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  • Review Article
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Male sexual dysfunction and HIV—a clinical perspective

Nature Reviews Urology volume 11, pages 99–109 (2014)Cite this article

Subjects

Key Points

  • Sexual problems, particularly erectile dysfunction, are more common in men with HIV than in the general population

  • Sexual dysfunction is often overlooked in men with HIV due to the reluctance of physicians or their patients to address sex-related issues

  • The clinical management of male sexual dysfunction requires a multidisciplinary approach involving specialists in infectious diseases and sexual medicine

  • Factors related to HIV infection, such as fear of virus transmission, body image change, HIV-related comorbidities, stigma, obligatory use of condoms, and safer sex should be considered

  • The treatment should take into account the risk of HIV transmission to partners, and always be accompanied by counselling on safe sexual practices

Abstract

Sexual dysfunction in men with HIV is often overlooked by clinicians owing to many factors, including the taboo of sexuality. The improved life expectancy of patients with HIV requires physicians to consider their general wellbeing and sexual health with a renewed interest. However, data on sexual dysfunction in those with HIV are scarce. Erectile dysfunction (ED) is the most common sexual dysfunction in men, with a prevalence of ∼30–50% and is frequent even in men <40 years of age. HIV infection itself is the strongest predictor of ED, and many factors related to the infection—fear of virus transmission, changes in body image, HIV-related comorbidities, infection stigma, obligatory condom use—all impair erectile function. The diagnosis and treatment of sexual dysfunction is based on a multidisciplinary approach, which involves specialists in both infectious diseases and sexual medicine. Particular attention should be paid to the promotion of safer sex in these patients. This Review, describes the issues surrounding sexual dysfunction in men with HIV and aims to provide clinical advice for the physician treating these patients.

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Figure 1: The prevalence of ED in healthy men with and without HIV stratified by age group.
Figure 2: Pathological and psychological factors affecting ED pathogenesis in men with HIV.
Figure 3: Diagnosis and therapeutic approach to ED in men with HIV.

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References

  1. Samaras, K. Endocrine disease in HIV infection. Best Pract. Res. Clin. Endocrinol. Metab. 25, vii–viii (2011).

    Article  PubMed  Google Scholar 

  2. Sellmeyer, D. E. & Grunfeld, C. Endocrine and metabolic disturbances in human immunodeficiency virus infection and the acquired immune deficiency syndrome. Endocr. Rev. 17, 518–532 (1996).

    CAS  PubMed  Google Scholar 

  3. Palella, F. J. Jr et al. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. N. Engl. J. Med. 338, 853–860 (1998).

    Article  PubMed  Google Scholar 

  4. Zirilli, L. et al. Hypopituitarism and HIV-infection: a new comorbidity in the HAART era? J. Endocrinol. Invest. 31, 33–38 (2008).

    CAS  PubMed  Google Scholar 

  5. Brown, T. T. The effects of HIV-1 infection on endocrine organs. Best Pract. Res. Clin. Endocrinol. Metab. 25, 403–413 (2011).

    Article  PubMed  Google Scholar 

  6. Collazos, J. Sexual dysfunction in the highly active antiretroviral therapy era. AIDS Rev. 9, 237–245 (2007).

    PubMed  Google Scholar 

  7. Neuhaus, J. et al. Risk of all-cause mortality associated with nonfatal AIDS and serious non-AIDS events among adults infected with HIV. AIDS 24, 697–706 (2010).

    Article  PubMed  PubMed Central  Google Scholar 

  8. Cotter, A. G. & Powderly, W. G. Endocrine complications of human immunodeficiency virus infection: hypogonadism, bone disease and tenofovir-related toxicity. Best Pract. Res. Clin. Endocrinol. Metab. 25, 501–515 (2011).

    Article  CAS  PubMed  Google Scholar 

  9. Zirilli, L. et al. GH response to GHRH plus arginine (GHRH+ARG) is impaired in lipoatrophic women with human immunodeficiency virus compared with controls. Eur. J. Endocrinol. 166, 415–424 (2012).

