The relationship between perceived stress and erectile function in patients with psychogenic erectile dysfunction: the mediating role of fatigue

BACKGROUND: Psychological stress is closely linked to psychogenic erectile dysfunction (pED). In our recent clinical work, many pED patients report high levels of stress and fatigue, leading us to hypothesize these factors may play a contributory role in the development of pED. AIM: This research aims to elucidate how fatigue may mediate the connection between perceived stress and erectile function in individuals with pED. METHODS: We assessed 125 patients diagnosed with pED. Erectile dysfunction severity was measured using the International Index of Erectile Function-5 (IIEF-5) and the Nocturnal Penile Tumescence and Rigidity (NPTR) tests. Perceived stress and fatigue were evaluated with the Perceived Stress Scale-14 and the Multidimensional Fatigue Inventory-20. Data were descriptively analyzed, and correlations among the 3 variables were examined. The mediating effect was assessed using the bootstrap method within the SPSS PROCESS macro. OUTCOMES: The outcomes include the relationship between perceived stress and erectile function and the mediating role of fatigue in patients with pED. RESULTS: Our findings revealed a substantial negative correlation between perceived stress and erectile function (β = -0.604, P < .001). Fatigue emerged as a mediator in this relationship (β = -0.214, P < .05). The significance of the indirect effect of perceived stress via fatigue was confirmed through non-parametric bootstrapping (95% CI = -0.426 to -0.153), with fatigue contributing 26.46% to the total effect. CLINICAL IMPLICATIONS: These findings have provided new ideas for interventions in the clinical management of pED, particularly for improving erectile function by simultaneously managing fatigue and stress. STRENGTHS AND LIMITATIONS: This study explores the broader context of pED and provides a new perspective on the etiology of pED. The main drawback of this study is its lack of generalizability, as it was conducted within a monocultural and specific social context. CONCLUSION: Our findings of this study suggest that targeting both fatigue and perceived stress may be effective strategies for improving erectile function in patients with pED, providing valuable insights for research and clinical practice.