Folic Acid: One Factor in Erectile Dysfunction?

Erectile dysfunction (ED) is diagnosed in men who have difficulty obtaining or maintaining an erection throughout sexual intercourse, or lack erectile rigidity for at least 6 months. Its prevalence is growing, and has been linked to our aging population. These symptoms are distressing to men who develop them, and are generally physiologically-based (arteriogenic, neurogenic, cavernosal, endocrinological, or iatrogenic), rather than psychologically-based.

ED has been associated with arteriosclerosis, chronic inflammation diabetes, hypercholesterolemia, hypertension, hypertriglyceridemia, and obesity. Unhealthy lifestyle choices, including smoking, sedentary activity level, and poor diet, also seem to have an impact on ED.

Researchers from Sapienza Universita di Roma in Rome, Italy have published a review article in the journal Aging Male that implicates folic acid as a contributing factor in ED. Previous research has suggested that a lack of folic acid may contribute to hyperhomocisteinemia (abnormally high level of homocysteine in the blood, usually exceeding 15 µmol/L. Deficiencies of vitamin B6, folic acid, and vitamin B12 alter biochemical reactions involving homocysteine, creating high homocysteine levels. Elevated homocysteine impairs endothelial function, and erectile function. These researchers propose that folic acid might affect ED through other mechanisms, including a decline in nitric oxide (NO) activity.

In this small study, the researchers examined 31 men diagnosed with ED, and compared them to a control group. Men with ED had significantly lower folic acid levels than those in the control group. Men with the lowest folic acid levels tended to have the most severe ED.

The researchers indicate that their most compelling finding was that folic acid levels did not correlate with hyperomocisteinemia, indicating that folic acid may work through different mechanisms.

Previous study has suggested that adding folic acid to tadfinanil increases the likelihood of positive outcomes in men who have diabetes (a population in which phosphodiesterase type 5 inhibitors tend to be less effective). Large studies using folic acid supplementation in men who have erectile dysfunction have not been conducted, so routine supplementation is not recommended at this time.

References

• Sansone M, Sansone A, Romano M, et al. A possible role in erectile dysfunction? Aging Male. 2018;21(2):116-120.
• Hamidi Madani A, Asadolahzade A, Mokhtari G, Shahrokhi Damavand R, Farzan A, Esmaeili S. Assessment of the efficacy of combination therapy with folic acid and tadalafil for the management of erectile dysfunction in men with type 2 diabetes mellitus. J Sex Med. 2013;10(4):1146-50.