A clinical guide to rare male sexual disorders. Nature, 2023

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Review Article
Published: 05 September 2023
A clinical guide to rare male sexual disorders
Murat Gül, Mikkel Fode, Ahmet Urkmez, Paolo Capogrosso, Marco Falcone, Selcuk Sarikaya, Ioannis Sokolakis, Afonso Morgado, Andrey Morozov, Maarten Albersen, Giorgio Ivan Russo & Ege Can Serefoglu
Nature Reviews Urology (2023)

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.