Hot topics of concern for married men: the correlation between male sexual function and vasectomy

Hot topics of concern for married men: the correlation between male sexual function and vasectomy | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Help Center Sign In Submit a Preprint Cite Share Download PDF Article Hot topics of concern for married men: the correlation between male sexual function and vasectomy Xujun Yu, Diang Chen, Meijing Wang, Xiucheng Lan, Chunyan Fang, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3836273/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract A considerable number of male patients express apprehension regarding the potential correlation between vasectomy and sexual functionality, and worrying about affecting the couple's quality of sexual life and causing anxiety and depression. We investigated 306 male patients who sought vasectomy surgery between March 2016 and February 2022 at the Reproductive Women and Children's Hospital affiliated with Chengdu University of Traditional Chinese Medicine. We assessed patients' postoperative erectile status, ejaculation status, and depression and anxiety mainly by means of rating scales, including International Index of Erectile Function-5 (IIEF-5), the Chinese Index of Premature Ejaculation (CIPE), Zungs Self-Rating Depression Scale (SDS), and Self-Rating Anxiety Scale (SAS). Descriptive statistics (t-test, analysis of variance, rank sum test) detail the effect of vasectomy on IIEF-5, CIPE, SDS, SAS in men of different age groups.The results of age analysis showed that IIEF-5 and CIPE scores improved before and after ligation in different age groups (P < 0.05), with IIEF-5 scores improving the most in the age range of 30–39 years (205, 66.34%) (P = 0.00);Vasectomy does not affect male sexual satisfaction or erections, increases male patients' sexual confidence and desire, and does not cause or increase anxiety or depressive symptoms in men. Health sciences/Diseases/Urogenital diseases/Urinary incontinence Health sciences/Health care/Quality of life sexual function vasectomy anxiety and depression scores 1. Introduction Vasectomy is an effective, reversible, simple and safe method of male sterilization and is one of the more widely used methods of long-lasting male sterilization. It is widely accepted among adult males in both developed and developing countries [ 1 – 2 ]. The number of adult males undergoing vasectomy in the United States and Germany is increasing every year [ 3 – 4 ]. Nearly 43 million people worldwide have undergone vasectomy [ 5 ]. The regions with the most prevalent rates of vasectomy utilization at present are Oceania, North America, certain areas of Asia, and Western Europe, with notable concentrations observed in Bhutan, Canada, New Zealand, and the United Kingdom., with current use rates of 14%, 15%, 19% and 20%, respectively [ 6 ]. Currently, the most prevalent surgical approaches employed in vasectomy procedures are incision-based vasectomy and no-scalpel vasectomy (NSV). The World Health Organization (WHO)recommends NSV [ 7 ]. Vasectomy is a surgical procedure with short-term and long-term complications. Short-term complications include haematoma formation, infection, sterilization failure, etc. Symptoms of short-term postoperative pain (nodal, scrotal, ejaculatory pains) and chronic pain [ 8 ]. Long-term safety concerns are mainly related to cardiovascular disease, impact of testicular or prostate cancer development, and long-term postoperative sexual function effects [ 9 – 10 ]. There is a concern among many male patients that vasectomy will adversely affect the couple's sexual life, particularly during the postoperative period and will bring anxiety and depression. In this study we demonstrate the effect of vasectomy on male sexual function and mood by investigating the changes in sexual function and mood before and after surgery in male patients who underwent vasectomy. 2. Materials and Methods 2.1. Study population This study was based on 306 male patients who sought vasectomy surgery at the ༲eproductive ༆ Women-Children Hospital of Chengdu University of Traditional Chinese Medicine between March 2016 and February 2022.The procedure was performed using no-scalpel vasectomy (NSV) with direct vision clamp penetration. All the patients were consistently and homogeneously evaluated, including a detailed health and sexual history and physical examination. We assessed patients' postoperative erectile status, ejaculatory status, and depression and anxiety before and at the third month after surgery, mainly using rating scales, including International Index of Erectile Function-5 (IIEF-5), the Chinese Index of Premature Ejaculation (CIPE), Zungs Self-Rating Depression Scale (SDS), and Self-Rating Anxiety Scale (SAS). Due to the COVID-19 pandemic, telehealth consultations have been offered since March 2020, including the use of mobile phones or web-based communication software. 2.2. Statistical analysis The distribution of the data was performed using the Kolmogorov-Smirnov test. Patients’ characteristics are presented as median (interquartile range [IQR]), and IIEF-5, CIPE, SDS, and SAS were expressed as mean ± standard deviation. Descriptive statistics (t-test, ANOVA, rank sum test) detailed the effect of vasectomy on men of different age groups on IIEF-5, CIPE, SDS, and SAS. Spearman's correlation analysis was used to assess the correlation between age, fertility, frequency of sex, and level of years of marriage and changes in IIEF-5, CIPE, SDS, and SAS values, respectively. Statistical tests were performed using SPSS statistical software version 22.0. All tests were two-sided and the significance level was set at 0.05 2.3. Ethics statement In accordance with the Helsinki Declaration, data collection was conducted. Consent was obtained from the patients for all questions asked and they agreed to provide their anonymised information for future research. 3. Results 3.1. Age, fertility, frequency of sexual intercourse, years of marriage and IIEF-5, CPSI, SDS, SAS score classification This was a study of 306 vasectomised patients with a mean age of 34 years, age range of 22-53 years and an average of 2 children ( Table 1 ). The grading according to the degree of scoring was as follows: IIEF-5 score: normal (≥22), mild (12-21), moderate (8-11), and severe (5-7); CIPE score: normal (36-50), critical (34-36), and premature ejaculation (10-34); and SDS score (sum of scores of all the items × 1.25): normal (<53), mild depression (53-62 points), moderate depression (63-72 points), severe depression (≥73 points); SAS anxiety scale (all items scores summed × 1.25): normal (<50 points), mild anxiety (50-59 points), moderate anxiety (60-69 points), severe anxiety (≥70 points). According to the rules of the scale, we counted the number of patients with abnormal IIEF-5, CPSI, SDS and SAS before and after vasectomy. Among them, 66 patients with mild IIEF-5 scores before surgery and 34 patients after surgery; 1 patient with mild SDS scores before surgery and 0 patients after surgery; 3 patients with mild SAS scores before surgery and 2 patients after surgery, and no moderate and severe patients were found before and after surgery for all scores ( Table 2 ). 3.2. Correlation of IIEF-5, CIPE, SDS, and SAS scores with age, fertility, frequency of sexual intercourse, and years of marriage In order to understand the correlation between IIEF-5, CIPE, SDS, and SAS scores and age, fertility status, frequency of sexual intercourse, and years of marriage, we analysed the difference in scores before and after the surgery in relation to age, fertility status, frequency of sexual intercourse, and years of marriage, and found that there was a correlation between fertility status and SAS (P < 0.05) ( Table 3 ). 3.3. Analysis of the comparison of IIEF-5, CIPE, SDS and SAS scores before and after vasectomy in patients of different age groups. In our study, we compared the IIEF-5, CIPE, SDS, and SAS scores of patients before and after vasectomy and found that IIEF-5 and CIPE improved after surgery (P<0.05) ( Table 4 ). In addition, we conducted a stratified age study into 4 age ranges (20-29 years, 30-39 years, 40-49 years, and 50-60 years). The results showed that IIEF-5 and CIPE scores improved before and after ligation in different age groups (P0.05) ( Table 5 ). 4. Discussion Because of its simplicity, low invasiveness, effectiveness, and relatively low complications, vasectomies have become the most convenient and effective method of contraception for men. For some men considering or who have recently had a vasectomy, the uncertainty of the procedure's effect on sexual function and the anxiety caused by this issue are common problems. Fortunately, most studies have shown that vasectomy has no effect on sexual function, and in some men it may even have a positive effect. 