Early endothelial dysfunction as a marker of vasculogenic erectile dysfunction in young habitual cannabis users

Abstract

Aim of the study was to evaluate whether endothelial dysfunction is a marker of erectile dysfunction (ED) in recreational drug abuse. Sixty-four non-consecutive men complaining of ED from at least 3 months were included. All patients underwent detailed history about recreational drug abuse and were then submitted to dynamic penile duplex ultrasound (PDU). According to pharmaco-stimulated peak systolic velocity (PSV) cutoff at 35 cm s À1 , patients were divided into two groups: organic (O; n ¼ 30) and non-organic (NO; n ¼ 34) ED. All subjects and 7 healthy age-matched subjects as controls, underwent veno-occlusive plethysmography (VOP) for the evaluation of endothelium-dependent dilatation of brachial arteries. Blood pressure, total and free testosterone, prolactin, estradiol, low-density lipoprotein and high-density lipoprotein cholesterol were also evaluated; patients were classified with regard to insulin resistance through the HOMA-IR index. Cannabis smoking was more frequent in O-ED vs NO-ED (78% vs 3%, Po0.001) in the absence of any concomitant risk factor or comorbidity for ED. VOP studies revealed impaired endotheliumdependent vasodilatation in O-ED but not in NO-ED and controls (12±6 vs 32±4 and 34 ± 5 ml min À1 , respectively; P ¼ 0.003). Overall patients showed a direct relationship between HOMA-IR and PSV (r 2 ¼ 0.47, Po0.0001), which was maintained in men with organic ED (r 2 ¼ 0.62, Po0.0001). In cannabis consumers, a direct relationship between HOMA-IR and VOP was also found (r 2 ¼ 0.74, Po0.0001). Receiver-operating characteristic (ROC) curve analysis revealed that VOP values below 17.22 ml min À1 were suggestive for vasculogenic ED. We conclude that early endothelial damage may be induced by chronic cannabis use (and endocannabinoid system activation); insulin resistance may be the hallmark of early endothelial dysfunction and may concur to determine vascular ED in the absence of obesity. Further studies are warranted to establish a direct relationship between cannabis abuse, onset of insulin resistance and development of vascular ED.

Marijuana, phytocannabinoids, the endocannabinoid system, and male fertility

“…Similarly, it was also showed in another recent study that chronic cannabis consumption can cause vascular ED in young habitual cannabis users through its effect on endothelial function [126]. However, no link between frequency of cannabis use and trouble keeping an erection was reported in a study where 4350 men were screened for the use of cannabis and its sexual effects [127].…”

Sexual dysfunction in men diagnosed as substance use disorder

“…Cohen (1982) compared the prevalence of ED in daily cannabis users and a male control group and reported an ED rate in the cannabis users more than double that in the controls. Similarly, another study showed that chronic cannabis consumption can cause vascular ED via its effect on endothelial function (Aversa et al, 2008). Abel (1981) concluded in a review of cannabis and sexuality that a small amount of cannabis can enhance sexual pleasure, but larger quantities can diminish sexual desire.…”

Sexual Dysfunctions Among Young Men: Prevalence and Associated Factors

“…PE is described to be linked with high alcohol consumption and former smoking [8]. ED is reported to be linked not only with alcohol and tobacco use [22] but also with cannabis [23]. The role of other illegal drugs is complex because they are supposed to increase not only ED but also ejaculation latency [24].…”