ORIGINAL ARTICLE

Depression is correlated with the psychological and physical

aspects of sexual dysfunction in men

AW Pastuszak

1,3

, N Badhiwala

2,3

, LI Lipshultz

and M Khera

Few studies have objectively examined the relationship between depression and various stages of sexual function. Here we

associate depression and sexual function using validated questionnaires. A retrospective review of 186 men was performed;

demographics and serum hormone levels were obtained. Responses to questionnaires evaluating depressive symptoms (Patient

Health Questionnaire (PHQ-9)), sexual function (International Index of Erectile Function (IIEF)) and hypogonadal symptoms

(quantitative Androgen Decline in the Aging Male (qADAM)) completed by each patient were correlated using Spearman’s rank

correlation. Mean

s.d. subject age: 52.6

12.7 years; mean serum hormone levels: TT 429.8

239.2 ng dl

, free testosterone

9.72

7.5 pg ml

and estradiol 34.4

22.8 pg ml

. Negative correlations were observed between total PHQ-9 score and the

sexual desire (

¼±

0.210,

0.006), intercourse satisfaction (

¼±

0.293,

0.0001) and overall satisfaction (

¼±

0.413,

0.0001) domains of the IIEF and individual IIEF questions pertaining to erectile function. Men with a PHQ-9 score

10 (mild

depression or worse), had lower sexual desire and sex life satisfaction. A negative correlation between PHQ-9 score and qADAM

score (

¼±

0.634,

0.0001) was observed and men with higher PHQ-9 score had lower qADAM scores. Depressive symptoms in

men correlate with both psychological as well as physical aspects of sexual function.

International Journal of Impotence Research

(2013)

25,

194–199; doi:10.1038/ijir.2013.4; published online 7 March 2013

Keywords:

ADAM; depression; IIEF; male sexual function; PHQ-9

INTRODUCTION

Studies have demonstrated numerous health bene±ts of sexual

expression and satisfaction, including improvements in physical,

emotional, mental and social health. Rosen

et al.

studied the

effects of erectile dysfunction (ED) therapy on family and overall

life satisfaction, and found that sexual expression is an integral

part of a lasting, healthy relationship, boosting self-esteem and

improving intimacy. Additional studies have demonstrated a

relationship between sexual dysfunction and age, cardiovascular

disease,

hypertension,

diabetes

and

lower

urinary

tract

symptoms.

2–5

Sexual dysfunction, which includes sexual desire disorders,

ED, ejaculation dif±culties and anorgasmia, is associated with

psychosocial problems including decreased quality of life, low

self-esteem and anxiety.

3,6–8

This association between sexual

dysfunction and psychosocial problems is bidirectional and further

complicated by the sexual side effects of antidepressants. Latini

et al.

reported a strong relationship between severe ED and

broad range of psychosocial domains. Problems with erections

have been found to affect men in both their intimate and non-

intimate life including how they see themselves as sexual beings.

Additionally, sexual function is related to a man’s androgen status,

with hypogonadal men having an increased incidence of ED.

10–12

Thus, sexual dysfunction in men with psychosocial issues likely

has a profound impact on their quality of life. While depressive

symptoms

are

associated

with

male

sexual

dysfunction,

few studies exist examining the impact of depression on sexual

function, or vice versa, in an objective manner.

3,13

Litwin

et al.

examined health-related quality of life using the RAND 36-Item

Health Survey (SF-36) questionnaire in 57 men with ED and

observed a more signi±cant effect on the emotional than

the physical domains. The SF-36 is a validated, self-administered

questionnaire that addresses eight domains of quality of life,

including physical function, general health perception and

emotional

wellbeing.

Comparably,

Feldman

al.

used

the results of the Massachusetts Male Aging Study (MMAS), a

cross-sectional community-based random-sample survey of 1265

men aged between 40–70 years, to demonstrate that ED is directly

correlated with anger and depression. Araujo

et al.

14,15

used the

MMAS to show that men with ED were almost twice as likely to be

depressed as their potent counterparts. These authors utilized the

Center for Epidemiological Studies-Depression (CES-D) scale, a

validated self-reporting scale, to assess depressive symptoms and

the un-validated Sexual Activity Questions Related To Potency

survey to assess ED, which did not permit evaluation of speci±c

domains of sexual function. Two studies from the Johns Hopkins

Sexual Behaviors Consultation Unit, examining patients with ED

between 1976 and 1979 (

199) and 1984 and 1986 (

223),

showed a high frequency of depressive symptoms and high scores

on measures of psychological distress in patients with ED.

16,17

Fagan

et al.

, examined a cohort of 224 men with sex-related

complaints or partners with sex-related complaints who were

evaluated using DSM-III criteria for psychosexual dysfunction and

found that men with ED had signi±cant psychological distress as

well as depressive and anxiety symptoms. However, this study did

not relate the psychological or physical aspects of sexual function

to depressive symptoms. Mathew

et al.

studied sexual

Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA and

Baylor College of Medicine, Houston, TX, USA. Correspondence: Assistant Professor, M Khera,

Scott Department of Urology, Baylor College of Medicine, 6620 Main Street, Suite 1325, Houston, TX 77030, USA.

E-mail: mkhera@bcm.edu

These authors contributed equally to this work.

Received 25 April 2012; revised 28 November 2012; accepted 5 February 2013; published online 7 March 2013

International Journal of Impotence Research (2013) 25, 194–199

2013 Macmillan Publishers Limited