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Multifactorial Issues Associated with Sexual Dysfunction in Men

James Um¹, Shivam Patel, M.D.² Michael D. Lutz, M.D.^2,3

¹B.S. Oakland University William Beaumont School of Medicine

²Department of Urology Corewell Health William Beaumont University Hospital

³Michigan Institute of Urology

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Introduction

• Male sexual dysfunction (erectile dysfunction, premature ejaculation, low libido) is common and multifactorial, involving neurologic, endocrine, and vascular systems, with significant impacts on quality of life, relationships, and mental health^1�
• Psychological and environmental factors play a major role, with studies demonstrating associations between sexual dysfunction and stress, depressive symptoms, and external stressors (e.g., fertility-related stress, COVID-19 pandemic)^2-4�
• Erectile dysfunction (ED) is a predominant contributor, driven by vascular and neurogenic mechanisms, and is strongly associated with comorbidities such as diabetes, hypertension, obesity, cancer, and advancing age^5�
• Lifestyle factors are modifiable contributors, and identifying behavioral patterns (e.g., smoking, alcohol use, physical inactivity, stress) may allow targeted interventions to improve sexual health and broader health outcomes.

Aims and Objectives

1. To understand the demographics of the participants who completed the Michigan Institute of Urology’s Men’s Health Questionnaire. The Men’s Health Foundation since its inception has been dedicated to the efforts to assist the men in the greater Detroit metropolitan area to become advocates for their own health. �

2. To explore the relationship between behavioral/lifestyle choices of men presenting with sexual dysfunction without any other comorbidities (Cardiovascular Disease, Stroke, Diabetes, obesity, cancer)

Methods

Cross-Sectional Survey Based Study:

Completed Health Questionnaires from Men’s Health Event 2023 (Detroit, MI) �(n ≈ 711 participants)

Study Population Selection

• Inclusion: Men ≥18
• Exclusion: Incomplete Responses, Women, Age <18 years

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Data Collection/Structured Questionnaires assessing:

• Demographics
• Sexual Function (Activity Frequency, Libido)
• Lifestyle Behaviors

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Statistical Analysis:

• Descriptive Analysis to characterize cohort
• Chi-Squared tests to assess associations between lifestyle factors and sexual function
• Sensitivity analysis excluding patients with select comorbidities associated with decreased sexual function (hypertension, heart disease, diabetes, kidney disease, cancer, depression, anxiety)

Results

Table 1. Demographics

Table 2. Association Between Lifestyle Factors and Sexual Desire/Libido

Table 3. Association Between Lifestyle Factors and Sexual Activity Frequency

Summary of Findings

Several lifestyle factors were associated with both sexual activity frequency and libido on bivariate analysis, including substance use and exercise-related behaviors. However, after exclusion of patients with comorbidities, most associations were attenuated. For sexual activity frequency, only red meat consumption remained significant (p=0.0126), while for libido, e-cigarette use (p=0.0360), aerobic exercise (p=0.0445), and fast food consumption (p=0.0049) remained significant. These findings suggest that observed relationships between lifestyle factors and sexual function may be influenced by underlying health status.

Conclusions

This study demonstrates that modifiable lifestyle behaviors are meaningfully associated with male sexual function. The attenuation of several associations following comorbidity exclusion suggests that men with underlying conditions may benefit most from targeted lifestyle intervention as a non-pharmacological adjunct to standard management of sexual dysfunction. Notably, red meat consumption more than three times per week was independently associated with decreased sexual activity frequency after comorbidity exclusion, highlighting the relevance of diet in men without traditional risk factors. Resistance training, aerobic exercise, and dietary modification emerge as the most clinically actionable recommendations for sexual health management.

References

1. Herkommer K, Meissner VH, Dinkel A, et al. Prevalence, lifestyle, and risk factors of erectile dysfunction, premature ejaculation, and low libido in middle-aged men: first results of the Bavarian Men's Health-Study. Andrology. 2023; 1-8. https://doi.org/10.1111/andr.13524�

2. Mollaioli, D., Ciocca, G., Limoncin, E. et al. Lifestyles and sexuality in men and women: the gender perspective in sexual medicine. Reprod Biol Endocrinol 18, 10 (2020). https://doi.org/10.1186/s12958-019-0557-9�

3. Song SH, Kim DS, Yoon TK, Hong JY, Shim SH. Sexual function and stress level of male partners of infertile couples during the fertile period. BJU Int. 2016 Jan;117(1):173-6. doi: 10.1111/bju.13201. Epub 2015 Jul 14. PMID: 26074135.�

4. Szuster E, Pawlikowska-Gorzelańczyk A, Kostrzewska P, Mandera-Grygierzec A, Rusiecka A, Biernikiewicz M, Brawańska K, Sobieszczańska M, Rożek-Piechura K, Kałka D. Mental and Sexual Health of Men in Times of COVID-19 Lockdown. Int J Environ Res Public Health. 2022 Nov 20;19(22):15327. doi: 10.3390/ijerph192215327. PMID: 36430046; PMCID: PMC9690699.�

5. Anderson D, Laforge J, Ross MM, Vanlangendonck R, Hasoon J, Viswanath O, Kaye AD, Urits I. Male Sexual Dysfunction. Health Psychol Res. 2022 Aug 20;10(3):37533. doi: 10.52965/001c.37533. PMID: 35999971; PMCID: PMC9392840.

Acknowledgements

We would like to thank the Department of Urology at Corewell Health William Beaumont University Hospital for their mentorship and support. We also acknowledge the Michigan Institute of Urology for providing access to shared data utilized in this study. We are grateful to the patients and participating sites in the Detroit Metropolitan Area for their contributions.