Impairment of couple relationship in male patients with sexual dysfunction is associated with overt hypogonadism.

Introduction: Couple sexual dysfunction is a common, but not often studied, problem.

Aim: We have previously reported that disturbance in the relational domain, as measured by SIEDY Scale 2 (exploring, as reported by the patient, menopausal symptoms, partner's medical illness interfering with sexual activity, and reduced partner desire and climax), is associated with different sexual dysfunctions, such as hypoactive sexual desire, erectile dysfunction (ED), delayed ejaculation, and psychological disturbances. As all of these symptoms could be associated with hypogonadism, we have investigated the possible relationship between androgen levels and an unhappy couple relationship.

Methods: A consecutive series of 2,302 (mean age 53.2 +/- 12.5 years) male patients with ED was studied.

Main Outcome Measures: Several hormonal parameters were investigated, along with penile Doppler ultrasound (PDU) and the Structured Interview on Erectile Dysfunction (SIEDY) and ANDROTEST. Higher ANDROTEST score identifies a higher prevalence of hypogonadism-related symptoms and signs.

Results: SIEDY Scale 2 score was associated with decreased intercourse frequency, severe ED, lower dynamic peak systolic velocity at PDU, and clinical (ANDROTEST score) and biochemical (low total and free testosterone) hypogonadism, even after adjusting for cofounders, such as patient's and partner's age, waist circumference, and smoking habit. Alternative models were explored using these different factors as dependent variables in order to evaluate the specific relationship among the parameters studied. Multiple logistic regression analysis indicated that low penile blood flow and decreased intercourse frequency are bi-directionally coupled to poor relational domain, while the association with hypogonadism was mediated through sexual hypoactivity or inertia.

Conclusions: Our data suggest that, in subjects consulting for sexual dysfunction, a deterioration of the couple's relationship is associated with impairment in sexual activities, which, in turn, can lead to a mild hypogonadism. Any speculation on pathogenetic relationships should be confirmed through prospective studies or intervention trials.