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.

  • Article
  • Published:

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

International Journal of Impotence Research volume 36, pages 83–88 (2024)Cite this article

Subjects

Abstract

The interrelationship between male sexual desire and erectile dysfunction (ED) has been scantly investigated. Thus, we aimed at investigating the prevalence of and the predictors of unrecognised low sexual desire/interest (uLSD/I) in a cohort of men with new onset ED. Complete data from 1587 men seeking for first medical help for ED between 2010 and 2021 were analysed. Comorbidities were scored with the Charlson Comorbidity Index (CCI). At entrance, all patients were asked to self-report low sexual desire/interest and completed the International Index of Erectile Function (IIEF) and the Beck Depression Inventory (BDI) (depressive symptoms scored as BDI ≥ 11). The IIEF-erectile function (IIEF-EF) domain was categorised according to Cappelleri’s criteria. The median value of the IIEF-sexual desire domain (IIEF-SD) was used to dichotomise men with uLSD/I along with ED (IIEF-SD < 7) vs. ED-only (IIEF-SD ≥ 7). Circulating hormones were measured in every patient. Hypogonadism was defined as total testosterone (tT) <3.0 ng/mL. Descriptive statistics and logistic regression models tested the association between clinical variables and uLSD/I. Of 1197 patients not self-reporting LSD/I, 369 (30.8%) had IIEF-SD < 7. Patients with ED + uLSD/I were older [median (IQR) 54(41–63) vs. 49(36–59) years], had lower IIEF-EF [10.5(5–22) vs. 22(11–28)] but higher BDI [6(3–12) vs. 4(1–8)] and lower tT [4.3(3.2–5.7) vs. 4.8(3.2–6.3) ng/mL] compared to ED-only men (all p < 0.05). Overall, ED + uLSD/I men had higher rate of severe ED (49.9% vs. 23.9%), and of BDI ≥ 11 (30.6% vs. 18.2%) (all p < 0.05). At multivariable logistic regression analysis, lower tT (OR: 0.82), lower IIEF-EF scores (OR:0.95) and BDI ≥ 11 (OR:2.51) were independently associated with ED + uLSD/I, after accounting for age (all p < 0.05). Almost 30% of men seeking first medical help for ED-only had also uLSD/I. Men with both conditions were older, had higher rates of severe ED and more depressive symptoms. A detailed investigation of sexual desire should be always included in men self-complaining only of ED.

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

Access options

Buy this article

  • Purchase on SpringerLink
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

Data availability

Data and materials are available whenever requested.

Code availability

Code is available whenever requested.

References

  1. McCabe MP, Sharlip ID, Atalla E, Balon R, Fisher AD, Laumann E, et al. Definitions of sexual dysfunctions in women and men: a consensus statement from the fourth international consultation on sexual medicine 2015. J Sex Med. 2016;13:135–43.

    Article  PubMed  Google Scholar 

  2. Laumann EO, Nicolosi A, Glasser DB, Paik A, Gingell C, Moreira E, et al. Sexual problems among women and men aged 40–80 y: prevalence and correlates identified in the Global Study of Sexual Attitudes and Behaviors. Int J Impot Res. 2005;17:39–57. https://doi.org/10.1038/sj.ijir.3901250

    Article  CAS  PubMed  Google Scholar 

  3. Salonia A, Bettocchi C, Boeri L, Capogrosso P, Carvalho J, Cilesiz NC, et al. European Association of Urology Guidelines on Sexual and Reproductive Health—2021 update: male sexual dysfunction. Eur Urol. 2021;80:333–57.

    Article  PubMed  Google Scholar 

  4. Pozzi E, Capogrosso P, Boeri L, Cazzaniga W, Matloob R, Ventimiglia E, et al. Trends in reported male sexual dysfunction over the past decade: an evolving landscape. Int J Impot Res. 2021;33:596–602. https://doi.org/10.1038/s41443-020-0324-7

    Article  PubMed  Google Scholar 

  5. Capogrosso P, Ventimiglia E, Boeri L, Cazzaniga W, Chierigo F, Pederzoli F, et al. Age at first presentation for erectile dysfunction: analysis of changes over a 12-yr period. Eur Urol Focus. 2019;5:899–905.

    Article  PubMed  Google Scholar 

  6. Rastrelli G, Cipriani S, Corona G, Vignozzi L, Maggi M. Clinical characteristics of men complaining of premature ejaculation together with erectile dysfunction: a cross-sectional study. Andrology. 2019;7:163–71.

