Hyperhomocysteinemia and sexual dissatisfaction: A clinical observation in neurological disorder patients
Introduction and Objectives: Homocysteine is an intermediate sulfur-containing amino acid synthesized in the methionine-cysteine cycle. Although hyperhomocysteinemia (HHcy) underlies a variety of neurological disorders that greatly interfere with sexual health and function, their exact relationship is substantially unknown.
Methods: This study enrolled heterosexual male patients presenting with stroke and non-stroke neurological disorders and healthy controls. Their age ranged from 50 to 65 years. Patients were asked to complete a list of questionnaires and receive blood test for homocysteine, cobalamin and folate. The plasma homocysteine level (PHL) was >15 μM/L in hyperhomocysteinemia (HHcy) whereas <10 μM/L in normohomocysteinemia (NHcy). Hydroxycobalamin/folate was prescribed for HHcy patients. Questionnaires and blood test were repeated at three months in the follow-up. Questionnaires were Golombok Rust Inventory of Sexual Satisfaction (GRISS), modified Rankin Scale (mRS), Brooke (BFS) and Vignos Functional Scale (VFS), Zung Self-Rating Depression (SDS) and Anxiety Scale (SAS). Motor function in Parkinsonism was assessed by the MDS-UPDRS.
Results: The overall GRISS was higher in HHcy patients than NHcy patients and controls (p < 0.05), mainly in the subscale of impotence. At three months after therapy, PHL was restored to reference range in all stroke and non-stroke patients. The overall GRISS, and subscale of impotence decreased in HHcy patients (p < 0.05) comparable to controls. The mRS, BFS, VFS, SDS, SAS and MDS-UPDRS, however, did not significantly change (p > 0.05). There was no difference in improvement between stroke and non-stroke patients. Patient reported that their improvement was mainly due to increased penile hardness.
Discussion: Accordingly, hyperhomocysteinemia obviously displays an independent role for sexual dissatisfaction in men, especially the impotence, and is amenable to correction. Treatment is simple, safe and economic, and the effectiveness is high. Therefore, we remind sexual therapists to be wary of hyperhomocysteinemia in sexual dysfunction, such as impotence in men, besides other comorbid states.
