Archives of Sexual Behavior

, Volume 45, Issue 8, pp 2047–2055 | Cite as

Prevalence and Associated Factors of Erectile Dysfunction in Patients With Moderate to Severe Psoriasis and Healthy Population: A Comparative Study Considering Physical and Psychological Factors

  • Alejandro Molina-Leyva
  • Ignacio Molina-Leyva
  • Ana Almodovar-Real
  • Jose Carlos Ruiz-Carrascosa
  • Ramon Naranjo-Sintes
  • Jose Juan Jimenez-Moleon
Original Paper


Recent studies have shown that psoriasis is associated with an increased prevalence of erectile dysfunction. To our knowledge, no comparative study has considered simultaneously the role of organic factors and psychological factors in this process. We performed a prospective case series study matched by age to explore the prevalence of erectile dysfunction in psoriasis patients compared to a healthy population and to investigate the role of anxiety, depression, and cardiovascular risk factors in the relationship between psoriasis and erectile dysfunction. The healthy group was matched by frequency to cases by age. Seventy-nine patients with moderate to severe psoriasis and 79 healthy controls participated in the study. Participants completed the Massachusetts General Hospital Sexual Functioning Questionnaire and the Hospital Anxiety and Depression Scale. Psoriasis patients had an increased prevalence of erectile dysfunction in comparison to controls, 34.2 vs. 17.7 % (p < .05). Multivariate analysis showed a significant association between erectile dysfunction and age, smoking and anxiety/depression, but not with psoriasis per se. In conclusion, the higher prevalence of smoking and anxiety/depression among patients with moderate to severe psoriasis probably explains the higher prevalence of erectile dysfunction in this population.


Anxiety Organic/medical factors Psychological factors Depression Erectile dysfunction Psoriasis 



The authors thank Jean Sanders and Ingrid de Ruiter for improving the use of English in the article. The results of this study are part of Ph.D. work of Alejandro Molina-Leyva.


