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2000
Volume 20, Issue 4
  • ISSN: 1574-8871
  • E-ISSN: 1876-1038

Abstract

Introduction

Chronic liver diseases have been reported to be associated with altered sexual function. The existing gap in understanding the pathophysiological mechanisms linking sexual disorders and chronic liver diseases may explain the lack of attention given to sexual health in this cohort of patients. We, therefore, aimed at reviewing the available evidence linking chronic liver diseases and sexual dysfunction in both sexes.

Methods

A search of the PubMed database was conducted for the period between January 1995 and July 2024 using the following terms: “chronic liver disease”, “liver cirrhosis”, “viral hepatitis B”, “viral hepatitis C”, “non-alcoholic fatty liver disease”, “metabolic dysfunction associated steatotic liver disease” “alcoholic liver disease” and “erectile dysfunction,” “hypogonadism”, “infertility”.

Results

A total of 100 articles were reviewed, including preclinical original research articles, human observational and clinical studies, systematic reviews, and meta-analyses. We found that sexual dysfunctions are often associated with chronic liver diseases and that this depends on the degree of the underlying liver damage and etiology. Contributing factors may include hormonal imbalances, psychological disturbances, and endothelial dysfunction.

Discussion

The degree of liver function impairment, the specific etiology, particularly metabolic dysfunction associated steatotic liver disease, and drugs used in the management of chronic liver diseases all contribute to sexual dysfunction in this clinical setting.

Conclusions

Chronic liver diseases are associated with a wide range of sexual dysfunctions in both sexes, causing an altered quality of life. This suggests that sexual function should be assessed in this clinical setting in order to reach a prompt diagnosis and start appropriate treatment.

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2025-04-24
2025-12-20
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References

