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Is inflammatory bowel disease causing your erectile dysfunction?

A recent Scientific Reports study used Mendelian randomization (MR) trials to explore the causal link between erectile dysfunction (ED) and inflammatory bowel disease (IBD).



The study found a causal association between IBD and ED. Nevertheless, further research was needed to explore the potential mechanism of the causative relationship between IBD and ED.

Study: A Mendelian randomization study on causal effects of inflammatory bowel disease on the danger of erectile dysfunction. Image Credit: ciobanetre/Shutterstock.com

Background

IBD is a non-specific and chronic disease of the gastrointestinal tract. Ulcerative colitis (UC) and Crohn’s disease (CD) are its two fundamental subtypes.

The previous causes chronic inflammation of the mucosa of the colon and rectum, while the latter is related to the inflammation of the tissues of the whole gastrointestinal tract.

Abdominal pain, diarrhea, various extraintestinal manifestations, and weight reduction are ceaselessly experienced by IBD patients, which significantly hampers their quality of life. 

Research has shown that IBD could also influence sexual function. Patients of ED are unable to sustain or attain an erection for successful sexual activity. Although previous studies have demonstrated a correlation, the causal link between ED and IBD stays unclear. 

Concerning the study

The current study used MR trials to explore the causal link between ED and IBD. MR uses an instrumental variables (IV) approach and might eliminate the influence of reverse causality and confounding aspects.

For successful MR trials, certain conditions should be met, namely, the existence of a correlation between the exposure and the IV, the absence of a correlation between the IV and confounding variables, and the flexibility of the IV to affect the consequence through exposure solely.

Concerning IVs, single nucleotide polymorphisms (SNPs) are ceaselessly used. These genetic elements are, due to this fact, free from time, lifestyle, and the environment.

Genome-wide association studies (GWAS) were used to acquire data for this study, where ED was deemed an consequence factor and IBD was the exposure factor. 

Key findings

The MR analyses conducted here suggested that IBD indeed has a causal effect on ED. The subtype evaluation found that UC may not result in heightened ED risk, but CD could. Various sensitivity analyses established the robustness of those results. 

With respect to heterogeneity, no significant heterogeneity was noted between IBD and ED. Nevertheless, heterogeneity was noted within the UC subgroup.

The proven fact that UC may not cause ED was demonstrated through an inverse variance-weighted random-effects model. Moreover, no significant horizontal pleiotropy was observed.

Several studies have highlighted that IBD patients report the next prevalence of ED. Actually, one cross-sectional study of 208 IBD patients and 190 normal individuals showed that the IBD patients reported a prevalence of ED, which was 3 times that of normal subjects. This study moreover highlighted depression as an independent risk factor for ED.

One other related study documented that the prevalence of ED in IBD patients was as high as 30.3%. Contrary to those results, there exists not less than one other study that didn’t report an increased prevalence of ED amongst IBD patients in comparison with healthy controls. 

Despite the presence of many studies suggesting a possible correlation between IBD and ED risk, there have been no causal studies establishing the link between IBD and ED.

Furthermore, in lots of the cross-sectional studies, confounding aspects and reverse causality have made causal inference difficult. This study is the primary to determine a causal link between IBD and ED, and it could facilitate a greater understanding of the sexual intercourse in IBD patients.

Here, it was hypothesized that depression could also be a mediator for ED in IBD patients because, like most other chronic diseases, IBD adversely affects psychological health.

A further concern to take note is that IBD medications may cause ED, as evidenced by the cases of sulfasalazine-induced ED.

Stoma and rectal surgery are common surgical procedures for IBD, but there exists the danger of harm to pelvic nerves. This study avoided confounding aspects related to age, treatment, and mental state on account of the usage of MR trials. 

Conclusions

This study also has some limitations. The important thing limitation is that the information was sourced from GWAS, which comprises mainly European nationals. This raises questions on the generalizability of the findings and the extension to non-European populations.

Secondly, no mediation analyses were conducted despite the opportunity of mediating aspects.

Thirdly, an ED subtype evaluation couldn’t be performed on account of the dearth of knowledge. Finally, the outcomes might have been affected by the proven fact that the ratio of the overlapping subgroup was not sufficiently clear within the sample.

In sum, that is the primary study that documented a causal link between IBD and ED. Moreover, it was also shown that IBD and its subtype CD could lead on to an increased risk of ED, but this causal link couldn’t be established within the case of UC. Future research should deal with the underlying mechanisms through which IBD results in ED.

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