Painkillers Increase Risk of Erectile Dysfunction

 

Regularly taking prescription painkillers, commonly called opioids, is linked to a greater risk of erectile dysfunction (ED) in men, according to a new study published in Spine.

Over 11,000 men suffering from back pain were involved in the research. The health records of the participants were analyzed to determine whether males taking prescription opioids were more likely to also receive prescriptions for testosterone replacement or ED medications.

The investigators found that over 19% of males who took high-dose opioids for 4 months or more were also given ED prescriptions, while fewer than 7% of males who did not take painkillers received prescriptions for ED.

Over 12% of men who took low-dose opioids for four months or more also received ED prescriptions or testosterone replacement.

Age was the factor most notably linked to receiving ED prescriptions. The men in the study over the age of 60 had a much higher probability of receiving ED prescriptions.

"Men 60 to 69 (years old) were 14 times more likely to receive prescriptions for ED medication than men 18 to 29," the researchers said.

Depression, other health problems (other than back pain), and use of sedative hypnotics, such as benzodiazepines, also raised the probability that men would receive prescriptions for ED.

However, the authors explained, even after adjusting for those factors, men with high-dose opioid use and males with long-term opioid use still had a 50% increased likelihood of recieving ED prescriptions than those who did not take opioids.

Leading author Richard A. Deyo, MD, MPH, investigator with the Kaiser Permanente Center for Health Research and Professor of Evidence-based Family Medicine at Oregon Health & Science University, said:

"Men who take opioid pain medications for an extended period of time have the highest risk of ED. This doesn't mean that these medications cause ED, but the association is something patients and clinicians should be aware of when deciding if opioids should be used to treat back pain."

According to the CDC (Centers for Disease Control and Prevention), the use of prescription painkillers is on the rise in the U.S. The Mortality and Morbidity Report by the CDC revealed that prescription opioid sales experienced a fourfold increase between 1999 and 2010.

A different report, published in the journal Pain, indicated that about 4.3 million Americans use opioid drugs on a regular basis.

The most commonly used prescription opioids include:

• oxycodone
• morphine
• hydrocodone

Deyo said:

"There is no question that for some patients opioid use is appropriate, but there is also increasing evidence that long-term use can lead to addiction, fatal overdoses, sleep apnea, falls in the elderly, reduced hormone production, and now erectile dysfunction."

A CDC report from 2011 found that more Americans die each year from prescription painkiller overdoses than the combined total for cocaine and heroin.

Deyo and his team studied 11,327 men in Oregon and Washington registered for the Kaiser Permanente health plan who saw a doctor for back pain during 2004.

The subjects' pharmacy records for 6 months before and after their doctor's visit for back pain were analyzed to determine whether they had received prescriptions for opioids and for ED or testosterone replacement.

Prescription painkiller use was categorized as:

• none - men who did not receive an opioid prescription
• acute - men who took opioids for 3 months or less
• episodic - men who took opioids for longer than 3 months, but less than 4 months and with fewer than 10 refills
• long-term - men who took opioids for at least four months, or more than 3 months with 10 or more refills

High-dose use was considered anything over 120 mg of morphine equivalent, and low-dose use was considered under 120 mg.

A 2011 study published in the British Journal of Urology International showed that erectile dysfunction is linked to how many different medications are taken.

Hysterectomy Does Not Raise Heart Risk

 

 Contrary to some previous research, a new study from the US finds women's risk of cardiovascular disease does not go up after having a hysterectomy in mid-life, with or without ovary removal. The risk is no higher than that faced by women who reach the menopause naturally, says the new study.

Lead author Karen A. Matthews of the University of Pittsburgh, and colleagues, write about their findings in a report due to be published online this week in the Journal of the American College of Cardiology.

Matthews, who is a distinguished professor of psychiatry and professor of epidemiology and psychology at Pittsburgh, declares in a press statement that the results should be encouraging to middle-aged women considering a hysterectomy:

"... our results suggest that increased levels of cardiovascular risk factors are not any more likely after hysterectomy relative to after natural menopause," says Matthews.

Hysterectomy and Risk of Cardiovascular Disease

Hysterectomy is a common surgical procedure that removes a woman's uterus. Sometimes she also has her ovaries removed, usually to reduce risk of ovarian cancer.

However, while the need for such a procedure may be obvious, for instance because of cancer, prolapsed uterus, fibroids, or because of very heavy and painful periods, as with all surgery, the benefits have to be weighed against the risks.

Because of changes to hormones, one of the effects of having a hysterectomy before the menopause is that it usually brings on the menopause earlier.

Some previous studies have suggested hysterectomy raises long term risk of cardiovascular disease, which is the number one killer of women. And they have inferred that the risk is even higher if ovaries are also removed.

But there are objections to this view, mainly because those studies tended to evaluate cardiovascular disease risk factors years after hysterectomy and/or ovary removal without taking into account what they might have been before surgery.

What the Researchers Did

For this new study, Matthews and colleagues followed 3,302 premenopausal women in the US for 11 years. The women were taking part in the Study of Women's Health across the Nation (SWAN).

At the start of the study period, when the women enrolled on SWAN, they were between 42 and 52 years of age, had an intact uterus, at least one ovary, and were not taking hormone therapy.

They underwent assessments every year over the follow up, during which time the majority reached the menopause naturally, some had hysterectomy with ovary removal, and some had hysterectomy without ovary removal.

The main reasons for hysterectomy were fibroids, heavy periods, and chronic pelvic pain.

The researchers assessed cardiovascular disease risk factors in the participants before and after hysterectomy, and compared this to the risk factors before and after the final menstrual period in those who went through the menopause naturally.

Matthews and colleagues say their study is the first multiethnic study to track prospective annual changes in cardiovascular disease risk factors relative to hysterectomy or natural menopause.

What They Found

The analysis showed that while some of the before and after individual cardiovascular risk factors changes were different for hysterectomy compared to natural menopause, overall, the pattern of changes did not suggest an increase in cardiovascular risk following hysterectomy say the researchers. And this was the same in all ethnic groups.

Plus, this was the case even after adjusting for possible influencers like Body Mass Index (BMI), which did go up after hysterectomy with ovary removal.

What the Reasons Might Be

Mathews says they are not sure why their findings disagree with earlier studies that suggest hysterectomy raises cardiovascular disease risk.

One reason could be because they did not include younger women, and hysterectomy that occurs earlier in life may result in higher cardiovascular disease risk.

Another reason, says Matthews, could be that this study excluded women who had hysterectomies because of cancer.

SWAN is co-sponsored by the National Institute on Aging, the National Institute of Nursing Research, the National Institutes of Health, Office of Research on Women's Health, and the National Center for Complementary and Alternative Medicine.

In 2011, writing in the journal Archives of Internal Medicine, researchers from the University of California at San Francisco reported finding women who underwent hysterectomy with ovary removal had a reduced risk of developing ovarian cancer, and no higher risk of developing other types of cancer, heart disease or hip fractures.