  1. McCabeM.P. SharlipI.D. LewisR. Incidence and prevalence of sexual dysfunction in and risk factors of sexual dysfunction in men and women. A consensus statement from the fourth international consultation on sexual medicine 2015.J. Sex. Med.201613214410.1016/j.jsxm.2015.12.034
    [Google Scholar]
  2. LaumannE.O. NicolosiA. GlasserD.B. Sexual problems among women and men aged 40–80 y: Prevalence and correlates identified in the Global Study of Sexual Attitudes and Behaviors.Int. J. Impot. Res.2005171395710.1038/sj.ijir.3901250 15215881
    [Google Scholar]
  3. JanniniE.A.S.M. = SM: The interface of systems medicine and sexual medicine for facing non-communicable diseases in a gender-dependent manner.Sex. Med. Rev.20175334936410.1016/j.sxmr.2017.04.002 28596070
    [Google Scholar]
  4. ChrysavgisL. AdamantouM. AngelousiA. CholongitasE. The association of testosterone with sarcopenia and frailty in chronic liver disease.Eur. J. Clin. Invest.2024542e1410810.1111/eci.14108 37837304
    [Google Scholar]
  5. DumanD.G. BiçakciE. ÇelikelÇ.A. AkbalC. Nonalcoholic fatty liver disease is associated with erectile dysfunction: A prospective pilot study.J. Sex. Med.201613338338810.1016/j.jsxm.2015.12.030 26853046
    [Google Scholar]
  6. ZsoldosM. PajorA. PusztafalviH. Relation between sexual dysfunction and metabolic syndrome.Orv. Hetil.201916039810310.1556/650.2019.31235 30640528
    [Google Scholar]
  7. HasanainA.F.A. MahdyR.E. MahranA.M.A.R. SafwatA.S.M. MohamedA.O. Abdel-AalS.M. Erectile dysfunction in patients with nonalcoholic fatty liver disease.Arab J. Gastroenterol.2017181212410.1016/j.ajg.2017.02.002 28325476
    [Google Scholar]
  8. VignozziL. FilippiS. ComeglioP. Nonalcoholic steatohepatitis as a novel player in metabolic syndrome-induced erectile dysfunction: An experimental study in the rabbit.Mol. Cell. Endocrinol.20143841-214315410.1016/j.mce.2014.01.014 24486698
    [Google Scholar]
  9. QuX. DonnellyR. Sex hormone-binding globulin (SHBG) as an early biomarker and therapeutic target in polycystic ovary syndrome.Int. J. Mol. Sci.20202121819110.3390/ijms21218191 33139661
    [Google Scholar]
  10. SinclairM. GrossmannM. GowP.J. AngusP.W. Testosterone in men with advanced liver disease: Abnormalities and implications.J. Gastroenterol. Hepatol.201530224425110.1111/jgh.12695 25087838
    [Google Scholar]
  11. ZangG. SunX. SunY. Chronic liver diseases and erectile dysfunction.Front. Public Health202310109235310.3389/fpubh.2022.1092353 36684968
    [Google Scholar]
  12. RomanoL. GranataL. FuscoF. Sexual dysfunction in patients with chronic gastrointestinal and liver diseases: A neglected Issue.Sex. Med. Rev.202210462063110.1016/j.sxmr.2021.02.002
    [Google Scholar]
  13. YounossiZ. AnsteeQ.M. MariettiM. Global burden of NAFLD and NASH: trends, predictions, risk factors and prevention.Nat. Rev. Gastroenterol. Hepatol.2018151112010.1038/nrgastro.2017.109 28930295
    [Google Scholar]
  14. FedericoA. DallioM. MasaroneM. PersicoM. LoguercioC. The epidemiology of non-alcoholic fatty liver disease and its connection with cardiovascular disease: Role of endothelial dysfunction.Eur. Rev. Med. Pharmacol. Sci.2016202247314741 27906428
    [Google Scholar]
  15. RosatoV. MasaroneM. DallioM. FedericoA. AglittiA. PersicoM. NAFLD and extra-hepatic comorbidities: Current evidence on a multi-organ metabolic syndrome.Int. J. Environ. Res. Public Health20191618341510.3390/ijerph16183415 31540048
    [Google Scholar]
  16. EslamM. SanyalA.J. GeorgeJ. MAFLD: A consensus-driven proposed nomenclature for metabolic associated fatty liver disease.Gastroenterology19991587199910.1053/j.gastro.2019.11.312
    [Google Scholar]
  17. TargherG ByrneCD TilgH MASLD: A systemic metabolic disorder with cardiovascular and malignant complications.Gut2024734gutjnl-2023-33059510.1136/gutjnl‑2023‑33059538228377
