Abstract
IntroductionThe association between folic acid (FA) and erectile dysfunction (ED) was contradictory in the published original articles, and no meta-analysis was conducted to pool these data.AimTo verify the role of FA in the pathology of ED and explore the treatment efficacy of FA for ED patients.MethodsAn extensive search was performed on PubMed, Cochrane Library, and Web of Science to obtain all relevant studies published up to October 31, 2020. Studies comparing the serum FA level between ED patients and healthy controls, or comparing the score of the IIEF-5, or IIEF before and after folic acid therapy alone or combination in ED patient were eligible for our meta-analysis. The Newcastle-Ottawa Scales (NOS) was used to qualify included studies.Main Outcome MeasuresThe standardized mean differences (SMD) and their corresponding 95% confidence intervals (95% CIs) were calculated to pool our data.ResultsNine studies were eligible for our meta-analysis to verify the association between FA and ED, and to explore the treatment efficacy of FA for ED patients. The pooled SMD of the FA level difference between ED patients and healthy subjects was -0.94 (95% CI: -1.59, -0.30, P = .004). Moreover, the level of folic acid in healthy subjects, Mild ED patients, Moderate ED patients and Severe ED patients was 11.847 (95%CI = 9.671, 14.022), 9.496 (95%CI = 8.425, 10.567), 6.597 (95%CI = 5.187, 8.007) and 5.623 (95%CI = 3.535, 7.711) respectively. The SMD of changes in score of IIEF-5 was 1.89 with 95%CI (1.60, 2.17) after FA administration in ED patients. Our analysis also showed that combination therapy of FA plus tadalafil changed the score of IIEF with 0.90 (95%CI = 0.44, 1.36) comparing to combination of placebo plus tadalafil.ConclusionThis novel meta-analysis demonstrated that FA was an independent risk factor for ED and FA supplement may have potentially positive effects in the treatment of ED patients.Zhang Y, Zhang W, Dai Y, et al. Serum Folic Acid and Erectile Dysfunction: A Systematic Review and Meta-Analysis. Sex Med 2021;9:100356.
Highlights
The association between folic acid (FA) and erectile dysfunction (ED) was contradictory in the published original articles, and no meta-analysis was conducted to pool these data
We excluded the duplicates through the software of EndNote
6 studies compared the folia acid level between the ED patients and healthy subjects; 2 studies compared the score of the IIEF-5 before and after folic acid therapy in ED patients; Only one study compared the score of the IIEF between tadalafil with folic acid therapy and tadalafil with placebo therapy in ED patients
Summary
The association between folic acid (FA) and erectile dysfunction (ED) was contradictory in the published original articles, and no meta-analysis was conducted to pool these data. Erectile dysfunction is defined as the inability to reach or maintain an erection that is sufficient for sexual performance.[1]. 2-40% of men aged 40-69 years are affected by this male sexual dysfunction.[2] The prevalence of ED will reach to 322 million men in 2025.3 It has a significant effect on the quality of life of the patients and their partners.[4]. Vascular ED is the most important and prevalent subtype of ED owing to the vascular network of the penis.[5] The risk factors of vascular ED mainly include obesity, diabetes mellitus (DM), hypertension (HT), dyslipidemia, metabolic syndrome (MetS), lack of exercise, and smoking.[6] Endothelial dysfunction (EnD) has been found to be a key bridge linking these risk factors and vascular ED.[7]
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