    Article  CAS  PubMed  Google Scholar 

  10. Rochira, V. et al. Premature decline of serum total testosterone in HIV-infected men in the HAART-era. PLoS ONE 6, e28512 (2011).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Luzi, K. et al. Body image is a major determinant of sexual dysfunction in stable HIV-infected women. Antivir. Ther. 14, 85–92 (2009).

    PubMed  Google Scholar 

  12. Guaraldi, G. et al. Sexual dysfunction in HIV-infected men: role of antiretroviral therapy, hypogonadism and lipodystrophy. Antivir. Ther. 12, 1059–1065 (2007).

    PubMed  Google Scholar 

  13. Scanavino Mde, T. Sexual dysfunctions of HIV-positive men: Associated factors, pathophysiology issues, and clinical management. Adv. Urol. 2011, 854792 (2011).

    PubMed  Google Scholar 

  14. Rochira, V. et al. Sex steroids and sexual desire mechanism. J. Endocrinol. Invest. 26, 29–36 (2003).

    Article  CAS  PubMed  Google Scholar 

  15. Carani, C., Rochira, V. & Granata, A. R. M. in Oxford Textbook of Endocrinology and Diabetes (eds Wass, J. A. & Stewart. P. M.) 1449–1458 (Oxford University Press, 2011).

    Book  Google Scholar 

  16. Lewis, R. W. et al. Definitions/epidemiology/risk factors for sexual dysfunction. J. Sex. Med. 7, 1598–1607 (2010).

    Article  PubMed  Google Scholar 

  17. Feldman, H. A., Goldstein, I., Hatzichristou, D. G., Krane, R. J. & McKinlay, J. B. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J. Urol. 151, 54–61 (1994).

    Article  CAS  PubMed  Google Scholar 

  18. Laumann, E. O., Paik, A. & Rosen, R. C. Sexual dysfunction in the United States: prevalence and predictors. JAMA 281, 537–544 (1999).

    Article  CAS  PubMed  Google Scholar 

  19. Braun, M. et al. Epidemiology of erectile dysfunction: results of the 'Cologne Male Survey'. Int. J. Impot. Res. 12, 305–311 (2000).

    Article  CAS  PubMed  Google Scholar 

  20. Chew, K. K., Stuckey, B., Bremner, A., Earle, C. & Jamrozik, K. Male erectile dysfunction: its prevalence in western Australia and associated sociodemographic factors. J. Sex. Med. 5, 60–69 (2008).

    Article  PubMed  Google Scholar 

  21. Ghalayini, I. F. et al. Erectile dysfunction in a Mediterranean country: results of an epidemiological survey of a representative sample of men. Int. J. Impot. Res. 22, 196–203 (2010).

    Article  CAS  PubMed  Google Scholar 

  22. Christensen, B. S. et al. Sexual dysfunctions and difficulties in Denmark: prevalence and associated sociodemographic factors. Arch. Sex. Behav. 40, 121–132 (2011).

    Article  PubMed  Google Scholar 

  23. Newshan, G., Taylor, B. & Gold, R. Sexual functioning in ambulatory men with HIV/AIDS. Int. J. STD AIDS. 9, 672–676 (1998).

    Article  CAS  PubMed  Google Scholar 

  24. Rosen, R. C., Cappelleri, J. C. & Gendrano, N. 3rd. The International Index of Erectile Function (IIEF): a state-of-the-science review. Int. J. Impot. Res. 14, 226–244 (2002).

    Article  CAS  PubMed  Google Scholar 

  25. Jones, M., Klimes, I. & Catalan, J. Psychosexual problems in people with HIV infection: controlled study of gay men and men with haemophilia. AIDS Care 6, 587–593 (1994).

    Article  CAS  PubMed  Google Scholar 

  26. Tindall, B., Forde, S., Goldstein, D., Ross, M. W. & Cooper, D. A. Sexual dysfunction in advanced HIV disease. AIDS Care 6, 105–107 (1994).

    Article  CAS  PubMed  Google Scholar 

  27. Hijazi, L., Nandwani, R. & Kell, P. Medical management of sexual difficulties in HIV-positive individuals. Int. J. STD AIDS 13, 587–592 (2002).

    Article  PubMed  Google Scholar 

  28. Martínez, E., Collazos, J., Mayo, J. & Blanco, M. S. Sexual dysfunction with protease inhibitors. Lancet 353, 810–811 (1999).

