Association between sleep quality, depression, and sexual dysfunction in men seeking treatment for sexual dysfunction: a multicenter prospective analysis

Background: Sleep quality, depression, and sexual dysfunction are interrelated yet under-investigated areas, particularly in clinical urology practice. Given the high prevalence of these conditions and their impact on men’s health, our study aimed to explore the associations between these factors in men seeking treatment for sexual dysfunction. Methods: This prospective multicenter study included 121 men aged 18–65 years with sexual dysfunction, recruited from eight urology clinics. Patients were assessed using the Pittsburgh Sleep Quality Index (PSQI), the International Index of Erectile Function (IIEF), the Premature Ejaculation Diagnostic Tool (PEDT), and the Beck Depression Inventory (BDI). Hormonal parameters were also evaluated. Participants were classified according to sleep quality and depression severity. Comparative and logistic regression analyses were performed. Results: Poor sleep quality was found in 72.7% of patients. These individuals had lower sexual desire and overall satisfaction scores, and higher PEDT scores (p < 0.05). Moderate to severe erectile dysfunction and premature ejaculation were more prevalent in this group. Depression severity was also significantly higher among those with poor sleep (p = 0.03). Logistic regression analysis showed independent associations between poor sleep quality, older age, erectile dysfunction severity, lower sexual desire, and the presence of premature ejaculation. Conclusions: Poor sleep quality is associated with increased sexual dysfunction and depressive symptoms. Evaluation of sleep and mood should be integrated into the clinical assessment of male patients presenting with sexual complaints.

Sleep wake disorders; Erectile dysfunction; Premature ejaculation; Depression; Sexual dysfunction

[1] Anderson D, Laforge J, Ross MM, Vanlangendonck R, Hasoon J, Viswanath O, et al. Male sexual dysfunction. Health Psychology Research. 2022; 10: 37533.

[2] Wang H, Zhao M, Zhang J, Yan B, Gao Q, Guo J. Traditional Chinese medicine regulates inflammatory factors in chronic prostatitis/chronic pelvic pain syndrome: a review. Integrative Medicine in Nephrology and Andrology. 2023; 10: e00001.

[3] Abdelwahab SI, Taha MME. A systematic literature review of natural products for male sexual dysfunction. Urologia Journal. 2024; 91: 647–658.

[4] Manfredi C, Boeri L, Sokolakis I, Schifano N, Pyrgidis N, Fernández-Pascual E, et al. Cell therapy for male sexual dysfunctions: systematic review and position statements from the European Society for Sexual Medicine. Sexual Medicine. 2024; 12: qfad071.

[5] Kohn TP, Kohn JR, Haney NM, Pastuszak AW, Lipshultz LI. The effect of sleep on men’s health. Translational Andrology and Urology. 2020; 9: S178–S185.

[6] Pastuszak AW, Moon YM, Scovell J, Badal J, Lamb DJ, Link RE, et al. Poor sleep quality predicts hypogonadal symptoms and sexual dysfunction in male nonstandard shift workers. Urology. 2017; 102: 121–125.

[7] Arnal PJ, Drogou C, Sauvet F, Regnauld J, Dispersyn G, Faraut B, et al. Effect of sleep extension on the subsequent testosterone, cortisol and prolactin responses to total sleep deprivation and recovery. Journal of Neuroendocrinology. 2016; 28: 12346.

[8] Lamon S, Morabito A, Arentson-Lantz E, Knowles O, Vincent GE, Condo D, et al. The effect of acute sleep deprivation on skeletal muscle protein synthesis and the hormonal environment. Physiological Reports. 2021; 9: e14660.

[9] Zhang J, He M, Wang X, Jiang H, Huang J, Liang S. Association of sleep duration and risk of mental disorder: a systematic review and meta-analysis. Sleep and Breathing. 2024; 28: 261–280.

[10] Chen CM, Kuo CY, Wu MN, Hung JY, Hsu CY, Tsai MJ. Increased risk of major depressive disorder in sleep apnea patients in Taiwan. Scientific Reports. 2021; 11: 765.

[11] Gutierrez-Velarde P, Valladares-Garrido MJ, Peralta CI, Vera-Ponce VJ, Grandez-Urbina JA. Poor sleep quality and erectile dysfunction in students from a Peruvian University: a cross-sectional study. Frontiers in Public Health. 2023; 11: 932718.

[12] Kim M, Um YH, Kim TW, Kim SM, Seo HJ, Jeong JH, et al. Association between age and sleep quality: findings from a community health survey. Sleep Medicine Research. 2021; 12: 155–160.

[13] Kay DB, Dzierzewski JM. Sleep in the context of healthy aging and psychiatric syndromes. Sleep Medicine Clinics. 2015; 10: 11–15.

[14] Smith L, Grabovac I, Veronese N, Soysal P, Isik AT, Stubbs B, et al. Sleep quality, duration, and associated sexual function at older age: findings from the English Longitudinal Study of Ageing. The Journal of Sexual Medicine. 2019; 16: 427–433.

[15] Chen KF, Liang SJ, Lin CL, Liao WC, Kao CH. Sleep disorders increase risk of subsequent erectile dysfunction in individuals without sleep apnea: a nationwide population-based cohort study. Sleep Medicine. 2016; 17: 64–68.

[16] Su L, Zhang SZ, Zhu J, Wu J, Jiao YZ. Effect of partial and total sleep deprivation on serum testosterone in healthy males: a systematic review and meta-analysis. Sleep Medicine. 2021; 88: 267–273.

