Lung

, Volume 190, Issue 5, pp 545–556 | Cite as

Sexual Dysfunction in Men with COPD: Impact on Quality of Life and Survival

  • Eileen G. Collins
  • Sahar Halabi
  • Mathew Langston
  • Timothy Schnell
  • Martin J. Tobin
  • Franco Laghi
Article

Abstract

Background

Most patients with chronic obstructive pulmonary disease (COPD) are middle-aged or older, and by definition all have a chronic illness. Aging and chronic illness decrease sexual interest, sexual function, and testosterone levels. To date, researchers have not simultaneously explored prevalence, risk factors, and impact of sexual dysfunctions on quality of life and survival in men with COPD. We tested three hypotheses: First, sexual dysfunctions, including erectile dysfunction, are highly prevalent and impact negatively the quality of life of those with COPD. Second, gonadal state is a predictor of erectile dysfunction. Third, erectile dysfunction, a potential maker of systemic atherosclerosis, is a risk factor for mortality in men with COPD.

Methods

In this prospective study, sexuality was assessed in 90 men with moderate-to-severe COPD (40 hypogonadal) by questionnaire. Testosterone levels, comorbidities, dyspnea, depressive symptoms, and survival (4.8 years median follow-up) were recorded.

Results

Seventy-four percent of patients had at least one sexual dysfunction, with erectile dysfunction being the most common (72 %). Most were dissatisfied with their current and expected sexual function. Severity of COPD was equivalent in patients with and without erectile dysfunction. Low testosterone, depressive symptoms, and presence of partner were independently associated with erectile dysfunction. Severity of lung disease and comorbidities, but not erectile dysfunction, were independently associated with mortality (p = 0.006).

Conclusions

Sexual dysfunctions, including erectile dysfunction, were highly prevalent and had a negative impact on quality of life in men with COPD. In addition, gonadal state was an independent predictor of erectile dysfunction. Finally, erectile dysfunction was not associated with all-cause mortality.

Keywords

Endocrine Erectile dysfunction Testosterone Sexuality Aging Outcome 

Notes

Acknowledgments

This work was supported in part by grants from AMVETS and the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development Rehabilitation Research and Development Service.

Conflict of interest

Eileen G. Collins, Sahar Halabi, Mathew Langston, Timothy Schnell, Martin Tobin, and Franco Laghi have no conflicts of interest of financial ties to disclose.

Supplementary material

408_2012_9398_MOESM1_ESM.docx (14 kb)
Supplementary material 1 (DOCX 14 kb)