  1. Ahdout, J., Kotlerman, J., Elashoff, D., Kim, J., & Chiu, M. W. (2012). Modifiable lifestyle factors associated with metabolic syndrome in patients with psoriasis. Clinical and Experimental Dermatology, 37, 477–483. doi: 10.1111/j.1365-2230.2012.04360.x.CrossRefPubMedGoogle Scholar
  2. AlShahwan, M. A. (2015). The prevalence of anxiety and depression in arab dermatology patients. Journal of Cutaneous Medicine and Surgery, 19, 297–303. doi: 10.2310/7750.2014.14110.PubMedGoogle Scholar
  3. Armstrong, A. W., Harskamp, C. T., & Armstrong, E. J. (2013). Psoriasis and metabolic syndrome: A systematic review and meta-analysis of observational studies. Journal of the American Academy of Dermatology, 68, 654–662. doi: 10.1016/j.jaad.2012.08.015.CrossRefPubMedGoogle Scholar
  4. Cabete, J., Torres, T., Vilarinho, T., & Ferreira, A. (2014). Erectile dysfunction in psoriasis patients. European Journal of Dermatology, 24, 482–486. doi: 10.1684/ejd.2014.2388.PubMedGoogle Scholar
  5. Chen, Y. J., Chen, C. C., Lin, M. W., Chen, T. J., Li, C. Y., Hwang, C. Y., … Liu, H. N. (2013). Increased risk of sexual dysfunction in male patients with psoriasis: A nationwide population-based follow-up study. Journal of Sexual Medicine, 10, 1212–1218. doi: 10.1111/j.1743-6109.2012.02767.x.
  6. Chew, K. K. (2004). Prevalence of erectile dysfunction in community-based studies. International Journal of Impotence Research, 16, 201–202. doi: 10.1038/sj.ijir.3901181.CrossRefPubMedGoogle Scholar
  7. Chung, S. D., Keller, J. J., Chu, T. W., & Lin, H. C. (2012). Psoriasis and the risk of erectile dysfunction: A population-based case-control study. Journal of Sexual Medicine, 9, 130–135. doi: 10.1111/j.1743-6109.2011.02510.x.CrossRefPubMedGoogle Scholar
  8. Corona, G., Mannucci, E., Forti, G., & Maggi, M. (2009). Hypogonadism, ED, metabolic syndrome and obesity: A pathological link supporting cardiovascular diseases. International Journal of Andrology, 32, 587–598. doi: 10.1111/j.1365-2605.2008.00951.x.CrossRefPubMedGoogle Scholar
  9. Corona, G., Ricca, V., Bandini, E., Rastrelli, G., Casale, H., Jannini, E. A., & Maggi, M. (2012). SIEDY scale 3, a new instrument to detect psychological component in subjects with erectile dysfunction. Journal of Sexual Medicine, 9, 2017–2026. doi: 10.1111/j.1743-6109.2012.02762.x.CrossRefPubMedGoogle Scholar
  10. Derogatis, L. R. (2008). Clinical and research evaluations of sexual dysfunctions. Advances in Psychosomatic Medicine, 29, 7–22. doi: 10.1159/000126621.CrossRefPubMedGoogle Scholar
  11. Feldman, H. A., Goldstein, I., Hatzichristou, D. G., Krane, R. J., & McKinlay, J. B. (1994). Impotence and its medical and psychosocial correlates: Results of the Massachusetts Male Aging Study. Journal of Urology, 151, 54–61. doi: 10.1038/sj.ijir.3901181.PubMedGoogle Scholar
  12. Ghazi, L. J., Patil, S. A., & Cross, R. K. (2015). Sexual dysfunction in inflammatory bowel disease. Inflammatory Bowel Diseases, 21, 939–947. doi: 10.1097/mib.0000000000000260.CrossRefPubMedGoogle Scholar
  13. Goulding, J. M., Price, C. L., Defty, C. L., Hulangamuwa, C. S., Bader, E., & Ahmed, I. (2011). Erectile dysfunction in patients with psoriasis: Increased prevalence, an unmet need, and a chance to intervene. British Journal of Dermatology, 164, 103–109. doi: 10.1111/j.1365-2133.2010.10077.x.CrossRefPubMedGoogle Scholar
  14. Hatzimouratidis, K., Amar, E., Eardley, I., Giuliano, F., Hatzichristou, D., Montorsi, F., & Wespes, E. (2010). Guidelines on male sexual dysfunction: Erectile dysfunction and premature ejaculation. European Journal of Urology, 57, 804–814. doi: 10.1016/j.eururo.2010.02.020.CrossRefGoogle Scholar
  15. Hatzimouratidis, K., Eardley, I., Giuliano, F., Hatzichristou, D., Moncada, I., Salonia, A., … Wespes, E. (2013). Guidelines on male sexual dysfunction: Erectile dysfunction and premature ejaculation. Retrieved from
  16. Hayes, J., & Koo, J. (2010). Psoriasis: Depression, anxiety, smoking, and drinking habits. Dermatology Therapy, 23, 174–180. doi: 10.1111/j.1529-8019.2010.01312.x.CrossRefGoogle Scholar
  17. Holt, R. I., Phillips, D. I., Jameson, K. A., Cooper, C., Dennison, E. M., & Peveler, R. C. (2013). The relationship between depression, anxiety and cardiovascular disease: Findings from the Hertfordshire Cohort Study. Journal of Affective Disorders, 150, 84–90. doi: 10.1016/j.jad.2013.02.026.CrossRefPubMedPubMedCentralGoogle Scholar
