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A clinical guide to rare male sexual disorders

Nature Reviews Urology volume 21, pages 35–49 (2024)Cite this article

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Abstract

Conditions referred to as ‘male sexual dysfunctions’ usually include erectile dysfunction, ejaculatory disorders and male hypogonadism. However, some less common male sexual disorders exist, which are under-recognized and under-treated, leading to considerable morbidity, with adverse effects on individuals’ sexual health and relationships. Such conditions include post-finasteride syndrome, restless genital syndrome, post-orgasmic illness syndrome, post-selective serotonin reuptake inhibitor (SSRI) sexual dysfunction, hard–flaccid syndrome, sleep-related painful erections and post-retinoid sexual dysfunction. Information about these disorders usually originates from case–control trials or small case series; thus, the published literature is scarce. As the aetiology of these diseases has not been fully elucidated, the optimal investigational work-up and therapy are not well defined, and the available options cannot, therefore, adequately address patients’ sexual problems and implement appropriate treatment. Thus, larger-scale studies — including prospective trials and comprehensive case registries — are crucial to better understand the aetiology, prevalence and clinical characteristics of these conditions. Furthermore, collaborative efforts among researchers, health-care professionals and patient advocacy groups will be essential in order to develop evidence-based guidelines and novel therapeutic approaches that can effectively address these disorders. By advancing our understanding and refining treatment strategies, we can strive towards improving the quality of life and fostering healthier sexual relationships for individuals suffering from these rare sexual disorders.

Key points

  • Rare male sexual disorders include post-finasteride syndrome, restless genital syndrome, post-orgasmic illness syndrome, post-elective serotonin reuptake inhibitor sexual dysfunction, hard–flaccid syndrome, sleep-related painful erections and post-retinoid sexual dysfunction.

  • The exact mechanisms of these disorders are unclear and the conditions could involve both physical and psychological components.

  • Post-finasteride syndrome symptoms can persist for months or even years after discontinuing treatment with 5α reductase inhibitors.

  • Symptoms of restless genital syndrome include unwanted and unpleasant genital sensations, often perceived as an imminent orgasm without sexual desire or stimuli, and a sense of restlessness in the genital area.

  • Post-orgasmic illness syndrome presents as a combination of local (mucosal) and systemic flu-like and allergic symptoms.

  • Post-selective serotonin reuptake inhibitor sexual dysfunction symptoms can occur even with a single dose of the drug and are not necessarily dose dependent.

  • Hard–flaccid syndrome often occurs following penile trauma, such as excessive masturbation.

  • In post-retinoid sexual dysfunction, symptoms can occur during retinoid treatment and persist after discontinuation, whereas in some patients symptoms can appear or worsen after isotretinoin is stopped.

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Fig. 1: Restless genital syndrome has the characteristics of small-fibre sensory neuropathy of the dorsal nerve of the penis, possibly triggered by hormonal changes, drugs, stress, trauma and other unknown contributors.
Fig. 2: The hypothetical pathophysiology of post-orgasmic illness syndrome in men.
Fig. 3: Potential pathophysiology of hard–flaccid syndrome.

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Acknowledgements

This Review was written by past and present members of the European Association of Urology Young Academic Urologists (EAU-YAU) Working Group Sexual and Reproductive Health. Current members of the group are Dr G. I. Russo (IT), Dr M. Capece (IT), Dr P. Capogrosso (IT), Dr M. Falcone (IT), Dr C. Manfredi (IT), Dr A. Ribeiro Morgado (PT), Dr S. Sarikaya (TR), Dr I. Sokolakis (GR), Dr G. Tsampoukas (GB), Dr M. D. Deger (TR), Dr B. García Gómez (ES), Dr A. O. Morozov (RU) and Mrs N. Stivalet Schoentgen (FR).

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Authors and Affiliations

  1. Department of Urology, Selcuk University School of Medicine, Urology, Konya, Turkey

    Murat Gül

  2. Department of Urology, Copenhagen University Hospital – Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark

    Mikkel Fode

  3. Department of Urology, St. Elizabeth’s Medical Center, Boston University School of Medicine, Boston, MA, USA

    Ahmet Urkmez

  4. Department of Urology, ASST Sette Laghi, Circolo and Fondazione Macchi Hospital, Varese, Italy

    Paolo Capogrosso

  5. Department of Urology, Molinette Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy

    Marco Falcone

  6. Department of Urology, Gulhane Training and Research Hospital, Ankara, Turkey

    Selcuk Sarikaya

  7. 2nd Department of Urology, Aristotle University of Thessaloniki, Medical School Thessaloniki,Greece, Thessaloniki, Greece

    Ioannis Sokolakis

  8. Department of Urology, Centro Hospitalar São João, Porto, Portugal

    Afonso Morgado

  9. Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia

    Andrey Morozov

  10. Department of Urology, University Hospitals Leuven, Leuven, Belgium

    Maarten Albersen

  11. Urology section, Department of Surgery, University of Catania, Catania, Italy

    Giorgio Ivan Russo

  12. Department of Urology, Biruni University, School of Medicine, Istanbul, Turkey

    Ege Can Serefoglu

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  1. Murat Gül
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Contributions

All authors researched data for the article. M.G. and M.F. contributed substantially to the discussion of the content. All authors wrote the article. M.G., M.F. and G.I.R. reviewed and/or edited the manuscript before submission.

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Related links

NIH GARD postorgasmic illness syndrome: https://rarediseases.info.nih.gov/diseases/10809/postorgasmic-illness-syndrome

Propecia help: https://www.propeciahelp.com/accutane-side-effects-isotretinoin/

RxISK: www.RxISK.org

WHO sexual health: https://www.who.int/health-topics/sexual-health

Glossary

Bushen Yinao

An ancient Chinese herbal medicine made of 15 different medical herbs used for clinical anti-ageing147.

Sabal fruit

A small palm tree native to south-eastern USA. The medicinal part is the ripe, dried berry145.

Wu Ling

A traditional Chinese medicine consisting of a rare type of fungus used in traditional Chinese medicine for the treatment of major depressive disorders146.

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Gül, M., Fode, M., Urkmez, A. et al. A clinical guide to rare male sexual disorders. Nat Rev Urol 21, 35–49 (2024). https://doi.org/10.1038/s41585-023-00803-5

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