4.1. Effects of vasectomy on sex life and sexual function In the 1980s, some scholars suggested that vasectomy was beneficial to the improvement of men's sexual intercourse status as well as harmony between couples, and increased men's libido and the frequency of sexual intercourse between couples to a certain extent [ 11 ]. The results of a questionnaire survey (IIEF) and FSFI (Female Sexual Function Index)) of 294 pairs of vasectomised men and their partners showed that vasectomy had no negative effects on the The results of the International Erectile Function Index (IEFI) and the Female Sexual Function Index (FSFI) showed that vasectomy had no negative impact on sexual satisfaction in affected couples, and that vasectomised men had significantly higher erectile function, orgasm, libido, and satisfaction with sexual intercourse than did healthy controls [ 12 ]. Smith A et al. demonstrated in a large-scale population-based study of 3,390 Australian men that vasectomy was not associated with any specific sexual problems and that there were significant differences in the number of men who did and did not undergo vasectomy. vasectomy were associated with a significant proportion of men who were sexually satisfied (33.7 per cent and 33.0 per cent, respectively) [ 13 ]. A prospective study evaluating the effect of vasectomy on the sexual life and satisfaction of couples in 76 couples showed a positive effect of vasectomy on the sexual satisfaction of couples. Men showed significant improvement in erectile function, orgasmic function and sexual satisfaction; women showed significant improvement in sexual arousal, satisfaction and orgasm as well as lubrication and libido [ 14 ]. Also Bertero E et al. conducted a prospective study using the IIEF-5 score in 64 men undergoing vasectomy and found a mild improvement in IIEF score after vasectomy (65.64 vs. 64.06, p < 0.001) [ 15 ]. Several studies have also confirmed that most men's sexual function does not change after vasectomy and that men feel more secure and confident during intercourse after the procedure [ 16 – 17 ]. The study from Guo also noted that vasectomy increased the average number of monthly sexual encounters for men, and a key factor may be that women's anxiety about unwanted pregnancies was reduced, women's libido improved, and they were more willing to co-operate with men during sex [ 18 ]. In the present study, we explored the reasons for men to undergo vasectomy; the vast majority of couples volunteered to undergo the procedure after having 1–2 children, having no desire to have children, and having some knowledge about vasectomy. Secondly, we conducted a scoring survey on men who had completed 3 months of the procedure. The 3-month period was established because it takes some time for patients to adapt to the procedure and have a regular sex life after the procedure. By using the IIEF-5 score, we found that 66 men were considered to have mild erectile dysfunction before surgery, which was reduced to 34 after surgery. Also, in our study, we compared the IIEF-5 and CIPE scores of the patients before and after vasectomy and found that IIEF-5 and CIPE improved after surgery (p < 0.05) (Table 4 ). This is in accordance with the findings of Engl Tobias and Bertero E [ 12 , 15 ]. In addition, we conducted a stratified study on age, and the highest number of men operated in the 30–39 years range (205 cases), which accounted for 66.34% of the cases; 2 reasons were found by questioning the patients, the first is that most men in this age group have completed their reproductive needs; the second is that, couples are more frequent and needy, and they are willing to pursue a better sexual life experience. Meanwhile, the results of the study found that IIEF-5 and CIPE scores improved after surgery (P < 0.05), with IIEF-5 scores improving most significantly in the age range of 30–39 years old (P = 0.00); the reason for this was analysed, which may be due to the fact that the rate of sexual life evaluation and needs of men at this age are greater than those of men in other age groups. 4.2. effects of vasectomy on anxiety and depression in men Some studies have reported an increased likelihood of depression and anxiety symptoms in men after vasectomy [ 18 – 19 ]. The presence of anxiety and depression may be caused by a number of factors, such as stress and fear, as well as concerns about postoperative complications, including infection, pain, recanalisation, decreased quality of sex, etc., which ultimately lead to the release of neurohormones, epinephrine and norepinephrine, and subsequent contraction of cavernous smooth muscle, which can lead to penile atrophy, and consequently, inability to maintain an erection sufficient to complete sexual intercourse [ 15 ]. The results of our current study suggest that SAS scores after vasectomy correlate with fertility status (P = 0.02), which suggests that vasectomy can alleviate the anxiety of fertile men about their wives causing pregnancy to some extent. In addition, we compared the SDS and SAS scores of patients before and after vasectomy in our study, and found that vasectomy had no significant effect on SDS and SAS scores of men (P > 0.05), which suggests that vasectomy does not lead to or increase the symptoms of anxiety and depression in men. This result is consistent with the results obtained from our previous review [ 21 ]. We speculate that it may be related to the level of awareness and active request for vasectomy surgery and related complications among male patients. 5. Conclusions The study confirms that vasectomy is a safe and reliable method of male birth control with few complications, male sexual life satisfaction and erection were not affected, and it can increase the male patient's sexual confidence and libido, and does not cause or increase the male's anxiety and depression symptoms, and it is a male contraceptive method that can be promoted in the clinic. Declarations Data availability The data generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request. Acknowledgments This study was supported by the Sichuan Science and Technology Program (Award Number: 2023NSFSC1802, Recipient: Fang Yang) and Xinglin Scholar Research Premotion Project of Chengdu University of TCM(Award Number: MPRC2023057, Recipient: Fang Yang) Contributions FY and DAC conceptualized the research study. CYF, MJW, and XCL conducted the investigation. FY provided the necessary resources for the study. The original draft of the manuscript was written by FY. The manuscript was reviewed and edited by FY, DAC, DGC, and XJY. The project was supervised by XJY, who also administered the project alongside JJL and LD. Competing interests The authors declare that there is no conflict of interest regarding the publication of this paper. Ethical approval Per the guidelines of our institution, no formal ethical approval or participant consent is necessary if it contains no patient-identifying information. However, we have obtained the patient's consent, and it can be requested from the corresponding author if needed. The methodologies employed in this study involving human participants align with the ethical norms of our institutional and national research committees and adhere to the principles outlined in the 1964 Helsinki declaration, its subsequent amendments, or equivalent ethical standards. References Smith RP, Lipshultz LI, Kovac JR. Vasectomy reversal and other strategies to mitigate postvasectomy pain syndrome. Asian J Androl. 2016;18:338. Munoz X, Mata A, Bassas L, Larriba S. Altered miRNA signature of developing germ-cells in infertile patients relates to the severity of spermatogenic failure and persists in spermatozoa. Sci Rep. 2015;9:17991. Eisenberg ML, Lipshultz LI. Estimating the number of vasectomies performed annually in the United States: data from the National Survey of Family Growth. J Urol. 2010; 184:2068–72. Engelmann UH, Gralla O. Vasectomy. In: Foundations and Clinic of Reproductive Health of Man, 3rd ed. Springer, Berlin Heidelberg New York. 2009;S:584–93. Barone MA, Hutchinson PL, Johnson CH, Hsia J, Wheeler J. Vasectomy in the United States, 2002. J Urol. 2006;176:232–6. World Contraceptive Use 2007. United Nations, Dept. of Economic and Social Affairs, Population Division. New York,2008. Vasectomy. In: World Health Organization Department of Reproductive Health and Research (WHO/RHR) and Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs(CCP), INFO Project. Family Planning: A Global Handbook for Providers. Baltimore and Geneva. CCP and WHO. 2007;183 – 98. Adams Christopher E, Wald Moshe, Risks and complications of vasectomy. Urol. Clin. North Am.2009;36:331–6. Labrecque Michel,Nazerali Hanif,Mondor Myrto et al. Effectiveness and complications associated with 2 vasectomy occlusion techniques. J. Urol. 2002;168:2495–8. Hupertan V, Graziana J P, Schoentgen N, Boulenger De A, Chaumel M, Ferretti L, et al. Recommendations of the Committee of Andrology and Sexual Medicine of the AFU concerning the management of Vasectomy. Prog Urol. 2023;33:223–36. Frances M, Kovacs GT. A comprehensive review of the sequelae of male sterilization. Contraception. 