References

  1. 1.
    NHLBI (National Heart, Lung and Blood Institute). Morbidity and Mortality 2009 Chartbook on Cardiovascular, Lung, and Blood Diseases. U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, Bethesda, MD. Available at http://www.nhlbi.nih.gov/resources/docs/cht-book.htm (Accessed 15 January 2012)
  2. 2.
    Harman SM, Metter EJ, Tobin JD, Pearson J, Blackman MR (2001) Longitudinal effects of aging on serum total and free testosterone levels in healthy men. Baltimore longitudinal study of aging. J Clin Endocrinol Metab 86:724–731PubMedCrossRefGoogle Scholar
  3. 3.
    Lindau ST, Schumm LP, Laumann EO, Levinson W, O’Muircheartaigh CA, Waite LJ (2007) A study of sexuality and health among older adults in the United States. N Engl J Med 357:762–774PubMedCrossRefGoogle Scholar
  4. 4.
    Schouten BW, Bohnen AM, Dohle GR, Groeneveld FP, Willemsen S, Thomas S, Bosch JL (2009) Risk factors for deterioration of erectile function: the Krimpen study. Int J Androl 32:166–175PubMedCrossRefGoogle Scholar
  5. 5.
    Rhoden EL, Teloken C, Mafessoni R, Souto CA (2002) Is there any relation between serum levels of total testosterone and the severity of erectile dysfunction? Int J Impot Res 14:167–171PubMedCrossRefGoogle Scholar
  6. 6.
    Araujo AB, Durante R, Feldman HA, Goldstein I, McKinlay JB (1998) The relationship between depressive symptoms and male erectile dysfunction: cross-sectional results from the Massachusetts Male Aging Study. Psychosom Med 60:458–465PubMedGoogle Scholar
  7. 7.
    Kupelian V, Shabsigh R, Travison TG, Page ST, Araujo AB, McKinlay JB (2006) Is there a relationship between sex hormones and erectile dysfunction? Results from the Massachusetts Male Aging Study. J Urol 176:2584–2588PubMedCrossRefGoogle Scholar
  8. 8.
    Karadag F, Ozcan H, Karul AB, Ceylan E, Cildag O (2007) Correlates of erectile dysfunction in moderate-to-severe chronic obstructive pulmonary disease patients. Respirology 12:248–253PubMedCrossRefGoogle Scholar
  9. 9.
    Svartberg J, Aasebo U, Hjalmarsen A, Sundsfjord J, Jorde R (2004) Testosterone treatment improves body composition and sexual function in men with COPD, in a 6-month randomized controlled trial. Respir Med 98:906–913PubMedCrossRefGoogle Scholar
  10. 10.
    Redoute J, Stoleru S, Pugeat M, Costes N, Lavenne F, Le Bars D, Dechaud H, Cinotti L, Pujol JF (2005) Brain processing of visual sexual stimuli in treated and untreated hypogonadal patients. Psychoneuroendocrinology 30:461–482PubMedCrossRefGoogle Scholar
  11. 11.
    Semple PD, Brown TM, Beastall GH, Semple CG (1983) Sexual dysfunction and erectile impotence in chronic obstructive pulmonary disease. Chest 83:587–588PubMedCrossRefGoogle Scholar
  12. 12.
    Aasebo U, Gyltnes A, Bremnes RM, Aakvaag A, Slordal L (1993) Reversal of sexual impotence in male patients with chronic obstructive pulmonary disease and hypoxemia with long-term oxygen therapy. J Steroid Biochem Mol Biol 46:799–803PubMedCrossRefGoogle Scholar
  13. 13.
    Semple PD, Beastall GH, Brown TM, Stirling KW, Mills RJ, Watson WS (1984) Sex hormone suppression and sexual impotence in hypoxic pulmonary fibrosis. Thorax 39:46–51PubMedCrossRefGoogle Scholar
  14. 14.
    Clark AS, MacLusky NJ, Goldman-Rakic PS (1988) Androgen binding and metabolism in the cerebral cortex of the developing rhesus monkey. Endocrinology 123:932–940PubMedCrossRefGoogle Scholar
  15. 15.
    Lugg JA, Rajfer J, Gonzalez-Cadavid NF (1995) Dihydrotestosterone is the active androgen in the maintenance of nitric oxide-mediated penile erection in the rat. Endocrinology 136:1495–1501PubMedCrossRefGoogle Scholar
  16. 16.
    Morelli A, Filippi S, Mancina R, Luconi M, Vignozzi L, Marini M, Orlando C, Vannelli GB, Aversa A, Natali A, Forti G, Giorgi M, Jannini EA, Ledda F, Maggi M (2004) Androgens regulate phosphodiesterase type 5 expression and functional activity in corpora cavernosa. Endocrinology 145:2253–2263PubMedCrossRefGoogle Scholar
