Abstract

Introduction: It is unknown if the Fontan circulation has an impact on sexual health in men. This study assessed self-reported sexual health and fertility in men with a Fontan circulation.Aims: In this prospective, cross-sectional study, Australian men ≥18 years enrolled in the Fontan Registry of Australia and New Zealand were invited to complete the International Index of Erectile Function (IIEF), alongside questions assessing fertility. These data were compared to historical, age-matched controls.Results: Of 227 eligible men, 54 completed the survey; of those 37 were sexually active and included in the final analysis. Mean age was 28 ± 3 years, age at Fontan was 5 ± 3 years. Fontan type was extra-cardiac conduit in 15 (41%), lateral tunnel in 12 (32%), and atriopulmonary connection (APC) in 10 (27%). Ventricular function was normal in 24 (83%), and all were New York Heart Association Class I (23 patients, 79%) and II (six patients, 21%). Nine participants (24%) had erectile dysfunction (IIEF-EF score ≤25). The severity was mild (IIEF 22–24) in six (16%), mild–moderate (IIEF 17–21) in two (5%), and moderate (IIEF 11–16) in one (3%). Baseline characteristics and current medication usage were similar in those with and without erectile dysfunction. Compared with historical control values, erectile function was not significantly impaired in the Fontan population (p =0.76). Men with a Fontan circulation had decreased levels of sexual desire and overall satisfaction (p < 0.001). There was no correlation between the presence of erectile dysfunction and any assessed parameter. Eleven (30%) of the cohort reported a pregnancy with a prior partner.Conclusion: In our cohort, overall erectile function was comparable between men with a Fontan circulation and historical controls, however sexual desire and overall satisfaction were reduced. There was no correlation between study parameters and the presence of erectile dysfunction. The proportion of the cohort who had a prior pregnancy was congruent with population data.

Highlights

  • It is unknown if the Fontan circulation has an impact on sexual health in men

  • Of 227 eligible men, 135 were unable to be contacted or did not complete the survey, 22 were excluded due to a history of mental disorder, 17 refused to complete the survey upon contact, 13 did not have sexual activity during the study period, two declined to have their registry data accessed, and one person died during the study period, leaving 37 men included in the final analysis

  • Patients with a Fontan circulation had significantly decreased levels of sexual desire at 8.1 ± 1.2 compared to 9.1 ± 1.0 (p < 0.001) and overall satisfaction at 8.3 ± 1.9 compared to 9.5 ± 0.8 in controls (p < 0.001)

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Summary

Introduction

It is unknown if the Fontan circulation has an impact on sexual health in men. This study assessed self-reported sexual health and fertility in men with a Fontan circulation. Since its initial development almost 50 years ago, the Fontan procedure has been increasingly implemented for children who have complex single ventricle cardiac anatomy [1,2,3,4]. Over this time the technique has undergone multiple advancements, including the lateral tunnel (LT) and extracardiac conduit (EC) modifications [2,3,4]. The impact that a Fontan circulation has upon sexual function, satisfaction and fertility is less well established.

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