1983;28:455–73. Engl T, Hallmen S, Beecken Wolf-D B, Peter R, Elmar-W G, Stefan V. Impact of vasectomy on the sexual satisfaction of couples: experience from a specialized clinic.Cent European J Urol. 2017;70: 275–9. Smith A, Lyons A, Ferris J, Richters J, Pitts M, Shelley J. Are sexual problems more common in men who have had a vasectomy? A population-based study of Australian men. J Sex Med. 2010;7:736–42. Mohamad Al-Ali B, Shamloul R, Ramsauer J, Bella J A, Scrinzi U, Treu T, et al. The effect of vasectomy on the sexual life of couples. J Sex Med. 2014;11: 2239–42. Bertero E, Hallak J, Gromatzky C, Lucon AM, Arap S. Assessment of sexual function in patients undergoing vasectomy using the international index of erectile function. Int Braz J Urol. 2005;31:452–8. Arratia-Maqueo J A, Cortés-González J R, Garza-Cortés R, Gómez-Guerra L S. Evaluation of male sexual satisfaction after vasectomy. Actas Urol Esp. 2010;34:870–3. Hofmeyr Doreen G, Greeff Abraham P. The influence of a vasectomy on the marital relationship and sexual satisfaction of the married man. J Sex Marital Ther. 2002;28:339–51. Guo DP, Lamberts RW, Eisenberg ML. Relationship between Vasectomy and Sexual Frequency. J Sex Med. 2015;12:1905–10. Luo L, Wu SZ, Zhu C, Fan Q, Liu K, Sun G. Psychological long-term effects of sterilization on anxiety and depression. Contraception. 1996;54:345–57. Shaik S, Rajkumar RP. Post-vasectomy depression: a case report and literature review. Ment Illn. 2014;6:5494. Yang F, Li J J, Dong L, Tan K, Huang X P, Zhang P H, et al. Review of Vasectomy Complications and Safety Concerns. World J Mens Health. 2021;39:406–18. Tables Table 1． General information on age, fertility, frequency of sexual intercourse and years of marriage Age Fertility Frequency of sexual intercourse (times/month) Years of marriage Median (IQR) 34（30,27） 2（1,2） 6（4,8） 6（4,9） Range 22-53 1-4 2-12 0-30 Table 2． Statistics on the number of cases of IIEF-5, CPSI, SDS and SAS before and after vasectomy Mild Moderate Severe Pre-operative Post-operative Pre-operative Post-operative Pre-operative Post-operative IIEF-5（N） 66 34 0 0 0 0 CIPE（N） 0 0 0 0 0 0 SDS（N） 1 0 0 0 0 0 SAS（N） 3 2 0 0 0 0 Table 3． Correlation of age, fertility status, frequency of sexual intercourse, and years of marriage with IIEF-5, CIPE, SDS,SAS Rating Factor Difference Age Fertility Frequency of sexual intercourse (times/month) Years of marriage r p-value r p-value r p-value r p-value IIEF-5 0.107 0.062 -0.093 0.104 0.022 0.701 0.002 0.974 CIPE -0.026 0.653 -0.002 0.974 0.022 0.696 0.033 0.560 SDS 0.045 0.436 0.027 0.636 0.069 0.231 0.005 0.925 SAS 0.07 0.222 0.133 0.02 0.075 0.194 0.093 0.105 Table 4． Comparison of IIEF-5, CIPE, SDS and SAS before and after vasectomy surgery IIEF-5 CIPE SDS SAS Pre-operative 22.00（22.00,24.00） 41.00 （39.00,44.00） 35.00 （30.04,37.50） 33.75 （32.50,43.75） Post-operative 23.00（22.00,24.00） 42.00 （42.00,46.00） 33.75 （30.00,36.25） 33.75 （32.50,36.25） Z -6.262 -11.111 -1.988 -0.135 P 0.000 0.000 0.047 0.893 Table 5 Comparison of IIEF-5, CIPE, SDS and SAS before and after ligation in different age groups Age (years) 20-29 30-39 40-49 50-60 number of examples N（%） 60（19.61%） 205（66.34%） 37（12.09%） 4（1.30%） IIEF-5 Pre-operative 22.58±1.35 22.48±1.38 22.65±1.40 20.75±1.26 Post-operative 23.12±1.18 23.03±1.16 23.14±1.32 22.25±0.96 T -3.257 -5.468 -2.134 -5.196 P 0.002 0.000 0.040 0.014 CIPE Pre-operative 41.18±3.25 41.43±3.17 41.76±4.19 40.25±2.63 Post-operative 43.27±2.82 43.49±2.77 43.84±3.20 42.75±2.36 T -6.016 -12.186 -5.499 -8.660 P 0.000 0.000 0.000 0.003 SDS Pre-operative 35.60±6.48 35.18±6.65 34.02±7.33 35.00±7.56 Post-operative 34.40±6.03 34.09±5.91 33.85±5.56 20.78±22.38 T 0.976 1.901 0.126 1.793 P 0.333 0.059 0.900 1.116 SAS Pre-operative 38.17±7.34 36.57±6.73 35.51±6.42 38.44±6.64 Post-operative 36.94±6.82 36.96±6.91 36.39±6.23 38.75±7.22 T 1.470 -0.682 -0.658 -0.225 P 0.147 0.496 0.515 0.836 Additional Declarations There is NO conflict of interest to disclose. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3836273","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":265729014,"identity":"6f50134a-ec64-45a3-88b6-4eeaa57c5316","order_by":0,"name":"Xujun Yu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAwUlEQVRIiWNgGAWjYBACfmbmww8+GPyX4ydai2R7W5rhjAJmY8kGYrUYnDmjIM3zgTlxwwGirbmRw2DMY8CWuPl48gaGHxXbCOtgnJF74OEcAx7jbWeeFTD2nLlNWAuzRF6CwRsDCdltN3IMmBnbiNDCJpFjIMFjYMC4eQaxWnh4zhhI8hgkKG6QIFaLBDsokA0OGEsA/XKQKL/YHwZF5Z8DcvztyRsf/KggQgsSSDA4QJJ6sBZSdYyCUTAKRsEIAQCLIj96iyhIDQAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0002-5620-6783","institution":"Hospital of Chengdu University of Traditional Chinese Medicine","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Xujun","middleName":"","lastName":"Yu","suffix":""},{"id":265729015,"identity":"4f291c8d-82a8-48ba-8c81-47d8cca0809f","order_by":1,"name":"Diang Chen","email":"","orcid":"","institution":"","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Diang","middleName":"","lastName":"Chen","suffix":""},{"id":265729016,"identity":"c40b2082-813c-4cdb-895f-974d1a2416a3","order_by":2,"name":"Meijing Wang","email":"","orcid":"","institution":"","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Meijing","middleName":"","lastName":"Wang","suffix":""},{"id":265729017,"identity":"d4c0d64a-834f-4fcb-b096-43ac6943223b","order_by":3,"name":"Xiucheng Lan","email":"","orcid":"","institution":"","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Xiucheng","middleName":"","lastName":"Lan","suffix":""},{"id":265729018,"identity":"7498f919-1496-479c-8c72-49ca22a6fec2","order_by":4,"name":"Chunyan Fang","email":"","orcid":"","institution":"","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Chunyan","middleName":"","lastName":"Fang","suffix":""},{"id":265729019,"identity":"ca92d6a0-c283-4e92-be13-1f82f8ee3300","order_by":5,"name":"Junjun Li","email":"","orcid":"","institution":"","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Junjun","middleName":"","lastName":"Li","suffix":""},{"id":265729020,"identity":"80ecbc20-6974-4e90-97d2-f4dd23a83b9c","order_by":6,"name":"Liang Dong","email":"","orcid":"","institution":"","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Liang","middleName":"","lastName":"Dong","suffix":""},{"id":265729021,"identity":"5778dba2-0b18-42b5-a8bf-05d6b2ef0b3e","order_by":7,"name":"Degui Chang","email":"","orcid":"https://orcid.org/0000-0003-1118-6907","institution":"TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Degui","middleName":"","lastName":"Chang","suffix":""},{"id":265729022,"identity":"a69f50c6-1d04-491b-8918-8bc4e2772b83","order_by":8,"name":"Fang Yang","email":"","orcid":"https://orcid.org/0000-0002-3964-1791","institution":"","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Fang","middleName":"","lastName":"Yang","suffix":""}],"badges":[],"createdAt":"2024-01-05 05:10:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3836273/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3836273/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":50361731,"identity":"2110ac3b-cd86-44c2-984f-b83cdf70f746","added_by":"auto","created_at":"2024-01-30 10:23:25","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":273161,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3836273/v1/722a4377-858e-4f25-a50d-b04d3669dbeb.pdf"}],"financialInterests":"There is \u003cb\u003eNO\u003c/b\u003e conflict of interest to disclose.","formattedTitle":"Hot topics of concern for married men: the correlation between male sexual function and vasectomy","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eVasectomy is an effective, reversible, simple and safe method of male sterilization and is one of the more widely used methods of long-lasting male sterilization. It is widely accepted among adult males in both developed and developing countries [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The number of adult males undergoing vasectomy in the United States and Germany is increasing every year [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Nearly 43\u0026nbsp;million people worldwide have undergone vasectomy [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The