Semen quality impairment is associated with sexual dysfunction according to its severity
Lotti, F1; Corona, G1; Castellini, G1; Maseroli, E1; Fino, MG1; Cozzolino, M2; Maggi, M1
1: Sexual Medicine and Andrology Unit, Italy; 2: Division of Obstetrics and Ginecology, Italy
Objectives. To investigate the relationship between sperm abnormality severity and sexual function.
Material and Methods. Evaluation of 448 men of infertile couples and 74 age-matched healthy, fertile men. All subjects underwent physical, biochemical, scrotal and flaccid penile ultrasound, semen analysis evaluation. Validated tools, such as IIEF-15, Premature Ejaculation Diagnostic Tool (PEDT), Middlesex Hospital Questionnaire (MHQ), NIH-CPSI, Chronic Disease Score (CDS), were used to evaluate, respectively, sexual dysfunction, PE, psychopathological traits, prostatitis-like symptoms and general health status.
Results. Among men with couple infertility, 96 showed azoospermia, 245 at least one abnormality in sperm parameters and 107 normozoospermia, according to WHO. Fertile men were considered as a control group. After adjusting for age, we observed a higher prevalence of ED(IIEF-15-erectile function domain score<26) and PE(PEDT score>8) in males of infertile couples when compared with fertile men(18.3%vs.0% and 12.9%vs.4.1%). The prevalence of ED increases as a function of sperm abnormality severity(p<0.0001), even after adjusting for confounders (age, CDS, MHQ, NIH-CPSI total score), despite similar hormonal, glyco-metabolic and penile vascular status. Compared to fertile men, all three groups of infertile men showed a poorer erectile function, the latter associated with overall psychopathological burden(MHQ total score), particularly somatized anxiety(MHQ-S). Azoospermic men showed the worst erectile function and general health. In this group, erectile function was negatively associated not only with psychopathological disturbances(MHQ total and MHQ-S scores;both p<0.0001) but also with a less healthy phenotype(higher CDS;p=0.015). In addition, azoospermic men reported a higher prevalence of PE, lower sexual desire and orgasmic function when compared to fertile men(all p<0.05), all related to psychopathological symptoms.
Conclusions. ED increases as a function of sperm abnormality, independently of conventional organic alterations and associated with mood disturbances. Azoospermic men reported the worst erectile function and general health status, all related to psychopathological status. Investigation of sexual function, general health and psychological status of males of infertile couples, especially if azoospermic, is advisable, in order to improve not only reproductive fitness but also general health and sexual function.
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