The impact of depression, microvasculopathy, and fibrosis on development of erectile dysfunction in men with systemic sclerosis

This article is a small case series that aims to discuss the impact of depression, vascular, and fibrotic changes on development of erectile dysfunction (ED) in patients with systemic sclerosis (SSc). In this paper, we present five male patients with SSc, aged 30-48 years. All patients are nonsmokers, and their past medical history does not reveal any other diseases or treatment procedures (drugs) that may have influence on erectile function. We used a five-item questionnaire, the International Index of Erectile Function (IIEF-5), to assess ED in our patients. Microvascular abnormalities (estimated by nailfold capillaroscopy), fibrotic changes (assessed by skin score, chest X-ray and reduction in forced vital capacity), and presence of depression (estimated using the Beck's Depression Inventory) were evaluated. To assess efficacy of sildenafil citrate (25-50 mg 1 h before each sexual activity), patients with ED filled up the IIEF-5 before and after 1-month therapy. We concluded that ED is a frequent and early clinical feature in men with SSc. Microvascular abnormalities are similar in patients with and without ED. Although patients with ED had higher depression indices, an unsatisfactory response to sildenafil citrate indicates that psychoneurogenic factors are not crucial in development of ED in SSc. Patients with ED had more extended fibrotic changes, which indirectly suggests that fibrosis of the corporal body may play the main role in the pathogenesis of ED in SSc.