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Perceived Ejaculate Volume Reduction in Patients With Erectile Dysfunction: Psychobiologic Correlates

GIOVANNI CORONA^*,

MAURO GACCI

ALESSANDRA SFORZA

GIANNI FORTI

From the ^* Sexual Medicine and Andrology Unit, Department of Clinical Physiopathology and the Department of Urology, University of Florence, Florence, Italy; the Endocrinology Unit, Azienda USL di Bologna, Medical Department, Maggiore-Bellaria Hospital, Bologna, Italy; and the Endocrinology Unit, Department of Clinical Physiopathology and the ^|| Diabetes Section Geriatric Unit, Department of Critical Care, University of Florence, Florence, Italy.

Correspondence to: Prof Mario Maggi, Sexual Medicine and Andrology Unit, Department of Clinical Physiopathology, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy (e-mail: m.maggi{at}dfc.unifi.it).

Abstract

The disorders of orgasm/ejaculation encompass a heterogeneous group of dysfunctions including premature ejaculation, delayed ejaculation, and perceived ejaculate volume reduction (PEVR). The aim of this study was to explore specific associations of PEVR in a consecutive series of 3141 patients (mean age, 51.6 ± 13.1 years) seeking consultation for erectile dysfunction (ED). Among these, 71 were excluded because they underwent prostate surgery. Different clinical and biochemical factors were evaluated along with parameters derived from the Structured Interview on Erectile Dysfunction evaluating the contribution of organic, relational, and intrapsychic factors to ED. After adjustment for confounders, PEVR was specifically associated with the use of androgen deprivation therapy as well as with different other medications including α-blockers, serotonergic reuptake inhibitor antidepressants, and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers. A higher prevalence of diabetes mellitus and hypogonadism was observed in patients with PEVR compared with the rest of the sample (23.0% vs 14.1% and 9.1% vs 5.3% respectively; both P < .05). In addition, different sexual parameters such as severe ED (hazard ratio [HR] = 1.25 [1.11–1.41]; P < .0001) and patient's (HR = 1.53 [1.38–1.70]; P < .0001) and partner's (HR = 1.21 [1.07–1.36]; P < .005) hypoactive sexual desire (HSD) were also significantly related to PEVR. Furthermore, PEVR was associated with an impairment of both the relational and intrapsychic components of ED. In a multivariate model, adjusting for age, body mass index, smoking habits, and medications, hypogonadism, diabetes mellitus, severe ED, and patient's and partner's HSD were all independently associated with PEVR. Our results indicate that PEVR is important not only for couple reproductive purposes but also appears to have a distinct role in the couple's sexual performance.

     Key words: Androgen, hormone

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