Behavior-Related Erectile Dysfunction: A Systematic Review and Meta-Analysis

Background: Erectile dysfunction (ED) is a common problem among men across the world. It is usually multifactorial in origin. Behavioral factors can be related to the development of ED and related to many other chronic diseases. It impacts not only the sexual function but also the psychology and their overall quality of life. Aim: To determine the association of the behavior factors in relation to ED and to identify the risk and protective factors. Method: A systematic review search based on Preferred Reporting Items for Systematic Reviews and Meta Analysis was conducted. The primary databases PubMed, PlosOne, Oxford Academic, SCOPUS, and Ovid were accessed using specific keyword searches. Quality of articles was assessed by using Newcastle-Ottawa Assessment Scale according to the study design. Outcome: Evaluation of the relationship between behavioral factors and ED. Results: 24 studies were identified from the 5 databases which met the predetermined criteria. Overall, the study population include adult male age between 18 and 80 years. The sample size of the studies ranges from 101 to the largest sample size of 51,329. Smoking, alcohol, and drugs usage are found to be risk factors for ED. Meanwhile, dietary intake, physical activity, and intimacy are the protective factors for ED. Clinical Implication: The findings from this review may aid clinicians to aim for early detection of ED by screening their risk factors and providing early treatment. This can also be used to promote awareness to the community on the sexual health and factors that can affect their sexual function. Strength & Limitation: This study looks at all types of behavioral factors that may affect ED; however, there was a substantial heterogeneity detected across the selected study factors. Furthermore, the lack of PROSPERO registration is also a limitation in this study. Conclusion: Overall, smoking, dietary intake, alcohol consumption, drugs, and physical activities are modifiable risk factors for ED in men. Therefore, it is crucial to promote healthy lifestyle and empower men to prevent ED and early detection of ED for early treatment. Sivaratnam L, Selimin DS, Abd Ghani SR, et al. Behavior Related Erectile Dysfunction: A Systematic Review and Meta-Analysis. Copyright (C) 2020, International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.