افسردگی و اضطراب در مردان با اختلال عملکرد جنسی: یک مطالعه گذشته نگر

Background Comorbid anxiety disorders and depression are commonly seen in men with sexual disorders such as erectile dysfunction (ED) and premature ejaculation (PE). However, they are often undiagnosed and untreated, and their relationship to sexual dysfunction is complex. This study examines the frequency and correlates of comorbid anxiety and depression in men with ED or PE. Methods The case records of 64 men with ED or PE attending a clinic for psychosexual disorders in a general hospital psychiatry unit during the period 2010–14 were reviewed. Information on comorbid anxiety disorders and depression was extracted from these records, and their clinical and demographic associations were analyzed. Results Eight (12.5%) men had comorbid depressive disorders, and fifteen (23.4%) had anxiety disorders. These disorders predated the onset of sexual dysfunction in the majority of patients. Generalized anxiety disorder was the commonest anxiety disorder. Men with comorbid depression had significantly elevated rates of suicidal ideation or behavior related to their sexual dysfunction, and were more likely to report a lack of libido. Men with pre-existing anxiety disorders were more likely to experience performance anxiety related to sex, and to have PE without comorbid ED. Conclusions Depression and anxiety affect a substantial minority of men with sexual dysfunction. Men presenting for the evaluation of ED and PE should be carefully screened for these disorders. The links between anxiety disorders and sexual performance anxiety merit further investigation in this patient group.

Premature ejaculation (PE) and erectile dysfunction (ED) are the two most common forms of sexual dysfunction in men [1] and [2]. Though these disorders, particularly ED, have traditionally been divided into “organic” and “psychogenic” categories [3] and [4], the distinction between these two is not clear, as neurobiological and psychological factors overlap substantially in individual cases [4], [5], [6], [7] and [8]. Depression is strongly associated with male sexual dysfunction. Major depression is mainly associated with reduced sexual desire, though 25% of male patients with depression may also experience ED [9] and [10]. The relationship between depression and ED is bi-directional: depressed affect can impair sexual arousal and cause ED [11], while decreased sexual activity and lack of satisfaction with one's sexual life can trigger depressive symptoms [12] and [13]. Further complicating this relationship are the well-documented sexual side-effects of antidepressants [10] and [14]. Symptoms of depression are commonly associated with ED even in the absence of syndromal depression [15] and [16]. Depression has also been associated with PE [17] and [18] and may reflect the impaired self-esteem caused by PE [19]. Various anxiety disorders have also been associated with sexual dysfunction. Social phobia, a condition associated with significant anxiety in social or performance situations, is strongly associated with PE [20], [21] and [22], and panic disorder has been linked to ED in several studies [22], [23] and [24]. Likewise, a significant number of men with generalized anxiety disorder (GAD) experience erectile dysfunction [25]. Anxiety related specifically to sexual performance can be a significant contributor to both ED [7] and [26] and PE [27] even without a diagnosed anxiety disorder, and “free-floating” anxiety of the type seen in GAD has also been documented in this patient population [28]. Despite the large number of studies linking depression and anxiety to sexual dysfunction, it is unclear how depression and anxiety relate to other psychological factors in this patient group, or if they affect the presentation of ED or PE. In order to investigate these relationships, we performed a chart review of 64 men with a diagnosis of ED or PE of presumed psychogenic origin, to assess the frequency, chronology, and correlates of comorbid anxiety and depressive disorders in this patient population. Our study was confined to ED and PE as these are the sexual disorders which have the best documented associations with anxiety and depression, and because none of the other patients attending our clinic, as described below, were diagnosed with these conditions.

Despite certain shortcomings, our study replicates the findings of earlier research in this patient population, though it did not generate any new results. Anxiety disorders and depression both affect a substantial minority of men with sexual dysfunction, and are often undiagnosed and untreated. Though their exact role in the pathogenesis of ED or PE is unknown, our data provide some evidence for a link between pre-existing anxiety disorders, sexual performance anxiety, and premature ejaculation. These results require replication in larger, prospective samples to confirm their applicability in clinical settings.