Low Frequency of Sexual Intercourse, Discrepancy Between Erectile Function Measures, and Sexual Satisfaction Among...

To examine sexual behavior, erectile function, and sexual satisfaction among middle-aged Japanese men using nationwide survey data.

This secondary analysis used data from a 2023 nationwide online survey of male sexual dysfunction in Japan. Men aged 45-64 years were included. Sexual behavior was assessed by frequencies of sexual intercourse and masturbation. Erectile function was assessed using the Sexual Health Inventory for Men (SHIM) and Erection Hardness Score (EHS), with ED defined as EHS ≤ 2. Sexual satisfaction was assessed using the overall satisfaction domain of the International Index of Erectile Function. Multivariable logistic regression identified factors associated with ED.

Overall, 2314 men were analyzed (mean age, 53.8 ± 5.6 years). Sexual intercourse was infrequent: 48.1% reported intercourse less than once per year and 35.1% within the past 6 months, whereas 45.9% reported masturbation once or twice weekly. ED prevalence differed substantially by assessment method: 82.1% according to SHIM versus 26.9% according to EHS. Men with EHS-defined ED had significantly lower overall sexual satisfaction scores than those without ED (p < 0.001), although satisfaction scores substantially overlapped. Older age, diabetes mellitus, hypertension, mental illness, and sleep apnea syndrome were independently associated with ED.

Among middle-aged Japanese men, the prevalence of ED varied substantially according to the assessment method, while EHS-defined ED was associated with lower overall sexual satisfaction despite substantial overlap in satisfaction scores. These findings support considering both erectile function and subjective sexual satisfaction when assessing sexual health.