regions with the most prevalent rates of vasectomy utilization at present are Oceania, North America, certain areas of Asia, and Western Europe, with notable concentrations observed in Bhutan, Canada, New Zealand, and the United Kingdom., with current use rates of 14%, 15%, 19% and 20%, respectively [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Currently, the most prevalent surgical approaches employed in vasectomy procedures are incision-based vasectomy and no-scalpel vasectomy (NSV). The World Health Organization (WHO)recommends NSV [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eVasectomy is a surgical procedure with short-term and long-term complications. Short-term complications include haematoma formation, infection, sterilization failure, etc. Symptoms of short-term postoperative pain (nodal, scrotal, ejaculatory pains) and chronic pain [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Long-term safety concerns are mainly related to cardiovascular disease, impact of testicular or prostate cancer development, and long-term postoperative sexual function effects [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. There is a concern among many male patients that vasectomy will adversely affect the couple's sexual life, particularly during the postoperative period and will bring anxiety and depression. In this study we demonstrate the effect of vasectomy on male sexual function and mood by investigating the changes in sexual function and mood before and after surgery in male patients who underwent vasectomy.\u003c/p\u003e"},{"header":"2. Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1. Study population\u003c/h2\u003e \u003cp\u003eThis study was based on 306 male patients who sought vasectomy surgery at the ༲eproductive ༆ Women-Children Hospital of Chengdu University of Traditional Chinese Medicine between March 2016 and February 2022.The procedure was performed using no-scalpel vasectomy (NSV) with direct vision clamp penetration. All the patients were consistently and homogeneously evaluated, including a detailed health and sexual history and physical examination. We assessed patients' postoperative erectile status, ejaculatory status, and depression and anxiety before and at the third month after surgery, mainly using rating scales, including International Index of Erectile Function-5 (IIEF-5), the Chinese Index of Premature Ejaculation (CIPE), Zungs Self-Rating Depression Scale (SDS), and Self-Rating Anxiety Scale (SAS). Due to the COVID-19 pandemic, telehealth consultations have been offered since March 2020, including the use of mobile phones or web-based communication software.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2. Statistical analysis\u003c/h2\u003e \u003cp\u003eThe distribution of the data was performed using the Kolmogorov-Smirnov test. Patients\u0026rsquo; characteristics are presented as median (interquartile range [IQR]), and IIEF-5, CIPE, SDS, and SAS were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation. Descriptive statistics (t-test, ANOVA, rank sum test) detailed the effect of vasectomy on men of different age groups on IIEF-5, CIPE, SDS, and SAS. Spearman's correlation analysis was used to assess the correlation between age, fertility, frequency of sex, and level of years of marriage and changes in IIEF-5, CIPE, SDS, and SAS values, respectively. Statistical tests were performed using SPSS statistical software version 22.0. All tests were two-sided and the significance level was set at 0.05\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3. Ethics statement\u003c/h2\u003e \u003cp\u003e In accordance with the Helsinki Declaration, data collection was conducted. Consent was obtained from the patients for all questions asked and they agreed to provide their anonymised information for future research.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cp\u003e3.1. Age, fertility, frequency of sexual intercourse, years of marriage and IIEF-5, CPSI, SDS, SAS score classification\u003c/p\u003e\n\u003cp\u003eThis was a study of 306 vasectomised patients with a mean age of 34 years, age range of 22-53 years and an average of 2 children (\u003cstrong\u003eTable 1\u003c/strong\u003e). The grading according to the degree of scoring was as follows: IIEF-5 score: normal (\u0026ge;22), mild (12-21), moderate (8-11), and severe (5-7); CIPE score: normal (36-50), critical (34-36), and premature ejaculation (10-34); and SDS score (sum of scores of all the items \u0026times; 1.25): normal (\u0026lt;53), mild depression (53-62 points), moderate depression (63-72 points), severe depression (\u0026ge;73 points); SAS anxiety scale (all items scores summed \u0026times; 1.25): normal (\u0026lt;50 points), mild anxiety (50-59 points), moderate anxiety (60-69 points), severe anxiety (\u0026ge;70 points).\u003c/p\u003e\n\u003cp\u003eAccording to the rules of the scale, we counted the number of patients with abnormal IIEF-5, CPSI, SDS and SAS before and after vasectomy. Among them, 66 patients with mild IIEF-5 scores before surgery and 34 patients after surgery; 1 patient with mild SDS scores before surgery and 0 patients after surgery; 3 patients with mild SAS scores before surgery and 2 patients after surgery, and no moderate and severe patients were found before and after surgery for all scores (\u003cstrong\u003eTable 2\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003e3.2. Correlation of IIEF-5, CIPE, SDS, and SAS scores with age, fertility, frequency of sexual intercourse, and years of marriage\u003c/p\u003e\n\u003cp\u003eIn order to understand the correlation between IIEF-5, CIPE, SDS, and SAS scores and age, fertility status, frequency of sexual intercourse, and years of marriage, we analysed the difference in scores before and after the surgery in relation to age, fertility status, frequency of sexual intercourse, and years of marriage, and found that there was a correlation between fertility status and SAS (P \u0026lt; 0.05) (\u003cstrong\u003eTable 3\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003e3.3. Analysis of the comparison of IIEF-5, CIPE, SDS and SAS scores before and after vasectomy in patients of different age groups.\u003c/p\u003e\n\u003cp\u003eIn our study, we compared the IIEF-5, CIPE, SDS, and SAS scores of patients before and after vasectomy and found that IIEF-5 and CIPE improved after surgery (P\u0026lt;0.05) (\u003cstrong\u003eTable 4\u003c/strong\u003e). In addition, we conducted a stratified age study into 4 age ranges (20-29 years, 30-39 years, 40-49 years, and 50-60 years). The results showed that IIEF-5 and CIPE scores improved before and after ligation in different age groups (P\u0026lt;0.05), with IIEF-5 scores improving most significantly in the age range of 30-39 years (205, 66.34%) (P=0.00); while there was no significant effect on SDS and SAS scores (P\u0026gt;0.05) (\u003cstrong\u003eTable 5\u003c/strong\u003e).\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eBecause of its simplicity, low invasiveness, effectiveness, and relatively low complications, vasectomies have become the most convenient and effective method of contraception for men. For some men considering or who have recently had a vasectomy, the uncertainty of the procedure's effect on sexual function and the anxiety caused by this issue are common problems. Fortunately, most studies have shown that vasectomy has no effect on sexual function, and in some men it may even have a positive effect.