[17] Wittert G. The relationship between sleep disorders and testosterone in men. Asian Journal of Andrology. 2014; 16: 262–265.

[18] Mogavero MP, Cosentino FII, Lanuzza B, Tripodi M, Lanza G, Aricò D, et al. Increased serum prolactin and excessive daytime sleepiness: an attempt of proof-of-concept study. Brain Sciences. 2021; 11: 1574.

[19] Andersen ML, Alvarenga TF, Mazaro-Costa R, Hachul HC, Tufik S. The association of testosterone, sleep, and sexual function in men and women. Brain Research. 2011; 1416: 80–104.

[20] Smith I, Salazar I, RoyChoudhury A, St-Onge MP. Sleep restriction and testosterone concentrations in young healthy males: randomized controlled studies of acute and chronic short sleep. Sleep Health. 2019; 5: 580–586.

[21] Hernández-Pérez JG, Taha S, Torres-Sánchez LE, Villasante-Tezanos A, Milani SA, Baillargeon J, et al. Association of sleep duration and quality with serum testosterone concentrations among men and women: NHANES 2011–2016. Andrology. 2024; 12: 518–526.

[22] Zhu Z, Wu S, Lin X, Wang C, Zhou X. Association of sleep duration with serum estradiol concentrations among American men and women: evidence from NHANES 2013–2016. International Journal of Endocrinology. 2025; 2025: 7863420.

[23] Zhang F, Xiong Y, Qin F, Yuan J. Short sleep duration and erectile dysfunction: a review of the literature. Nature and Science of Sleep. 2022; 14: 1945–1961.

[24] Kobori Y, Koh E, Sugimoto K, Izumi K, Narimoto K, Maeda Y, et al. The relationship of serum and salivary cortisol levels to male sexual dysfunction as measured by the International Index of Erectile Function. International Journal of Impotence Research. 2009; 21: 207–212.

[25] Castro-Diehl C, Diez Roux AV, Redline S, Seeman T, McKinley P, Sloan R, et al. Sleep duration and quality in relation to autonomic nervous system measures: the multi-ethnic study of atherosclerosis (MESA). Sleep. 2016; 39: 1927–1940.

[26] Bain AR, Weil BR, Diehl KJ, Greiner JJ, Stauffer BL, DeSouza CA. Insufficient sleep is associated with impaired nitric oxide-mediated endothelium-dependent vasodilation. Atherosclerosis. 2017; 265: 41–46.

[27] Irwin MR, Olmstead R, Carroll JE. Sleep disturbance, sleep duration, and inflammation: a systematic review and meta-analysis of cohort studies and experimental sleep deprivation. Biological Psychiatry. 2016; 80: 40–52.

[28] Cho JW, Duffy JF. Sleep, sleep disorders, and sexual dysfunction. World Journal of Men’s Health. 2019; 37: 261–275.

[29] Cantone E, Massanova M, Crocetto F, Barone B, Esposito F, Arcaniolo D, et al. The relationship between obstructive sleep apnoea and erectile dysfunction: an underdiagnosed link? A prospective cross-sectional study. Andrologia. 2022; 54: e14504.

[30] Seehuus M, Pigeon W. The sleep and sex survey: relationships between sexual function and sleep. Journal of Psychosomatic Research. 2018; 112: 59–65.

[31] Mun JK, Choi SJ, Kang MR, Hong SB, Joo EY. Sleep and libido in men with obstructive sleep apnea syndrome. Sleep Medicine. 2018; 52: 158–162.

[32] Zhang W, Zhang Y, Gao J, Peng D, Zhang Y, Wu X, et al. Poor sleep quality is an independent risk factor for acquired premature ejaculation. Nature and Science of Sleep. 2022; 14: 255–263.

[33] Zheng Z, Pan J, Chen Z, Gao P, Gao J, Jiang H, et al. The association between shift work, shift work sleep disorders and premature ejaculation in male workers. BMC Public Health. 2024; 24: 1772.

[34] Dewitte M, Bettocchi C, Carvalho J, Corona G, Flink I, Limoncin E, et al. a psychosocial approach to erectile dysfunction: position Statements from the European Society of Sexual Medicine (ESSM). Sexual Medicine. 2021; 9: 100434.

[35] Keten T, Eroğlu Ü, Özercan AY, Coşer Ş, Çelikkaleli F, Öztürk E, et al. The mess of erectile dysfunction, anxiety disorder, and decreased self-esteem. Comprehensive Medicine. 2023; 15: 350–355.

[36] Elgellaie A, Larkin T, Kaelle J, Mills J, Thomas S. Plasma prolactin is higher in major depressive disorder and females, and associated with anxiety, hostility, somatization, psychotic symptoms and heart rate. Comprehensive Psychoneuroendocrinology. 2021; 6: 100049.

[37] Gupta S, Mukherjee A, Biswas S, Bose S, Nath S, Das HN. Evaluation of endocrine parameters as predictor of major depressive disorder. Comprehensive Psychoneuroendocrinology. 2017; 39: 766–769.

[38] Hu D, Zhang Y, Zhang Y, Liu Y, Han J. The relationship between social support and erectile dysfunction in middle-aged and older males. Frontiers in Public Health. 2024; 12: 1332561.

[39] Rezali MS, Mohamad Anuar MF, Abd Razak MA, Chong ZL, Shaharudin AB, Kassim MSA, et al. Prevalence and associated factors of moderate to severe erectile dysfunction among adult men in Malaysia. Scientific Reports. 2023; 13: 21483.