Discussion
In this study, the data of 6 310 ED patients and 31 550
controls were analysed. We found that the OR for prior
haemorrhoids among cases was 1.90 that of controls after
adjusting for confounding factors. In addition, we found
this association to be stronger among the sub-group aged
less than 40 years. To the best of our knowledge, this is
the first study to document the association between ED
and haemorrhoids based on a nationwide populationbased
dataset.
There are several reasons why we found the strongest
associations among those aged less than 40 years. The
prevalence of ED increases with age in the absence of
haemorrhoids (Blumentals et al., 2003). A greater share of
the older men in this study likely suffered from ED on
account of factors that were unrelated to haemorrhoids,
such as naturally decreased testosterone levels or the
increased peripheral vascular resistance, resulting from
the narrowing of the lumen on account of accumulations
on vessel walls (Okabe et al., 1999). Such increased resistance
has been shown to result in structural changes to
the penile vasculature, including both arterial and erectile
tissues (Hale et al., 2001).
Pilkington et al. demonstrated that the rectum is in
close proximity to the autonomic nerves within the prostatic
plexus responsible for penile erection (Pilkington
et al., 2000). Their findings not only suggested an anatomical
basis for impotence following sclerotherapy for
haemorrhoids, but also provided a possible mechanism of
ED in patients with haemorrhoids. In addition to
treatment modalities including surgery and injection
therapy, the localized swelling of the varicose veins
around the deep perineum may induce local irritation
and erectile disorders. Nevertheless, the detailed
Discussion
In this study, the data of 6 310 ED patients and 31 550
controls were analysed. We found that the OR for prior
haemorrhoids among cases was 1.90 that of controls after
adjusting for confounding factors. In addition, we found
this association to be stronger among the sub-group aged
less than 40 years. To the best of our knowledge, this is
the first study to document the association between ED
and haemorrhoids based on a nationwide populationbased
dataset.
There are several reasons why we found the strongest
associations among those aged less than 40 years. The
prevalence of ED increases with age in the absence of
haemorrhoids (Blumentals et al., 2003). A greater share of
the older men in this study likely suffered from ED on
account of factors that were unrelated to haemorrhoids,
such as naturally decreased testosterone levels or the
increased peripheral vascular resistance, resulting from
the narrowing of the lumen on account of accumulations
on vessel walls (Okabe et al., 1999). Such increased resistance
has been shown to result in structural changes to
the penile vasculature, including both arterial and erectile
tissues (Hale et al., 2001).
Pilkington et al. demonstrated that the rectum is in
close proximity to the autonomic nerves within the prostatic
plexus responsible for penile erection (Pilkington
et al., 2000). Their findings not only suggested an anatomical
basis for impotence following sclerotherapy for
haemorrhoids, but also provided a possible mechanism of
ED in patients with haemorrhoids. In addition to
treatment modalities including surgery and injection
therapy, the localized swelling of the varicose veins
around the deep perineum may induce local irritation
and erectile disorders. Nevertheless, the detailed
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