Management tactics for patients with sexual dysfunctions: a step-by-step algorithm based on the SFM questionnaire scores

Background. Sexual dysfunctions in men of fertile age are multifactorial in nature, which requires a systematic approach to diagnosis. The lack of standardized algorithms leads to hypo- and overdiagnosis of both psychogenic and organic forms.

Objective. To present a structured step-by-step algorithm for the diagnosis of sexual disorders in men, integrating the assessment of sexual constitution, psychometric scales (HADS, IPDE), sexual formula (SFM) and instrumental methods, as well as to prove the diagnostic necessity of each of these tools in a clinical sample.

Materials and methods. The study included 100 men aged 18-50 years (average age 35.4 ± 8.2 years) with complaints of sexual dysfunction. The developed algorithm has been consistently applied to all of them. Regardless of the algorithm, the final diagnosis was determined by an expert panel of four specialists (psychiatrist, urologist, endocrinologist, neurologist). ROC analysis was performed, sensitivity, specificity, predictive value, Cohen's agreement coefficient, Pearson correlation, and criterion χ2 were calculated.

Results. The overall accuracy of the algorithm was 90% (κ = 0.86; p < 0.001). Sensitivity in detecting organic pathology was 88.6%, specificity was 91.1%. ROC analysis of HADS (AUC = 0.92) confirmed the high predictive power of the anxiety scale. A strong correlation of a weak sexual constitution with endocrine disorders was revealed (r = 0.78; p < 0.001). The presence of personality disorders (IPDE) was significantly more often associated with a psychogenic etiology (p < 0.001). The structuring of complaints by SFM allowed us to correctly determine the diagnostic search vector in 94% of cases.

Conclusion. The proposed algorithm has high diagnostic accuracy. Each of the instruments used (SFM, sexual constitution, HADS, IPDE) makes an independent and significant contribution to differential diagnosis, which justifies their mandatory use in clinical practice in men aged 18-50 years.

1. Yagubov M. I., Kan I. Yu., Dobaeva N. V., Ayriyants I. R. Sexual dysfunction in anxiety disorders. Lechaschi Vrach. 2024; 10 (27): 107-116. (In Russ.)

2. Zhao S., Tang Z., Xie Q., et al. Association between epilepsy and risk of sexual dysfunction: A meta-analysis. Seizure. 2019; 65: 80-88. DOI: 10.1016/j.seizure.2019.01.004. Epub 2019 Jan 10. PMID: 30639977.

3. Pop-Busui R., Hotaling J., Braffett B. H., et al. DCCT/EDIC Research Group. Cardiovascular autonomic neuropathy, erectile dysfunction and lower urinary tract symptoms in men with type 1 diabetes: findings from the DCCT/EDIC. J Urol. 2015; 193 (6): 2045-2051. DOI: 10.1016/j.juro.2014.12.097. Epub 2015 Jan 10. Erratum in: J Urol. 2015 Sep; 194 (3): 855. DOI: 10.1016/j.juro.2015.07.030. PMID: 25584994; PMCID: PMC4439365.

4. Blair Y. A., Doherty L., Temprosa M., et al. Diabetes Prevention Program Research Group. Prevalence and predictors of erectile dysfunction among men in the diabetes prevention program outcomes study. J Diabetes Complications. 2024; 38 (2): 108669. DOI: 10.1016/j.jdiacomp.2023.108669. Epub 2023 Dec 29. PMID: 38219334; PMCID: PMC10922921.

5. Herder T., Spoelstra S. K., Peters A. W. M., et al. Sexual dysfunctionrelated to psychiatric disorders: a systematic review. J Sex Med. 2023; 20 (7): 965-976. DOI: 10.1093/jsxmed/qdad074. PMID: 37279603.

6. Karasheva B. G., Kibrick N. D. Sexual dysfunctions in the remote period of craniocerebral trauma. Sotsialnaya i klinicheskaya psikhiatriya. 23 (2): 106-109. (In Russ.)

7. Vasilchenko G. S. Sexopathology. Reference book. Moscow: Meditsina, 1990. 576 p. (In Russ.)

8. Yagubov M. I., Kan I. Yu., Dobayeva N. V., Ayriyants I. R. A modified method for assessing sexual function in men. Lechaschi Vrach. 2025; 4 (28): 42-48. (In Russ.)