Mendelian randomization analyses reveal causal relationships between chronic psychological stress and risk of erectile dysfunction

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Abstract
Background: The association between psychological stress and erectile dysfunction (ED) has been reported, but the causality of different types of stressors on ED is poorly understood. Aim: This study aims to investigate the causal relationship between various forms of psychological stress and ED through Mendelian randomization (MR). Methods: Several genome-wide association study (GWAS) datasets related to chronic psychological stress were used in this study for the identification of instrumental variables. Concurrently, a genome-wide association studies database provided the ED outcome data containing 6175 ED patients and 217 630 controls. The MR-Egger, inverse variance weighting (IVW), weighted median, and maximum likelihood methods were applied to conduct the MR study and IVW was taken as the primary criterion. Outcomes: Mendelian randomization analyses revealed that financial difficulties were associated with a heightened risk of ED, whereas the absence of stressors was linked to a decreased risk. Results: Among the various types of psychological stressors analyzed, financial difficulties were found to significantly increase the risk of ED (P = .022, OR = 4.343, 95%CI = 1.240-15.216). In contrast, other stressors did not significantly elevate the risk of ED. Furthermore, the absence of these stressors was associated with a reduced risk of ED (P = .009, OR = 0.211, 95% CI = 0.066-0.681). Clinical implications: This study emphasizes the enormous impact of psychological stress, especially financial hardship, in increasing the risk of ED. Strengths and limitations: This study is the first to employ MR analysis to investigate the causal relationship between various stressors and ED. However, this study did not consider the influence of non-genetic factors such as living environment and lifestyles. Conclusion: Psychological stress, particularly financial difficulties, can increase the risk of ED, while the absence of such stressors appears to be protective. Consequently, it is imperative to enhance medical education and awareness among economically disadvantaged populations and to address the detrimental effects of adverse lifestyles.
Funding Information
  • National Natural Science Foundation of China (81871158)

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