Serum folic acid levels and erectile dysfunction: A meta-analysis and systematic review

Correlation between erectile dysfunction and serum B12 levels: a 136-case cross-sectional analysis

BACKGROUND

Erectile dysfunction (ED) involves the inability to initiate or sustain penile erection with sufficient hardness to ensure satisfying sexual relations. Many causes are blamed in the etiology.

OBJECTIVES

In this study, the correlation between serum vitamin B12 (vit B12) levels with ED was researched in a homogeneous case group after exclusion of all other predisposing conditions causing ED.

METHODS

The study included male patients attending the urology clinic from 2015 to 2022. Patients were prospectively registered to the study. Cases were divided into two groups as low and normal according to vit B12 levels. In the study, vit B12 levels ≤200 mg/dL were accepted as low. The Sexual Health Inventory for Men-5 (SHIM-5) was used to assess the erectile function. The SHIM-5 scores for the groups were compared. All patients with comorbid diseases, medication use, or previous surgical history predisposing toward ED and organic and/or psychogenic causes for ED were excluded from the study.

RESULTS

The study included 136 patients abiding by the study criteria among 957 patients. The mean age of cases was 63.35 ± 7.83 years. Mean vit B12 value was 320.74 ± 184.74 mg/dL and 32 cases (23.5%) had inadequate vit B12 (< 200 mg/dL). The mean SHIM-5 value in the group was 15.48 ± 6.71. In the inadequate vit B12 and normal vit B12 groups, the mean SHIM-5 values were 15.30 ± 6.85 and 16.06 ± 6.28, respectively, with no significant difference between the two groups (t = 0.562, p = 0.575). Vit B12 deficiency was identified in 26.7% of patients with sexual desire disorder (SDD) (n = 90) and 17.4% of those without SDD (X2 = 1.46, p = 0.228).

DISCUSSION

Contrary to the general trend in the literature, we found no significant correlation between vit B12 levels and ED.

CONCLUSION

There is a need for prospective randomized controlled studies for detailed analysis of the correlation between erectile dysfunction and vit B12.

Association between folic acid, homocysteine, vitamin B12 and erectile dysfunction-A cross-sectional study

To evaluate the relationship between serum levels of folic acid (FA), homocysteine (HCY), vitamin B12 (B12) and erectile dysfunction (ED) and to explore their internal relationships. The study included 134 ED patients and 50 healthy controls. ED was assessed using IIEF-5 scores. ED group had lower median FA (6.08 versus 10.21; p < .001) and B12 (256.0 versus 337.5; p < .001) levels, and higher median HCY (11.4 versus 7.95; p < .001) levels, and these differences seemed to be more pronounced in the younger participants (age < 35 yr). FA decreased with the severity of ED (7.52 versus 6.15 versus 5.49 versus 3.97; p < .001), while HCY increased (10.35 versus 11.8 versus 12.9 versus 15; p < .001). Smoking and shift work were associated with lower FA levels. Multivariate analysis showed that serum FA and HCY revealed significant relation with ED. ROC analysis showed that FA ≤ 8.84 and HCY ≥ 10.35 were the best cut-off values for ED diagnosis. Both FA (r = -0.703, p < .001) and B12 (r = -0.576, p < .001) were negatively correlated with HCY. In conclusion, low FA levels and high HCY levels might be independent risk factors for ED. Low serum FA and B12 levels might co-cause high HCY levels and lead to ED.