title: Relationship between sexual dysfunction and psychological burden in men with infertility: a large observational study in China.
abstract: BACKGROUND
  Although infertility is known to be associated with psychological and sexual problems, the relationship between these two aspects in infertile men has not been well investigated.
  
  
  OBJECTIVE
  To investigate the incidence of sexual dysfunction and psychological burden, and their possible associations in infertile men.
  
  
  METHODS
  From June 2009 to June 2012, a total of 1,468 infertile men and 942 fertile men were evaluated. Premature ejaculation (PE) and erectile dysfunction (ED) were measured by the PE diagnostic tool (PEDT), the intravaginal ejaculatory latency time (IELT) and the international index of erectile function (IIEF)-5. Anxiety and depression, which reflect the degree of psychological burden, were measured by the self-rating anxiety scale (SAS) and self-rating depression scale (SDS), respectively.
  
  
  METHODS
  PE and ED were measured by the PEDT, IELT, and IIEF-5. Anxiety and depression were measured by the SAS and SDS, respectively.
  
  
  RESULTS
  The incidences of PE and ED in the infertile group were significantly higher than those in the fertile group (PE: 19.01% vs.10.93%, P < 0.001; ED: 18.05% vs. 8.28%, P < 0.001). In addition, anxiety and depression were more prevalent in infertile than fertile men (Anxiety: 38.01% vs. 26.65%, P < 0.001; Depression: 15.74% vs. 10.08%, P < 0.001). Furthermore, after adjusting for age in the infertile group, the PEDT score was positively associated with anxiety (adjusted r = 0.57; P < 0.001) and depression (adjusted r = 0.54; P < 0.001). Moreover, the IELT were negatively associated with anxiety (adjusted r = -0.40; P < 0.001) and depression (adjusted r = -0.52; P < 0.001). Similar negative relationships were also observed between the IIEF-5 score and anxiety (adjusted r = -0.49; P < 0.001) or depression (adjusted r = -0.50; P < 0.001).
  
  
  CONCLUSIONS
  This is the first study to systematically evaluate the incidence of sexual dysfunction and psychological burden, and their possible associations in infertile men in China. Further in-depth studies are needed to confirm and extend these results.
authors.affiliation: Department of Urology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.
authors.forename: Jingjing
authors.initials: J
authors.lastname: Gao
authors.forename: Xiansheng
authors.initials: X
authors.lastname: Zhang
authors.forename: Puyu
authors.initials: P
authors.lastname: Su
authors.forename: Jishuang
authors.initials: J
authors.lastname: Liu
authors.forename: Kai
authors.initials: K
authors.lastname: Shi
authors.forename: Zongyao
authors.initials: Z
authors.lastname: Hao
authors.forename: Jun
authors.initials: J
authors.lastname: Zhou
authors.forename: Chaozhao
authors.initials: C
authors.lastname: Liang
mesh_terms: D000328:Adult; D001007:Anxiety; D002681:China; D003863:Depression / Q000150:complications* / Q000523:psychology; D007172:Erectile Dysfunction / Q000150:complications* / Q000523:psychology; D006801:Humans; D007248:Infertility, Male / Q000150:complications* / Q000523:psychology; D008297:Male; D008875:Middle Aged; D061686:Premature Ejaculation / Q000150:complications* / Q000523:psychology; D057566:Self Report; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Association; Infertility; Prevalence; Psychological Distress; Sexual Dysfunction