  17. 17.
    Mills TM, Reilly CM, Lewis RW (1996) Androgens and penile erection: a review. J Androl 17:633–638PubMedGoogle Scholar
  18. 18.
    Isidori AM, Giannetta E, Gianfrilli D, Greco EA, Bonifacio V, Aversa A, Isidori A, Fabbri A, Lenzi A (2005) Effects of testosterone on sexual function in men: results of a meta-analysis. Clin Endocrinol (Oxf) 63:381–394CrossRefGoogle Scholar
  19. 19.
    Laghi F, Antonescu-Turcu A, Collins E, Segal J, Tobin DE, Jubran A, Tobin MJ (2005) Hypogonadism in men with chronic obstructive pulmonary disease: prevalence and quality of life. Am J Respir Crit Care Med 171:728–733PubMedCrossRefGoogle Scholar
  20. 20.
    Slag MF, Morley JE, Elson MK, Trence DL, Nelson CJ, Nelson AE, Kinlaw WB, Beyer HS, Nuttall FQ, Shafer RB (1983) Impotence in medical clinic outpatients. JAMA 249:1736–1740PubMedCrossRefGoogle Scholar
  21. 21.
    Melman A, Gingell JC (1999) The epidemiology and pathophysiology of erectile dysfunction. J Urol 161:5–11PubMedCrossRefGoogle Scholar
  22. 22.
    Meldrum DR, Gambone JC, Morris MA, Meldrum DA, Esposito K, Ignarro LJ (2011) The link between erectile and cardiovascular health: the canary in the coal mine. Am J Cardiol 108(4):599–606PubMedCrossRefGoogle Scholar
  23. 23.
    Miner MM (2011) Erectile dysfunction: a harbinger or consequence: does its detection lead to a window of curability? J Androl 32:125–134PubMedCrossRefGoogle Scholar
  24. 24.
    Solomon H, Man JW, Jackson G (2003) Erectile dysfunction and the cardiovascular patient: endothelial dysfunction is the common denominator. Heart 89:251–253PubMedCrossRefGoogle Scholar
  25. 25.
    Araujo AB, Travison TG, Ganz P, Chiu GR, Kupelian V, Rosen RC, Hall SA, McKinlay JB (2009) Erectile dysfunction and mortality. J Sex Med 6:2445–2454PubMedCrossRefGoogle Scholar
  26. 26.
    Curkendall SM, Lanes S, de Luise C, Stang MR, Jones JK, She D, Goehring E Jr (2006) Chronic obstructive pulmonary disease severity and cardiovascular outcomes. Eur J Epidemiol 21:803–813PubMedCrossRefGoogle Scholar
  27. 27.
    Mannino DM, Thorn D, Swensen A, Holguin F (2008) Prevalence and outcomes of diabetes, hypertension and cardiovascular disease in COPD. Eur Respir J 32:962–969PubMedCrossRefGoogle Scholar
  28. 28.
    Laumann EO, Paik A, Glasser DB, Kang JH, Wang T, Levinson B, Moreira ED Jr, Nicolosi A, Gingell C (2006) A cross-national study of subjective sexual well-being among older women and men: findings from the Global Study of Sexual Attitudes and Behaviors. Arch Sex Behav 35:145–161PubMedCrossRefGoogle Scholar
  29. 29.
    Inman BA, Sauver JL, Jacobson DJ, McGree ME, Nehra A, Lieber MM, Roger VL, Jacobsen SJ (2009) A population-based, longitudinal study of erectile dysfunction and future coronary artery disease. Mayo Clin Proc 84:108–113PubMedCrossRefGoogle Scholar
  30. 30.
    Halabi S, Collins E, Thorevska N, Tobin MJ, Laghi F (2011) Relationship between depressive symptoms and hypogonadism in men with COPD. COPD 8:346–353PubMedCrossRefGoogle Scholar
  31. 31.
    Collins EG, Langbein WE, Fehr L, O’Connell S, Jelinek C, Hagarty E, Edwards L, Reda D, Tobin MJ, Laghi F (2008) Can ventilation-feedback training augment exercise tolerance in patients with chronic obstructive pulmonary disease? Am J Respir Crit Care Med 177:844–852PubMedCrossRefGoogle Scholar
  32. 32.
    Charlson M, Szatrowski TP, Peterson J, Gold J (1994) Validation of a combined comorbidity index. J Clin Epidemiol 47:1245–1251PubMedCrossRefGoogle Scholar
  33. 33.
    Nicolosi A, Laumann EO, Glasser DB, Moreira ED Jr, Paik A, Gingell C (2004) Sexual behavior and sexual dysfunctions after age 40: the global study of sexual attitudes and behaviors. Urology 64:991–997PubMedCrossRefGoogle Scholar
  34. 34.
    Stewart AL, Ware JE (1992) Measuring Functioning and Well-Being: The Medical Outcomes Study Approach. Duke University Press, DurhamGoogle Scholar