    [Google Scholar]
  18. RinellaM.E. LazarusJ.V. RatziuV. A multisociety Delphi consensus statement on new fatty liver disease nomenclature.Ann. Hepatol.202429110113310.1016/j.aohep.2023.101133 37364816
    [Google Scholar]
  19. KayaE. YilmazY. Metabolic-associated fatty liver disease (MAFLD): A multi-systemic disease beyond the liver.J. Clin. Transl. Hepatol.202210232933810.14218/JCTH.2021.00178 35528971
    [Google Scholar]
  20. Tarik KaniH. Emre SenerT. Emre AykutU. Ozer DemirtasC. KeklikkiranC. Causes of erectile dysfunction in non-alcoholic fatty liver disease.Hepatol. Forum202122606310.14744/hf.2021.2021.0012
    [Google Scholar]
  21. SongM.J. ChoiJ.Y. Androgen dysfunction in non-alcoholic fatty liver disease: Role of sex hormone binding globulin.Front. Endocrinol. (Lausanne)202213105370910.3389/fendo.2022.1053709 36482993
    [Google Scholar]
  22. SakrH.F. HusseinA.M. EidE.A. AlKhateebM. Possible mechanisms underlying fatty liver in a rat model of male hypogonadism: A protective role for testosterone.Steroids2018135213010.1016/j.steroids.2018.04.004 29674209
    [Google Scholar]
  23. YilmazM. OdabasO. KaraaslanM. Predicting risk of erectile dysfunction in patients with nonalcoholic fatty liver disease.Andrologia2021537e1409110.1111/and.14091 33951744
    [Google Scholar]
  24. LiY. LiuL. WangB. ChenD. WangJ. Nonalcoholic fatty liver disease and alteration in semen quality and reproductive hormones.Eur. J. Gastroenterol. Hepatol.20152791069107310.1097/MEG.0000000000000408 26062079
    [Google Scholar]
  25. HawksworthD.J. BurnettA.L. Nonalcoholic fatty liver disease, male sexual dysfunction, and infertility: Common links, common problems.Sex. Med. Rev.20208227428510.1016/j.sxmr.2019.01.002 30898592
    [Google Scholar]
  26. MontorsiP. RavagnaniP.M. GalliS. AliS.G. BrigantiA. The triad of endothelial dysfunction, cardiovascular disease, and erectile dysfunction: Clinical implications.European. Urology.200982586610.1016/j.eursup.2008.10.010
    [Google Scholar]
  27. TilgH. DiehlA.M. Cytokines in alcoholic and nonalcoholic steatohepatitis.N. Engl. J. Med.2000343201467147610.1056/NEJM200011163432007 11078773
    [Google Scholar]
  28. CarneiroF.S. SturgisL.C. GiachiniF.R.C. TNF-α knockout mice have increased corpora cavernosa relaxation.J. Sex. Med.20096111512510.1111/j.1743‑6109.2008.01029.x 19170842
    [Google Scholar]
  29. ErenH. HorsanaliM.O. The independent association of non-alcoholic fatty liver disease with lower urinary tract symptoms/benign prostatic hyperplasia and erectile function scores.BJU Int.2019124232910.1111/bju.14753
    [Google Scholar]
  30. HaiderA. GoorenL.J.G. PadungtodP. SaadF. Improvement of the metabolic syndrome and of non-alcoholic liver steatosis upon treatment of hypogonadal elderly men with parenteral testosterone undecanoate.Exp. Clin. Endocrinol. Diabetes2010118316717110.1055/s‑0029‑1202774 19472103
    [Google Scholar]
  31. TaylorFL LevineLA Peyronie’s disease.Urol Clin North Am2007344517534vi10.1016/j.ucl.2007.08.01717983892
    [Google Scholar]
  32. CrocettoF. BaroneB. ManfrediC. TramaF. RomanoL. Are insulin resistance and NAFLD associated with peyronie’s disease? A pilot study.Physiol Pharmacol202273152410.26402/jpp.2022.1.05 35639037
    [Google Scholar]
  33. GlinaF.P.A. LopesL. SilvaR.S. BarrosE.A.C. BiselliB. GlinaS. Do statins decrease testosterone in men? Systematic review and meta-analysis.Int. Braz J Urol202450211913510.1590/s1677‑5538.ibju.2023.0578 38386784
    [Google Scholar]
  34. DobrekL. Lower urinary tract disorders as adverse drug reactions: A literature review.Pharmaceuticals (Basel)2023167103110.3390/ph16071031 37513941
    [Google Scholar]
