The Role of the Microbiome in Erectile Dysfunction

Purpose of Review There is now growing evidence that the commensal relationship between man and bacteria may be a critical aspect of human health and disease. In this narrative review, we examine the small but growing body of literature exploring the microbiome in comorbidities known to cause sexual dysfunction. We explore the causal relationship between the microbiome and ED. Finally, we identify current gaps in knowledge that may be amenable to future research studies and therapeutics. Recent Findings A critical review of the current literature reveals several ways in which the gut microbiome is connected to ED. First, there is strong evidence linking the gut microbiome to known risk factors for ED such as diabetes, hypertension, metabolic syndrome, and obesity. A common theme noted amongst the studies presented in this review article is a shift towards a lower Bacteroidetes to Firmicutes ratio, particularly in obese individuals. The literature also supports a role for the gut microbiome in modulating androgen levels. The data implicating a direct mechanistic effect of the microbiome in ED, however, remains limited. Finally, the gut microbiome does appear to alter PDE5i metabolism and may explain why these drugs are effective in some, but not all, men. Summary Despite the limited amount of literature on this emerging topic, recent data does indeed suggest a direct link to the microbiome. This area remains minimally studied ***and much work is needed given the healthcare burden of ED. Further research could provide tools for modulation of the microbiome as part of a multi-pronged approach towards a multifactorial disease like ED.