title: Autoeroticism, mental health, and organic disturbances in patients with erectile dysfunction.
abstract: BACKGROUND
  Masturbation is a common, but often neglected, male sexual behavior.
  
  
  OBJECTIVE
  To investigate the psychobiological correlates of self-reported masturbation in the last 3 months.
  
  
  METHODS
  A consecutive series of 2,786 heterosexual male patients (mean age 48.4 +/- 13.2) consulting an outpatient clinic for erectile dysfunction (ED) was studied.
  
  
  METHODS
  Several hormonal, biochemical and instrumental parameters (penile Doppler ultrasound [PDU]) were investigated. Patients were interviewed, prior to the beginning of any treatment, with Structured Interview on Erectile Dysfunction (SIEDY) and ANDROTEST structured interviews. They also completed the Middlesex Hospital Questionnaire, a brief self-reported questionnaire for the screening of the symptoms of mental disorders in a nonpsychiatric setting.
  
  
  RESULTS
  Among the patients studied, 1,781 (61.9%) reported they had masturbated at least once per month in the preceding 3 months. The frequency of masturbation was inversely related to age (r = -0.329; P < 0.0001) and directly associated with education level (adj r = 0.052, P < 0.05 after adjustment for age). A feeling of guilt during masturbation was reported by 274 (15.4%) patients. After adjusting for age, masturbation was positively associated with testosterone levels, stressful conditions, and both unstable and long-lasting couple relationship. Urogenital problems such as varicocele and prostate abnormalities also increased the chance of masturbation. Reported guiltiness during autoeroticism was associated with psychological disturbances, low prolactin, low testosterone, and increased relational problems. An erection not normal during masturbation was declared by 1,361 (76.4%) patients and associated with a prevalent organic component of ED, because of lower peak systolic velocity PDU and higher SIEDY Scale 1 scores.
  
  
  CONCLUSIONS
  This study indicates that masturbation is a relatively frequent behavior in male subjects with ED. Inquiring about this sexual behavior is an important issue for understanding overall patients' sexual attitudes and behavior.
authors.affiliation: Andrology Unit, Department of Clinical Physiopathology, University of Florence, Florence Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Corona
authors.forename: Valdo
authors.initials: V
authors.lastname: Ricca
authors.forename: Valentina
authors.initials: V
authors.lastname: Boddi
authors.forename: Elisa
authors.initials: E
authors.lastname: Bandini
authors.forename: Francesco
authors.initials: F
authors.lastname: Lotti
authors.forename: Alessandra D
authors.initials: AD
authors.lastname: Fisher
authors.forename: Alessandra
authors.initials: A
authors.lastname: Sforza
authors.forename: Gianni
authors.initials: G
authors.lastname: Forti
authors.forename: Edoardo
authors.initials: E
authors.lastname: Mannucci
authors.forename: Mario
authors.initials: M
authors.lastname: Maggi
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000367:Age Factors; D000368:Aged; D015897:Comorbidity; D004522:Educational Status; D004542:Ejaculation; D007172:Erectile Dysfunction / Q000097:blood / Q000453:epidemiology / Q000523:psychology*; D054541:Family Conflict / Q000523:psychology; D006167:Guilt; D006801:Humans; D008297:Male; D008418:Masturbation / Q000097:blood / Q000453:epidemiology / Q000523:psychology*; D001523:Mental Disorders / Q000097:blood / Q000453:epidemiology / Q000523:psychology*; D008875:Middle Aged; D010410:Penile Erection / Q000523:psychology; D011388:Prolactin / Q000097:blood; D012725:Sexual Behavior; D012735:Sexual Dysfunction, Physiological / Q000097:blood / Q000453:epidemiology / Q000523:psychology; D013315:Stress, Psychological / Q000150:complications; D013739:Testosterone / Q000097:blood
chemical_list: D013739:Testosterone; D011388:Prolactin