Cilio Simone, Pozzi Edoardo, Fallara Giuseppe, Belladelli Federico, Raffo Massimiliano, Lanzaro Francesco, Bertini Alessandro, Boeri Luca, Capogrosso Paolo, d'Arma Alessia, Palmieri Alessandro, Imbimbo Ciro, Mirone Vincenzo, Montorsi Francesco, Salonia Andrea
Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy.
Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples 'Federico II', Naples, Italy.
Andrology. 2024 Mar;12(3):606-612. doi: 10.1111/andr.13506. Epub 2023 Aug 9.
Orgasmic phase disorders in men worsen the burden of erectile dysfunction on sexual satisfaction.
To investigate the prevalence of and predictors of unreported orgasmic phase disorder in a cohort of men looking for their first urological assessment for new-onset erectile dysfunction in a real-life setting.
Data from 1107 heterosexual, sexually active men consecutively assessed for new-onset erectile dysfunction were analysed. Throughout a comprehensive medical and sexual history, all patients were asked to self-report any orgasmic phase disorder and to complete the International Index of Erectile Function and the Beck's Inventory for Depression (depressive symptoms scored as Beck's Inventory for Depression ≥11). Men self-reporting orgasmic phase disorder during the interview were excluded from further analyses. The median value of the International Index of Erectile Function-orgasmic function domain was arbitrarily used to categorise men with (International Index of Erectile Function-orgasmic function ≤5) and without unreported orgasmic phase disorder (International Index of Erectile Function-orgasmic function >5). Circulating hormones were measured in every patient. Descriptive statistics and logistic regression models were used to test the association between clinical variables and unreported orgasmic phase disorder.
Of 1098 patients with non-self-reporting orgasmic phase disorder, 314 (28.6%) had International Index of Erectile Function-orgasmic function ≤5. Patients with erectile dysfunction + unreported orgasmic phase disorder were older (median [interquartile range]: 58 [44-66] years vs. 51 [40-60] years), had higher body mass index [25.8 (23.7-28.1) kg/m vs. 25.2 (23.3-27.4) kg/m ], higher prevalence of type 2 diabetes (36 [11.5%] vs. 45 [5.7%]) and lower International Index of Erectile Function-erectile function scores (6 [2-10] vs. 18 [11-24]) than men with erectile dysfunction-only (all p < 0.05). Patients with erectile dysfunction + unreported orgasmic phase disorder depicted higher rates of severe erectile dysfunction (75.5% vs. 25%) and Beck's Inventory for Depression ≥11 (22.6% vs. 17.9%) (all p < 0.05). In the multivariable logistic regression analysis, older age (odds ratio: 1.02) and lower International Index of Erectile Function-erectile function scores (odds ratio: 0.83) were independently associated with unreported orgasmic phase disorder (all p < 0.05).
Almost one in three men seeking first medical help for erectile dysfunction depicted criteria suggestive of unreported orgasmic phase disorder. Men with unreported orgasmic phase disorder were older and had higher rates of severe erectile dysfunction and concomitant depressive symptoms. These real-life findings outline the clinical relevance of a comprehensive investigation of concomitant sexual dysfunction in men only complaining of erectile dysfunction to more effectively tailor patient management.
男性性高潮期障碍会加重勃起功能障碍对性满意度的负担。
在现实环境中，调查一群因新发勃起功能障碍首次寻求泌尿外科评估的男性中未报告的性高潮期障碍的患病率及预测因素。
分析了1107名连续接受新发勃起功能障碍评估的异性恋、性活跃男性的数据。在全面的医学和性病史询问过程中，所有患者均被要求自我报告任何性高潮期障碍，并完成国际勃起功能指数和贝克抑郁量表（抑郁症状以贝克抑郁量表≥11分计分）。在访谈中自我报告性高潮期障碍的男性被排除在进一步分析之外。国际勃起功能指数-性高潮功能领域的中位数被随意用于将有（国际勃起功能指数-性高潮功能≤5）和无未报告性高潮期障碍（国际勃起功能指数-性高潮功能>5）的男性进行分类。对每位患者测量循环激素水平。使用描述性统计和逻辑回归模型来检验临床变量与未报告性高潮期障碍之间的关联。
在1098名未自我报告性高潮期障碍的患者中，314名（28.6%）国际勃起功能指数-性高潮功能≤5。勃起功能障碍合并未报告性高潮期障碍的患者年龄更大（中位数[四分位间距]：58[44 - 66]岁对51[40 - 60]岁），体重指数更高[25.8(23.7 - 28.1)kg/m对25.2(23.3 - 27.4)kg/m]，2型糖尿病患病率更高（36[11.5%]对45[5.7%]），国际勃起功能指数-勃起功能得分更低（6[2 - 10]对18[11 - 24]），均高于仅患有勃起功能障碍的男性（所有p<0.05）。勃起功能障碍合并未报告性高潮期障碍的患者严重勃起功能障碍发生率更高（75.5%对25%），贝克抑郁量表≥11分的比例更高（22.6%对17.9%）（所有p<0.05）。在多变量逻辑回归分析中，年龄较大（比值比：1.02）和国际勃起功能指数-勃起功能得分较低（比值比：0.83）与未报告性高潮期障碍独立相关（所有p<0.05）。
在因勃起功能障碍首次寻求医疗帮助的男性中，近三分之一表现出提示未报告性高潮期障碍的标准。患有未报告性高潮期障碍的男性年龄更大，严重勃起功能障碍和伴随抑郁症状的发生率更高。这些现实生活中的发现凸显了对仅主诉勃起功能障碍的男性进行伴随性功能障碍全面调查的临床相关性，以便更有效地制定患者管理方案。
