Childhood Sexual Abuse and Self‐Reported Erectile Difficulties in Adult Men

BACKGROUND: History of childhood sexual abuse (CSA) may affect adult male sexual function, yet population-based evidence remains limited. OBJECTIVES: This study aimed to evaluate the associations between a history of CSA and recent sexual function outcomes, specifically self-reported erectile difficulties and decreased libido, and to examine differences by age group and cohabitation status. MATERIALS AND METHODS: We analyzed data from 8837 men aged 18-79 years who participated in the 2023 JACSIS study, a population-based online survey in Japan. CSA before age 18 years was identified using behavior-specific items and two direct screening questions. Outcomes were defined as binary measures of self-reported erectile difficulties and decreased libido. We adjusted for confounding using inverse probability of treatment weighting (IPTW) based on prespecified propensity scores. Effect modification by age group and cohabitation status was tested. Secondary analyses included depression, anxiety, and sleep problems to evaluate the attenuation of associations. RESULTS: Among 8837 eligible men, 667 (7.5%) reported CSA. CSA was associated with significantly higher odds of self-reported erectile difficulties (adjusted odds ratio [aOR] 3.14, 95% confidence interval [CI] 2.61-3.78, p < 0.001) and decreased libido (aOR 2.83, 95% CI 2.37-3.38, p < 0.001). Stratified analyses showed consistent associations across all age groups and cohabitation statuses, with no significant effect modification detected. Simultaneous adjustment for depression, anxiety, and sleep problems attenuated these associations. DISCUSSION: The associations observed across age groups suggest that CSA appears to have a lasting and independent negative impact on male sexual function. These findings imply that the consequences of early trauma may persist throughout adulthood, involving mechanisms beyond concurrent mental health or sleep burdens. CONCLUSION: CSA history is significantly associated with self-reported male sexual difficulties. Integrating trauma-informed care and routine screening for psychological and sleep comorbidities into urological practice is essential for comprehensive patient management.