The issue of sexual dysfunction in infertile couples is often neglected and underreported. As sexual dysfunction can both contribute to and result from infertility, clinicians should be equipped to identify and address these issues as part of comprehensive fertility care.
To develop evidence- and consensus-based recommendations for the clinical management of male sexual dysfunction (MSD) in the context of infertility.
Initial recommendations were formulated based on expert opinion and exploratory analysis of various types of MSD associated with infertility. A focused literature review was conducted for each topic, followed by iterative rounds of expert discussion to refine recommendations. Final consensus was achieved at the 5th International Consultation on Sexual Medicine meeting, and recommendations were rated using GRADE criteria.
MSD and infertility often coexist, necessitating a detailed sexual history and physical examination during the initial infertility evaluation. Erectile dysfunction may be effectively managed with counseling, phosphodiesterase-5 inhibitors, or intracavernosal injections (eg, alprostadil, papaverine, phentolamine), which do not impair fertility outcomes. For low libido or unconsummated marriages, a multidisciplinary approach tailored to the couple's priorities-sexual function or fertility-is recommended. Ejaculatory disorders may be treated with counseling, penile vibratory stimulation, electro-ejaculation, medications, or assisted reproduction, depending upon the underlying cause. Selective serotonin reuptake inhibitors, used for premature ejaculation, may adversely affect sperm parameters and should be prescribed cautiously. Men with hypogonadism seeking fertility should avoid exogenous testosterone; alternatives such as selective estrogen receptor modulators, aromatase inhibitors, or gonadotropins may be considered. Lifestyle optimization, management of comorbidities, and use of fertility-safe lubricants can improve sexual and reproductive outcomes for couples trying to conceive.
MSD and infertility are often interrelated. Incorporating routine sexual health assessments into fertility evaluations enables clinicians to diagnose and treat MSD effectively, thereby improving both sexual function and reproductive success.
Sexual medicine reviews. 2026 Jan 05 [Epub]
David Shin, Andrea Sansone, Pramod Krishnappa, Abdulaziz Baazeem, Helen L Bernie, Mohammad Shamsul Ahsan, Nannan Thirumavalavan, Wayne J G Hellstrom, Rupin Shah
Department of Urology, Hackensack University Medical Center and Hackensack Meridian School of Medicine, Hackensack, NJ 07601, United States., Department of Systems Medicine, Chair of Endocrinology and Medical Sexology (ENDOSEX), University of Rome Tor Vergata, Rome 00133, Italy., Department of Urology, Andrology Division, AndroNeo, Orchidz Health, NU Hospitals, Bangalore, Karnataka 560010, India., Department of General Surgery, College of Medicine, Umm Al-Qura University, Makkah 24382, Saudi Arabia., Department of Urology, Indiana University, Indianapolis, IN 46202, United States., Department of Psychiatry, Bangladesh Medical University, Dhaka 1000, Bangladesh., Division of Male Reproductive and Sexual Health, Urology Institute, University Hospitals Cleveland, Case Western Reserve University School of Medicine, Cleveland, OH 44106, United States., Department of Urology, Tulane University School of Medicine, New Orleans, LA 70112, United States., Department of Urology, Lilavati Hospital and Research Center, Mumbai 400050, India.