  35. PettaS. CiresiA. BiancoJ. Insulin resistance and hyperandrogenism drive steatosis and fibrosis risk in young females with PCOS.PLoS One20171211e018613610.1371/journal.pone.0186136 29161258
    [Google Scholar]
  36. Di StasiV. MaseroliE. RastrelliG. SHBG as a marker of NAFLD and metabolic impairments in women referred for oligomenorrhea and/or hirsutism and in women with sexual dysfunction.Front. Endocrinol. (Lausanne)20211264144610.3389/fendo.2021.641446 33854482
    [Google Scholar]
  37. PaschouS.A. PolyzosS.A. AnagnostisP. Nonalcoholic fatty liver disease in women with polycystic ovary syndrome.Endocrine20206711810.1007/s12020‑019‑02085‑7 31538291
    [Google Scholar]
  38. Diamanti-KandarakisE. DunaifA. Insulin resistance and the polycystic ovary syndrome revisited: An update on mechanisms and implications.Endocr. Rev.2012336981103010.1210/er.2011‑1034 23065822
    [Google Scholar]
  39. JonesH. SprungV.S. PughC.J.A. Polycystic ovary syndrome with hyperandrogenism is characterized by an increased risk of hepatic steatosis compared to nonhyperandrogenic PCOS phenotypes and healthy controls, independent of obesity and insulin resistance.J. Clin. Endocrinol. Metab.201297103709371610.1210/jc.2012‑1382 22837189
    [Google Scholar]
  40. LeeJ.Y. ShinD.W. OhJ.W. Non-alcoholic fatty liver disease as a risk factor for female sexual dysfunction in premenopausal women.PLoS One2017128e018270810.1371/journal.pone.0182708 28854246
    [Google Scholar]
  41. PawlotskyJ-M. NegroF. AghemoA. EASL recommendations on treatment of hepatitis C: Final update of the series☆.J. Hepatol.20207351170121810.1016/j.jhep.2020.08.018 32956768
    [Google Scholar]
  42. WiędłochaM. MarcinowiczP. SokallaD. StańczykiewiczB. The neuropsychiatric aspect of the HCV infection.Adv. Clin. Exp. Med.201726116717510.17219/acem/37787 28397449
    [Google Scholar]
  43. ColaciM. MalatinoL. AntonelliA. FallahiP. GiuggioliD. FerriC. Endocrine disorders associated with hepatitis C virus chronic infection.Rev. Endocr. Metab. Disord.201819439740310.1007/s11154‑018‑9475‑y 30499080
    [Google Scholar]
  44. HunterS.S. GadallahA. AzawiM.K. DossW. Erectile dysfunction in patients with chronic hepatitis C virus infection.Arab J. Gastroenterol.2014151162010.1016/j.ajg.2014.01.012 24630508
    [Google Scholar]
  45. DanoffA. KhanO. WanD.W. Sexual dysfunction is highly prevalent among men with chronic hepatitis C virus infection and negatively impacts health-related quality of life.Am. J. Gastroenterol.200610161235124310.1111/j.1572‑0241.2006.00544.x 16771944
    [Google Scholar]
  46. FerriC. BertozziM.A. ZignegoA.L. Erectile dysfunction and hepatitis C virus infection.JAMA2002288669869910.1001/jama.288.6.698 12169072
    [Google Scholar]
  47. MaB.O. ShimS.G. YangH.J. Association of erectile dysfunction with depression in patients with chronic viral hepatitis.World J. Gastroenterol.201521185641564610.3748/wjg.v21.i18.5641 25987790
    [Google Scholar]
  48. ChungS.D. KellerJ.J. LinH.C. A case–control study of chronic prostatitis/chronic pelvic pain syndrome and colorectal cancer.BJU Int.2012110455055410.1111/j.1464‑410X.2012.10929.x 22314042
    [Google Scholar]
  49. TriantosC.K. TsintoniA. KaraivazoglouK. Male hepatitis C patients’ sexual functioning and its determinants.Eur. J. Gastroenterol. Hepatol.201729111241124610.1097/MEG.0000000000000971 28914698
    [Google Scholar]
  50. KaraivazoglouK. TsermpiniE.E. AssimakopoulosK. TriantosC. Sexual functioning in patients with chronic hepatitis C: A systematic review.Eur. J. Gastroenterol. Hepatol.201729111197120510.1097/MEG.0000000000000949 28834789
    [Google Scholar]
  51. RaoJ. DanoffA. BiniE.J. Elevated sex hormone binding globulin levels may contribute to sexual dysfunction in men with chronic hepatitis C virus infection.J. Clin. Gastroenterol.2009431949510.1097/MCG.0b013e3180cabc14 18622303
