Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Epidemiology and pathophysiology of male sexual dysfunction

Abstract

Male sexual dysfunction (MSD) is a common disorder associated with a wide range of physical and psychological conditions. Erectile dysfunction, the most commonly studied aspect of MSD, is common and increases with age and with certain comorbid conditions. The pathophysiology of ED and other forms of MSD can be traced to a variety of etiologies, including vascular, hormonal, psychiatric, iatrogenic and potentially neurobiological causes.

This is a preview of subscription content, access via your institution

Relevant articles

Open Access articles citing this article.

Access options

Buy article

Get time limited or full article access on ReadCube.

$32.00

All prices are NET prices.

Figure 1
Figure 2
Figure 3

References

  1. Lue T . Erectile dysfunction. N Engl J Med 2000; 342: 1802–1813.

    Article  CAS  Google Scholar 

  2. Lue T, Guiliano F, Montorsi F, Rosen RC, Andersson KE, Altof S et al. Summary of the recommendations on sexual dysfunctions in men. J Sex Med 2004; 1: 6–23.

    Article  Google Scholar 

  3. Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB . Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol 1994; 151: 54–61.

    Article  CAS  Google Scholar 

  4. Johannes CB, Araujo AB, Feldman HA, Derby CA, Kleinman KP, McKinlay JB . Incidence of erectile dysfunction in men 40–69 years old: longitudinal results from the Massachusetts Male Aging Study. J Urol 2000; 163: 460–463.

    Article  CAS  Google Scholar 

  5. Laumann EO, Paik A, Rosen RC . Sexual dysfunction in the United States: prevalence and predictors. JAMA 1999; 281: 537–544.

    Article  CAS  Google Scholar 

  6. Lindau ST, Schumm P, Laumann EO, Levinson W, O’Muircheartaigh CA, Waite LJ . A study of sexuality and health among older adults in the United States. N Engl J Med 2007; 357: 762–774.

    Article  CAS  Google Scholar 

  7. Bacon CG, Mittleman MA, Kawachi I, Giovannucci E, Glasser DB, Rimm EB . Sexual function in men older than 50 years of age: results from the Health Professionals Follow-up Study. Ann Intern Med 2003; 139: 161–168.

    Article  Google Scholar 

  8. Panser LA, Rhodes T, Girman CJ, Guess HA, Chute CG, Oesterling JE et al. Sexual function of men ages 40–79 years: the Olmsted County Study of Urinary Symptoms and Health Status Among Men. J Am Geriatr Soc 1995; 43: 1107–1111.

    Article  CAS  Google Scholar 

  9. Rosen RC, Hatzikristou D, Broderick G, Clayton A, Couzin B, Derogatis L et al. Clinical evaluation and symptom scales: sexual dysfunction assessment in males. In: Lue TF, Basson R, Rosen R, Giuliano F, Khoury S, Montorsi F (eds). Sexual Medicine. International Society for Sexual Medicine: online edition, available at http://www.issm.info/. Accessed 24 July 2007.

  10. Simons JS, Carey MP . Prevalence of sexual dysfunctions: results from a decade of research. Arch Sex Behav 2001; 30: 177–219.

    Article  CAS  Google Scholar 

  11. Basson R, Schultz WW . Sexual sequelae of general medical disorders. Lancet 2007; 369: 409–424.

    Article  Google Scholar 

  12. Bivalacqua TJ, Usta MF, Champion HC, Kadowitz PJ, Hellstrom WJ . Endothelial dysfunction in erectile dysfunction: role of the endothelium in erectile physiology and disease. J Androl 2003; 24: S17–S37.

    Article  CAS  Google Scholar 

  13. Jackson G, Rosen RC, Kloner RA, Kostis JB . The second Princeton consensus on sexual dysfunction and cardiac risk: new guidelines for sexual medicine. J Sex Med 2006; 3: 28–36.

    Article  CAS  Google Scholar 

  14. Thompson IM, Tangen CM, Goodman PJ, Probstfield JL, Moinpour CM, Coltman CA . Erectile dysfunction and subsequent cardiovascular disease. JAMA 2005; 294: 2996–3002.

    Article  CAS  Google Scholar 

  15. Burchardt M, Burchardt T, Baer L, Kiss AJ, Pawar RV, Shabsigh A et al. Hypertension is associated with severe erectile dysfunction. J Urol 2000; 164: 1188–1191.

    Article  CAS  Google Scholar 

  16. Heruti RJ, Sharabi Y, Arbel Y, Shochat T, Swartzon M, Brenner G et al. The prevalence of erectile dysfunction among hypertensive and prehypertensive men aged 25–40 years. J Sex Med 2007; 4: 596–601.