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e4.1. Effects of vasectomy on sex life and sexual function\u003c/h2\u003e \u003cp\u003eIn the 1980s, some scholars suggested that vasectomy was beneficial to the improvement of men's sexual intercourse status as well as harmony between couples, and increased men's libido and the frequency of sexual intercourse between couples to a certain extent [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The results of a questionnaire survey (IIEF) and FSFI (Female Sexual Function Index)) of 294 pairs of vasectomised men and their partners showed that vasectomy had no negative effects on the The results of the International Erectile Function Index (IEFI) and the Female Sexual Function Index (FSFI) showed that vasectomy had no negative impact on sexual satisfaction in affected couples, and that vasectomised men had significantly higher erectile function, orgasm, libido, and satisfaction with sexual intercourse than did healthy controls [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Smith A et al. demonstrated in a large-scale population-based study of 3,390 Australian men that vasectomy was not associated with any specific sexual problems and that there were significant differences in the number of men who did and did not undergo vasectomy. vasectomy were associated with a significant proportion of men who were sexually satisfied (33.7 per cent and 33.0 per cent, respectively) [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. A prospective study evaluating the effect of vasectomy on the sexual life and satisfaction of couples in 76 couples showed a positive effect of vasectomy on the sexual satisfaction of couples. Men showed significant improvement in erectile function, orgasmic function and sexual satisfaction; women showed significant improvement in sexual arousal, satisfaction and orgasm as well as lubrication and libido [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Also Bertero E et al. conducted a prospective study using the IIEF-5 score in 64 men undergoing vasectomy and found a mild improvement in IIEF score after vasectomy (65.64 vs. 64.06, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Several studies have also confirmed that most men's sexual function does not change after vasectomy and that men feel more secure and confident during intercourse after the procedure [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The study from Guo also noted that vasectomy increased the average number of monthly sexual encounters for men, and a key factor may be that women's anxiety about unwanted pregnancies was reduced, women's libido improved, and they were more willing to co-operate with men during sex [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the present study, we explored the reasons for men to undergo vasectomy; the vast majority of couples volunteered to undergo the procedure after having 1\u0026ndash;2 children, having no desire to have children, and having some knowledge about vasectomy. Secondly, we conducted a scoring survey on men who had completed 3 months of the procedure. The 3-month period was established because it takes some time for patients to adapt to the procedure and have a regular sex life after the procedure. By using the IIEF-5 score, we found that 66 men were considered to have mild erectile dysfunction before surgery, which was reduced to 34 after surgery. Also, in our study, we compared the IIEF-5 and CIPE scores of the patients before and after vasectomy and found that IIEF-5 and CIPE improved after surgery (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). This is in accordance with the findings of Engl Tobias and Bertero E [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. In addition, we conducted a stratified study on age, and the highest number of men operated in the 30\u0026ndash;39 years range (205 cases), which accounted for 66.34% of the cases; 2 reasons were found by questioning the patients, the first is that most men in this age group have completed their reproductive needs; the second is that, couples are more frequent and needy, and they are willing to pursue a better sexual life experience. Meanwhile, the results of the study found that IIEF-5 and CIPE scores improved after surgery (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), with IIEF-5 scores improving most significantly in the age range of 30\u0026ndash;39 years old (P\u0026thinsp;=\u0026thinsp;0.00); the reason for this was analysed, which may be due to the fact that the rate of sexual life evaluation and needs of men at this age are greater than those of men in other age groups.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e4.2. effects of vasectomy on anxiety and depression in men\u003c/h2\u003e \u003cp\u003eSome studies have reported an increased likelihood of depression and anxiety symptoms in men after vasectomy [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The presence of anxiety and depression may be caused by a number of factors, such as stress and fear, as well as concerns about postoperative complications, including infection, pain, recanalisation, decreased quality of sex, etc., which ultimately lead to the release of neurohormones, epinephrine and norepinephrine, and subsequent contraction of cavernous smooth muscle, which can lead to penile atrophy, and consequently, inability to maintain an erection sufficient to complete sexual intercourse [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe results of our current study suggest that SAS scores after vasectomy correlate with fertility status (P\u0026thinsp;=\u0026thinsp;0.02), which suggests that vasectomy can alleviate the anxiety of fertile men about their wives causing pregnancy to some extent. In addition, we compared the SDS and SAS scores of patients before and after vasectomy in our study, and found that vasectomy had no significant effect on SDS and SAS scores of men (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05), which suggests that vasectomy does not lead to or increase the symptoms of anxiety and depression in men. This result is consistent with the results obtained from our previous review [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. We speculate that it may be related to the level of awareness and active request for vasectomy surgery and related complications among male patients.\u003c/p\u003e \u003c/div\u003e"},{"header":"5. Conclusions","content":"\u003cp\u003eThe study confirms that vasectomy is a safe and reliable method of male birth control with few complications, male sexual life satisfaction and erection were not affected, and it can increase the male patient's sexual confidence and libido, and does not cause or increase the male's anxiety and depression symptoms, and it is a male contraceptive method that can be promoted in the clinic.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the Sichuan Science and Technology Program (Award Number: 2023NSFSC1802, Recipient: Fang Yang) and Xinglin Scholar Research Premotion Project of Chengdu University of TCM(Award Number: MPRC2023057, Recipient: Fang Yang)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eContributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFY and DAC conceptualized the research study. CYF, MJW, and XCL conducted the investigation. FY provided the necessary resources for the study. The original draft of the manuscript was written by FY. The manuscript was reviewed and edited by FY, DAC, DGC, and XJY. The project was supervised by XJY, who also administered the project alongside JJL and LD.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that there is no conflict of interest regarding the publication of this paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePer the guidelines of our institution, no formal ethical approval or participant consent is necessary if it contains no patient-identifying information. However, we have obtained the patient\u0026apos;s consent, and it can be requested from the corresponding author if needed. The methodologies employed in this study involving human participants align with the ethical norms of our institutional and national research committees and adhere to the principles outlined in the 1964 Helsinki declaration, its subsequent amendments, or equivalent ethical standards.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSmith RP, Lipshultz LI, Kovac JR. Vasectomy reversal and other strategies to mitigate postvasectomy pain syndrome. Asian J Androl. 2016;18:338.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMunoz X, Mata A, Bassas L, Larriba S. Altered miRNA signature of developing germ-cells in infertile patients relates to the severity of spermatogenic failure and persists in spermatozoa. Sci Rep. 2015;9:17991.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEisenberg ML, Lipshultz LI. Estimating the number of vasectomies performed annually in the United States: data from the National Survey of Family Growth. J Urol. 2010; 184:2068\u0026ndash;72.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEngelmann UH, Gralla O. Vasectomy. In: Foundations and Clinic of Reproductive Health of Man, 3rd ed. Springer, Berlin Heidelberg New York. 2009;S:584\u0026ndash;93.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBarone MA, Hutchinson PL, Johnson CH, Hsia J, Wheeler J. Vasectomy in the United States, 2002. J Urol. 2006;176:232\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Contraceptive Use 2007. United Nations, Dept. of Economic and Social Affairs, Population Division. New York,2008.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVasectomy. In: World Health Organization Department of Reproductive Health and Research (WHO/RHR) and Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs(CCP), INFO Project. Family Planning: A Global Handbook for Providers. Baltimore and Geneva. CCP and WHO. 2007;183\u0026thinsp;\u0026ndash;\u0026thinsp;98.