Links between chronic health conditions and sexual dysfunction in men: insights from a German population-based study

Abstract Background Sexual dysfunction (SD) is common among men and significantly impacts quality of life. Chronic health conditions (CHC), particularly with comorbid mental health (MH) issues, may be associated with increased risk of SD, yet large-scale population data are limited. Objective This study examined the prevalence and associations of sexual problems (SP), ICD-11-defined SD, and sexual distress among men with and without CHC in a representative German sample. Methods From a cross-sectional online survey, data from N = 1742 cisgender men (unweighted sample size) were included in the analysis. Participants reported on CHC status (i.e., cardiovascular, urological, mental health, cancer), SP, SD, and sexual distress (SDS-DAO). Regression models assessed associations between CHC and SD. Network analyses explored interrelations between CHC subgroups and SD domains. Results CHC were reported by 50.8% of participants. Men with CHC had higher rates of SP (79.2%) and SD (23.2%) than those without CHC (66.7% SP, OR 1.90, 95% CI 1.52–2.37; 9.1% SD, OR 3.00, 95% CI 2.24–4.07). SD was most prevalent in men with urological disorders, cancer, pain-related, mental health and cardiovascular conditions. Among men with CHC, comorbid MH conditions were substantially associated with sexual distress (β = 3.4, 95% CI 1.3–5.4, p = .001 ). Regression models demonstrated strong associations between CHC, comorbid MH conditions, and SD, with network analysis revealing strong links between erectile dysfunction with hypoactive sexual desire dysfunction and delayed ejaculation dysfunction, and conditions such as urological disorders, mental health conditions, cancer and cardiovascular disease. Conclusion CHC, especially mental health conditions, urological disorders, cancer and cardiovascualr disease, are strongly associated with SD and sexual distress in men. Integrated care approaches that include routine sexual health screening and address mental wellbeing may thus be essential to improving outcomes for men with chronic illness.