Low serum folic acid can be a potential independent risk factor for erectile dysfunction: a prospective case–control study



The purpose of the study was to compare serum level of folic acid (FA) in patients with erectile dysfunction (ED) versus healthy controls and to assess its correlation with other well-known confounders for ED.


Our prospective study compared FA in 60 patients with ED versus 30 healthy controls. Patients were excluded if they had any hormonal disorders, Peyronie’s disease, or decompensated systemic illnesses. ED was evaluated by the validated Arabic version of the abbreviated five-item form of the International Index Of Erectile Function and confirmed by penile duplex. Serum FA level was assayed using ELIZA. Mann–Whitney, Kruskal–Wallis, and Chi-square tests and Spearman correlation were used as appropriate and confirmed by logistic regression model.


Our study revealed that the median FA of the cases and the controls were 7.1 ng/mL and 13.4 ng/mL, respectively, and this difference was of high statistical significance (p < 0.001). Moreover, our study demonstrated significant relations between serum FA with DM, HTN, smoking, age, and cholesterol (p 0.01, 0.03, 0.014, 0.001, and 0.015, respectively). Our study showed that the best cut-off point of serum FA to detect patients with ED was found to be ≤ 9.42 with sensitivity of 80.00%, specificity of 93.33% and area under curve (AUC) of 91.3%.


Serum FA level decreased as the severity of ED increased even after adjustment of age, serum testosterone, DM, HTN, and smoking. FA deficiency might be an independent risk factor of ED.

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Corresponding author

Correspondence to Sameh Fayek GamalEl Din.

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The authors declare that they have no conflict of interest.

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All procedures performed were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the local ethical committee.

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Informed consent was obtained from all individual participants included in the study.

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Attia, A.A.A., Amer, M.A.E.M., Hassan, M. et al. Low serum folic acid can be a potential independent risk factor for erectile dysfunction: a prospective case–control study. Int Urol Nephrol 51, 223–229 (2019). https://doi.org/10.1007/s11255-018-2055-y

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  • Erectile dysfunction
  • IIEF-5
  • Serum folic acid
  • Severity of erectile dysfunction