Asymptomatic peripheral arterial occlusive disease and erection problems.

We would like to report the association between peripheral arterial occlusive disease (PAOD) and perceived erection problems found in the Limburg PAOD study.1 Intermittent claudication (IC), the first symptomatic stage of PAOD, is a common atherosclerotic condition among mostly elderly subjects. However, the majority of PAOD cases are asymptomatic.1 Symptomatic PAOD is associated with organic impotence, particularly when the occlusion involves the aortoiliac vascular bed.2 Data on the prevalence of erectile impairment in asymptomatic PAOD subjects are non-existent. Our study population consisted of 3649 male subjects (47%) with a mean age of 59 years (range = 40 to 78 years), who were selected out of a group of 26 620 subjects from 18 general practice centres by means of a stratified sampling procedure. Strata were formed on the basis of the number of positive answers on a short postal screening questionnaire, concerning complaints on walking and cardiovascular risk.1 PAOD was defined as an ankle–brachial pressure index (ABPI) <0.95, measured twice in the same leg with a one-week interval. The ABPI was calculated as the ratio of ankle systolic blood pressure to the highest arm systolic blood pressure, using a Doppler device. Reproducibility and diagnostic accuracy of Doppler ABPI measurements have been shown to be adequate.3,4 IC was assessed according to a modified version of the Rose questionnaire.1,5 Asymptomatic PAOD was defined as an ABPI <0.95 without IC complaints. In addition, data were collected on experienced erection problems, smoking habits, hypertension, diabetes, and hypercholesterolaemia.1 Among male asymptomatic PAOD subjects, 44% (66 out of 150) reported erection problems compared with 25% (358 out of 1405) among male subjects without PAOD. For claudicants, this number was 47% (41 out of 87). Logistic regression analysis showed that experienced erection problems were significantly associated with asymptomatic PAOD (odds ratio = 1.6, 95% confidence interval 1.1–2.4), as well as with symptomatic PAOD (odds ratio = 1.6, 95% confidence interval 1.2–2.9), adjusted for higher age, smoking, diabetes, hypercholesterolaemia, and hypertension. Our findings are consistent with the notion that subclinical atherosclerosis of the aorta and distal arteries (aortoiliac, penile, and testicular arteries) may result in penile ischaemia. In case of a patient complaining of erection problems, the general practitioner could perform a vascular physical examination including ABPI measurements and assessment of atherosclerotic risk factors. Positive findings raise the possibility of organic impotence. Conversely, in male subjects with asymptomatic or symptomatic PAOD, attention could be paid to the possible presence of erection problems.