    Article  PubMed  Google Scholar 

  29. Schrooten, W. et al. Sexual dysfunction associated with protease inhibitor containing highly active antiretroviral treatment. AIDS 15, 1019–1023 (2001).

    Article  CAS  PubMed  Google Scholar 

  30. Sollima, S. et al. Protease inhibitors and erectile dysfunction. AIDS 15, 2331–2333 (2001).

    Article  CAS  PubMed  Google Scholar 

  31. Collazos, J., Martínez, E., Mayo, J. & Ibarra, S. Sexual dysfunction in HIV-infected patients treated with highly active antiretroviral therapy. J. Acquir. Immune Defic. Syndr. 31, 322–326 (2002).

    Article  PubMed  Google Scholar 

  32. Colson, A. E. et al. Male sexual dysfunction associated with antiretroviral therapy. J. Acquir. Immune Defic. Syndr. 30, 27–32 (2002).

    Article  PubMed  Google Scholar 

  33. Lallemand, F., Salhi, Y., Linard, F., Giami, A. & Rozenbaum, W. Sexual dysfunction in 156 ambulatory HIV-infected men reciving highly active antiretroviral therapy combinations with and without protease inhibitors. J. Aquir. Immune Defic. Syndr. 30, 187–190 (2002).

    Article  CAS  Google Scholar 

  34. Cove, J. & Petrak, J. Factors associated with sexual problems in HIV-positive gay men. Int. J. STD AIDS 15, 732–736 (2004).

    Article  PubMed  Google Scholar 

  35. Ende, A. R., Lo Re, V. 3rd, DiNubile, M. J. & Mounzer, K. Erectile dysfunction in an urban HIV-positive population. AIDS Patient Care STDS 20, 75–78 (2006).

    Article  PubMed  Google Scholar 

  36. Asboe, D. et al. Sexual dysfunction in HIV-positive men is multi-factorial: a study of prevalence and associated factors. AIDS Care 19, 955–965 (2007).

    Article  CAS  PubMed  Google Scholar 

  37. Crum-Cianflone, N. F. et al. Erectile dysfunction and hypogonadism among men with HIV. AIDS Patient Care STDS 21, 9–19 (2007).

    Article  PubMed  Google Scholar 

  38. Moreno-Pérez, O. et al. Risk factors for sexual and erectile dysfunction in HIV-infected men: the role of protease inhibitors. AIDS 24, 255–264 (2010).

    Article  PubMed  Google Scholar 

  39. Guaraldi, G. et al. Erectile dysfunction is not a mirror of endothelial dysfunction in HIV-infected patients. J. Sex. Med. 9, 1114–1121 (2012).

    Article  PubMed  Google Scholar 

  40. Zona, S. et al. Erectile dysfunction is more common in young to middle-aged HIV-infected men than in HIV-uninfected men. J. Sex. Med. 9, 1923–1930 (2012).

    Article  PubMed  Google Scholar 

  41. Hart, T. A. et al. The cumulative effects of medication use, drug use, and smoking on erectile dysfunction among men who have sex with men. J. Sex. Med. 9, 1106–1113 (2012).

    Article  PubMed  PubMed Central  Google Scholar 

  42. De Ryck, I. et al. Sexual satisfaction among men living with HIV in Europe. AIDS Behav. 16, 225–230 (2012).

    Article  CAS  PubMed  Google Scholar 

  43. Vansintejan, J., Janssen, J., Van De Vijver, E., Vandevoorde, J. & Devroey, D. The Gay Men Sex Studies: prevalence of sexual dysfunctions in Belgian HIV(+) gay men. HIV AIDS (Auckl.) 5, 89–96 (2013).

    Google Scholar 

  44. Wang, Q. et al. The prevalence of erectile dysfunction and its association with antiretroviral therapy in HIV-infected men: the Swiss HIV Cohort Study. Antivir. Ther. 18, 337–344 (2013).

    Article  CAS  PubMed  Google Scholar 

  45. Fakoya, A. et al. British HIV Association, BASHH and FSRH guidelines for the management of the sexual and reproductive health of people living with HIV infection 2008. HIV Med. 9, 681–720 (2008).