    [Google Scholar]
  52. AbdelhamidA.A. SheriefM.H. NemrN.A. HassobaH.M. El-SakkaA.I. Homocysteine, insulin-like growth factor one and oestrogen levels in patients with erectile dysfunction-associated chronic hepatitis C virus infection.Andrologia20185010e1311610.1111/and.13116 30063074
    [Google Scholar]
  53. RetamozoS. QuartuccioL. Ramos-CasalsM. Crioglobulinemia.Med. Clín. (Barc.)20221581047848710.1016/j.medcli.2021.11.017 35216803
    [Google Scholar]
  54. DoveL.M. RosenR.C. RamcharranD. WahedA.S. BelleS.H. Decline in male sexual desire, function, and satisfaction during and after antiviral therapy for chronic hepatitis C.Gastroenterology2009137387310.1053/j.gastro.2009.05.060
    [Google Scholar]
  55. MasoudM.S. AshfaqU.A. KhalidH. Interferon-free regimen for hepatitis C: Insight and management.Crit. Rev. Eukaryot. Gene Expr.201828437338410.1615/CritRevEukaryotGeneExpr.2018025121 30311586
    [Google Scholar]
  56. AklE.M. SalahA.A. Effect of new oral direct acting antiviral therapy on sexual function in male patients with hepatitis C virus.Andrologia20205211e1383510.1111/and.13835 33070383
    [Google Scholar]
  57. OmarS.S. EllakanyW.I. AbdelmeniemI.M. Impact of sofosbuvir/] ledipasvir versus sofosbuvir/daclatasvir regimens on the male sexual function of patients with chronic hepatitis C.Infez. Med.202129345646310.53854/liim‑2903‑17 35146351
    [Google Scholar]
  58. ElshimiE. MoradW. MohamadN.E. Male sexual dysfunction among egyptian patients with chronic hepatitis C virus infection before and after direct-acting antiviral drugs.J. Sex. Med.201916340240910.1016/j.jsxm.2019.01.309 30846113
    [Google Scholar]
  59. AlhefnawyM. MoheyA. FathiA. Effect of direct-acting antiviral drugs on erectile functions among hepatitis C Patients: A prospective interventional study.Endocr. Metab. Immune Disord. Drug Targets202222331031710.2174/1871530321666210212143932 33583390
    [Google Scholar]
  60. El KassasM. SalahE. GadA. HosnyA. Improvement of sexual dysfunction in patients after treatment of hepatitis C virus using directly acting antivirals.Curr. Med. Res. Opin.202137696797210.1080/03007995.2021.1901677 33688780
    [Google Scholar]
  61. YuY.F. ChenY. ShenX.F. WangR.J. ShenJ.W. FangZ.H. Entecavir improves the reproductive function of male patients with chronic hepatitis B.National J Androl2020264326330 33351299
    [Google Scholar]
  62. LiaoX. ZhaoS. YinJ. Sexual dysfunction in patients with chronic hepatitis B: Prevalence and risk factors.J. Sex. Med.202219220721510.1016/j.jsxm.2021.11.016 34969615
    [Google Scholar]
  63. KimM. KimS.Y. RouW.S. HwangS.W. LeeB.S. Erectile dysfunction in patients with liver disease related to chronic hepatitis B.Clin. Mol. Hepatol.201521435235710.3350/cmh.2015.21.4.352 26770923
    [Google Scholar]
  64. MengX. DaiX. HuangJ. The influence of male HBV infection on sperm quality, embryonic development, and assisted reproductive outcomes.Hum. Reprod.2024391435210.1093/humrep/dead235 37994690
    [Google Scholar]
  65. ÜzelA. EbikB. BucaktepeG.E. YolaçanR. KarabulutÜ. UçmakF. Do oral antiviral drugs used in the treatment of chronic hepatitis B cause erectile dysfunction?Eur. J. Gastroenterol. Hepatol.202436218418910.1097/MEG.0000000000002672 37942730
    [Google Scholar]
  66. SingalA.K. BatallerR. AhnJ. KamathP.S. ShahV.H. ACG clinical guideline: Alcoholic liver disease.Am. J. Gastroenterol.2018113217519410.1038/ajg.2017.469 29336434
    [Google Scholar]
  67. YanC. HuW. TuJ. LiJ. LiangQ. HanS. Pathogenic mechanisms and regulatory factors involved in alcoholic liver disease.J. Transl. Med.202321130010.1186/s12967‑023‑04166‑8 37143126
    [Google Scholar]
  68. Martínez-RieraA. Santolaria-FernándezF. González ReimersE. Alcoholic hypogonadism: Hormonal response to clomiphene.Alcohol199512658158710.1016/0741‑8329(95)02006‑3 8590623
