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

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 unrecognized low sexual desire/interest (uLSD/I) in a cohort of men with new onset ED. Complete data from 1509 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 LSD/I 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 categorized according to Cappelleri’s criteria. The median value of the IIEF-sexual desire domain (IIEF-SD) was used to dichotomize 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(5-21.8) 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(3.2–6.8) 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. 23.1%), 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.