    Article  CAS  PubMed  Google Scholar 

  46. Rhoden, E. L., Telöken, C., Sogari, P. R. & Vargas Souto, C. A. The use of the simplified International Index of Erectile Function (IIEF-5) as a diagnostic tool to study the prevalence of erectile dysfunction. Int. J. Impot. Res. 14, 245–250 (2002).

    Article  CAS  PubMed  Google Scholar 

  47. Graham, C. A. et al. Erection loss in association with condom use among young men attending a public STI clinic: potential correlates and implications for risk behaviour. Sex Health 3, 255–260 (2006).

    Article  PubMed  Google Scholar 

  48. Basson, R. & Schultz, W. W. Sexual sequelae of general medical disorders. Lancet 369, 409–424 (2007).

    Article  PubMed  Google Scholar 

  49. Basson, R., Rees, P., Wang, R., Montejo, A. L. & Incrocci, L. Sexual function in chronic illness. J. Sex. Med. 7, 374–388 (2010).

    Article  PubMed  Google Scholar 

  50. Trotta, M. P., Ammassari, A., Murri, R., Monforte, A. D. & Antinori, A. Sexual dysfunction in HIV infection. Lancet 369, 905–906 (2007).

    Article  PubMed  Google Scholar 

  51. Reiss, P. P., Battegay, M., Clumeck, N., Mulcahy, F. & European AIDS Clinical Society (EACS) Executive Guidelines Members. EACS Guidelines [online], (2011).

  52. Granata, A., Bancroft, J. & Del Rio, G. Stress and the erectile response to intracavernosal prostaglandin E1 in men with erectile dysfunction. Psychosom. Med. 57, 336–344 (1995).

    Article  CAS  PubMed  Google Scholar 

  53. Petrone, L. et al. Structured interview on erectile dysfunction (SIEDY): a new, multidimensional instrument for quantification of pathogenetic issues on erectile dysfunction. Int. J. Impot. Res. 15, 210–220 (2003).

    Article  CAS  PubMed  Google Scholar 

  54. Guay, A. T. ED2: erectile dysfunction = endothelial dysfunction. Endocrinol. Metab. Clin. North. Am. 36, 453–463 (2007).

    Article  PubMed  Google Scholar 

  55. Corona, G. et al. Psychobiologic correlates of the metabolic syndrome and associated sexual dysfunction. Eur. Urol. 50, 595–604 (2006).

    Article  PubMed  Google Scholar 

  56. Corona, G. et al. Is metabolic syndrome a useless category in subjects with high cardiovascular risk? Results from a cohort study in men with erectile dysfunction. J. Sex. Med. 8, 504–511 (2011).

    Article  PubMed  Google Scholar 

  57. Murri, R. et al. Nonnucleoside reverse transcriptase inhibitor-containing regimens are associated with increased satisfaction with sexual life. J. Acquir. Immune Defic. Syndr. 34, 532–534 (2003).

    Article  PubMed  Google Scholar 

  58. Guaraldi, G. et al. Multidisciplinary approach to the treatment of metabolic and morphologic alterations of HIV-related lipodystrophy. HIV Clin. Trials 7, 97–106 (2006).

    Article  PubMed  Google Scholar 

  59. Amini Lari, M., Parsa, N., Marzban, M., Shams, M. & Faramarzi, H. Depression, testosterone concentration, sexual dysfunction and methadone use among men with hypogonadism and HIV Infection. AIDS Behav. 16, 2236–2243 (2012).

    Article  PubMed  Google Scholar 

  60. Richardson, D., Lamba, H., Goldmeier, D., Nalabanda, A. & Harris, J., R. Factors associated with sexual dysfunction in men with HIV infection. Int. J. STD AIDS 17, 764–767 (2006).

    Article  PubMed  Google Scholar 

  61. Shindel, A. W., Horberg, M. A., Smith, J. F. & Breyer, B., N. Sexual dysfunction, HIV, and AIDS in men who have sex with men. AIDS Patient Care STDS 25, 341–349 (2011).

    Article  PubMed  PubMed Central  Google Scholar 

  62. Dirks, H. et al. Substance use and sexual risk behaviour among HIV-positive men who have sex with men in specialized out-patient clinics. HIV Med. 13, 533–540 (2012).