    Article  CAS  PubMed  Google Scholar 

  7. Corona G, Rastrelli G, Limoncin E, Sforza A, Jannini EA, Maggi M. Interplay between premature ejaculation and erectile dysfunction: a systematic review and meta-analysis. J Sex Med. 2015;12:2291–300.

    Article  PubMed  Google Scholar 

  8. Serefoglu EC, Smith TM, Kaufman GJ, Liu G, Yafi FA, Hellstrom WJG. Factors associated with erectile dysfunction and the peyronie’s disease questionnaire in patients with Peyronie disease. Urology. 2017;107:155–60.

    Article  PubMed  Google Scholar 

  9. Chin CW, Tsai CM, Lin JT, Chen YS, Chen IH, Jiann BP. A cross-sectional observational study on the coexistence of erectile dysfunction and premature ejaculation. Sex Med. 2021;9:100438.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Cilio S, Pozzi E, Fallara G, Belladelli F, Corsini C, d’Arma A, et al. Premature ejaculation among men with erectile dysfunction-findings from a real-life cross-sectional study. Int J Impot Res. 2022; https://doi.org/10.1038/s41443-022-00601-4

  11. Salonia A, Clementi MC, Ventimiglia E, Colicchia M, Capogrosso P, Castiglione F, et al. Prevalence and predictors of concomitant low sexual desire/interest and new-onset erectile dysfunction - a picture from the everyday clinical practice. Andrology. 2014;2:702–8.

    Article  CAS  PubMed  Google Scholar 

  12. Castelló-Porcar AM, Martínez-Jabaloyas JM. Testosterone/estradiol ratio, is it useful in the diagnosis of erectile dysfunction and low sexual desire? Aging Male J Int Soc Study Aging Male. 2016;19:254–8.

    Article  Google Scholar 

  13. Corona G, Mannucci E, Petrone L, Giommi R, Mansani R, Fei L, et al. Psycho-biological correlates of hypoactive sexual desire in patients with erectile dysfunction. Int J Impot Res. 2004;16:275–81. https://doi.org/10.1038/sj.ijir.3901158

    Article  CAS  PubMed  Google Scholar 

  14. Hess RA, Bunick D, Lee KH, Bahr J, Taylor JA, Korach KS, et al. A role for oestrogens in the male reproductive system. Nature. 1997;390:509–12.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Krysiak R, Kowalcze K, Okopień B. Sexual function and depressive symptoms in men with hypoprolactinaemia secondary to overtreatment of prolactin excess: a pilot study. Endocrinol Diabetes Nutr. 2022;69:279–88.

    Article  Google Scholar 

  16. Gabrielson AT, Sartor RA, Hellstrom WJG. The impact of thyroid disease on sexual dysfunction in men and women. Sex Med Rev. 2019;7:57–70.

    Article  PubMed  Google Scholar 

  17. Salonia A, Rastrelli G, Hackett G, Seminara SB, Huhtaniemi IT, Rey RA, et al. Paediatric and adult-onset male hypogonadism. Nat Rev Dis Prim. 2019;5:38.

    Article  PubMed  Google Scholar 

  18. Shigehara K, Kato Y, Iijima M, Kawaguchi S, Nohara T, Izumi K, et al. Risk factors affecting decreased libido among middle-aged to elderly men; nocturnal voiding is an independent risk factor of decreased libido. Sex Med. 2021;9:100426.

    PubMed  PubMed Central  Google Scholar 

  19. Cunningham GR, Stephens-Shields AJ, Rosen RC, Wang C, Ellenberg SS, Matsumoto AM, et al. Association of sex hormones with sexual function, vitality, and physical function of symptomatic older men with low testosterone levels at baseline in the testosterone trials. J Clin Endocrinol Metab. 2015;100:1146–55.

    Article  CAS  PubMed  Google Scholar 

  20. Hintikka J, Niskanen L, Koivumaa-Honkanen H, Tolmunen T, Honkalampi K, Lehto SM, et al. Hypogonadism, decreased sexual desire, and long-term depression in middle-aged men. J Sex Med. 2009;6:2049–57.

    Article  PubMed  Google Scholar 

  21. Boeri L, Capogrosso P, Ventimiglia E, Cazzaniga W, Pederzoli F, Moretti D, et al. Does calculated free testosterone overcome total testosterone in protecting from sexual symptom impairment? Findings of a cross-sectional study. J Sex Med. 2017;14:1549–57.

