Perceived Reduced Sleep-Related Erections in Subjects with Erectile Dysfunction: Psychobiological Correlates

Abstract

Perceived reduced sleep-related erections (PR-SREs), along with erectile dysfunction (ED) and hypoactive sexual desire, have been recently recognized as the most important symptoms characterizing late-onset hypogonadism in community-dwelling European men. However, the clinical correlates of PR-SREs have not been thoroughly investigated. To evaluate the psychobiological correlates of PR-SREs in a large series of subjects consulting for ED. A consecutive series of 3,888 (mean age 51.6 ± 13.0 years) ED patients attending an outpatient ED clinic was retrospectively analyzed. PR-SREs were investigated using validated question #13 of structured interview on ED, which showed an accuracy of approximately 70% in predicting Rigiscan™ (Dacomed Corp., Minneapolis, MN, USA) parameters in a consecutive subset of 199 subjects. Clinical, biochemical, hormonal, instrumental (penile color Doppler ultrasound; PCDU), and intrapsychic (Middlesex Health Questionnaire) correlates were also evaluated. PR-SREs were reported by 63.6% of patients. After adjustment for age, total, analog free, calculated free and calculated bioavailable testosterone (T) were significantly lower in subjects reporting more severe PR-SREs. After adjusting for T levels and other confounders, PR-SREs were still associated with higher body mass index, glucose, and triglyceride levels, as well as with an increased 10-year cardiovascular risk score. Accordingly, PR-SREs were more prevalent in subjects showing a reduced dynamic peak systolic velocity at PCDU or reporting severe ED. Among intrapsychic parameters, depressive and histrionic traits were significantly higher and lower, respectively, in subjects with any degree of PR-SREs. Our study indicates that investigating PR-SREs represents an important step during the andrological consultation. In fact, reduced SREs might indicate an endocrine, organic, and/or psychiatric ED background that might help in directing further investigation.