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAdams Christopher E, Wald Moshe, Risks and complications of vasectomy. Urol. Clin. North Am.2009;36:331\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLabrecque Michel,Nazerali Hanif,Mondor Myrto et al. Effectiveness and complications associated with 2 vasectomy occlusion techniques. J. Urol. 2002;168:2495\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHupertan V, Graziana J P, Schoentgen N, Boulenger De A, Chaumel M, Ferretti L, et al. Recommendations of the Committee of Andrology and Sexual Medicine of the AFU concerning the management of Vasectomy. Prog Urol. 2023;33:223\u0026ndash;36.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFrances M, Kovacs GT. A comprehensive review of the sequelae of male sterilization. Contraception. 1983;28:455\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEngl T, Hallmen S, Beecken Wolf-D B, Peter R, Elmar-W G, Stefan V. Impact of vasectomy on the sexual satisfaction of couples: experience from a specialized clinic.Cent European J Urol. 2017;70: 275\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSmith A, Lyons A, Ferris J, Richters J, Pitts M, Shelley J. Are sexual problems more common in men who have had a vasectomy? A population-based study of Australian men. J Sex Med. 2010;7:736\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMohamad Al-Ali B, Shamloul R, Ramsauer J, Bella J A, Scrinzi U, Treu T, et al. The effect of vasectomy on the sexual life of couples. J Sex Med. 2014;11: 2239\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBertero E, Hallak J, Gromatzky C, Lucon AM, Arap S. Assessment of sexual function in patients undergoing vasectomy using the international index of erectile function. Int Braz J Urol. 2005;31:452\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArratia-Maqueo J A, Cort\u0026eacute;s-Gonz\u0026aacute;lez J R, Garza-Cort\u0026eacute;s R, G\u0026oacute;mez-Guerra L S. Evaluation of male sexual satisfaction after vasectomy. Actas Urol Esp. 2010;34:870\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHofmeyr Doreen G, Greeff Abraham P. The influence of a vasectomy on the marital relationship and sexual satisfaction of the married man. J Sex Marital Ther. 2002;28:339\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuo DP, Lamberts RW, Eisenberg ML. Relationship between Vasectomy and Sexual Frequency. J Sex Med. 2015;12:1905\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLuo L, Wu SZ, Zhu C, Fan Q, Liu K, Sun G. Psychological long-term effects of sterilization on anxiety and depression. Contraception. 1996;54:345\u0026ndash;57.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShaik S, Rajkumar RP. Post-vasectomy depression: a case report and literature review. Ment Illn. 2014;6:5494.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYang F, Li J J, Dong L, Tan K, Huang X P, Zhang P H, et al. Review of Vasectomy Complications and Safety Concerns. World J Mens Health. 2021;39:406\u0026ndash;18.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1．\u0026nbsp;General information on age, fertility, frequency of sexual intercourse and years of marriage\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"576\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.92361111111111%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.79861111111111%\" valign=\"top\"\u003e\n \u003cp\u003eAge\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\" valign=\"top\"\u003e\n \u003cp\u003eFertility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.29861111111111%\" valign=\"top\"\u003e\n \u003cp\u003eFrequency of sexual intercourse (times/month)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.354166666666668%\" valign=\"top\"\u003e\n \u003cp\u003eYears of marriage\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.92361111111111%\" valign=\"top\"\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.79861111111111%\"\u003e\n \u003cp\u003e34（30,27）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\"\u003e\n \u003cp\u003e2（1,2）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.29861111111111%\"\u003e\n \u003cp\u003e6（4,8）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.354166666666668%\"\u003e\n \u003cp\u003e6（4,9）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.92361111111111%\" valign=\"top\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.79861111111111%\"\u003e\n \u003cp\u003e22-53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\"\u003e\n \u003cp\u003e1-4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.29861111111111%\"\u003e\n \u003cp\u003e2-12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.354166666666668%\"\u003e\n \u003cp\u003e0-30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 2．\u0026nbsp;Statistics on the number of cases of IIEF-5, CPSI, SDS and SAS before and after vasectomy\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.571428571428573%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eMild\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.571428571428573%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.571428571428573%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eSevere\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003ePre-operative\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003ePost-operative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003ePre-operative\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003ePost-operative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003ePre-operative\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003ePost-operative\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003eIIEF-5（N）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003eCIPE（N）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003eSDS（N）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003eSAS（N）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 3．\u0026nbsp;Correlation of age, fertility status, frequency of sexual intercourse, and years of marriage with IIEF-5, CIPE, SDS,SAS\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"553\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.768115942028986%\" rowspan=\"2\"\u003e\n \u003cp\u003eRating Factor Difference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.471014492753625%\" colspan=\"2\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.014492753623188%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eFertility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.73913043478261%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eFrequency of sexual intercourse (times/month)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.007246376811594%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eYears of marriage\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.394957983193278%\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.344537815126051%\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.025210084033613%\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.344537815126051%\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.134453781512605%\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.865546218487395%\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.865546218487395%\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.025210084033613%\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.768115942028986%\"\u003e\n \u003cp\u003eIIEF-5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.68840579710145%\"\u003e\n \u003cp\u003e0.107\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.782608695652174%\"\u003e\n \u003cp\u003e0.062\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.231884057971014%\"\u003e\n \u003cp\u003e-0.093\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.782608695652174%\"\u003e\n \u003cp\u003e0.104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.601449275362318%\"\u003e\n \u003cp\u003e0.022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.956521739130435%\"\u003e\n \u003cp\u003e0.701\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.956521739130435%\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.231884057971014%\"\u003e\n \u003cp\u003e0.974\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.768115942028986%\"\u003e\n \u003cp\u003eCIPE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.68840579710145%\"\u003e\n \u003cp\u003e-0.026\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.782608695652174%\"\u003e\n \u003cp\u003e0.653\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.231884057971014%\"\u003e\n \u003cp\u003e-0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.782608695652174%\"\u003e\n \u003cp\u003e0.974\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.601449275362318%\"\u003e\n \u003cp\u003e0.022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.956521739130435%\"\u003e\n \u003cp\u003e0.696\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.956521739130435%\"\u003e\n \u003cp\u003e0.033\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.231884057971014%\"\u003e\n \u003cp\u003e0.560\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.768115942028986%\"\u003e\n \u003cp\u003eSDS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.68840579710145%\"\u003e\n \u003cp\u003e0.045\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.782608695652174%\"\u003e\n \u003cp\u003e0.436\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.231884057971014%\"\u003e\n \u003cp\u003e0.027\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.782608695652174%\"\u003e\n \u003cp\u003e0.636\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.601449275362318%\"\u003e\n \u003cp\u003e0.069\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.956521739130435%\"\u003e\n \u003cp\u003e0.231\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.956521739130435%\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.231884057971014%\"\u003e\n \u003cp\u003e0.925\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.768115942028986%\"\u003e\n \u003cp\u003eSAS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.68840579710145%\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.782608695652174%\"\u003e\n \u003cp\u003e0.222\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.231884057971014%\"\u003e\n \u003cp\u003e0.133\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.782608695652174%\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.601449275362318%\"\u003e\n \u003cp\u003e0.075\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.956521739130435%\"\u003e\n \u003cp\u003e0.194\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.956521739130435%\"\u003e\n \u003cp\u003e0.093\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.231884057971014%\"\u003e\n \u003cp\u003e0.105\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 4．\u0026nbsp;Comparison of IIEF-5, CIPE, SDS and SAS before and after vasectomy surgery\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"660\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"8.636363636363637%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"23.03030303030303%\"\u003e\n \u003cp\u003eIIEF-5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.575757575757574%\"\u003e\n \u003cp\u003eCIPE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.87878787878788%\"\u003e\n \u003cp\u003eSDS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.87878787878788%\"\u003e\n \u003cp\u003eSAS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"8.636363636363637%\" valign=\"top\"\u003e\n \u003cp\u003ePre-operative\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.03030303030303%\"\u003e\n \u003cp\u003e22.00（22.00,24.00）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.575757575757574%\"\u003e\n \u003cp\u003e41.00\u003c/p\u003e\n \u003cp\u003e（39.00,44.00）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.87878787878788%\"\u003e\n \u003cp\u003e35.00\u003c/p\u003e\n \u003cp\u003e（30.04,37.50）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.87878787878788%\"\u003e\n \u003cp\u003e33.75\u003c/p\u003e\n \u003cp\u003e（32.50,43.75）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"8.636363636363637%\" valign=\"top\"\u003e\n \u003cp\u003ePost-operative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.03030303030303%\"\u003e\n \u003cp\u003e23.00（22.00,24.00）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.575757575757574%\"\u003e\n \u003cp\u003e42.00\u003c/p\u003e\n \u003cp\u003e（42.00,46.00）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.87878787878788%\"\u003e\n \u003cp\u003e33.75\u003c/p\u003e\n \u003cp\u003e（30.00,36.25）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.87878787878788%\"\u003e\n \u003cp\u003e33.75\u003c/p\u003e\n \u003cp\u003e（32.50,36.25）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"8.636363636363637%\"\u003e\n \u003cp\u003eZ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.03030303030303%\"\u003e\n \u003cp\u003e-6.262\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.575757575757574%\"\u003e\n \u003cp\u003e-11.111\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.87878787878788%\"\u003e\n \u003cp\u003e-1.988\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.87878787878788%\"\u003e\n \u003cp\u003e-0.135\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"8.636363636363637%\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.03030303030303%\"\u003e\n \u003cp\u003e0.000\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.575757575757574%\"\u003e\n \u003cp\u003e0.000\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.87878787878788%\"\u003e\n \u003cp\u003e0.047\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.87878787878788%\"\u003e\n \u003cp\u003e0.893\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5 Comparison of IIEF-5, CIPE, SDS and SAS before and after ligation in different age groups\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"614\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.592833876221498%\" colspan=\"2\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.938110749185668%\"\u003e\n \u003cp\u003e20-29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03257328990228%\"\u003e\n \u003cp\u003e30-39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.172638436482085%\"\u003e\n \u003cp\u003e40-49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.263843648208468%\"\u003e\n \u003cp\u003e50-60\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.592833876221498%\" colspan=\"2\"\u003e\n \u003cp\u003enumber of examples\u003c/p\u003e\n \u003cp\u003eN（%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.938110749185668%\"\u003e\n \u003cp\u003e60（19.61%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03257328990228%\"\u003e\n \u003cp\u003e205（66.34%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.172638436482085%\"\u003e\n \u003cp\u003e37（12.09%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.263843648208468%\"\u003e\n \u003cp\u003e4（1.30%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.843648208469055%\" rowspan=\"4\"\u003e\n \u003cp\u003eIIEF-5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.749185667752442%\"\u003e\n \u003cp\u003ePre-operative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.938110749185668%\"\u003e\n \u003cp\u003e22.58\u0026plusmn;1.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03257328990228%\"\u003e\n \u003cp\u003e22.48\u0026plusmn;1.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.172638436482085%\"\u003e\n \u003cp\u003e22.65\u0026plusmn;1.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.263843648208468%\"\u003e\n \u003cp\u003e20.75\u0026plusmn;1.26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.476370510396976%\"\u003e\n \u003cp\u003ePost-operative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.659735349716446%\"\u003e\n \u003cp\u003e23.12\u0026plusmn;1.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.251417769376182%\"\u003e\n \u003cp\u003e23.03\u0026plusmn;1.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.574669187145556%\"\u003e\n \u003cp\u003e23.14\u0026plusmn;1.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03780718336484%\"\u003e\n \u003cp\u003e22.25\u0026plusmn;0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.476370510396976%\"\u003e\n \u003cp\u003eT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.659735349716446%\"\u003e\n \u003cp\u003e-3.257\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.251417769376182%\"\u003e\n \u003cp\u003e-5.468\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.574669187145556%\"\u003e\n \u003cp\u003e-2.134\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03780718336484%\"\u003e\n \u003cp\u003e-5.196\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.476370510396976%\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.659735349716446%\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.251417769376182%\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.574669187145556%\"\u003e\n \u003cp\u003e0.040\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03780718336484%\"\u003e\n \u003cp\u003e0.014\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.843648208469055%\" rowspan=\"4\"\u003e\n \u003cp\u003eCIPE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.749185667752442%\"\u003e\n \u003cp\u003ePre-operative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.938110749185668%\"\u003e\n \u003cp\u003e41.18\u0026plusmn;3.