C-reactive protein levels predict risk of erectile dysfunction

Erectile dysfunction (ED) is associated with negative effects on the physical and mental health of men, as well as the life satisfaction of their partners. Although men of any age can be diagnosed with erectile dysfunction, it is much more common in older men, especially those over 75. Worldwide, erectile dysfunction-related comorbidities are expected to affect nearly 320 million men by 2025.

Study: New predictive risk factor for erectile dysfunction: high sensitivity serum C-reactive protein. Image Credit: Wasan Tita / Shutterstock.com


Multiple factors contribute to the pathogenesis of erectile dysfunction. Vascular erectile dysfunction, for example, is related to vascular endothelial dysfunction and is associated with lower nitric oxide production and restricted blood flow which, taken together, inhibit erectile function. Thus, cardiovascular disease (CVD) is linked to ED.

C-reactive protein (CRP) is expressed in humans during the acute immune response. Moreover, high-sensitivity CRP (hs-CRP) is a sensitive biomarker of inflammation that can independently predict CVD in its early stages. It has been hypothesized that CRP is strongly associated with erectile dysfunction and that erectile dysfunction may indicate early phase CVD.

About the study

A recent meta-analysis published in Andrology aimed to describe the relationship between CRP and ED. This study followed the PRISMA statement (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Here, the researchers performed a systemic search of PubMed, Web of Science and Cochrane Library to identify relevant republished literature before January 1, 2022.

A total of 12 relevant articles were selected. These included nine studies comparing serum CRP levels in ER patients and controls, and three studies analyzing CRP levels in ER patients on phosphodiesterase 5 (PDE-5i) inhibitor therapy.

The nine studies comparing serum CRP levels in ED patients and controls included 1363 ED patients and 1400 healthy controls. The results showed significantly higher CRP levels in ED patients than in healthy controls, indicating higher levels of inflammation in ED patients.

Protective effect of PDE-5i therapy on CRP in ED patients

Previous evidence has shown that on-demand PDE-5i can improve erectile function, as well as cavernous endothelial function.

A comparative study of changes in ED patients and their CRP levels before and after PDE-5i treatment indicated that CRP levels decreased by 0.38 mg/l in ED patients after starting treatment. This decrease was greater in emergency patients who complied with the medication regimen.

In the present study, PDE-5is therapy was found to significantly reduce hs-CRP levels. This finding could expand current indications for erectile dysfunction risk assessment in asymptomatic patients, as well as those not considered at risk for erectile dysfunction.

The results suggest that hs-CRP levels can be used for general risk assessment of patients with ED, as they provide information about patients’ inflammatory risk profile. However, the mechanism responsible for this association remains unclear.


The current meta-analysis is the first to investigate the relationship between CRP and ED. Taken together, the study results indicate that ED patients have significantly higher CRP levels than healthy individuals. Additionally, treatment with PDE-5i could significantly decrease serum CRP levels in patients with erectile dysfunction.

Journal reference:

  • Liu, G., Zhang, Y., Zhang, W., et al. (2022). New predictive risk factor for erectile dysfunction: high sensitivity serum C-reactive protein. Andrology. do I:10.1111/andr.13206.

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