    [Google Scholar]
  69. AcharyaR.K. PanigrahiS. SamaniM.J. ChoudharyA.K. Prevalence and pattern of sexual dysfunction in male patients with alcohol dependence.Addict. Health202214319219710.34172/ahj.2022.1335 36544980
    [Google Scholar]
  70. SalariN. HasheminezhadR. AlmasiA. The risk of sexual dysfunction associated with alcohol consumption in women: A systematic review and meta-analysis.BMC Womens Health202323121310.1186/s12905‑023‑02400‑5 37131197
    [Google Scholar]
  71. KarunakaranA. PrabhakaranA. KarunakaranV. MichaelJ.P. Erectile dysfunction in alcohol use disorder and the change in erectile function after one month of abstinence.J. Addict. Dis.202442211212110.1080/10550887.2022.2157199 36606722
    [Google Scholar]
  72. KarunakaranA. MichaelJ.P. The impact of abstinence from alcohol on erectile dysfunction: A prospective follow up in patients with alcohol use disorder.J. Sex. Med.202219458158910.1016/j.jsxm.2022.01.517 35236641
    [Google Scholar]
  73. MaimoneS. SaffiotiF. OlivaG. Erectile dysfunction in compensated liver cirrhosis.Dig. Liver Dis.201951684384910.1016/j.dld.2018.10.015 30467076
    [Google Scholar]
  74. MargreiterM. HeinischB.B. SchwarzerR. KlatteT. ShariatS.F. FerlitschA. Lower urinary tract symptoms in patients with liver cirrhosis.World J. Urol.201533331532110.1007/s00345‑014‑1313‑6 24798455
    [Google Scholar]
  75. PaternostroR. HeinischB.B. ReibergerT. Erectile dysfunction in cirrhosis is impacted by liver dysfunction, portal hypertension, diabetes and arterial hypertension.Liver Int.20183881427143610.1111/liv.13704 29368385
    [Google Scholar]
  76. HuygheE. KamarN. WagnerF. Erectile dysfunction in end-stage liver disease men.J. Sex. Med.2009651395140110.1111/j.1743‑6109.2008.01169.x 19207273
    [Google Scholar]
  77. FakhryM. MahfouzH. AbdelazeemK. Prevalence and risk factors of erectile dysfunction in cirrhotic patients: An observational study.Arab J. Urol.202422161210.1080/2090598X.2023.2238933 38205383
    [Google Scholar]
  78. JagdishR.K. KamaalA. ShasthryS.M. Tadalafil improves erectile dysfunction and quality of life in men with cirrhosis: A randomized double blind placebo controlled trial.Hepatol. Int.202317243445110.1007/s12072‑021‑10264‑w 34775577
    [Google Scholar]
  79. DarmadiD. PakpahanC. RuslieR.H. AmandaB. IbrahimR. The sex life of male patients with cirrhosis and its organic factors: What we have got so far?PLoS One2023182e028091510.1371/journal.pone.0280915 36730272
    [Google Scholar]
  80. GungorG. PerkH. SoyupekS. BaykalB. DemirM. SezerM.T. Nebivolol protects erectile functions compared to Metoprolol in hypertensive men with atherogenic, venogenic, psychogenic erectile dysfunction: A prospective, randomized, cross-over, clinical trial.Eur. J. Intern. Med.2022103697510.1016/j.ejim.2022.06.013 35752527
    [Google Scholar]
  81. ChrysantS.G. Antihypertensive therapy causes erectile dysfunction.Curr. Opin. Cardiol.201530438339010.1097/HCO.0000000000000189 26049386
    [Google Scholar]
  82. ManolisA.A. ManolisT.A. MelitaH. ManolisA.S. Eplerenone versus spironolactone in resistant hypertension: An efficacy and/or cost or just a men’s issue?Curr. Hypertens. Rep.20192132210.1007/s11906‑019‑0924‑0 30826898
    [Google Scholar]
  83. MitchellL. GovindV. BarelaK. GoldsteinA.T. Spironolactone may be a cause of hormonally associated vestibulodynia and female sexual arousal disorder.J. Sex. Med.20191691481148310.1016/j.jsxm.2019.06.012 31351850
    [Google Scholar]
  84. MüllerP.C. KabacamG. VibertE. GermaniG. PetrowskyH. Current status of liver transplantation in Europe.Int. J. Surg.202082S222910.1016/j.ijsu.2020.05.062 32454252
    [Google Scholar]
  85. FidanC. AkdurA. KirnapM. Analysis of quality of life, depression, and sexual function in patients on the liver transplant list.Turk. J. Gastroenterol.202132980180710.5152/tjg.2021.21229 34609310
