Erectile Dysfunction in Patients with Multiple Chronic Conditions: A Cross-Sectional Study

Background The prevalence of erectile dysfunction (ED) rises with the number and severity of chronic diseases. Aims This cross-sectional study assessed the frequency and severity of ED in patients with multiple chronic conditions. Methods The 5-item International Index of Erectile Function questionnaire (IIEF-5) to diagnose and classify ED. The Charlson Comorbidity Index (CCI) was used to assess the burden of chronic comorbidity. The primary outcome was to assess the ED frequency according to CCI severity. The secondary outcomes included the assessment of correlation between 1) IIEF-5 and total testosterone (TT), 2) CCI and TT, 3) IIEF-5 and CCI. Lastly, the CCI and modified CCI (mCCI) performance were compared with each other. Results The overall frequency of ED increased along with the CCI score severity: 45% for CCI=0; 95% for CCI=1; 91% for CCI=2; 99% for CCI≥3 (p<.0001). CCI correlated negatively with TT levels and IIEF-5 score (r=-0.34 and -0.44; p<.0001). Compared to the CCI, a novel proposed mCCI performs well. Discussion The frequency and severity of ED are relevant in outpatients with sexual complaints and those with chronic comorbidities. Despite limitations, mCCI may be considered a reliable tool to assess the overall burden of multiple chronic conditions in patients with comorbidities. Conclusion ED is a reliable proxy of overall male health. Further studies are needed to confirm this potential application.