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03257328990228%\"\u003e\n \u003cp\u003e41.43\u0026plusmn;3.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.172638436482085%\"\u003e\n \u003cp\u003e41.76\u0026plusmn;4.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.263843648208468%\"\u003e\n \u003cp\u003e40.25\u0026plusmn;2.63\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.476370510396976%\"\u003e\n \u003cp\u003ePost-operative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.659735349716446%\"\u003e\n \u003cp\u003e43.27\u0026plusmn;2.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.251417769376182%\"\u003e\n \u003cp\u003e43.49\u0026plusmn;2.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.574669187145556%\"\u003e\n \u003cp\u003e43.84\u0026plusmn;3.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03780718336484%\"\u003e\n \u003cp\u003e42.75\u0026plusmn;2.36\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.476370510396976%\"\u003e\n \u003cp\u003eT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.659735349716446%\"\u003e\n \u003cp\u003e-6.016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.251417769376182%\"\u003e\n \u003cp\u003e-12.186\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.574669187145556%\"\u003e\n \u003cp\u003e-5.499\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03780718336484%\"\u003e\n \u003cp\u003e-8.660\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.476370510396976%\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.659735349716446%\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.251417769376182%\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.574669187145556%\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03780718336484%\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.843648208469055%\" rowspan=\"4\"\u003e\n \u003cp\u003eSDS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.749185667752442%\"\u003e\n \u003cp\u003ePre-operative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.938110749185668%\"\u003e\n \u003cp\u003e35.60\u0026plusmn;6.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03257328990228%\"\u003e\n \u003cp\u003e35.18\u0026plusmn;6.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.172638436482085%\"\u003e\n \u003cp\u003e34.02\u0026plusmn;7.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.263843648208468%\"\u003e\n \u003cp\u003e35.00\u0026plusmn;7.56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.476370510396976%\"\u003e\n \u003cp\u003ePost-operative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.659735349716446%\"\u003e\n \u003cp\u003e34.40\u0026plusmn;6.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.251417769376182%\"\u003e\n \u003cp\u003e34.09\u0026plusmn;5.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.574669187145556%\"\u003e\n \u003cp\u003e33.85\u0026plusmn;5.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03780718336484%\"\u003e\n \u003cp\u003e20.78\u0026plusmn;22.38\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.476370510396976%\"\u003e\n \u003cp\u003eT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.659735349716446%\"\u003e\n \u003cp\u003e0.976\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.251417769376182%\"\u003e\n \u003cp\u003e1.901\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.574669187145556%\"\u003e\n \u003cp\u003e0.126\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03780718336484%\"\u003e\n \u003cp\u003e1.793\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.476370510396976%\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.659735349716446%\"\u003e\n \u003cp\u003e0.333\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.251417769376182%\"\u003e\n \u003cp\u003e0.059\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.574669187145556%\"\u003e\n \u003cp\u003e0.900\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03780718336484%\"\u003e\n \u003cp\u003e1.116\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.843648208469055%\" rowspan=\"4\"\u003e\n \u003cp\u003eSAS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.749185667752442%\"\u003e\n \u003cp\u003ePre-operative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.938110749185668%\"\u003e\n \u003cp\u003e38.17\u0026plusmn;7.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03257328990228%\"\u003e\n \u003cp\u003e36.57\u0026plusmn;6.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.172638436482085%\"\u003e\n \u003cp\u003e35.51\u0026plusmn;6.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.263843648208468%\"\u003e\n \u003cp\u003e38.44\u0026plusmn;6.64\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.476370510396976%\"\u003e\n \u003cp\u003ePost-operative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.659735349716446%\"\u003e\n \u003cp\u003e36.94\u0026plusmn;6.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.251417769376182%\"\u003e\n \u003cp\u003e36.96\u0026plusmn;6.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.574669187145556%\"\u003e\n \u003cp\u003e36.39\u0026plusmn;6.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03780718336484%\"\u003e\n \u003cp\u003e38.75\u0026plusmn;7.22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.476370510396976%\"\u003e\n \u003cp\u003eT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.659735349716446%\"\u003e\n \u003cp\u003e1.470\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.251417769376182%\"\u003e\n \u003cp\u003e-0.682\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.574669187145556%\"\u003e\n \u003cp\u003e-0.658\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03780718336484%\"\u003e\n \u003cp\u003e-0.225\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.476370510396976%\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.659735349716446%\"\u003e\n \u003cp\u003e0.147\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.251417769376182%\"\u003e\n \u003cp\u003e0.496\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.574669187145556%\"\u003e\n \u003cp\u003e0.515\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03780718336484%\"\u003e\n \u003cp\u003e0.836\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"sexual function,vasectomy, anxiety and depression, scores","lastPublishedDoi":"10.21203/rs.3.rs-3836273/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3836273/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eA considerable number of male patients express apprehension regarding the potential correlation between vasectomy and sexual functionality, and worrying about affecting the couple's quality of sexual life and causing anxiety and depression. We investigated 306 male patients who sought vasectomy surgery between March 2016 and February 2022 at the Reproductive Women and Children's Hospital affiliated with Chengdu University of Traditional Chinese Medicine. We assessed patients' postoperative erectile status, ejaculation status, and depression and anxiety mainly by means of rating scales, including International Index of Erectile Function-5 (IIEF-5), the Chinese Index of Premature Ejaculation (CIPE), Zungs Self-Rating Depression Scale (SDS), and Self-Rating Anxiety Scale (SAS). Descriptive statistics (t-test, analysis of variance, rank sum test) detail the effect of vasectomy on IIEF-5, CIPE, SDS, SAS in men of different age groups.The results of age analysis showed that IIEF-5 and CIPE scores improved before and after ligation in different age groups (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), with IIEF-5 scores improving the most in the age range of 30\u0026ndash;39 years (205, 66.34%) (P\u0026thinsp;=\u0026thinsp;0.00);Vasectomy does not affect male sexual satisfaction or erections, increases male patients' sexual confidence and desire, and does not cause or increase anxiety or depressive symptoms in men.\u003c/p\u003e","manuscriptTitle":"Hot topics of concern for married men: the correlation between male sexual function and vasectomy","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-01-09 08:17:27","doi":"10.21203/rs.3.rs-3836273/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a22d8605-d2d8-4fb8-baa3-eb7b37631e86","owner":[],"postedDate":"January 9th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":27994720,"name":"Health sciences/Diseases/Urogenital diseases/Urinary incontinence"},{"id":27994721,"name":"Health sciences/Health care/Quality of life"}],"tags":[],"updatedAt":"2024-01-30T10:15:19+00:00","versionOfRecord":[],"versionCreatedAt":"2024-01-09 08:17:27","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3836273","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3836273","identity":"rs-3836273","version":["v1"]},"buildId":"oE6Zbj460LM0Up2FdVbMZ","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}