Erectile dysfunction among male patients receiving methadone maintenance treatment: focusing on anxiety-related symptoms.

Background: Erectile dysfunction (ED) in patients receiving methadone maintenance treatment (MMT) is a relatively neglected issue. Aim: In this study we sought to determine the actual prevalence of ED and risky sexual behaviors in patients receiving MMT and identify clinically relevant risk factors for ED, particularly mental health conditions, that may contribute to achieving holistic healthcare and improving treatment adherence in this patient population. Methods: A cross-sectional study of male Chinese MMT patients was conducted. Comprehensive demographic and clinical data regarding age, obesity, history of major mental and physical illness, HIV infection, other substance use, methadone dose/duration, and associated risky sexual behaviors were all collected. Assessment tools, including the 5-item International Index of Erectile Function, the Chinese Health Questionnaire, and the Taiwanese Depression Questionnaire were administered. Outcomes: The relationship between mental health-related factors and ED was fully analyzed and elaborated. Results: The prevalence of ED among male patients in a methadone maintenance therapy outpatient clinic was 55.7%. The prevalence rate of ED among the individuals treated for longer than 6 months was 56.8%, whereas that for untreated individuals was 52.0%. Additionally, methadone-treated individuals were older and had a higher proportion of condom use and drug-assisted sexual activity than untreated individuals. Pearson correlation revealed that higher Chinese Health Questionnaire and Taiwanese Depression Questionnaire scores were negatively correlated with lower scores on the 5-item International Index of Erectile Function. In the multivariate regression model, anxiety and other psychosomatic symptoms were associated with more severe ED, whereas individuals who consumed alcohol within the past month had less severe ED after adjustment for other demographic and clinical variables. The findings of the present study revealed no association between ED and methadone treatment duration or dosage. Clinical Implications: Healthcare professionals should discuss mental health issues in patients on MMT with ED, especially anxiety symptoms and recent alcohol use. Strengths and Limitations: This study is one of the few reports within the limited body of research highlighting a significant association of ED with anxiety-related symptoms in patients undergoing MMT. Our study had some limitations. First, the sample size of HIV-infected individuals was insufficient. Second, the cross-sectional study design could not definitively demonstrate a causal mechanism. Conclusion: In patients undergoing MMT, individuals who reported less severe anxiety symptoms and alcohol consumption in the past month tended to have less severe ED, regardless of the MMT duration or dosage.