Chronic health conditions (CHC), both somatic and mental, increase the risk of sexual dysfunctions (SD) in men, which are associated with reduced quality of life. Despite existing guidelines, help-seeking remains low due to barriers such as shame and limited access, with many turning to anonymous sources. Representative data on care pathways and treatment preferences across SD domains and CHC subgroups is lacking. This study examines SD diagnoses, help-seeking, and treatment preferences in men with and without CHC meeting ICD-11 SD criteria to inform more tailored care.
Of all N = 1815 (unweighted N = 1787) cis-men, n = 265 (16.6%) fulfilled positive ICD-11 SD criteria and were included in this study (mean age 49.2; SD = 16.9 years). CHC were present in 74.1% of men, of whom 23.2% had self-reported SD. While the internet remains the most used information source, urologists were the preferred information sources and dialogue partners for sexual health concerns. Men with mental health conditions (MH +) valued psychotherapists and psychiatrists more highly in this regard. Shame was the most cited barrier to help-seeking, particularly present in men with MH + , with 50.4%. Only 46.6% of men with SD symptoms meeting the ICD-11 criteria reported an SD diagnosis. Previous therapy was rare, with 3-4 months of waiting times. Medication was the most commonly used treatment in the past. As preferred treatment, men with CHC prioritized medication (42.6% vs. 36.7% in men without CHC), whereas men without CHC also favored relaxation methods (29.3%). Desired treatment goals included improved sexual and relationship satisfaction. Digital tools such as apps or websites were also of interest, with reimbursement considered essential.
Despite the high burden, SD diagnoses remain rare, and help-seeking behaviors vary, especially between men with somatic versus mental CHC. Regular healthcare contact may offer opportunities to address sexual health in trusted settings. Interventions should target both sexual and relationship satisfaction. Digital solutions can help close treatment gaps and improve access to specialized care. However, given low interest and adherence-particularly among men with CHC-tailored approaches are essential. Reimbursement within the German healthcare system is needed to lower financial barriers.
RéSUMé: CONTEXTE: Les affections chroniques (CHC) augmentent le risque de dysfonctions sexuelles (SD) chez les hommes et affectent leur qualité de vie. Malgré des lignes directrices existantes, la recherche d’aide reste faible. RéSULTATS: Parmi N = 1815 hommes, n = 265 (16.6%) répondaient aux critères de SD selon la CIM-11 (âge moyen: 49.2 ans, SD 16.9). Des CHC étaient présentes chez 74.1%, dont 23.2% déclaraient une SD. Internet était fréquemment utilisé, mais les urologues restaient les interlocuteurs préférés. La honte était le principal obstacle à la recherche d’aide (50.4% chez les MH+). Seuls 46,6% avaient reçu un diagnostic de SD. Les traitements antérieurs étaient rares, avec des délais d’attente de 3-4 mois. Les médicaments étaient les plus utilisés et préférés, notamment par les hommes avec CHC (42.6% contre 36.7% sans CHC). Les hommes sans CHC privilégiaient aussi des méthodes de relaxation (29.3%). Les objectifs souhaités comprenaient une amélioration de la satisfaction sexuelle et relationnelle. Les outils numériques suscitaient de l’intérêt; leur remboursement était jugé essentiel. CONCLUSION: Malgré la charge élevée, les diagnostics de SD sont rares. La recherche d’aide varie selon le type de CHC. Les solutions numériques peuvent améliorer l’accès, mais requièrent des approches personnalisées et un remboursement systémique.
Basic and clinical andrology. 2025 Nov 20*** epublish ***
Elena Mühle, Selina M Kronthaler, Carlotta Oesterling, Tatjana Tissen-Diabaté, Klaus M Beier, Jörg Neymeyer, Thorsten Schlomm, Laura Hatzler
Charité - Universitätsmedizin Berlin, Institute of Sexology and Sexual Medicine, Berlin, Germany., Charité - Universitätsmedizin Berlin, Institute of Social Medicine, Epidemiology and Health Economics, Berlin, Germany., Charité - Universitätsmedizin Berlin, Department of Urology, Berlin, Germany., Charité - Universitätsmedizin Berlin, Institute of Sexology and Sexual Medicine, Berlin, Germany. .