The Cumulative Effects of Medication Use, Drug Use, and Smoking on Erectile Dysfunction Among Men Who Have Sex with Men

Trevor A. Hart, David Moskowitz, Christopher Cox, Xiuhong Li, David G. Ostrow, Ron D. Stall, Pamina M. Gorbach, Michael Plankey

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


Introduction. Erectile dysfunction (ED) is highly prevalent among human immunodeficiency virus-seropositive (HIV+) men who have sex with men (MSM). There is a need for additional research to determine the correlates of HIV+ and HIV-seronegative (HIV-) MSM, especially regarding nonantiretroviral medication use. Aims. This study examined the prevalence of ED and the sociodemographic, medical conditions, medication use, and substance use correlates of ED among HIV+ and HIV- MSM. Methods. A modified version of the International Index of Erectile Function (IIEF) for MSM was self-administered by participants enrolled in the Multicenter AIDS Cohort Study, an ongoing prospective study of the natural and treated histories of HIV infection among MSM in the United States. The study sample included 1,340 participants, including 612 HIV+ and 728 HIV- men. Poisson regression with robust error variance was used to estimate prevalence ratios of ED in multivariable models in combined (HIV+/-) and separate analyses. Main Outcome Measure. ED was determined by the summed scores of a modified version of the IIEF validated among MSM. Results. Twenty-one percent of HIV+ MSM and 16% of HIV- MSM reported ED. Being >55years of age, black race, cumulative pack years of smoking, cumulative antihypertensive use, and cumulative antidepressant use had significant positive associations with the prevalence of ED in the total sample. Among HIV+ men, duration of antihypertensive use and antidepressant use were significantly associated with increasing prevalence of ED. Among HIV- men, being >55years of age, black race, and cigarette smoking duration were associated with increased prevalence of ED. Conclusion. Predictors of ED may differ by HIV status. Although smoking cessation and effective medication management may be important as possible treatment strategies for ED among all MSM, there may be a burden on sexual functioning produced by non-HIV medications for HIV+ men. Hart TA, Moskowitz D, Cox C, Li X, Ostrow DG, Stall RD, Gorbach PM, and Plankey M. The cumulative effects of medication use, drug use, and smoking on erectile dysfunction among men who have sex with men.

Original languageEnglish (US)
Pages (from-to)1106-1113
Number of pages8
JournalJournal of Sexual Medicine
Issue number4
StatePublished - Apr 2012


  • Erectile dysfunction
  • Gay
  • HIV
  • Male erectile disorder
  • Men who have sex with men
  • Non-HIV medications

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynecology
  • Urology


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