Clinical phenotypes and multidomain sexual function in men with ejaculatory and orgasmic dysfunction: a cross-sectional analysis of the CLIMAX Registry
Leona Hariharan, Sara Perelmuter, Regina Hill, Rachel S Rubin, Alan W ShindelAbstract
Introduction
Delayed ejaculation (DE) and anorgasmia/anejaculation are frequently grouped together, yet whether they represent distinct clinical phenotypes or points along a shared spectrum remains unclear. Relationships between erectile function and other sexual function domains have been characterized primarily in men with erectile dysfunction rather than ejaculatory or orgasmic dysfunction. We sought to characterize clinical phenotypes and multidomain sexual function among men with ejaculatory or orgasmic dysfunction using baseline data from the CLIMAX Registry.
Methods
We performed a cross-sectional secondary analysis of baseline data from 43 participants enrolled in the prospective, multi-institutional CLIMAX Registry. The phenotype analysis included isolated DE (n = 14) and isolated anorgasmia/anejaculation (n = 13), defined as selection of these diagnoses without another ejaculatory/orgasmic diagnosis. These groups were compared using clinical, psychosocial, and sexual function characteristics. A separate analysis of the broader registry cohort evaluated relationships between erectile function and other sexual function domains. Participants with complete International Index of Erectile Function erectile function domain (IIEF-EF) scores were stratified by erectile function severity (IIEF-EF ≥17 [none/mild erectile dysfunction] vs IIEF-EF ≤16 [moderate/severe erectile dysfunction]). Continuous variables were compared using Mann–Whitney U tests, categorical variables using Fisher exact tests, and erectile function and orgasmic function were evaluated using Pearson correlation.
Results
The overall cohort included 43 participants (mean age, 56.4 ± 15.7 years). Participants with isolated anorgasmia/anejaculation were significantly older than those with isolated DE (67.6 ± 14.6 vs 53.3 ± 12.8 years; P = .004). Beck Depression Inventory scores were higher among participants with DE (14.3 ± 12.3 vs 4.8 ± 4.1; P = .013), whereas standardized sexual function domains did not differ significantly between phenotypes. Notably, 6 of 13 participants (46.2%) in the combined anorgasmia/anejaculation category reported ability to achieve orgasm. Erectile and orgasmic function were not significantly correlated (r = −0.03; P = .84; n = 37), and 7 of 22 participants (31.8%) with unassisted erections sufficient for penetration reported inability to achieve orgasm. Moderate/severe erectile dysfunction was associated with lower intercourse satisfaction (P = .017) but not orgasmic function.
Conclusions
Diagnostic phenotype and erectile function alone incompletely characterized sexual function in this exploratory cohort. These findings support multidimensional phenotyping of uncommon ejaculatory and orgasmic disorders and highlight the value of prospective registries for clinical characterization.