Sexual dysfunction and cardiovascular diseases: a systematic review of
prevalence

Nascimento, Elisabete Rodrigues; Maia, Ana Claudia Ornelas; Pereira, Valeska; Soares-Filho, Gastão; Nardi, Antonio Egidio; Silva, Adriana Cardoso

doi:10.6061/clinics/2013(11)13

Brazil

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REVIEWS • Clinics 68 (11) • Nov 2013 • https://doi.org/10.6061/clinics/2013(11)13 linkcopy

Sexual dysfunction and cardiovascular diseases: a systematic review of prevalence

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The aim of this study was to conduct a systematic review of the literature regarding the prevalence of sexual dysfunction in patients with cardiovascular diseases. An article search of the ISI Web of Science and PubMed databases using the search terms "sexual dysfunction”, “cardiovascular diseases”, “coronary artery disease", “myocardial infarct" and “prevalence” was performed. In total, 893 references were found. Non-English-language and repeated references were excluded. After an abstract analysis, 91 references were included for full-text reading, and 24 articles that evaluated sexual function using validated instruments were selected for this review. This research was conducted in October 2012, and no time restrictions were placed on any of the database searches. Reviews and theoretical articles were excluded; only clinical trials and epidemiological studies were selected for this review. The studies were mostly cross-sectional, observational and case-control in nature; other studies used prospective cohort or randomized clinical designs. In women, all domains of sexual function (desire, arousal, vaginal lubrication, orgasm, sexual dissatisfaction and pain) were affected. The domains prevalent in men included erectile dysfunction and premature ejaculation and orgasm. Sexual dysfunction was related to the severity of cardiovascular disease. When they resumed sexual activity, patients with heart disease reported significant difficulty, including a lack of interest in sex, sexual dissatisfaction and a decrease in the frequency of sexual activity.

Sexual Dysfunction; Cardiovascular Diseases; Prevalence

Authors and year	Population	Instrument/Measure	Summary
Wabrek et al., 1980 (¹¹)	Male	IIEF (35)	Six weeks after their first MI, 64% of patients presented with ED, 28% presented with decreased sexual frequency, and 8% presented with premature ejaculation.
Jaarsma et al., 1996 (¹²)	Male and Female	SAS and PAIS (³⁶)	Heart failure resulted in significant changes in sexual desire and the frequency of sexual activity.
Greenstein et al., 1997 (¹³)	Male	Questionnaire by O'Leary (37)	The severity of CAD decreased the frequency of erections.
Abramov LA et al., 1997 (¹⁴)	Female	Student's t-test and X² contingency (³⁸)	High prevalence of reduced desire and sexual dissatisfaction among 50 patients (65%) after MI compared with 20 (24%) controls.
Drory et al., 1998 (¹⁵)	Male	QSF (³⁹)	After MI, patients showed changes in sexual frequency (32%) associated with age and education. For 23%, sexual dissatisfaction was correlated with age.
Hultgren et al., 1999 (¹⁶)	Female	FSFI (⁴⁰)	Patients with AIOD experienced negative effects on sexual arousal, orgasm and vulvar sensitivity.
Drory et al., 2000 (¹⁷)	Male and Female	QSF (³⁹)	The frequency of and satisfaction with sexual activity were similarly reduced for both sexes.
Burchardt et al., 2001 (¹⁸)	Male	IIEF (³⁵) and CESD (⁴¹)	ED was considered as a marker of cardiovascular complications (p<0.05) in 70 patients (70.6%) with hypertension. In total, 22 (30.6%) patients with ED showed signs of depression.
Montorsi et al., 2003 (¹⁹)	Male	IIEF (³⁵)	ED occurred 38.8 months before the advent of CAD in 99 patients (67%) men. ED was evident before heart disease in 70% of all cases.
Vacanti et al., 2005 (²⁰)	Male	IIEF (³⁵) and HADS (⁴²)	After MI, patients showed an incidence of 40.5% of ED and depressive symptoms.
Addis et al., 2005 (²¹)	Female	Logistic regression	A total of 1,091 patients had SD, of whom 140 (13%) complained of one sexual problem, and 570 (52%) complained of two or more.
Shi et al., 2006 (²²)	Male	IIEF (³⁵)	Patients with CAD in the acute (p>0.05) and chronic (p<0.05) phases.
Kazemi-Saleh et al., 2007 (²³)	Male	HADS (⁴²) and RSS (⁴³)	Twenty-nine patients (33.3%) showed sexual fear, depressive symptoms and a decreased frequency of sexual activity.
Eyada et al., 2007 (²⁴)	Female	ASEX (⁴⁴)	Pectoral angina had a negative effect on the frequency and sexual satisfaction of patients.
Kaya et al., 2007 (²⁵)	Female	FSFI (⁴⁰)	All FSFI domain scores, except satisfaction, were lower in patients with CAD compared with healthy individuals (p<0.05).
Lunelli et al., 2008 (²⁶)	Male and Female	Mann-Whitney tests (²⁶)	In total, 60% of patients had doubts about their return to sexual activity, and 44% had reduced their sexual frequency.
Cook et al., 2008 (²⁷)	Male	t-tests with Bonferroni correction (⁴⁵)	Patients using BBs reported three times more ED (p = 0.045).
Kazemi et al., 2008 (²⁸)	Male and Female	RSS (⁴⁶) and HADS (⁴²)	Male and female patients with CAD and symptoms of depression had sex less frequently. Male depression was correlated with the couple's fear of sexual intercourse.
Schwarz et al., 2008 (²⁹)	Male and Female	IIEF (³⁵) and FSFI (⁴⁰)	Male and female patients showed a high prevalence of SD.
Hoffman et al., 2010 (³⁰)	Male	ASEX (⁴⁴)	ED was associated with greater CVD risk and impaired vascular endothelial function in depressed men.
Lemogne et al., 2010 (³¹)	Male	IIEF-5 (⁴⁷), BDI-13 (⁴⁸),STAI (⁴⁹) and DS-14 (⁵⁰)	The prevalence of ED (57.6%) was negatively associated with age and depressed mood.
Kriston et al., 2010 (³²)	Male and Female	IIEF (³⁵), FSFI (⁴⁰) and HADS (⁴²)	ED was found in 20.3% of men, and SD was found in 43.1% of women. Symptoms of moderate depression were found in 16.5% and 14.4% of men and women, respectively.
Foruzan-Nia et al., 2011 (³³)	Male	IIEF (³⁵)	SD was prevalent one year after MI.
Lindau et al., 2012 (³⁴)	Male and Female	PHQ-9 (⁵¹) and F-12 PCS (⁵²)	A lack of sexual desire contributed to a decrease in sexual frequency among 59% of women and 48% of men.

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[TFN01t01] IIEF = International Index of Erectile Function; SAS = Adjustment Sexual Scale; PAIS = Psychosocial Adjustment to Illness Scale; QSF = Sexual Function Questionnaire; CESD = Center for Epidemiologic Studies, Depression Scale; HADS = Hospital Anxiety and Depression Scale; RSS = Relationship and Sexuality Scale; ASEX = Arizona Sexual Experience Scale; FSFI = Female Sexual Function Index; BDI = Beck Depression Inventory; STAI = State-Trait Anxiety Inventory; DS-14 = Type-D Personality Scale-14; PHQ-9 = 9-Item Patient Health Questionnaire; and SF-12 PCS = 12-Item Short-Form Health Survey, Physical Composite Score.