47:80–5
Helle Gerbild, Camilla Marie Larsen, Christian Graugaard, Kristina Areskoug Josefsson, Physical Activity to Improve Erectile Function: A Systematic Review of Intervention Studies, Sexual Medicine, Volume 6, Issue 2, June 2018, Pages 75–89, https://doi.org/10.1016/j.esxm.2018.02.001
Mingming Zhang, Zichun Wang, Wanpeng Liu, Minglei Wang, Huaying Wu, Ruihua An, (2024) Association between the recommended volume of leisure-time physical activity and erectile dysfunction: A cross-sectional analysis of the national health and nutrition examination survey, 2001–2004, Heliyon, Volume 10, Issue 12, e32884, ISSN 2405-8440, https://doi.org/10.1016/j.heliyon.2024.e32884
La Vignera, S., Condorelli, R., Vicari, E., D’agata, R., & Calogero, A. (2011). Aerobic physical activity improves endothelial function in the middle-aged patients with erectile dysfunction. The Aging Male, 14(4), 265–272. https://doi.org/10.3109/13685538.2010.544344
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Konrad Wawszkowicz, Liliana Dyląg, Magdalena Graca, Kinga Szopińska, Weronika Łowicka, Anna Szeliga, Agata Szostak, Karolina Korta, Karolina Oluszczak, Maria Janina Śmigielska-Mikołajczyk

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 119
Number of citations: 0