Sexual health among infertile men

Fifteen percent of couples have difficulty achieving a natural pregnancy and in about half of the cases a male factor contributes to the infertility. Sexual dysfunction is frequent among men of reproductive age, however, the relationship between male infertility and sexual health is not well understood.

It seems that sexual dysfunctions are more frequent in infertile men compared to fertile men with about one in six infertile men suffering from erectile dysfunction or premature ejaculation (Lotti et al. Nat Rev Urol. 2018 May;15(5):287-307.). A lack of sexual desire is also prevalent in infertile men (Kruljac et al. Andrology. 2019 Jul 19.), while it is not known how many infertile men suffer from retrograde ejaculation (backflow of semen in to the bladder) or anejaculation (absent ejaculation).

Importantly, current evidence does generally not determine a causal relationship between sexual health and male infertility. In other words, it is generally not known whether infertility causes sexual dysfunction or sexual dysfunction causes infertility. However, it is hypothesized that getting an infertility diagnosis might have a psychosexual impact on the couple resulting in sexual dysfunction. Further, sexual dysfunction such as erectile dysfunction and a lack of sexual desire may be linked to a low level of the male hormone, testosterone, which is seen in some infertile men. Finally, ejaculation disorders such as premature ejaculation, retrograde ejaculation and anejaculation might be the reason for infertility in some men.

As many of the above conditions can be treated successfully it is important that medical professionals treating infertile men or men with sexual dysfunctions are aware of the connection. However, more studies are needed to characterize the complicated relationship between sexual health and male infertility.

Christian Fuglesang S. Jensen, MD
Department of Urology, Herlev and Gentofte Hospital, University of Copenhagen

HFTHQ19016_D