    Article  Google Scholar 

  17. Selvin E, Burnett AL, Platz EA . Prevalence and risk factors for erectile dysfunction in the US. Am J Med 2007; 120: 151–157.

    Article  Google Scholar 

  18. Jesmin S, Sakuma I, Salah-eldin A, Nonomura K, Hattori Y, Kitabatake A . Diminished penile expression of vascular endothelial growth factor and its receptors at the insulin-resistant stage of a type II diabetic rat model: a possible cause for erectile dysfunction in diabetes. J Mol Endocrinol 2003; 31: 401–418.

    Article  CAS  Google Scholar 

  19. Cellek S, Rodrigo J, Lobos E, Fernandez P, Serrano J, Moncada S . Selective nitrergic neurodegeneration in diabetes mellitus—a nitric oxide-dependent phenomenon. Br J Pharmacol 1999; 128: 1804–1812.

    Article  CAS  Google Scholar 

  20. Bivalacqua TJ, Champion HC, Usta MF, Cellek S, Chitaley K, Webb RC et al. RhoA/Rho-kinase suppresses endothelial nitric oxide synthase in the penis: a mechanism for diabetes-associated erectile dysfunction. Proc Natl Acad Sci USA 2004; 101: 9121–9126.

    Article  CAS  Google Scholar 

  21. Naya Y, Soh J, Ochiai A, Mizutani Y, Kawauchi A, Fujito A et al. Erythrocyte aldose reductase correlates with erectile dysfunction in diabetic patients. Int J Impot Res 2002; 14: 213–216.

    Article  CAS  Google Scholar 

  22. Agarwal A, Nandipati KC, Sharma RK, Zippe CD, Raina R . Role of oxidative stress in the pathophysiological mechanism of erectile dysfunction. J Androl 2006; 27: 335–347.

    Article  CAS  Google Scholar 

  23. Yesilli C, Yaman O, Anafarta K . Effect of experimental hypercholesterolemia on cavernosal structures. Urology 2001; 57: 1184–1188.

    Article  CAS  Google Scholar 

  24. Esposito K, Giugliano F, Martedì E, Feola G, Marfella R, D’Armiento M et al. High proportions of erectile dysfunction in men with the metabolic syndrome. Diabetes Care 2005; 298: 1201–1203.

    Article  Google Scholar 

  25. Kaminetsky JC . Comorbid LUTS and erectile dysfunction: optimizing their management. Curr Med Res Opin 2006; 22: 2497–2506.

    Article  Google Scholar 

  26. Rhoden EL, Morgentaler A . Risks of testosterone-replacement therapy and recommendations for monitoring. N Engl J Med 2004; 350: 482–492.

    Article  CAS  Google Scholar 

  27. Ajumu A, Dobs AS . Is hypogonadism a risk factor for sexual dysfunction? J Androl 2003; 24 (6 Suppl): S46–S51.

    Article  Google Scholar 

  28. Carani C, Bancroft J, Del Rio G, Granata AR, Facchinetti F, Marrama P . The endocrine effects of visual erotic stimuli in normal men. Psychoneuroendocrinology 1990; 15: 207–216.

    Article  CAS  Google Scholar 

  29. Haren MT, Kim MJ, Tariq SH, Wittert GA, Morley JE . Andropause: a quality-of-life issue in older males. Med Clin N Am 2006; 90: 1005–1023.

    Article  CAS  Google Scholar 

  30. Kupelian V, Shabsigh R, Travison TG, Page ST, Araujo AB, McKinlay JB . Is there a relationship between sex hormones and erectile dysfunction? Results from the Massachusetts Male Aging Study. J Urol 2006; 176: 2584–2588.

    Article  CAS  Google Scholar 

  31. Isidori AM, Giannetta E, Gianfrilli D, Greco EA, Bonifacio V, Aversa A et al. Effects of testosterone on sexual function in men: results of a meta-analysis. Clin Endocrinol (Oxf) 2005; 63: 601–602.

    Article  Google Scholar 

  32. Yassin AA, Saad F, Diede HE . Testosterone and erectile function in hypogonadal men unresponsive to tadalafil: results from an open-label uncontrolled study. Andrologia 2006; 38: 61–68.

    Article  CAS  Google Scholar 

  33. Zitzmann M, Faber S, Nieschlag E . Association of specific symptoms and metabolic risks with serum testosterone in older men. J Clin Endocrinol Metab 2006; 91: 4335–4343.

