Erectile dysfunction and PNH
Last updated Aug. 20, 2025, by Agata Boxe
Fact-checked by Joana Carvalho, PhD
Paroxysmal nocturnal hemoglobinuria (PNH) often causes erectile dysfunction in addition to other symptoms, such as anemia and fatigue. While it may be difficult or unexpected to deal with, you’re not alone, and support and treatment options are available.
Learning about the causes and treatments for erectile dysfunction with PNH can help you manage it and keep it from affecting your physical and emotional well-being.
Causes of erectile dysfunction with PNH
Erectile dysfunction in people with PNH is often associated with the condition’s impact on blood flow, red blood cell counts, and overall energy levels. These physical changes can interfere with the body’s ability to achieve or maintain an erection.
The role of nitric oxide
One of the main causes of erectile dysfunction with PNH has to do with the breakdown of red blood cells and the resulting release of free hemoglobin into the bloodstream. Hemoglobin binds to and depletes nitric oxide, which normally allows blood vessels to relax and expand, enabling an erection.
A decrease in nitric oxide due to the ongoing breakdown of red blood cells prevents blood vessels from expanding and contributes to erectile dysfunction. It can also affect the functioning of the relevant muscles that play a role in the dysfunction.
Fatigue and other PNH symptoms
Additionally, PNH causes debilitating fatigue, which can greatly impact quality of life. It can also lead to a lower libido and affect sexual performance.
It is one of the reasons why managing PNH symptoms is so important in addressing erectile dysfunction with PNH.
Vascular issues
PNH can also cause the formation of blood clots in various parts of the body, including the vessels that supply the pelvic organs.
If the blood flow to the relevant tissues is impaired due to vascular complications, erectile dysfunction can occur.
Treatments for PNH erectile dysfunction
Because the causes and effects of PNH erectile dysfunction can be complex, a multidisciplinary approach is often required that can involve PNH medications, erectile dysfunction therapies, and psychological support.
PNH medications and symptom management
Managing PNH and its symptoms is the first step in addressing erectile dysfunction related to the disease. Your doctor may recommend medications that can help address certain processes that occur with PNH and contribute to erectile dysfunction. Those treatments can help through:
- reducing the breakdown of red blood cells
- lowering the levels of free hemoglobin
- preserving the bioavailability of nitric oxide.
Addressing these issues can lead to an improvement in erectile dysfunction and other PNH symptoms.
Erectile dysfunction therapies
Depending on the severity of your PNH and other factors, your doctor may also choose to prescribe a medication that directly targets erectile dysfunction.
Your doctor may recommend that you first undergo a complete cardiovascular evaluation before deciding to prescribe medication specifically for erectile dysfunction.
Emotional support
Erectile dysfunction may cause you to feel anxious and worried, which can make the dysfunction worse. Counseling or sex therapy can help you manage the impact of erectile dysfunction on your emotional well-being and personal life.
For more targeted therapy, you can ask your doctor to refer you to a therapist who has treated people with rare diseases.
Open communication
Managing erectile dysfunction as well as other PNH symptoms, such as breathing issues and abdominal pain, can be a complex and deeply personal experience.
But by working closely with your doctor and communicating openly and honestly with them, you can try to manage it as effectively as possible.
PNH News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
