Sexual activities, erectile dysfunction, and the use of sexual management strategies among assigned males with genital ablation interests.

Background: Assigned males with genital ablation interests may be at higher risk of having erectile dysfunction (ED), especially those who have gone through androgen suppressing pharmacological therapies, orchiectomy and/or penectomy. Aim: To determine the prevalence and severity of ED in assigned males with castration interests, the types of management strategies they use and what factors are associated with using these strategies. Methods: We launched an online survey on the Eunuch Archive website to better understand how common ED is, as well as sexual frequencies, and the use of sexual management strategies among assigned males with genital ablation interests. Outcomes: ED and sexual activity frequencies, preferred role in sexual activities, and previous use of sexual management strategies. Results: Data from 363 assigned male individuals (50.7 ± 15.6 years old; 23.6% and 3.7% had been orchiectomized and penectomized respectively) showed that 11.2% reported having ED 25-50% of the time, 12.8% had ED 50-75% of the time, and 22.9% had ED 75-100% of the time. Yet a large proportion remained sexually active. For example, 63.5%, 56.2% and 8.8% reported watching porn, masturbating, and having partnered sex several times a week respectively. During partnered sex, 13% of the participants preferred to be in the insertive role, whereas nearly 40% preferred to be in the receptive role. A quarter preferred non-penetrative sex. To maintain sexual activities, commonly used strategies included oral medication (38.8%), vacuum erection devices (25.6%), and strap-on dildo (17.5%). Penile sleeve, penile injection and penile support device were rarely used (<10%). Clinical Implications: Data from our study can be used by clinicians to advise their clients, for example individuals with genital ablation interest who seek to maintain their sexual activities. Strengths & Limitations: Participants completed validated questionnaires. Data were collected online and could not be independently verified. Conclusions: A strong interest in genital ablation is often associated with a desire to be less sexual. Consistent with that is a high incidence of ED in this population. However, many men with exceptional interests in genital ablation nevertheless remain sexually active and use various strategies to maintain penetrative sex.