Erectile dysfunction in dermatology and venereology: From aetiopathogenic mechanisms to practical considerations for dermato-venereologists

Abstract

Erectile dysfunction (ED) is an often undiagnosed but significantly prevalent condition among male dermato-venereological patients, characterized by a complex pathophysiology and a substantial impact on quality of life. This review aimed to synthesize recent literature on the increased risk of ED in skin diseases, the underlying pathogenic mechanisms-including vasculogenic, endocrine, neurogenic, psychogenic and immunologic pathways-as well as the dermatologist's role in managing patients' sexual health. Inflammatory conditions (e.g. psoriasis, atopic dermatitis, lichen simplex chronicus and chronic hand eczema), infections (viral, bacterial and fungal, including sexually transmitted infections), autoimmune conditions (e.g. scleroderma and pemphigus) and disorders of the apocrine and eccrine glands (such as hidradenitis suppurativa) have all been linked to ED. The multi-systemic nature of many dermatologic diseases has become increasingly evident due to their associations with cardiovascular and metabolic comorbidities (atherosclerosis, hypertension, metabolic syndrome and vitamin D deficiency), central and peripheral neuropathies, endocrine disorders (hypogonadism and diabetes mellitus) or genito-urinary sequelae of sexually transmitted infections, while psychogenic ED further highlights the major mental health burden of skin conditions. Dermatologists are in the unique position to evaluate patients' sexual function and risk factors, investigate potential causes through accessible routine tests, prescribe impotence medication, consider erectile and overall sexual function in the dermatologic treatment choice and provide integrative lifestyle recommendations. Addressing sexual health in dermatologic practice offers significant benefits for both patients and healthcare systems, improving compliance, reducing logistical challenges and optimizing financial outcomes.