Background:
Sexual health has a profound impact on quality of life. For male adult patients with congenital heart disease (ACHD), data on erectile dysfunction (ED) is limited. The aim of our study was to identify parameters predicting ED in male ACHD patients, frequency of ED and its role in the patient-physician communication.

Methods:
Male patients >18 years registered at the German National Register for Congenital Heart Defects who consented to be contacted digitally were invited by e-mail to take part at an online questionnaire about sexual health in ACHD patients. Responding patients were classified as having ED based on an established scoring system to diagnose ED (IIEF6). Patients with and without ED were compared in order to identify predictors for ED using uni- and multivariable regression analysis.

Results:
371 patients (return rate: 16.7%) participated in the survey. Of these, 15.6% were older than 50 years, 69.8% presented with moderate to severely complex congenital heart defect, 66.3% stated to be in a relationship, 10.2% had a diagnosed psychiatric disorder, 9.2% with heart failure, 9.4% were under antiarrhythmic drug therapy. 45.8% had ED based on questionnaire response. These patients reported to undergo sexual activity significantly less often than those in whom the score did not suggest ED (p<0.001).

On univariable analysis, advanced age >50 years (Odds ratio [OR] 3.4; p<0.0001), a more than moderately complex congenital heart disease (OR 1.4081; p=0.0152), being single (OR 4.1073; p<0.0001), diabetes  (OR 3.8205; p=0.0024), diagnosis of heart failure (OR 3.0524; p=0.0036), intake of antiarrhythmic drugs (OR 3.2086; p=0.0022), intake of antidepressants (OR 6.22; p=0.0204) and diagnosis of a psychiatric disorder (OR 4.9685; p<0.0001) emerged as significant predictors of ED. On multivariable analysis, we identified advanced age >50 years (OR 5.7; p<0.0001), psychiatric disorders and being single (OR 6.174; p<0.0001) as independent risk factors. Overall, patients sought medical advice in 19.3% (35.9% with score suggestive of ED), whilst in 29.7% (38.8% with score suggestive of ED) wished for an active approach of the physician to address this topic. Potency aids were used in 25 patients, all of whom had a score indicating ED. The majority of these patients used phosphodiesterase inhibitors (n=16; 53.4%).

Conclusion:

Erectile dysfunction is common in ACHD men affecting 46%. Using established self-questionnaires it is feasible to identify affected patients. On multivariable analysis, advanced age, history of psychiatric disorder and being single were identified as independent risk factorsGenerally, this topic should be addressed proactively in clinical practice.