    [Google Scholar]
  86. ParkE.S. VillanuevaC.A. ViersB.R. SirefA.B. FeloneyM.P. Assessment of sexual dysfunction and sexually related personal distress in patients who have undergone orthotopic liver transplantation for end-stage liver disease.J. Sex. Med.2011882292229810.1111/j.1743‑6109.2011.02264.x 21492399
    [Google Scholar]
  87. MagroJ.T.J. MendesK.D.S. GalvãoC.M. Sexual aspects of liver transplant candidates and recipients: Evidence available in the literature.Rev. Lat. Am. Enfermagem2018260e303310.1590/1518‑8345.2744.3033 30183871
    [Google Scholar]
  88. ChanM.Y. ChokK.S.H. FungJ.Y.Y. NgS.L. YiuM.K. LoC.M. Prospective study on sexual dysfunction in male chinese liver transplant recipients.Am. J. Men Health2019132155798831983513910.1177/1557988319835139 30836839
    [Google Scholar]
  89. ChiangH.C. ChienY.C. LinP.Y. LeeH.L. ChenY.L. Assessing men with erectile dysfunction before and after living donor liver transplantation in real-world practice: Integrating laboratories into clinical settings.PLoS One20181311e020643810.1371/journal.pone.0206438 30458009
    [Google Scholar]
  90. NitscheR. CoelhoJ.C.U. FreitasA.C.T. Zeni NetoC. MartinsE. Testosterone changes in patients with liver cirrhosis before and after orthotopic liver transplantation and its correlation with MELD.Arq. Gastroenterol.2014511596310.1590/S0004‑28032014000100012 24760066
    [Google Scholar]
  91. GarianiK. TosoC. PhilippeJ. OrciL.A. Effects of liver transplantation on endocrine function: A systematic review.Liver Int.201636101401141110.1111/liv.13158 27163168
    [Google Scholar]
  92. MeiY. WangX. LiY. XuR. FengX. Liver transplantation improves erectile function in patients with end-stage liver disease: A systematic review and meta-analysis.Transl. Androl. Urol.20241391795180410.21037/tau‑24‑185 39434727
    [Google Scholar]
  93. RomanoL. PellegrinoR. SciorioC. Erectile and sexual dysfunction in male and female patients with celiac disease: A cross‐sectional observational study.Andrology202210591091810.1111/andr.13186 35419983
    [Google Scholar]
  94. PriadkoK. RomanoL. OlivieriS. Intestinal microbiota, intestinal permeability and the urogenital tract: is there a pathophysiological link?J. Physiol. Pharmacol.202273510.26402/Jpp.2022.5.01
    [Google Scholar]
  95. RomanoL. NapolitanoL. CrocettoF. Prostate and gut: Any relationship? A narrative review on the available evidence and putative mechanisms.Prostate202484651352410.1002/pros.24675 38353479
    [Google Scholar]
  96. RomanoL. PellegrinoR. ArcanioloD. Lower urinary tract symptoms in patients with inflammatory bowel diseases: A cross-sectional observational study.Dig. Liver Dis.202356462863410.1016/j.dld.2023.10.010
    [Google Scholar]
  97. RomanoL. FonticelliM. MirandaA. Sexual dysfunctions in inflammatory bowel disease: Role of Mediterranean diet and quality of life.Andrology2024Epub ahead of print10.1111/andr.13791 39492590
    [Google Scholar]
  98. RomanoL. ZagariR.M. ArcanioloD. Sexual dysfunction in gastroenterological patients: Do gastroenterologists care enough? A nationwide survey from the Italian Society of Gastroenterology (SIGE).Dig. Liver Dis.202254111494150110.1016/j.dld.2022.05.016 35710521
    [Google Scholar]
  99. DicksteinD.R. EdwardsC.R. RowanC.R. Pleasurable and problematic receptive anal intercourse and diseases of the colon, rectum and anus.Nat. Rev. Gastroenterol. Hepatol.202421637740510.1038/s41575‑024‑00932‑1 38763974
    [Google Scholar]
  100. Justice, equity, diversity and inclusion in gastroenterology and hepatology.Nat. Rev. Gastroenterol. Hepatol.2024211066110.1038/s41575‑024‑00985‑2 39327523
    [Google Scholar]
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