Sexuality in Males With Congenital Adrenal Hyperplasia Resulting From 21-Hydroxylase Deficiency

Abstract

Purpose Although sexuality has been reported to be impaired in females with congenital adrenal hyperplasia (CAH) resulting from 21-hydroxylase deficiency, sexuality in males with CAH so far has remained largely unconsidered. Patients One of the largest European male cohorts of patients with CAH in which sexuality in male patients with CAH was assessed. Methods Sexuality was evaluated in 91 sexually active male patients with CAH using questionnaires investigating sexual orientation, age at sexual initiation, sexual activity, satisfaction with sex life, and sexual problems, such as fears or dislike of sexual activity, lack or excessive sexual desire, difficulties getting aroused or reaching an orgasm, premature ejaculation, and no or incomplete erection. Results Sexuality in male patients with CAH was similar to European reference populations. If sexuality problems were present, they were less frequently reported by the most severely affected CAH males. Adducing a holistic perspective, sexual problems showed substantial association to psychological problems, such as anxiety and depression. Conclusions Sexuality in male patients with CAH in general was unaffected and sexuality problems seemed to be associated in particular with psychological problems. Because sexual health is a key factor of general health, we recommend that sexuality as well as psychological issues explicitly should be addressed in health care of patients with a CAH diagnosis, independent of sex.

Long-Term Outcomes of Congenital Adrenal Hyperplasia

“…In adult males with CAH sexual satisfaction was in general similar to controls/general population [96,116].…”

“…Long-term negative effects of genital surgery on genital/clitoral sensitivity can contribute to lower satisfaction with sexual function [ 115 ]. In adult males with CAH sexual satisfaction was in general similar to controls/general population [ 96 , 116 ].…”

Gender Identity and Sexual Orientation Identity in Women and Men Prenatally Exposed to Diethylstilbestrol

“…Results of numerous studies of women with CAH show that these women are less likely to be exclusively or almost exclusively heterosexual compared with women who do not have CAH, and some of these studies show a positive association with severity of the disorder (Hines, 2011a). In contrast, most studies in men with CAH find little difference in sexual orientation (Gehrmann et al, 2019). Androgen insensitivity syndrome (AIS) is an intersex condition that results in partial or complete inability of the cell to respond to androgens.…”

Acute Gastroenteritis Induced Adrenal Crisis in a patient with Congenital Adrenal Hyperplasia: A Case Report

“…Subtle findings such as hyperpigmentation of the scrotum or an enlarged phallus are frequently missed. 13 Hence males are particularly prone to the occurrence of associated salt adrenal crisis and death. 14 Female infants with classic 21-OHD are typically born with atypical genitalia characterized by clitoral enlargement labial fusion, and formation of a urogenital sinus and rarely, virilization may be so profound that genital atypia is unrecognized, and are assigned as males.…”