    Article  PubMed  Google Scholar 

  22. Rubio-Aurioles E, Bivalacqua TJ. Standard operational procedures for low sexual desire in men. J Sex Med. 2013;10:94–107.

    Article  PubMed  Google Scholar 

  23. Charlson M, Szatrowski TP, Peterson J, Gold J. Validation of a combined comorbidity index. J Clin Epidemiol. 1994;47:1245–51.

    Article  CAS  PubMed  Google Scholar 

  24. Cappelleri JC, Rosen RC, Smith MD, Mishra A, Osterloh IH. Diagnostic evaluation of the erectile function domain of the international index of erectile function. Urology. 1999;54:346–51.

    Article  CAS  PubMed  Google Scholar 

  25. Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A. The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology. 1997;49:822–30.

    Article  CAS  PubMed  Google Scholar 

  26. D’Elia C, Cerruto MA, Cavicchioli FM, Cardarelli S, Molinari A, Artibani W. Critical points in understanding the Italian version of the IIEF 5 questionnaire. Arch Ital Urol Androl Organo Uff Soc Ital Ecogr Urol E Nefrol. 2012;84:197–201.

    Google Scholar 

  27. Richter P, Werner J, Heerlein A, Kraus A, Sauer H. On the validity of the Beck Depression Inventory. Psychopathology. 1998;31:160–8.

    Article  CAS  PubMed  Google Scholar 

  28. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry. 1961;4:561–71.

    Article  CAS  PubMed  Google Scholar 

  29. Sacco R, Santangelo G, Stamenova S, Bisecco A, Bonavita S, Lavorgna L, et al. Psychometric properties and validity of Beck Depression Inventory II in multiple sclerosis. Eur J Neurol. 2016;23:744–50.

    Article  CAS  PubMed  Google Scholar 

  30. Bhasin S, Brito JP, Cunningham GR, Hayes FJ, Hodis HN, Matsumoto AM, et al. Testosterone therapy in men with hypogonadism: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2018;103:1715–44.

    Article  PubMed  Google Scholar 

  31. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, et al. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Epidemiology. 2007;18:800–4.

    Article  Google Scholar 

  32. Boeri L, Capogrosso P, Ventimiglia E, Cazzaniga W, Pederzoli F, Gandaglia G, et al. Depressive symptoms and low sexual desire after radical prostatectomy: early and long-term outcomes in a real-life setting. J Urol. 2018;199:474–80.

    Article  PubMed  Google Scholar 

  33. Capogrosso P, Ventimiglia E, Boeri L, Pozzi E, Chierigo F, Schifano N, et al. Should we tailor the clinical management of erectile dysfunction according to different ages? J Sex Med. 2019;16:999–1004.

    Article  PubMed  Google Scholar 

  34. Pozzi E, Fallara G, Capogrosso P, Boeri L, Belladelli F, Corsini C, et al. Primary organic versus primary psychogenic erectile dysfunction: Findings from a real-life cross-sectional study. Andrology. 2022;10:1302–9.

  35. Goethe VE, Angerer H, Dinkel A, Arsov C, Hadaschik B, Imkamp F, et al. Concordance and discordance of sexual identity, sexual experience, and current sexual behavior in 45-year-old men: results from the german male sex-study. Sex Med. 2018;6:282–90.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Corona G, Rastrelli G, Ricca V, Jannini EA, Vignozzi L, Monami M, et al. Risk factors associated with primary and secondary reduced libido in male patients with sexual dysfunction. J Sex Med. 2013;10:1074–89.

    Article  PubMed  Google Scholar 

  37. Saramies J, Koiranen M, Auvinen J, Uusitalo H, Hussi E, Becker S, et al. A natural history of erectile dysfunction in elderly men: a population-based, twelve-year prospective study. J Clin Med. 2022;11:2146.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Corona G, Lee DM, Forti G, O’Connor DB, Maggi M, O’Neill TW, et al. Age-related changes in general and sexual health in middle-aged and older men: results from the European Male Ageing Study (EMAS). J Sex Med. 2010;7:1362–80.

    Article  PubMed  Google Scholar 

  39. Gentile I, Fusco F, Buonomo AR, Scotto R, Zappulo E, Pinchera B, et al. Prevalence and risk factors of erectile dysfunction in patients with hepatitis B virus or hepatitis C virus or chronic liver disease: results from a prospective study. Sex Health. 2018;15:408–12.

