Premature ejaculation and erectile dysfunction in a cohort of infertility men: clinical and ultrasonographic correlations
F. Lotti1, G. Corona1, G. Rastrelli1, G. Forti1, E. Jannini2 & M. Maggi1
Introduction: Premature ejaculation (PE) and erectile dysfunction (ED) are considered pre-testicular causes of male subfertility. No previous study systematically evaluated the prevalence of ED and PE along with their possible correlations with clinical and colour-Doppler ultrasound (CDU) features in infertile men.
Methods: Ejaculatory status, erectile function, prostatitis symptoms and psychopathological traits of 244 men complaining of couple infertility were evaluated by Premature Ejaculation Diagnostic Tool (PEDT), International Index of Erectile Function-15 (IIEF-15), National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) and Middlesex Hospital Questionnaire (MHQ), respectively. PEDT score ≤8 indicates no-PE. IIEF-15 erectile function domain (IIEF-15-EFD) score <26 indicates erectile dysfunction. All patients underwent simultaneous hormone evaluation, seminal analysis and interleukin 8 (sIL8), a reliable surrogate marker of prostatitis, along with penile, scrotal and transrectal CDU, before and after ejaculation.
Results: PE was found in 38 (15.6%) and ED in 43 (17.8%) subjects. After adjusting for age, a positive association between PEDT score and prostatitis symptoms (NIH-CPSI score) and signs (sIL8) was observed. In addition, subjects with a higher PEDT score more often had CDU features suggestive of prostate inflammation, including hypoechoic texture, hyperaemia and a higher arterial peak systolic velocity (APSV). Finally, they showed a higher prevalence of psychopathological traits (MHQ score). In a multivariate model including age and calculated free testosterone (also positively related to PEDT score), APSV, NIH-CPSI and MHQ score were independently positively associated with PEDT score. IIEF-15-EFD score was positively associated with mean arterial blood flow acceleration at basal penile CDU, while a negative association with NIH-CPSI and MHQ score was observed. No correlation between IIEF-15-EFD or PEDT score and semen parameters was observed.
Conclusions: PE and ED should be ruled out in infertile patients. However, they have no impact on semen parameters. PEDT score is positively associated with prostatitis symptoms and signs including CDU features.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.