Tags:  Erectile dysfunction; Meta-analysis; Cannabis; Systematic review

 

The problem:  It is unclear if cannabis use impacts sexual health in men. With increasing cannabis legalization, it is essential to identify any associations between cannabis use and erectile dysfunction (ED).

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Why do this study? The aim of this meta-analysis was to understand the prevalence of ED among cannabis users compared to non-users.

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The study:  The authors conducted a systematic review of major scientific databases (e.g PubMed) until January 2019, to identify studies that investigated cannabis use and presence of ED. The primary goal was to compare the prevalence of ED in cannabis users versus non-users. The authors identified 5 case-control studies that characterized ED among cannabis users. This yielded data from 3,395 healthy men: 1,035 were cannabis (smoking) users and 2,360 were nonusers. The analysis revealed that the prevalence of ED was almost 2-fold higher among cannabis users compared to non-users (69% in users vs. 35% in nonusers).

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Conclusions:  The main conclusion from this study was that ED was nearly 2-fold more prevalent among men who used cannabis, compared to non-users.

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What does this study add? There is conflicting evidence in the literature regarding the effect of cannabis on men’s health. While some reports show that cannabis can negatively impact fertility in men, others show no effect on men’s health. This study by Pizzol et al is the first meta-analysis performed to understand the effect of cannabis on men’s sexual health; the authors report a strong association between cannabis use and prevalence of ED.

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Funder:  Health Education England and the National Institute for Health Research

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Author conflicts:  None

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Commentary: The study explores the relationship between two factors that are common among millions of people worldwide- erectile dysfunction and cannabis use. The study sheds light on the potential harmful effects of cannabis on men’s health. Cannabis use was associated with ~2-fold increase in ED prevalence. The inclusion criteria for the meta-analysis were strong, and the authors only included cannabis studies which had a control group of non-cannabis users. Also, ED was measured using validated tools. However, the results need to be interpreted with caution because no correlations were obtained between duration of cannabis use and onset of ED. Probably the most significant concern about this study is the possibility of reverse causality. Although one interpretation of these results is that cannabis use can lead to ED, if men with ED are more likely to use cannabis, we’d see similar associations. Additionally, what seems to be an association between cannabis and ED might be an effect of other conditions such as chronic pain or depression, which may themselves be associated with ED. In many situations, it might be hard to identify direct associations between these factors.  Ideally, a next step would be to evaluate the incidence of new ED in randomized controlled trials—that would help to address many of these concerns and would give us a more rigorous answer.