  35. 35.
    Schonhofer B, Von Sydow K, Bucher T, Nietsch M, Suchi S, Kohler D, Jones PW (2001) Sexuality in patients with noninvasive mechanical ventilation due to chronic respiratory failure. Am J Respir Crit Care Med 164:1612–1617PubMedGoogle Scholar
  36. 36.
    Eakin EG, Resnikoff PM, Prewitt LM, Ries AL, Kaplan RM (1998) Validation of a new dyspnea measure: the UCSD shortness of breath questionnaire. University of California, San Diego. Chest 113:619–624PubMedCrossRefGoogle Scholar
  37. 37.
    Peach J, Koob JJ, Kraus MJ (2001) Psychometric evaluation of the Geriatric Depression Scale (GDS): supporting its use in health care settings. Clin Gerontol 23:57–68CrossRefGoogle Scholar
  38. 38.
    Salameh WA, Redor-Goldman MM, Clarke NJ, Reitz RE, Caulfield MP (2010) Validation of a total testosterone assay using high-turbulence liquid chromatography tandem mass spectrometry: total and free testosterone reference ranges. Steroids 75:169–175PubMedCrossRefGoogle Scholar
  39. 39.
    Rosen RC, Seidman SN, Menza MA, Shabsigh R, Roose SP, Tseng LJ, Orazem J, Siegel RL (2004) Quality of life, mood, and sexual function: a path analytic model of treatment effects in men with erectile dysfunction and depressive symptoms. Int J Impot Res 16:334–340PubMedCrossRefGoogle Scholar
  40. 40.
    Koseoglu N, Koseoglu H, Ceylan E, Cimrin HA, Ozalevli S, Esen A (2005) Erectile dysfunction prevalence and sexual function status in patients with chronic obstructive pulmonary disease. J Urol 174:249–252PubMedCrossRefGoogle Scholar
  41. 41.
    Fletcher EC, Martin RJ (1982) Sexual dysfunction and erectile impotence in chronic obstructive pulmonary disease. Chest 81:413–421PubMedCrossRefGoogle Scholar
  42. 42.
    Wu C, Zhang H, Gao Y, Tan A, Yang X, Lu Z, Zhang Y, Liao M, Wang M, Mo Z (2012) The association of smoking and erectile dysfunction: results from the Fangchenggang Area Male Health and Examination Survey (FAMHES). J Androl 33(1):59–65PubMedCrossRefGoogle Scholar
  43. 43.
    Nicolosi A, Moreira ED Jr, Shirai M, Bin Mohd Tambi MI, Glasser DB (2003) Epidemiology of erectile dysfunction in four countries: cross-national study of the prevalence and correlates of erectile dysfunction. Urology 61:201–206PubMedCrossRefGoogle Scholar
  44. 44.
    Marquis K, Debigare R, Lacasse Y, LeBlanc P, Jobin J, Carrier G, Maltais F (2002) Midthigh muscle cross-sectional area is a better predictor of mortality than body mass index in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 166:809–813PubMedCrossRefGoogle Scholar
  45. 45.
    Paduch DA, Bolyakov A, Beardsworth A, Watts SD (2012) Factors associated with ejaculatory and orgasmic dysfunction in men with erectile dysfunction: analysis of clinical trials involving the phosphodiesterase type 5 inhibitor tadalafil. BJU Int 109:1060–1067PubMedCrossRefGoogle Scholar
  46. 46.
    Beckman N, Waern M, Gustafson D, Skoog I (2008) Secular trends in self reported sexual activity and satisfaction in Swedish 70 year olds: cross sectional survey of four populations, 1971–2001. BMJ 337:a279PubMedCrossRefGoogle Scholar
  47. 47.
    Vincent EE, Singh SJ (2007) Review article: addressing the sexual health of patients with COPD: the needs of the patient and implications for health care professionals. Chron Respir Dis 4:111–115PubMedCrossRefGoogle Scholar
  48. 48.
    Stannek T, Hurny C, Schoch OD, Bucher T, Munzer T (2009) Factors affecting self-reported sexuality in men with obstructive sleep apnea syndrome. J Sex Med 6:3415–3424PubMedCrossRefGoogle Scholar
  49. 49.
    Kaptein AA, van Klink RC, de Kok F, Scharloo M, Snoei L, Broadbent E, Bel EH, Rabe KF (2008) Sexuality in patients with asthma and COPD. Respir Med 102:198–204PubMedCrossRefGoogle Scholar
  50. 50.
    Timms RM (1982) Sexual dysfunction and chronic obstructive pulmonary disease. Chest 81:398–400PubMedCrossRefGoogle Scholar
  51. 51.