    CAS  PubMed  Google Scholar 

  63. Bancroft, J., Carnes, L. & Janssen, E. Unprotected anal intercourse in HIV-positive and HIV-negative gay men: the relevance of sexual arousability, mood, sensation seeking, and erectile problems. Arch. Sex. Behav. 34, 299–305 (2005).

    Article  PubMed  Google Scholar 

  64. Foresta, C. et al. Clinical and metabolic evaluation of subjects with erectile dysfunction: a review with a proposal flowchart. Int. J. Androl. 32, 198–211 (2009).

    Article  CAS  PubMed  Google Scholar 

  65. Shamloul, R. & Ghanem, H. Erectile dysfunction. Lancet 381, 153–165 (2013).

    Article  CAS  PubMed  Google Scholar 

  66. Altman, D. et al. Men who have sex with men: stigma and discrimination. Lancet 380, 439–445 (2012).

    Article  PubMed  Google Scholar 

  67. Coyne, K. et al. The International Index of Erectile Function: development of an adapted tool for use in HIV-positive men who have sex with men. J. Sex. Med. 7, 769–774 (2010).

    Article  PubMed  Google Scholar 

  68. Sanders, S. A., Milhausen, R. R., Crosby, R. A., Graham, C. A. & Yarber, W. L. Do phosphodiesterase type 5 inhibitors protect against condom-associated erection loss and condom slippage? J. Sex. Med. 6, 1451–1456 (2009).

    Article  CAS  PubMed  Google Scholar 

  69. Granata, A. R., Rochira, V., Lerchl, A., Marrama, P. & Carani, C. Relationship between sleep-related erections and testosterone levels in men. J. Androl. 18, 522–527 (1997).

    CAS  PubMed  Google Scholar 

  70. Lenzi, A. & Jannini, E. A. The andrologist from medicine of reproduction to sexual medicine: the Italian experience. Int. J. Androl. 28, 9–13 (2005).

    Article  PubMed  Google Scholar 

  71. Nettles, C. D., Benotsch, E. G. & Uban, K. A. Sexual risk behaviors among men who have sex with men using erectile dysfunction medictions. AIDS Patient Care STDS 23, 1017–1023 (2009).

    Article  PubMed  Google Scholar 

  72. Pescatori, E. S., Giammusso, B., Piubello, G., Gentile, V. & Farina, F. P. Journey into the realm of requests for help presented to sexual medicine specialists: introducing male sexual distress. J. Sex. Med. 4, 762–770 (2007).

    Article  PubMed  Google Scholar 

  73. Bechara, A., Casabè, A., De Bonis, W., Helien, A. & Bertolino, M. V. Recreational use of phosphodiesterase type 5 inhibitors by healthy young men. J. Sex. Med. 7, 3736–3742 (2010).

    Article  PubMed  Google Scholar 

  74. Richardson, D., Goldmeier, D., Bell, C. & Lamba, H. Do phosphodiesterase 5 inhibitors promote onward transmission of HIV in men who have sex with men? Sex. Transm. Infect. 83, 250 (2007).

    Article  PubMed  PubMed Central  Google Scholar 

  75. Graham, N. A., Polles, A. & Gold, M. S. Performance enhancing, non-prescription use of erectile dysfunction medications. J. Addict. Dis. 25, 61–68 (2006).

    Article  Google Scholar 

  76. Kell, P., Sadeghi-Nejad, H. & Price, D. An ethical dilemma: erectile dysfunction in the HIV-positive patient: to treat or not to treat. Int. J. STD AIDS 13, 355–357 (2002).

    Article  CAS  PubMed  Google Scholar 

  77. Sadeghi-Nejad, H. et al. Lecture 5: erectile dysfunction in the HIV-positive male: a review of medical, legal and ethical considerations in the age of oral pharmacotherapy. Int. J. Impot. Res. 3, S49–S53 (2000).

    Article  Google Scholar 

  78. Rosen, R. C. et al. The Bolger conference on PDE-5 inhibition and HIV risk: implications for health policy and prevention. J. Sex. Med. 3, 960–975 (2006).

    Article  CAS  PubMed  Google Scholar 

  79. Romanelli, F. & Smith, K. M. Recreational use of sildenafil by HIV-positive and -negative homosexual/bisexual males. Ann. Pharmacother. 38, 1024–1030 (2004).