    Article  PubMed  Google Scholar 

  40. Di Bello F, Creta M, Napolitano L, Califano G, Passaro F, Morra S, et al. Male sexual dysfunction and infertility in spinal cord injury patients: state-of-the-art and future perspectives. J Pers Med. 2022;12:873.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Mirone V, Longo N, Fusco F, Verze P, Creta M, Parazzini F, et al. Renal transplantation does not improve erectile function in hemodialysed patients. Eur Urol. 2009;56:1047–53.

    Article  PubMed  Google Scholar 

  42. Wu FCW, Tajar A, Beynon JM, Pye SR, Silman AJ, Finn JD, et al. Identification of late-onset hypogonadism in middle-aged and elderly men. N Engl J Med. 2010;363:123–35.

    Article  CAS  PubMed  Google Scholar 

  43. Barone B, Napolitano L, Abate M, Cirillo L, Reccia P, Passaro F, et al. The role of testosterone in the elderly: what do we know? Int J Mol Sci. 2022;23:3535.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Corona G, Isidori AM, Aversa A, Burnett AL, Maggi M. Endocrinologic control of men’s sexual desire and arousal/erection. J Sex Med. 2016;13:317–37.

    Article  PubMed  Google Scholar 

  45. Salonia A, Castagna G, Saccà A, Ferrari M, Capitanio U, Castiglione F, et al. Is erectile dysfunction a reliable proxy of general male health status? The case for the International Index of Erectile Function-Erectile Function domain. J Sex Med. 2012;9:2708–15.

    Article  PubMed  Google Scholar 

  46. Özkent MS, Hamarat MB, Taşkapu HH, Kılınç MT, Göger YE, Sönmez MG. Is erectile dysfunction related to self-esteem and depression? A prospective case-control study. Andrologia. 2021;53:e13910.

    Article  PubMed  Google Scholar 

  47. Rosen RC, Catania J, Pollack L, Althof S, O’Leary M, Seftel AD. Male Sexual Health Questionnaire (MSHQ): scale development and psychometric validation. Urology. 2004;64:777–82.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Experimental Oncology/Unit of Urology, URI; IRCCS Ospedale San Raffaele, Milan, Italy

    Simone Cilio, Edoardo Pozzi, Giuseppe Fallara, Federico Belladelli, Christian Corsini, Alessia d’Arma, Francesco Montorsi & Andrea Salonia

  2. Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples “Federico II”, Naples, Italy

    Simone Cilio, Ciro Imbimbo, Alessandro Palmieri & Vincenzo Mirone

  3. Department of Urology, Foundation IRCCS Ca’ Granda -Ospedale Maggiore Policlinico, Milan, Italy

    Luca Boeri

  4. University Vita-Salute San Raffaele, Milan, Italy

    Edoardo Pozzi, Giuseppe Fallara, Federico Belladelli, Christian Corsini, Francesco Montorsi & Andrea Salonia

  5. Department of Urology, Circolo & Fondazione Macchi Hospital -ASST Sette Laghi, Varese, Italy

    Paolo Capogrosso

Authors
  1. Simone Cilio
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Luca Boeri
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Edoardo Pozzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Giuseppe Fallara
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Federico Belladelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Christian Corsini
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Paolo Capogrosso
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Alessia d’Arma
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Ciro Imbimbo
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Alessandro Palmieri
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Vincenzo Mirone
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Francesco Montorsi
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Andrea Salonia
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conception and design of the study: SC, LB, PC, AS. Data acquisition: FB, AD, EP. Analysis and interpretation of data: SC, LB, GF, AS. Drafting the manuscript: SC, LB, CC. Style revision: CI, VM, AP, FM. All authors revised the manuscript and read and approved the version submitted.

Corresponding author

Correspondence to Andrea Salonia.

Ethics declarations

Competing interests

The authors declare no competing interests.

Statement of ethics

Data collection followed the principles outlined in the Declaration of Helsinki; all patients had signed an informed consent agreeing to deliver their own anonymous information for future studies. The study was approved by our local ethics committee.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cilio, S., Boeri, L., Pozzi, E. et al. Prevalence and predictors of unrecognised low sexual desire/interest in men with new onset erectile dysfunction: findings from a cross-sectional, real-life study. Int J Impot Res 36, 83–88 (2024). https://doi.org/10.1038/s41443-022-00647-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41443-022-00647-4

Search

Advanced search

Quick links