    Article  CAS  Google Scholar 

  34. Bhasin S, Enzlin P, Coviello A, Basson R . Sexual dysfunction in men and women with endocrine disorders. Lancet 2007; 369: 597–611.

    Article  CAS  Google Scholar 

  35. Clayton AH . Sexual function and dysfunction in women. Psychiatr Clin North Am 2003; 263: 673–682.

    Article  Google Scholar 

  36. Ferretti A, Caulo M, Del Gratta C, Di Matteo R, Merla A, Montorsi F et al. Dynamics of male sexual arousal: distinct components of brain activation revealed by fMRI. Neuroimage 2005; 26: 1086–1096.

    Article  Google Scholar 

  37. Kim SW, Sohn DW, Cho YH, Yang WS, Lee KU, Juh R et al. Brain activation by visual erotic stimuli in healthy middle aged males. Int J Impot Res 2006; 18: 452–457.

    Article  CAS  Google Scholar 

  38. Guiliano F, Rampin O . Neural control of erection. Physiol Behav 2004; 83: 189–201.

    Article  Google Scholar 

  39. Frajese G, Lazzari R, Magnani A, Moretti C, Sforza V, Nerozzi D . Neurotransmitter, opiodergic system, steroid–hormone interaction and involvement in the replacement therapy of sexual disorders. J Steroid Biochem Mol Biol 1990; 37: 411–419.

    Article  CAS  Google Scholar 

  40. Verhelst J, Abs R . Hyperprolactinemia: pathophysiology and management. Treat Endocrinol 2003; 2: 23–32.

    Article  Google Scholar 

  41. Clayton AH, Pradko JF, Croft HA, Montano CB, Leadbetter RA, Bolden-Watson C et al. Prevalence of sexual dysfunction among newer antidepressants. J Clin Psychiatry 2002; 63: 357–366.

    Article  Google Scholar 

  42. Casper RC, Redmond Jr DE, Katz MM, Schaffer CB, Davis JM, Koslow SH . Somatic symptoms in primary affective disorder. Presence and relationship to the classification of depression. Arch Gen Psychiatry 1985; 42: 1098–1104.

    Article  CAS  Google Scholar 

  43. American Psychiatric Association. DMS-IV. Diagnostic and Statistical Manual of Mental Disorders, 4th edn. The American Psychiatric Association: Washington DC, 1994.

  44. Araujo AB, Durante R, Feldman HA, Goldstein I, McKinlay JB . The relationship between depressive symptoms and male erectile dysfunction: cross-sectional results from the Massachusetts Male Aging Study. Psychosom Med 1998; 60: 458–465.

    Article  CAS  Google Scholar 

  45. Cosgrove DJ, Gordon Z, Bernie JE, Hami S, Montoya D, Stein MB et al. Sexual dysfunction in combat veterans with post-traumatic stress disorder. Urology 2002; 60: 881–884.

    Article  Google Scholar 

  46. Buvat J . Hyperprolactinemia and sexual function in men: a short review. Int J Impot Res 2003; 15: 373–377.

    Article  CAS  Google Scholar 

  47. Rees PM, Fowler CJ, Maas CP . Sexual function in men and women with neurological disorders. Lancet 2007; 369: 512–525.

    Article  Google Scholar 

  48. Voisey J, Carroll L, van Daal A . Melanocortins and their receptors and antagonists. Curr Drug Targets 2003; 4: 586–597.

    Article  CAS  Google Scholar 

  49. Van der Ploeg LH, Martin WJ, Howard AD, Nargund RP, Austin CP, Guan X et al. A role for the melanocortin 4 receptor in sexual function. Proc Natl Acad Sci USA 2002; 99: 11381–11386.

    Article  CAS  Google Scholar 

  50. Nicolosi A, Laumann EO, Glasser DB, Moreira Jr ED, Paik A, Gingell C et al. Sexual behavior and sexual dysfunctions after age 40: the global study of sexual attitudes and behaviors. Urology 2004; 64: 991–997.

    Article  Google Scholar 

Download references

Acknowledgements

This study was supported by a grant from Palatin Technologies, Inc. Editorial support for the preparation of this paper was provided by Kevin Kehres.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to J Kaminetsky.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Kaminetsky, J. Epidemiology and pathophysiology of male sexual dysfunction. Int J Impot Res 20 (Suppl 1), S3–S10 (2008). https://doi.org/10.1038/ijir.2008.16

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ijir.2008.16

Keywords

  • male sexual dysfunction
  • erectile dysfunction
  • epidemiology
  • pathophysiology

This article is cited by

Search

Quick links