Statins and Sexual Dysfunction

Guideline Recommendations

• The American College of Cardiology/American Heart Association (ACC/AHA) guidelines recognize that certain antihypertensives may have negative effects on libido and erectile function, but statins are not mentioned as causing sexual dysfunction 1, 2, 3, 4
• The Princeton III Consensus guidelines report that there have been several reports of improvements in erectile function among men using statins with and without phosphodiesterase type 5 inhibitors 5, 6
• The UK guidelines list statins (simvastatin, pravastatin) as alternative drugs with a lower risk of erectile dysfunction compared to other cardiovascular medications 7

Clinical Considerations

• The American College of Cardiology recommends that if a patient on simvastatin presents with sexual dysfunction, other causes should be investigated before attributing it to the statin: beta-blockers, diuretics, psychosocial factors, uncontrolled hypertension, diabetes, smoking, excessive alcohol consumption 7, 8
• The American College of Cardiology suggests that the underlying cardiovascular disease itself (not simvastatin) is the most likely cause of erectile dysfunction 1, 2, 3, 4

Mechanisms and Associations

• Erectile dysfunction itself can be a precursor to cardiovascular disease and shares risk factors with atherosclerosis and hypertension, with endothelial dysfunction being the common denominator 1, 2, 3, 4