• Infertility;
  • Sexual Dysfunction;
  • Psychological Distress;
  • Prevalence;
  • Association



Although infertility is known to be associated with psychological and sexual problems, the relationship between these two aspects in infertile men has not been well investigated.


To investigate the incidence of sexual dysfunction and psychological burden, and their possible associations in infertile men.


From June 2009 to June 2012, a total of 1,468 infertile men and 942 fertile men were evaluated. Premature ejaculation (PE) and erectile dysfunction (ED) were measured by the PE diagnostic tool (PEDT), the intravaginal ejaculatory latency time (IELT) and the international index of erectile function (IIEF)-5. Anxiety and depression, which reflect the degree of psychological burden, were measured by the self-rating anxiety scale (SAS) and self-rating depression scale (SDS), respectively.

Main Outcome Measures

PE and ED were measured by the PEDT, IELT, and IIEF-5. Anxiety and depression were measured by the SAS and SDS, respectively.


The incidences of PE and ED in the infertile group were significantly higher than those in the fertile group (PE: 19.01% vs.10.93%, P < 0.001; ED: 18.05% vs. 8.28%, P < 0.001). In addition, anxiety and depression were more prevalent in infertile than fertile men (Anxiety: 38.01% vs. 26.65%, P < 0.001; Depression: 15.74% vs. 10.08%, P < 0.001). Furthermore, after adjusting for age in the infertile group, the PEDT score was positively associated with anxiety (adjusted r = 0.57; P < 0.001) and depression (adjusted r = 0.54; P < 0.001). Moreover, the IELT were negatively associated with anxiety (adjusted r = −0.40; P < 0.001) and depression (adjusted r = −0.52; P < 0.001). Similar negative relationships were also observed between the IIEF-5 score and anxiety (adjusted r = −0.49; P < 0.001) or depression (adjusted r = −0.50; P < 0.001).


This is the first study to systematically evaluate the incidence of sexual dysfunction and psychological burden, and their possible associations in infertile men in China. Further in-depth studies are needed to confirm and extend these results. Gao J, Zhang X, Su P, Liu J, Shi K, Hao Z, Zhou J, and Liang C. Relationship between sexual dysfunction and psychological burden in men with infertility: A large observational study in China. J Sex Med 2013;10:1935-1942.