Psychological Factors in Male Sexual Dysfunction: Anxiety, Depression and Gender Role / 대한남성과학회지

PURPOSE: It has been presumed that male sexual dysfunction correlates highly with psychological factors. We assessed psychological factors such as anxiety, depression, and gender role in patients of psychogenic impotence. We also evaluated the differences in serum lipid profile, norepinephrine and serotonin between the patients and age-matched control subjects. SUBJECTS AND METHODS: Twenty-five men with psychogenic impotence were enrolled in this study, and thirty patients were enrolled as the age-matched control subjects. Lipid profile and norepinephrine were measured with random blood samples. Twenty-four hour urinary 5-hydroxyindoleacetic acid (5-HIAA), a urinary metabolite of serotonin, was measured. Psychological assessment, including Minnesota Multiphasic Personality Inventory (MMPI), Beck's Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI) for anxiety, and the Bem Sexual Inventory (BSRI) for gender role, was conducted. RESULTS: There was no significant difference between the patients and control subjects I any laboratory test except low-density lipoprotein (LDL). The value of LDL wee within normal reference ranges but significantly higher in the patients (p<0.05). Scores for depression (p<0.001), psychasthenia (p<0.001), social introversion (p<0.001), schizophrenia (p<0.01), hypochondriasis (p<0.05), and hysteria (p<0.05) were significantly higher in men with sexual dysfunction than in the controls. Patients with sexual dysfunction had higher scores for state and trait anxiety, especially trait anxiety, than the control subjects (p<0.05). In BSRI, a female profile was more apparent in patients than in the control group (37% versus 14%). CONCLUSIONS: These results suggest that psychosocial factors such as stress, anxiety, and depression are highly correlates with male sexual dysfunction. These factors are poorly correlated with random norepinephrine, lipid profiles and serotonin in the patients with sexual dysfunction.

Norepinephrine and Serotonin in the Patients with Psychogenic Impotence

Various neurotransmitters have been proposed as possible mediators of penile erection. Especially, norepinephrine and serotonin might have a important role in sexual arousal and penile erection. And it could be hypothesized that the psychogenic impotence is associated with the depletion or imbalance of norepinephrine and serotonin from evidences such as the symptomatic manifestation of depression and the antidepressant-induced sexual dysfunction. The authors investigates the association of norepienphrine and serotonin with psychogenic impotence. The psychogenic impotent group(PIG) consisted of twenty-three patients with psychogenic impotence and the controlled group(CG) consisted of twenty-seven patients without psychogenic impotence. PIG had no organic cause accounting for their erectile dysfunction. The Beck Depression Inventory(BDI) and the State-Trait Anxiety Inventory(STAI) were applied to each subject to assess mood, state anxiety(SA) and trait anxiety(TA). Plasma norepinephrine level from systemic blood and 5-hydroxyindoleacetic acid(HIAA) levels from 24-hours urine were measured in each subject. The mean score of BDI of PIG was significantly higher than that of CG(p=0.015). PIG had a tendency of higher TA compared with CG(p=0.054). And also SA was higher in PIG, bud did not show significant difference(p=0.193). The level of norepinephrine was significantly lower in patient with psychogenic impotence(p=0.000). And the level of 24-hours urine 5-HIAA was lower in PIG but did not show significant difference(p=0.494). Although the authors did not exclude depressive disorders in PIG, the present findings suggest that psychogenic impotence might have higher depressive mood and trait anxiety, and be associated with the depletion of norepinephrine in systemic blood.