Prevalence and predictors of unrecognized low sexual desire in men with new onset erectile dysfunction – findings from a cross-sectional, real-life study

Abstract

The interrelationship between sexual desire and erectile dysfunction (ED) has been variously investigated. We aimed to investigate the prevalence of and the predictors of unrecognized low sexual desire (LSD) in the real-life setting. Data from 1509 men seeking first medical help for new-onset ED at a single andrology centre were analyzed. All participants self-reported the presence of LSD. Moreover, patients completed the International Index of Erectile Function (IIEF) and the Beck Depression Inventory (BDI). Depressive symptoms were defined as BDI ≥11. The median value of the IIEF-Sexual desire domain (IIEF-SD = 7) was arbitrarily used to categorize the cohort in low vs. normal SD. Hypogonadism was defined as total testosterone (tT) < 3.0 ng/mL. Descriptive statistics and logistic regression models tested the association between clinical variables and unrecognized LSD. Of 1197 (79.3%) patients not self-reporting LSD, 369 (30.8%) had IIEF-SD <7. Patients with unrecognized LSD were older [median (IQR) 54 yrs (41-63) vs. 49 yrs (36-59), p<0.001], had lower IIEF-EF [10 (5-20) vs. 22 (11-28)] but higher BDI [6 (3-12) vs. 4 (1-8)] and lower tT [4.3 (3.2-5.7) vs. 4.7 (3.2-7.3) ng/ml] (all p<0.001). Overall, men with unrecognized LSD presented a higher rate of severe ED (50% vs. 24%, p<0.001), and of BDI suggestive for depressive symptoms (30.6% vs. 18.3%) and of hypogonadism (19.9% vs. 10%) (all p<0.001). At multivariable logistic regression analysis, lower tT, not suggestive for hypogonadism (OR 0.91, p=0.03), lower IIEF-EF (OR 0.94, p<0.001) and BDI suggestive for depressive symptoms (OR 1.83, p<0.001) were independent predictors of unrecognized LSD, after accounting for age. One out of three men seeking first medical help for ED showed unrecognized LSD. Men with unrecognized LSD were older, had higher rates of severe ED and depressive symptoms and lower tT values than men with normal SD. None