Abstract
Purpose: The aim of this study was to compare the initial request for sexual consultation with the final diagnosis and to evaluate the limits of the active andrological anamnesis concerning unclassified male sexual dysfunction. Methods: In this 12-year observational retrospective study, we collected data from patients referring to an andrological outpatient clinic, evaluating the requests, perceptions, needs, and self-diagnosis at their first visit and comparing them with the final diagnosis reached after a complete clinical, laboratory, and instrumental investigation. Results: A total of 11,200 patients were evaluated. The main request of andrological consultation was erectile dysfunction (ED) (52%), followed by premature ejaculation (PE) (28%), and low sexual desire (11.5%). Among the patients seeking help for ED, about 30% were ultimately found to have a different type of dysfunction and 24% were diagnosed with an “unmet need”, which included issues not present in the current nosography nonetheless affecting sexual and relational life. Among the patients referring for PE, the final diagnosis was lifelong PE for the large majority of them, regardless of whether initially they thought to have an acquired form. Several of those who sought consultation for acquired PE were frequently found to be able to compensate for lifelong PE by a subsequent coitus or were able to induce orgasm in the partner with different modalities. Among the patients referring for low sexual desire, only 57.5% were confirmed to have it; 23% had ED and 18.5% showed a raised threshold of penile sensitivity. Conclusions: The results of this study show that the reason for consultation is frequently misleading and raise the relevance of being aware of the so-called “unmet needs” and to discuss with the patient and the couple to explore the sexual history behind the self-diagnosis. These findings also suggest the need to expand the current taxonomy of male sexual dysfunctions.
Highlights
The most frequent sexual complaints of male patients are related to erection, ejaculation, and desire
Erectile dysfunction (ED) is a common male sexual dysfunction that may be due to a dysfunction of any component of the erectile function, including organic factors, and non-organic factors [1]
Two milestone studies have risen the awareness of its epidemiology: the Massachusetts Male Ageing Study (MMAS) [2] and the European Male Ageing Study (EMAS) [3]
Summary
The most frequent sexual complaints of male patients are related to erection, ejaculation, and desire. The MMAS showed that the combined prevalence of mild–moderate ED was 52% in men aged 40–70 years; ED was strongly related to age, health status, and emotional function. The EMAS, the largest European multicenter population-based study of ageing men (40–79 years), reported a prevalence of ED ranging from 6% to 64%, depending on different age subgroups. The prevalence of ED in younger men has been poorly highlighted [4,5]. In this context, a study reported that one man out of four who seeks medical help for ED in the real-life setting is
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