Erectile Dysfunction in Systemic Sclerosis

Abstract

Erectile dysfunction (ED) is a major issue in systemic sclerosis (SSc) as it is observed in around 80 to 90 % of men with this connective tissue disease. ED greatly impacts the quality of life and should be actively addressed as a common complication. Whereas ED in the general population is usually associated with risk factors for atherosclerosis as well as cardiovascular disease, the main aetiology of ED in SSc is microangiopathic. In SSc, the blood flow is reduced in the small penile arteries due to corporal fibrosis and myointimal proliferation. There are no data on the prevention of ED in SSc. On-demand phosphodiesterase-5 inhibitors have little effect in improving erectile function, but daily or alternate day regimens of long-acting phosphodiesterase-5 inhibitors provide a measurable, although often limited, benefit. When intracavernous prostaglandin E1 injections are also ineffective, the implantation of a penile prosthesis should be considered as an option.

Sexual Dysfunction in Patients with Systemic Sclerosis

“…There are also risk factors that are presented in non-SSc men as well, like older age or alcohol consumption. The ED association with more severe diseases in terms of worse skin involvement, elevated pulmonary arterial pressures, presence of restrictive lung disease, and muscular and renal involvement in SSc patients was also confirmed [5,12,13,59].…”

“…Sexual dysfunction in men has been given more attention than female sexual dysfunction, and the etiology is more obvious compared to women. Erectile dysfunction is a result of microangiopathic changes, when the blood flow is reduced in the small penile arteries due to corporal fibrosis and myointimal proliferation [5]. It was proven that damage of the penile cavernous arteries occurs in almost all SSc patients regardless of clinical symptoms.…”

“…Other causes such as hormonal abnormalities or neurological causes have not been confirmed. No disturbances have been found in follicle-stimulating hormone, luteinizing hormone, serum testosterone, prolactin, estradiol, and thyroid hormones in SSc patients [5,11,59,60].…”

“…The choice of a PDE5-I depends on the frequency of intercourse and the patient's personal experience [64,65]. However, research on the efficacy of PDE-5 inhibitors is very limited in SSc patients [5]. Proietti et al reported that once-daily tadalafil improved both erectile function and vascular measures of cavernous arteries in men with SScrelated erectile dysfunction.…”

“…Impaired sexual functioning in women was probably less studied due to the complexity and multifactorial nature of female sexual response. A little bit more attention was paid to erectile dysfunction, where etiology is more pronounced even though women are affected by this disease more often [3][4][5]. The etiology of sexual dysfunctions in systemic sclerosis is not well known; the causes are multifactorial and are related to both the disease symptoms and the therapy.…”