Clinical correlates of erectile dysfunction and premature ejaculation in men with couple infertility

Abstract

Introduction: The frequency and the clinical characteristics of erectile dysfunction (ED) and premature ejaculation (PE) in infertile men have been poorly investigated.

Aim: To assess the prevalence of ED and PE and their clinical correlates in men seeking medical care for couple infertility.

Methods: A consecutive series of 244 men (mean age 35.2±7.8) with couple infertility was systematically evaluated. Erectile function was investigated with the International Index of Erectile Function-15 erectile function domain (IIEF-15-EFD) whereas ejaculatory status with the PE diagnostic tool (PEDT).

Main outcome measures: All patients underwent psychological (Middlesex Hospital Questionnaire [MHQ]), prostatitis symptoms (National Institutes of Health-chronic prostatitis symptom index [NIH-CPSI]); hormonal, seminal, and interleukin 8 (sIL-8; a surrogate marker of prostatitis) evaluation; along with scrotal and transrectal color Doppler ultrasound (CDU) assessment.

Results: ED was found in 43 (17.8%) and PE in 38 (15.6%) subjects. After adjusting for age, IIEF-15-EFD score was negatively associated with depressive symptoms (MHQ-D score), somatization (MHQ-S score), NIH-CPSI total, and quality of life subdomain score. In a logistic multivariate model, among all these variables, only depression was significantly associated with ED (adjusted odds ratio [OR]=1.19 [1.02-1.39]; P<0.05). PEDT score was positively associated with prostatitis symptoms and signs, such as sIL-8 and prostate CDU abnormalities (including arterial prostatic peak systolic velocity, APPSV), phobic anxiety (MHQ-P score), and calculated free testosterone (cFT). The association between PE and NIH-CPSI score or APPSV was confirmed even after adjustment for age, MHQ-P score and cFT (adjusted OR=1.11 [1.05-1.17]; P<0.0001 and 1.22 [1.03-1.44]; P=0.02, for NIH-CPSI score and APPSV, respectively).

Conclusions: ED and PE are reported by one in six infertile patients. ED is mainly associated with depressive symptoms, while PEDT score is positively associated with prostatitis symptoms and signs, phobic anxiety, and cFT.