Studies show that male infertility is related to an increased prevalence of sexual dysfunction, affecting areas such as erectile function, premature ejaculation, orgasm and sexual desire. Globally, 20-30% of adult males have at least one type of sexual dysfunction, with rising prevalence as age increases.
Erectile Dysfunction
Male sexual dysfunction in the condition of infertility is presented with erectile dysfunction (ED). ED is found in 18% to 89% of men experiencing infertility. ED increases with age, rising from 5% to 17% for males aged 40-49. The number of males having ED is expected to reach 322 million in 2025 around the world.
ED might be an indicator of serious health conditions. Males with ED, despite no prior history of cardiovascular disease, face a 45% higher risk of developing a cardiovascular condition within 5 years compared with males without ED. ED is also linked to some other risk factors or conditions such as smoking, depression, hypertension, diabetes and heart disease.
The severity level of ED can be assessed by a detailed history or a recognized questionnaire such as the International Index of Erectile Function (IIEF). One key component to evaluate ED is having a complete history focused on risk factors for cardiovascular disease.
The foundation for ED treatment is ensuring patients believe that the majority can ultimately be solved. A change in Lifestyle which includes a healthy diet, exercise and weight control may help with ED. A combination of improved lifestyle, medications and follow-up with a care physician is the key to starting a care pathway.
Ejaculatory Dysfunction
Aspermia is a medical condition in which males can not ejaculate semen during orgasm. Males undergoing surgeries for testicular cancer may lose emission. Therefore, it is recommended that they consider using a sperm bank prior to surgery if they have a future fertility plan. Additionally, men who have an ejaculatory duct obstruction may experience little to no seminal fluid emission during ejaculation.
Other reasons for not being able to ejaculate semen can include spinal cord injuries, surgery to remove the prostate (radical prostatectomy), pelvic injuries, diabetes, multiple sclerosis, and Parkinson's disease. For patients who cannot ejaculate, testicular sperm extraction might be an option to collect sperm directly from the testicles.
Psychological Stress and Treatment
Infertility together with sexual dysfunction also causes psychological issues such as depression and anxiety. Infertility affects the couple’s relationship negatively and this causes sexual dissatisfaction. Healthy men at the fertility age who are suffering from fertility pressure may also experience sexual dysfunction.
Psychotherapy monitoring can be used to reduce sexual dysfunction and therefore improve the quality of life. Counseling of sexual dysfunction and proposed treatment can help couples enhance their sexual and emotional relations and meanwhile increase the success of the treatment.
Psychological factors, including stress and anxiety, can contribute to diminished libido, often overlapping with hormonal imbalances. A validated questionnaire can help assess the impact of these psychological and hormonal factors. While treatment for testosterone deficiency in erectile dysfunction may have limitations, hormonal therapy can still be a supportive option in appropriate cases.
Conclusion
Male infertility and sexual dysfunction are deeply interconnected, affecting not only reproductive health but also overall well-being and quality of life. Erectile dysfunction, ejaculatory disorders, and psychological stress can significantly impact a man's confidence, relationships, and mental health.
Recognizing the underlying causes, whether physiological, psychological, or lifestyle-related is essential for effective diagnosis and treatment. A holistic approach that includes lifestyle modifications, medical interventions, and psychological support can help manage these conditions and improve both sexual function and fertility outcomes.
References
1.ASRM. 2023. Diagnostic Evaluation of Sexual Dysfunction in the Male Partner in the Setting of Infertility: A Committee opinion (2023). www.asrm.org/practice-guidance/practice-committee-documents/diagnostic-evaluation-of-sexual-dysfunction-in-the-male-partner-in-the-setting-of-infertility-a-committee-opinion-2018/
2 Francesco Lotti, Mario Maggi. 2018. Sexual Dysfunction and Male Infertility. https://pubmed.ncbi.nlm.nih.gov/29532805/
3 Yang Liu, Yuning Wang et al. 2022. Sexual Dysfunction in Infertile Men: A Systematic Review and Meta-Analysis. https://pmc.ncbi.nlm.nih.gov/articles/PMC9386642/
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