Endocrine and psychological aspects of sexual dysfunction in Klinefelter patients

Abstract

Klinefelter syndrome is a frequent cause of hypogonadism, but despite hundreds of publications on different aspects of Klinefelter syndrome, only a few studies dealt with sexual dysfunction. In particular, testosterone is critical for various aspects of sexual response, but its role on sexuality in Klinefelter syndrome patients is debatable and no studies have evaluated the efficacy of testosterone treatment on sexual dysfunction in these subjects. Furthermore, the impact of psychological and relational aspects on sexual function of Klinefelter syndrome subjects is poorly defined. In this study, we aimed to determine the presence and type of sexual dysfunctions in Klinefelter syndrome subjects; to correlate them with testosterone levels and psychosexological and relational domains; and to evaluate the effects of testosterone therapy. We studied 62 non-mosaic naïve Klinefelter syndrome patients and 60 age-matched controls by means of medical history, psychosexological history, 15-item International Index of Erectile Function questionnaire, endocrine assessment, and dynamic penile color Doppler ultrasound. Twenty-five hypogonadal Klinefelter syndrome patients were studied after 6 months of testosterone replacement therapy. Klinefelter syndrome subjects have reduced 15-item International Index of Erectile Function scores regarding sexual desire, intercourse satisfaction, and overall satisfaction with respect to controls, and these aspects were significantly associated with testosterone levels. Klinefelter syndrome subjects had also higher prevalence of erectile dysfunction, but no relation with testosterone levels was evident. A high prevalence of a range of psychological disturbances was present in Klinefelter syndrome subjects with erectile dysfunction with respect to those without erectile dysfunction. No statistical difference in the prevalence of premature and delayed ejaculation was observed between Klinefelter syndrome and control subjects. Testosterone replacement therapy improved sexual desire, intercourse satisfaction, and overall satisfaction scores, but had no effect on erectile function. Penile color Doppler ultrasound was normal in all subjects. This study shows that sexual dysfunction in Klinefelter syndrome is multifactorial and related only in part to hypogonadism and largely to psychological disturbances. Evaluation and therapy of sexual dysfunction should include a combined andrological and psychosexological approach.

The decline in sexual function, psychological disorders (anxiety and depression) and life satisfaction in older men: A cross‐sectional study in a hospital‐based population

“…Interestingly, when patients experienced decline in sexual function and had PE or ED at the same time, the difference in emotion and life quality/satisfaction measurements increased. According to previous studies, some possible mechanisms are as follows: (1) Great sex brings about great self‐esteem, improving self‐worth; (2) more feel‐good hormones are secreted in the brains of sexually active men, resulting in better life experience and emotions (Ferlin et al, 2018); and (3) sex is a good way to improve marital relationships. We suppose that sexual dysfunction and decline in sexuality could contribute to negative moods and poor quality of life or make it worse.…”

European academy of andrology guidelines on Klinefelter Syndrome Endorsing Organization: European Society of Endocrinology

“…Psychosexual development is often delayed and sexual problems might be more frequent in KS 164 . Most patients identify as male, but gender incongruence in KS has been reported in some studies 72,165‐173 …”

“…[159][160][161][162][163] Psychosexual development is often delayed and sexual problems might be more frequent in KS. 164 Most patients identify as male, but gender incongruence in KS has been reported in some studies. 72,[165][166][167][168][169][170][171][172][173] Values Attention to eventual psychological, sexual, psychiatric as well as gender incongruence aspects is suggested (Table 2).…”

Estradiol–Testosterone Imbalance Is Associated with Erectile Dysfunction in Patients with Klinefelter Syndrome

“…On the other hand, other data showed that ED in KS is also linked to psychological disturbances, while erectile function seems to be less related to T levels and hypogonadism. Moreover, T replacement therapy is not able to improve erections [ 25 ]. Therefore, the exact role of T in the sexuality of KS patients is still debated.…”

“…Furthermore, psychological and cognitive aspects are quite typical in KS and have been extensively investigated [ 24 ]. In particular, some psychological disturbances have been linked to ED in KS, while the role of T levels and hypogonadism in sexual function of subjects with KS is not fully elucidated [ 25 ]. Moreover, sexual function in KS has not been studied in depth, and only a few studies have investigated the different roles of hormonal, neuropsychological, cognitive, and relational disturbances.…”