  18. Kubin, M., Wagner, G., & Fugl-Meyer, A. R. (2003). Epidemiology of erectile dysfunction. International Journal of Impotence Research, 15, 63–71. doi: 10.1038/sj.ijir.3900949.CrossRefPubMedGoogle Scholar
  19. Kurd, S. K., Troxel, A. B., Crits-Christoph, P., & Gelfand, J. M. (2010). The risk of depression, anxiety, and suicidality in patients with psoriasis: A population-based cohort study. Archives of Dermatology, 146, 891–895. doi: 10.1001/archdermatol.2010.186.PubMedPubMedCentralGoogle Scholar
  20. Labbate, L. A., & Lare, S. B. (2001). Sexual dysfunction in male psychiatric outpatients: Validity of the Massachusetts General Hospital Sexual Functioning Questionnaire. Psychotherapy and Psychosomatics, 70, 221–225. doi: 10.1159/000056257.CrossRefPubMedGoogle Scholar
  21. Litwin, M. S., Nied, R. J., & Dhanani, N. (1998). Health-related quality of life in men with erectile dysfunction. Journal of General Internal Medicine, 13, 159–166. doi: 10.1046/j.1525-1497.1998.00050.x.CrossRefPubMedPubMedCentralGoogle Scholar
  22. Martin-Morales, A., Sanchez-Cruz, J. J., Saenz de Tejada, I., Rodriguez-Vela, L., Jimenez-Cruz, J. F., & Burgos-Rodriguez, R. (2001). Prevalence and independent risk factors for erectile dysfunction in Spain: Results of the Epidemiologia de la Disfuncion Erectil Masculina Study. Journal of Urology, 166, 569–574. doi: 10.1016/S0022-5347)05=65986-1.CrossRefPubMedGoogle Scholar
  23. McDermott, E., Mullen, G., Moloney, J., Keegan, D., Byrne, K., Doherty, G. A., & Mulcahy, H. E. (2015). Body image dissatisfaction: Clinical features, and psychosocial disability in inflammatory bowel disease. Inflammatory Bowel Diseases, 21, 353–360. doi: 10.1097/mib.0000000000000287.CrossRefPubMedGoogle Scholar
  24. McDonough, E., Ayearst, R., Eder, L., Chandran, V., Rosen, C. F., Thavaneswaran, A., & Gladman, D. D. (2014). Depression and anxiety in psoriatic disease: Prevalence and associated factors. Journal of Rheumatology, 41, 887–896. doi: 10.3899/jrheum.130797.CrossRefPubMedGoogle Scholar
  25. McMahon, C. G. (2014). Erectile dysfunction. Internal Medicine Journal, 44, 18–26. doi: 10.1111/imj.12325.CrossRefPubMedGoogle Scholar
  26. Miettinen, O. S., & Cook, E. F. (1981). Confounding: Essence and detection. American Journal of Epidemiology, 114, 593–603.Google Scholar
  27. Morse, W. I., & Morse, J. M. (1982). Erectile impotence precipitated by organic factors and perpetuated by performance anxiety. Canadian Medical Association Journal, 127, 599–601.Google Scholar
  28. Naccarato, A. M., Reis, L. O., Zani, E. L., Cartapatti, M., & Denardi, F. (2014). Psychotherapy: A missing piece in the puzzle of post radical prostatectomy erectile dysfunction rehabilitation. Actas Urologicas Españolas, 38, 385–390. doi: 10.1016/j.acuro.2013.10.012.CrossRefPubMedGoogle Scholar
  29. Navines, R., Castellvi, P., Moreno-Espana, J., Gimenez, D., Udina, M., Canizares, S., … Martin-Santos, R. (2012). Depressive and anxiety disorders in chronic hepatitis C patients: Reliability and validity of the Patient Health Questionnaire. Journal of Affective Disorders, 138, 343–351. doi: 10.1016/j.jad.2012.01.018.
  30. Nehra, A., Jackson, G., Miner, M., Billups, K. L., Burnett, A. L., Buvat, J., … Wu, F. C. (2012). The Princeton III Consensus recommendations for the management of erectile dysfunction and cardiovascular disease. Mayo Clinic Proceedings, 87, 766–778. doi: 10.1016/j.mayocp.2012.06.015.
  31. Nelson, C. J., Mulhall, J. P., & Roth, A. J. (2011). The association between erectile dysfunction and depressive symptoms in men treated for prostate cancer. Journal of Sexual Medicine, 8, 560–566. doi: 10.1111/j.1743-6109.2010.02127.x.CrossRefPubMedGoogle Scholar
  32. Nunes, K. P., Labazi, H., & Webb, R. C. (2012). New insights into hypertension-associated erectile dysfunction. Current Opinion in Nephrology Hypertension, 21, 163–170. doi: 10.1097/MNH.0b013e32835021bd.CrossRefPubMedPubMedCentralGoogle Scholar
  33. Puig, L., Bordas, X., Carrascosa, J. M., Dauden, E., Ferrandiz, C., Hernanz, J. M., … Vazquez-Veiga, H. (2009). Documento de consenso sobre la evaluacion y el tratamiento de la psoriasis moderada/grave del grupo espanol de psoriasis de la Academia Espanola de Dermatologia y Venereologia [Consensus document on the evaluation and treatment of moderate-to-severe psoriasis. Spanish psoriasis group of the Spanish Academy of Dermatology and Venereology]. Actas Dermosifiliograficas, 100, 277–286.Google Scholar
