Predictors of Male Sexual Dysfunction in Urologic Chronic Pelvic Pain Syndrome (UCPPS), Other Chronic Pain Syndromes,and Healthy Controls in the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network |
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| Institution: | 1. USC Institute of Urology, USC/Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA;2. Department of Biostatistics, Epidemiology and Informatics, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA;3. Albert Einstein College of Medicine, Department of Obstetrics & Gynecology and Women''s Health, Albert Einstein College of Medicine, Bronx, NY, USA;4. Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA;5. Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA;6. Department of Urology, University of Washington, Seattle, WA, USA;7. Departments of Surgery (Urologic Surgery) and Anesthesiology, Washington University School of Medicine, Division of Urologic Surgery, St Louis MO, USA;1. Kinsey Institute, Indiana University, Bloomington, IN, United States;2. Department of Sociology, Indiana University, Bloomington, IN, United States;1. Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA;2. Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA;1. Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA, USA;2. Department of Psychiatry, Harvard Medical School, Boston, MA, USA;3. Department of Psychology, Bowling Green State University, Bowling Green, OH, USA;4. Department of Psychological Science, Texas Tech University, Lubbock, TX, USA;5. Department of Psychology, University of Nevada Las Vegas, Las Vegas, NV, USA;1. Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy;2. School of Endocrinology, Department of Experimental Medicine, University of Rome Sapienza, Rome, Italy;3. Department of Infertility and Sexual Medicine, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, PRC;1. Department of Clinical Sciences, Division of Obstetrics and Gynecology, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden;2. Center for clinical research, Uppsala University, County Council of Västmanland Central Hospital, Västerås, Sweden;3. The School of Health, Care and Social Welfare, Mälardalen University, Sweden;1. Department of Medicine, Lillebaelt Hospital, Vejle, Denmark;2. Department of Clinical Medicine, Aarhus University, Aarhus, Denmark;3. Unit for Sexology, Aarhus University Hospital Psychiatry, Aarhus, Denmark;4. Department of Regional Health Research, University of Southern Denmark, Odense, Denmark |
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| Abstract: | BackgroundSexual dysfunction (SD), including erectile (ED) and ejaculatory dysfunction, is associated with diminished quality of life (QoL) in men with UCPPS (chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and/or interstitial cystitis/bladder pain syndrome (IC/BPS)).AimWe sought to compare SD among male patients with UCPPS, other chronic pain conditions (positive controls, PC), and healthy controls (HC) without chronic pain, and to evaluate the association of comorbidities, psychosocial factors, and urologic factors of SD in all 3 groups.MethodsBaseline data from male UCPPS participants, PC (irritable bowel syndrome, chronic fatigue syndrome, fibromyalgia) and HC enrolled in the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network Epidemiology and Phenotyping Study were included in the analysis. Sexual function was assessed using the International Index of Erectile Function-Erectile Function Domain (IIEFEF) and Ejaculatory Function Scale (EFS). Male ED was defined as a composite IIEF-EF score <21. Higher EFS score indicated worse sexual dysfunction; no threshold to define SD was identified for the EFS. Multivariable logistic and linear regression was used to investigate associations of comorbidities, psychosocial factors, and urologic factors with ED and ejaculatory, respectively.OutcomesComorbidities, genital pain, and psychosocial factors are associated with SD across the study population and male patients with UCPPS had a high prevalence of ED and greater ejaculatory dysfunction.ResultsThere were 191 males with UCPPS; 44 PC; and 182 HC. Males with UCPPS had worse SD compared to PC and HC including lower mean IIEF-EF scores, greater degree of ejaculatory dysfunction, and lower quality of sexual relationships. Among all 3 cohorts, depression, stress, and pain were associated with ED in univariable and multivariable analysis, as was diabetes mellitus. Pain in the genitalia, severity of urinary symptoms, depression, stress, and history of childhood sexual trauma were associated with ejaculatory dysfunction in univariable and multivariable analysis.Clinical ImplicationsA multidisciplinary approach that addresses the identified risk factors for SD may improve overall QoL in males with UCPPS.Strengths and LimitationsOur study is strengthened by its use of validated, patient-reported questionnaires and inclusion of healthy and positive controls. Our understanding of the role of IC in this study is limited because only 1 patient in the study had IC/BPS as a sole diagnosis.ConclusionsWhen compared to healthy controls and patients with other chronic pain conditions, males with UCPPS experience higher degrees of SD, including erectile and ejaculatory dysfunction.Loh-Doyle JC, Stephens-Shields AJ, Rolston R, et al. Predictors of Male Sexual Dysfunction in Urologic Chronic Pelvic Pain Syndrome (UCPPS), Other Chronic Pain Syndromes, and Healthy Controls in the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network. J Sex Med 2022;19:1804–1812. |
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