title: The Role of Somatic Symptoms in Sexual Medicine: Somatization as Important Contextual Factor in Male Sexual Dysfunction.
abstract: An important feature of somatic symptom disorder is the subjective perception of the physical symptoms and its maladaptive interpretation. Considering that psychological distress is often expressed through somatic symptoms, it is possible that they underlie at least a part of the symptoms in subjects complaining of sexual dysfunction. Nevertheless, studies on the impact of somatoform disorders in sexual dysfunction are scanty.
  
  
  
  To define the psychological, relational, and organic correlates of somatic symptoms in a large sample of patients complaining of sexual problems.
  
  
  
  A consecutive series of 2833 men (mean age 50.2 ± 13.5 years) was retrospectively studied.
  
  
  
  Somatic symptoms were assessed using the "somatized anxiety symptoms" subscale of the Middlesex Hospital Questionnaire (MHQ-S). Several clinical, biochemical, psychological, and relational parameters were studied. Patients were interviewed with the previously validated Structured Interview on Erectile Dysfunction (SIEDY), and ANDROTEST (a structured interview for the screening of hypogonadism in patients with sexual dysfunction).
  
  
  
  Among the 2833 patients studied, subjects scoring higher on somatic symptoms were older, more obese, reporting unhealthy lifestyle (current smoking, alcohol consumption), and a lower education (all P < .05). Moreover, they reported a general impairment of their sexuality more often, including erectile problems (spontaneous or sexual-related), low sexual desire, decreased frequency of intercourse, and perceived reduction of ejaculate volume (all P < .005). Interestingly, we observed a significant association between MHQ-S scoring with a reduced testosterone level and hypogonadism symptoms (both P < .05). Finally, we found a significant association between somatic symptoms and both SIEDY Scales 1 (organic domain of ED) and 3 (intrapsychic domain of ED) (both P < .0001).
  
  
  
  The present study demonstrates that the presence of somatic symptoms can represent an important contextual factor in the determination of or in the exacerbation of male sexual dysfunction. High levels of somatic symptoms in subjects with sexual dysfunction can be related to the sexual symptom itself. The consequences of this pattern have great clinical relevance in a sexual medicine setting, considering their severe impact on sexuality.
authors.affiliation: Andrology Unit, Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy.
authors.forename: Egidia
authors.initials: E
authors.lastname: Fanni
authors.affiliation: Psychology, Drug Research and Child Health, Department of Neuroscience, University of Florence, Florence, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Castellini
authors.affiliation: Andrology Unit, Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy; Endocrinology Unit, Medical Department, Azienda Usl Bologna Maggiore-Bellaria Hospital, Bologna, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Corona
authors.affiliation: Andrology Unit, Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Boddi
authors.affiliation: Psychology, Drug Research and Child Health, Department of Neuroscience, University of Florence, Florence, Italy.
authors.forename: Valdo
authors.initials: V
authors.lastname: Ricca
authors.affiliation: Andrology Unit, Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Rastrelli
authors.affiliation: Andrology Unit, Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy.
authors.forename: Alessandra Daphne
authors.initials: AD
authors.lastname: Fisher
authors.affiliation: Andrology Unit, Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy.
authors.forename: Sarah
authors.initials: S
authors.lastname: Cipriani
authors.affiliation: Andrology Unit, Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy. Electronic address: m.maggi@dfc.unifi.it.
authors.forename: Mario
authors.initials: M
authors.lastname: Maggi
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000453:epidemiology; D015897:Comorbidity; D007172:Erectile Dysfunction / Q000453:epidemiology* / Q000523:psychology; D006801:Humans; D007989:Libido; D008019:Life Style; D008297:Male; D000071896:Medically Unexplained Symptoms; D008875:Middle Aged; D010410:Penile Erection; D012189:Retrospective Studies; D012725:Sexual Behavior / Q000523:psychology / Q000706:statistics & numerical data; D020018:Sexual Dysfunctions, Psychological / Q000453:epidemiology* / Q000523:psychology
keywords: Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition; Male Sexual Dysfunction; Sexual Medicine; Somatic Symptoms