    Perelman MA (2011) Erectile dysfunction and depression: screening and treatment. Urol Clin North Am 38:125–139PubMedCrossRefGoogle Scholar
  52. 52.
    Bancroft J (2005) The endocrinology of sexual arousal. J Endocrinol 186:411–427PubMedCrossRefGoogle Scholar
  53. 53.
    Thorson AI (2003) Sexual activity and the cardiac patient. Am J Geriatr Cardiol 12:38–40PubMedCrossRefGoogle Scholar
  54. 54.
    Ibanez M, Aguilar JJ, Maderal MA, Prats E, Farrero E, Font A, Escarrabill J (2001) Sexuality in chronic respiratory failure: coincidences and divergences between patient and primary caregiver. Respir Med 95:975–979PubMedCrossRefGoogle Scholar
  55. 55.
    Schouten BW, Bohnen AM, Bosch JL, Bernsen RM, Deckers JW, Dohle GR, Thomas S (2008) Erectile dysfunction prospectively associated with cardiovascular disease in the Dutch general population: results from the Krimpen Study. Int J Impot Res 20:92–99PubMedCrossRefGoogle Scholar
  56. 56.
    O’Donnell AB, Araujo AB, Goldstein I, McKinlay JB (2005) The validity of a single-question self-report of erectile dysfunction. Results from the Massachusetts Male Aging Study. J Gen Intern Med 20:515–519PubMedCrossRefGoogle Scholar
  57. 57.
    Melman A, Fogarty J, Hafron J (2006) Can self-administered questionnaires supplant objective testing of erectile function? A comparison between the International Index of Erectile Function and objective studies. Int J Impot Res 18:126–129PubMedCrossRefGoogle Scholar
  58. 58.
    Yang CC, Porter MP, Penson DF (2006) Comparison of the International Index of Erectile Function erectile domain scores and nocturnal penile tumescence and rigidity measurements: does one predict the other? BJU Int 98:105–109PubMedCrossRefGoogle Scholar
  59. 59.
    Wu CJ, Hsieh JT, Lin JS, Hwang TI, Jiann BP, Huang ST, Wang CJ, Lee SS, Chiang HS, Chen KK, Lin HD (2007) Comparison of prevalence between self-reported erectile dysfunction and erectile dysfunction as defined by five-item International Index of Erectile Function in Taiwanese men older than 40 years. Urology 69:743–747PubMedCrossRefGoogle Scholar
  60. 60.
    De Berardis G, Franciosi M, Belfiglio M, Di Nardo B, Greenfield S, Kaplan SH, Pellegrini F, Sacco M, Tognoni G, Valentini M, Nicolucci A (2002) Erectile dysfunction and quality of life in type 2 diabetic patients: a serious problem too often overlooked. Diabetes Care 25:284–291PubMedCrossRefGoogle Scholar
  61. 61.
    Liverman CT, Blazer DG (eds) (2004) Future research directions. In: Testosterone and aging: clinical research directions. Washington, DC: The National Academic Press, pp 112–158Google Scholar
  62. 62.
    Laghi F, Adiguzel N, Tobin MJ (2009) Endocrinological derangements in COPD. Eur Respir J 34:975–996PubMedCrossRefGoogle Scholar
  63. 63.
    Soran H, Wu FC (2005) Endocrine causes of erectile dysfunction. Int J Androl 28(Suppl 2):28–34PubMedCrossRefGoogle Scholar
  64. 64.
    Basaria S, Coviello AD, Travison TG, Storer TW, Farwell WR, Jette AM, Eder R, Tennstedt S, Ulloor J, Zhang A, Choong K, Lakshman KM, Mazer NA, Miciek R, Krasnoff J, Elmi A, Knapp PE, Brooks B, Appleman E, Aggarwal S, Bhasin G, Hede-Brierley L, Bhatia A, Collins L, LeBrasseur N, Fiore LD, Bhasin S (2010) Adverse events associated with testosterone administration. N Engl J Med 363:109–122PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Eileen G. Collins
    • 2
    • 4
  • Sahar Halabi
    • 1
  • Mathew Langston
    • 1
    • 3
  • Timothy Schnell
    • 1
    • 3
  • Martin J. Tobin
    • 1
    • 3
  • Franco Laghi
    • 1
    • 3
  1. 1.Division of Pulmonary and Critical Care MedicineEdward Hines, Jr. VA HospitalHinesUSA
  2. 2.College of NursingUniversity of Illinois at ChicagoChicagoUSA
  3. 3.Division of Pulmonary and Critical Care MedicineLoyola UniversityMaywoodUSA
  4. 4.Research ServicesEdward Hines, Jr. VA HospitalHinesUSA

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