    Article  CAS  PubMed  Google Scholar 

  80. Rochira, V., Balestrieri, A., Madeo, B., Granata, A. R. & Carani, C. Sildenafil improves sleep-related erections in hypogonadal men: evidence from a randomized, placebo-controlled, crossover study of a synergic role of both testosterone and sildenafil on penile erections. J. Androl. 27, 165–175 (2006).

    Article  CAS  PubMed  Google Scholar 

  81. Gallego, L., Barreiro, P. & López-Ibor, J. J. Psychopharmacological treatments in HIV patients under antiretroviral therapy. AIDS Rev. 14, 101–111 (2012).

    PubMed  Google Scholar 

  82. Lau, J. T., Kim, J. H. & Tsui, H. Y. Prevalence and sociocultural predictors of sexual dysfunction among Chinese men who have sex with men in Hong Kong. J. Sex. Med. 5, 2766–2779 (2008).

    Article  PubMed  Google Scholar 

  83. Shindel, A. W., Vittinghoff, E. & Breyer, B. N. Erectile dysfunction and premature ejaculation in men who have sex with men. J. Sex. Med. 9, 576–584 (2012).

    Article  PubMed  PubMed Central  Google Scholar 

  84. Martin, J. & Volberding, P. HIV and premature aging: A field still in its infancy. Ann. Intern. Med. 153, 477–479 (2010).

    Article  PubMed  Google Scholar 

  85. Deeks, S. G. HIV infection, inflammation, immunosenescence, and aging. Annu. Rev. Med. 62, 141–155 (2011).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  86. Marcus, E. N. Bones of contention: premature aging and bone loss emerge as new concerns with HIV. Posit. Aware 23, 28–29 (2011).

    PubMed  Google Scholar 

  87. Guaraldi, G. et al. Premature age-related comorbidities among HIV-infected persons compared with the general population. Clin. Infect. Dis. 53, 1120–1126 (2011).

    Article  PubMed  Google Scholar 

  88. Sadeghi-Nejad, H. Special considerations in the management of erectile dysfunction in the HIV-positive patient. Curr. Sex. Health Rep. 1, 49–53 (2004).

    Article  Google Scholar 

  89. World Health Organization. Defining sexual health: report of a technical consultation on sexual health [online], (2006).

  90. Havlir, D. & Beyrer, C. The beginning of the end of AIDS? N. Engl. J. Med. 367, 685–687 (2012).

    Article  CAS  PubMed  Google Scholar 

  91. Korkes, F., Costa-Matos, A., Gasperini, R., Reginato, P. V. & Perez, M. D. Recreational use of PDE5 inhibitors by young healthy men: recognizing this issue among medical students. J. Sex. Med. 5, 2414–2418 (2008).

    Article  PubMed  Google Scholar 

  92. Somers, K. J. & Philbrick, K. L. Sexual dysfunction in the medically ill. Curr. Psychiatry Rep. 9, 247–254 (2007).

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors thank Professor Paola Ugolini, Visiting Assistant Professor, Department of Romance Languages & Literatures, SUNY Buffalo, New York, USA for manuscript proofreading and editing.

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  1. Department of Biomedical, Metabolic and Neural Sciences, Section of Endocrinology, University of Modena & Reggio Emilia, Via Campi 287, Modena, 41125, Italy

    Daniele Santi, Giulia Brigante & Vincenzo Rochira

  2. Department of Medicine and Medical Specialties, Metabolic Clinic, Infectious and Tropical Disease Unit, University of Modena & Reggio Emilia, Via del Pozzo 71, Modena, 41124, Italy

    Stefano Zona & Giovanni Guaraldi

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V. Rochira, D. Santi and G. Brigante researched data for the article. All authors contributed equally to the writing of the article and made substantial contribution to discussion of the content. V. Rochira and G. Guaraldi reviewed and edited the manuscript before publication.

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Santi, D., Brigante, G., Zona, S. et al. Male sexual dysfunction and HIV—a clinical perspective. Nat Rev Urol 11, 99–109 (2014). https://doi.org/10.1038/nrurol.2013.314

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