Relationship between cannabis use and erectile dysfunction: a systematic review and meta-analysis

Globally, there is increasing usage and legalization of cannabis. In addition to its reported thera-peutic effects, cannabis has several health risks which are not clearly defined. Erectile dysfunction (ED) is the most common male sexual disorder and there are plausible mechanisms linking canna-bis use to ED. No attempt has been made to collate the literature on this topic. The aim of this re-view was to summarize the prevalence and risk of ED in cannabis users compared to controls. A systematic review of major databases from inception to 16/01/2019, without language re-striction, was undertaken to identify studies investigating cannabis use and presence of ED. The analysis compared the prevalence of ED in cannabis users versus controls. Consequently was cal-culated the odds ratio (OR) with 95% confidence intervals (CI), applying a random-effect model. Were included five case-control studies with data from 3,395 healthy men, 1,035 using cannabis (smoking) and 2,360 non-users. The overall prevalence of ED in cannabis users was 69.1% (95% CI: 38.0-89.1), whilst the correspondent figure in controls was 34.7% (95% CI: 20.3-52.7). The odds of ED in cannabis users was almost four times that of controls (OR=3.83; 95%CI: 1.30-11.28; p=0.02), even if characterized by high heterogeneity (I2=90%) and the prediction intervals overlapped 1.00 (95% CI: 0.35-7.26). Data suggest that ED is twice as high in cannabis users compared to controls. Future longitudinal research is needed to confirm/refute this and explore if a dose response relationship between cannabis and ED may be evident.