  34. Quintana, J. M., Padierna, A., Esteban, C., Arostegui, I., Bilbao, A., & Ruiz, I. (2003). Evaluation of the psychometric characteristics of the Spanish version of the Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinava, 107, 216–221. doi: 10.1034/j.1600-0447.2003.00062.x.CrossRefGoogle Scholar
  35. Rapp, S. R., Feldman, S. R., Exum, M. L., Fleischer, A. B., Jr., & Reboussin, D. M. (1999). Psoriasis causes as much disability as other major medical diseases. Journal of the American Academy of Dermatology, 41, 401–407. doi: 10.1016/S0190-9622(99)70112-X.CrossRefPubMedGoogle Scholar
  36. Raychaudhuri, S. P., & Farber, E. M. (2001). The prevalence of psoriasis in the world. Journal of the European Academy of Dermatology and Venereology, 15, 16–17. doi: 10.1046/j.1468-3083.2001.00192.x.CrossRefPubMedGoogle Scholar
  37. Rieder, E., & Tausk, F. (2012). Psoriasis, a model of dermatologic psychosomatic disease: Psychiatric implications and treatments. International Journal of Dermatology, 51, 12–26. doi: 10.1111/j.1365-4632.2011.05071.x.CrossRefPubMedGoogle Scholar
  38. Robinson, A., Kardos, M., & Kimball, A. B. (2012). Physician Global Assessment (PGA) and Psoriasis Area and Severity Index (PASI): Why do both? A systematic analysis of randomized controlled trials of biologic agents for moderate to severe plaque psoriasis. Journal of the American Academy of Dermatology, 66, 369–375. doi: 10.1016/j.jaad.2011.01.022.CrossRefPubMedGoogle Scholar
  39. Rosen, R. C., Seidman, S. N., Menza, M. A., Shabsigh, R., Roose, S. P., Tseng, L. J., … Siegel, R. L. (2004). Quality of life, mood, and sexual function: A path analytic model of treatment effects in men with erectile dysfunction and depressive symptoms. International Journal of Impotence Research, 16, 334–340. doi: 10.1038/sj.ijir.3901197.
  40. Russo, P. A., Ilchef, R., & Cooper, A. J. (2004). Psychiatric morbidity in psoriasis: A review. Australasian Journal of Dermatology, 45, 155–159; quiz 160–151. doi: 10.1111/j.1440-0960.2004.00078.x.
  41. Schmidt, H. M., Munder, T., Gerger, H., Fruhauf, S., & Barth, J. (2014). Combination of psychological intervention and phosphodiesterase-5 inhibitors for erectile dysfunction: A narrative review and meta-analysis. Journal of Sexual Medicine, 11, 1376–1391. doi: 10.1111/jsm.12520.CrossRefPubMedGoogle Scholar
  42. Sierra, J. C., Vallejo-Medina, P., Santos-Iglesias, P., & Lameiras Fernandez, M. (2012). Validation of Massachusetts General Hospital-Sexual Functioning Questionnaire (MGH-SFQ) in a Spanish population. Atencion Primaria, 44, 516–524. doi: 10.1016/j.aprim.2012.02.004.CrossRefPubMedGoogle Scholar
  43. Tasliyurt, T., Bilir, Y., Sahin, S., Seckin, H. Y., Kaya, S. U., Sivgin, H., … Erdemir, F. (2014). Erectile dysfunction in patients with psoriasis: Potential impact of the metabolic syndrome. European Review for Medical and Pharmacological Sciences, 18, 581–586.Google Scholar
  44. Tostes, R. C., Carneiro, F. S., Lee, A. J., Giachini, F. R., Leite, R., Osawa, Y., & Webb, R. C. (2008). Cigarette smoking and erectile dysfunction: Focus on NO bioavailability and ROS generation. Journal of Sexual Medicine, 5, 1284–1295. doi: 10.1111/j.1743-6109.2008.00804.x.CrossRefPubMedPubMedCentralGoogle Scholar
  45. Tristano, A. G. (2014). Impact of rheumatoid arthritis on sexual function. World Journal of Orthopedics, 5, 107–111. doi: 10.5312/wjo.v5.i2.107.CrossRefPubMedPubMedCentralGoogle Scholar
  46. Turel Ermertcan, A., Temeltas, G., Deveci, A., Dinc, G., Guler, H. B., & Ozturkcan, S. (2006). Sexual dysfunction in patients with psoriasis. Journal of Dermatology, 33, 772–778. doi: 10.1111/j.1346-8138.2006.00179.x.CrossRefPubMedGoogle Scholar
  47. Zigmond, A. S., & Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinava, 67, 361–370. doi: 10.1111/j.1600-0447.1983.tb09716.x.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Alejandro Molina-Leyva
    • 1
    • 4
  • Ignacio Molina-Leyva
    • 2
  • Ana Almodovar-Real
    • 3
  • Jose Carlos Ruiz-Carrascosa
    • 4
  • Ramon Naranjo-Sintes
    • 4
  • Jose Juan Jimenez-Moleon
    • 2
    • 5
  1. 1.Department of DermatologyComplejo Hospitalario TorrecárdenasAlmeriaSpain
  2. 2.Department of Preventive Medicine and Public HealthUniversity of GranadaGranadaSpain
  3. 3.Department of DermatologyHospital Santa AnaGranadaSpain
  4. 4.Department of DermatologyComplejo Hospitalario Universitario GranadaGranadaSpain
  5. 5.CIBER de Epidemiología y Salud PúblicaMadridSpain

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