Erectile dysfunction, depression, and anxiety in patients with functional anorectal pain: a case-control study
Authors: Ma Huang Fu , Zhang Ying Ying , Yu Qiang , Li Jia Nan , Lai Li Xia , Wang Yan Mei , Ma Jian Xiong 
Published: June 2023

Abstract

Background
Men with functional anorectal pain (FARP) report having erectile dysfunction (ED) and significant changes in psychological status.

Aim
The study sought to investigate the risk factors associated with FARP among male Chinese outpatients, alongside the impact of FARP on patients' ED, depression, and anxiety.

Methods
This case-control study included 406 male participants, divided into FARP (n = 323) and healthy control (n = 73) groups. Demographic and disease characteristics were collected from the patients, and the 5-item International Index of Erectile Function, Patient Health Questionnaire–9, and Generalized Anxiety Disorder 7 were used to assess erectile function, depression, and anxiety symptoms. Baseline characteristics were described using descriptive statistics, logistic regression analysis identified factors influencing FARP, and its association with ED, depression, and anxiety were analyzed using linear and ordinal logistic regression analyses. Validity was ensured through subgroup and sensitivity analyses.

Outcomes
The primary outcome was the association between FARP and ED, depression, and anxiety; the secondary outcome was the influencing factors of FARP such as lifestyle and work habits.

Results
Men with FARP were likely to have more serious ED (59.8% vs 32.9%), depression (20.7% vs 4.1%), and anxiety(31.5% vs 12.3%); have lower 5-item International Index of Erectile Function scores; or have higher Patient Health Questionnaire–9 and Generalized Anxiety Disorder 7 scores compared with unaffected participants. Alcohol intake, family relationship, high work pressure, and prolonged bowel movements were significantly associated with FARP severity. The association between FARP with ED, depression, and anxiety was statistically significant in both crude and adjusted models. FARP was associated with 2.47, 2.73, and 2.67 times higher risk for ED, depression, and anxiety, respectively. An increase pain severity increased the incidence of ED (moderate pain: 4.80 times, P &lt; .000; severe pain: 3.49 times, P &lt; .004), depression (moderate pain: 1.85 times, P &lt; .017; severe pain: 2.04 times, P &lt; .037), and anxiety (moderate pain: 1.86 times, P &lt; .014).
Clinical Implications: Changes in lifestyle and work habits can help prevent pain symptom exacerbation. Attention to erection and psychological issues in patients with FARP and interdisciplinary comprehensive treatment may improve the efficacy.

Strengths and Limitations
The study highlights a correlation between FARP and ED, depression, and anxiety, with pain severity being a contributing factor. However, the study's limitations include a small sample size and potential recall bias, and other sexual functions were not thoroughly explored.

Conclusion
Patients with FARP have a higher prevalence of ED, depression, and anxiety, which increase with pain severity. Factors such as alcohol intake, work pressure, prolonged sitting, and longer defecation times are significantly correlated with FARP pain severity.