Page 87 - Remedial Andrology

Coronary disease and heart failure
Ageing
HIV infection
Body-building and eating disorders
Erectile dysfunction
Prostatitis/chronic pelvic pain syndrome

7.2.3 Risk factors
In an international survey aimed at estimating the prevalence and correlates of sexual problems in 13,882
women and 13,618 men from 29 countries (Global Study of Sexual Attitudes and Behaviours), risk factors for
male LSD were age 60-69 and 70-80 years, poor overall health, vascular diseases, being a current smoker,
belief that ageing reduces sex, divorce in the past 3 years, financial problems in the last 3 years, major
depression, being worried about the future of a relationship and less than one sexual relation in a week [193]. In
a recent study that determined the factors associated with LSD in a large sample of middle-aged German men,
PE, ED, and lower urinary tract symptoms were associated with LSD [925]. In contrast, men having more than
two children, higher frequency of solo-masturbation, perceived importance of sexuality, and higher sexual self-
esteem were less likely to have LSD [925].

7.3 Diagnostic work-up
7.3.1 Assessment questionnaires
Sexual Desire Inventory (SDI) evaluates different components influencing the development and expression
of sexual desire [939]. This self-administered questionnaire consists of 14 questions that weigh the strength,
frequency, and significance of an individual’s desire for sexual activity with others and by themselves. The SDI
suggests that desire can be split into two categories: dyadic and solitary desire. While dyadic desire refers to
“interest in or a wish to engage in sexual activity with another person and desire for sharing and intimacy with
another”, solitary desire refers to “an interest in engaging in sexual behaviour by oneself, and may involve a
wish to refrain from intimacy and sharing with others” [939].

7.3.2 Physical examination and investigations
Similar to other forms of sexual dysfunctions, a thorough medical and sexual history must be obtained from
men who complain of LSD. The depressive symptoms of the patients must be assessed [940] and relationship
problems (e.g., conflict with the sexual partner) must be questioned. In the presence of accompanying
symptoms suggestive of endocrinological problems, circulating total testosterone [941], prolactin [942] and
thyroid hormones [671] levels can be evaluated.

7.4 Disease management
Treatment of LSD should be tailored according to the underlying aetiology.

7.4.1 Psychological intervention
Data on efficacy of psychological interventions for LSD are scarce. Accordingly, recommendations must be
interpreted with caution. Psychological interventions with a focus on cognitive and behavioural strategies may
be beneficial for LSD in men [430, 943] (Figure 10). Since both members of a couple may experience age-
related changes concurrently and interdependently, it could be helpful to address the sexual health needs of
the ageing couple (including LSD) as a whole rather than treating the individual patient [944].

86 SEXUAL AND REPRODUCTIVE HEALTH - MARCH 2021