Erectile dysfunction linked to opioid use in men

(Author – Cheryl Mussatto MS, RD, LD for use by Dr. David Samadi)

Men with chronic pain using opioids to deal with the discomfort should reconsider that decision. Pain-killing medications known as opioids may relieve the pain, but they also can shut down your sex life.  This fact is not necessarily well-known among the medical community but should be discussed with men before automatically prescribing these drugs.

A study back in 2013 which was published in the journal Spine found that men who were prescribed medications for erectile dysfunction (ED) or low testosterone levels were more likely to be taking an opioid medication for chronic back pain. Men with persistent pain should be informed of this potential side effect of long-term opioid use. Since the study was an observational study, it limits the ability to make a cause-and-effect inference.  While opioid use and ED seem to go together, it can’t be said that one causes the other.

Around 11,000 men were included in this study that all had back pain. Out of this group, more than 900 men received medications for ED (Viagra, Cialis, or Levitra), or testosterone replacement. Generally, those men were older than those who did not have a prescription for ED. These same men were also more likely to have depression and other health conditions.  

Commonly used prescribed opioids include hydrocodone, oxycodone, and morphine. For this study, men who used an opioid for more than 120 days, or more than 90 days if more than 10 prescriptions were filled for the drug, as long-term use.

The most significant factor for the men in getting a prescription for ED was their age. Men between ages of 60 and 69 were 14 times more likely to receive a prescription for ED than men who were between 18 and 29.

When the data was adjusted for other possible factors, including age, the researchers found that men who took opioid pain medications for long periods, were about 50 percent more likely to have ED medications or testosterone replacement therapy. Again limitations with the study do not prove that opioid use causes ED as ED could be related to the pain the men were experiencing. However, there is evidence that men who stop taking opioids after using them for a short time will see an improvement in erectile dysfunction but it’s not clear if the same is true after long-term use.

In recent years, there has been growing evidence and much concern on long-term use of opioids on overall health of anyone taking them for pain. The body compensates for taking long-term pain medications, due to changes in the brain and spinal cord making people more sensitive to them.

There can be other contributing factors to ED besides possibly opioid medication use such as diabetes, heart disease, peripheral vascular disease, and alcohol use. In the meantime, all doctors treating any man for chronic pain should discuss with them if they are also experiencing ED.