Liver, Pancreas and Biliary Tract| Volume 51, ISSUE 6, P843-849, June 2019

Download started.


Erectile dysfunction in compensated liver cirrhosis

Published:October 29, 2018DOI:



      Data on erectile dysfunction (ED) in cirrhotic patients are limited as yet. Aim of this study was to investigate the prevalence of ED and the factors potentially involved in its development in compensated cirrhosis.


      We prospectively enrolled 102 male (mean age 63 ± 10 years) affected by cirrhosis in Child–Pugh Class A. The following questionnaires were used: simplified International Index of Erectile Function (IIEF-5) Questionnaire, Centre of Epidemiologic Studies Depression Scale and ANDROTEST.


      ED was found in 57/102(55.9%) patients, and was mild, moderate and severe in 21(36.8%), 6(10.5%) and 30(52.6%) subjects, respectively. ED patients were significantly older than those without (66 ± 10 vs 60 ± 10,p = 0.006); ED prevalence gradually increased with age. There was no statistically significant difference between patients with and without ED concerning the coexistence of diabetes, hypertension, and cardiovascular disease. Age(p = 0.040) and serum haemoglobin(p = 0.027) were identified as predictors of ED on multivariate analysis. Liver-related factors and pharmacological treatment, including β-blockers, were not associated with the presence of ED.


      In patients with compensated liver cirrhosis, even in concomitance with other chronic comorbidities, the prevalence of ED is not markedly different from the general population. Compensated cirrhosis per se is not a risk factor for ED occurrence. Older age and low haemoglobin values are significantly associated with ED in cirrhotics.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Digestive and Liver Disease
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Shamloul R.
        • Ghanem H.
        Erectile dysfunction.
        Lancet. 2013; 381: 153-165
        • Booth F.W.
        • Roberts C.K.
        • Laye M.J.
        Lack of exercise is a major cause of chronic diseases.
        Compr Physiol. 2012; 2: 1143-1211
        • Rosen R.C.
        • Riley A.
        • Wagner G.
        • et al.
        The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction.
        Urology. 1997; 49: 822-830
        • Cappelleri J.C.
        • Rosen R.C.
        • Smith M.D.
        • et al.
        Diagnostic evaluation of the erectile function domain of the International Index of Erectile Function.
        Urology. 1999; 54: 346-351
        • Grimm Jr., R.H.
        • Grandits G.A.
        • Prineas R.J.
        • et al.
        Long-term effects on sexual function of five antihypertensive drugs and nutritional hygienic treatment in hypertensive men and women. Treatment of Mild Hypertension Study (TOMHS).
        Hypertension. 1997; 29: 8-14
        • Toda K.
        • Miwa Y.
        • Kuriyama S.
        • et al.
        Erectile dysfunction in patients with chronic viral liver disease: its relevance to protein malnutrition.
        J Gastroenterol. 2005; 40: 894-900
        • Paternostro R.
        • Heinisch B.B.
        • Reiberger T.
        • et al.
        Erectile dysfunction in cirrhosis is impacted by liver dysfunction, portal hypertension, diabetes and arterial hypertension.
        Liver Int. 2018; 38: 1427-1436
        • Jensen S.B.
        • Gluud C.
        Sexual dysfunction in men with alcoholic liver cirrhosis. A comparative study.
        Liver. 1985; 5: 94-100
        • Huyghe E.
        • Kamar N.
        • Wagner F.
        • et al.
        Erectile dysfunction in end-stage liver disease men.
        J Sex Med. 2009; 6: 1395-1401
        • Wang Y.J.
        • Wu J.C.
        • Lee S.D.
        • et al.
        Gonadal dysfunction and changes in sex hormones in postnecrotic cirrhotic men: a matched study with alcoholic cirrhotic men.
        Hepatogastroenterology. 1991; 38: 531-534
        • Child C.G.
        The liver and portal hypertension.
        Saunders, Philadelphia1964
        • Grundy S.M.
        • Cleeman J.I.
        • Daniels S.R.
        • et al.
        Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Executive summary.
        Crit Pathw Cardiol. 2005; 4: 198-203
        • Hernandez-Mijares A.
        • Garcia-Malpartida K.
        • Sola-Izquierdo E.
        • et al.
        Testosterone levels in males with type 2 diabetes and their relationship with cardiovascular risk factors and cardiovascular disease.
        J Sex Med. 2010; 7: 1954-1964
        • American Association for the Study of Liver D
        • European Association for the Study of the L
        Hepatic encephalopathy in chronic liver disease: 2014 practice guideline by the European Association for the Study of the Liver and the American Association for the Study of Liver Diseases.
        J Hepatol. 2014; 61: 642-659
        • Rosen R.C.
        • Cappelleri J.C.
        • Smith M.D.
        • et al.
        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: 319-326
        • Weissman M.M.
        • Sholomskas D.
        • Pottenger M.
        • et al.
        Assessing depressive symptoms in five psychiatric populations: a validation study.
        Am J Epidemiol. 1977; 106: 203-214
        • Nicolosi A.
        • Glasser D.B.
        • Moreira E.D.
        • et al.
        Prevalence of erectile dysfunction and associated factors among men without concomitant diseases: a population study.
        Int J Impot Res. 2003; 15: 253-257
        • Lewis R.W.
        Epidemiology of sexual dysfunction in Asia compared to the rest of the world.
        Asian J Androl. 2011; 13: 152-158
        • Derosa G.
        • Romano D.
        • Tinelli C.
        • et al.
        Prevalence and associations of erectile dysfunction in a sample of Italian males with type 2 diabetes.
        Diabetes Res Clin Pract. 2015; 108: 329-335
        • Cheung K.K.
        • Luk A.O.
        • So W.Y.
        • et al.
        Testosterone level in men with type 2 diabetes mellitus and related metabolic effects: a review of current evidence.
        J Diabetes Invest. 2015; 6: 112-123
        • Papadopoulou E.
        • Varouktsi A.
        • Lazaridis A.
        • et al.
        Erectile dysfunction in chronic kidney disease: from pathophysiology to management.
        World J Nephrol. 2015; 4: 379-387
        • Paternostro R.
        • Heinisch B.B.
        • Reiberger T.
        • et al.
        Erectile dysfunction in cirrhosis is impacted by liver dysfunction, portal hypertension, diabetes and arterial hypertension.
        Liver Int. 2018;
        • Costa M.R.
        • Ponciano V.C.
        • Costa T.R.
        • et al.
        Prevalence and factors associated with erectile dysfunction in patients with chronic kidney disease on conservative treatment.
        Int J Impot Res. 2017;
        • Toda N.
        Age-related changes in endothelial function and blood flow regulation.
        Pharmacol Ther. 2012; 133: 159-176
        • Seals D.R.
        • Jablonski K.L.
        • Donato A.J.
        Aging and vascular endothelial function in humans.
        Clin Sci (Lond). 2011; 120: 357-375
        • Corona G.
        • Rastrelli G.
        • Monami M.
        • et al.
        Hypogonadism as a risk factor for cardiovascular mortality in men: a meta-analytic study.
        Eur J Endocrinol. 2011; 165: 687-701
        • Panach-Navarrete J.
        • Martinez-Jabaloyas J.M.
        • DE-SDT study group
        The influence of comorbidities on the aging males’ symptoms scale in patients with erectile dysfunction.
        Aging Male. 2017; 20: 146-152
        • Hu L.S.
        • George J.
        • Wang J.H.
        Current concepts on the role of nitric oxide in portal hypertension.
        World J Gastroenterol. 2013; 19: 1707-1717
        • Cirera I.
        • Elizalde J.I.
        • Pique J.M.
        • et al.
        Anemia worsens hyperdynamic circulation of patients with cirrhosis and portal hypertension.
        Dig Dis Sci. 1997; 42: 1697-1702
        • Iwakiri Y.
        • Groszmann R.J.
        The hyperdynamic circulation of chronic liver diseases: from the patient to the molecule.
        Hepatology. 2006; 43: S121-S131
        • Edey M.M.
        Male sexual dysfunction and chronic kidney disease.
        Front Med (Lausanne). 2017; 4: 32
        • Kirby R.S.
        Impotence: diagnosis and management of male erectile dysfunction.
        BMJ. 1994; 308: 957-961
        • Bortolotti A.
        • Parazzini F.
        • Colli E.
        • et al.
        The epidemiology of erectile dysfunction and its risk factors.
        Int J Androl. 1997; 20: 323-334
        • Papelbaum M.
        • Moreira R.O.
        • Coutinho W.
        • et al.
        Depression, glycemic control and type 2 diabetes.
        Diabetol Metab Syndr. 2011; 3: 26
        • Fedele D.
        • Bortolotti A.
        • Coscelli C.
        • et al.
        Erectile dysfunction in type 1 and type 2 diabetics in Italy. On Behalf of Gruppo Italiano Studio Deficit Erettile Nei Diabetici.
        Int J Epidemiol. 2000; 29: 524-531
        • El-Sakka A.I.
        Association of risk factors and medical comorbidities with male sexual dysfunctions.
        J Sex Med. 2007; 4: 1691-1700
        • Sinclair M.
        • Gow P.J.
        • Angus P.W.
        • et al.
        High circulating oestrone and low testosterone correlate with adverse clinical outcomes in men with advanced liver disease.
        Liver Int. 2016; 36: 1619-1627

      Linked Article

      • Erectile dysfunction in patients with liver cirrhosis
        Digestive and Liver DiseaseVol. 51Issue 6
        • Preview
          Erectile dysfunction (ED) is defined as the inability to achieve or maintain an erection sufficient for satisfactory sexual performance [1]. The reported prevalence of ED ranges between 10% and 50% in the general population and is related to age, overall health status and emotional function [2,3]. Based on this high prevalence of ED and the progressive importance given to health related quality of life (HRQoL) of the patients, several investigations into the clinical and pathophysiologic mechanisms of sexual dysfunction have been carried out during the last decade [4,5].
        • Full-Text
        • PDF