Gaps in diagnosis and unmet healthcare needs in male sexual dysfunction and chronic health conditions: insights from a German population-based study.

BACKGROUND: Chronic health conditions (CHC), both somatic and mental, increase the risk of sexual dysfunctions (SD) in men, which are associated with reduced quality of life. Despite existing guidelines, help-seeking remains low due to barriers such as shame and limited access, with many turning to anonymous sources. Representative data on care pathways and treatment preferences across SD domains and CHC subgroups is lacking. This study examines SD diagnoses, help-seeking, and treatment preferences in men with and without CHC meeting ICD-11 SD criteria to inform more tailored care. RESULTS: Of all N = 1815 (unweighted N = 1787) cis-men, n = 265 (16.6%) fulfilled positive ICD-11 SD criteria and were included in this study (mean age 49.2; SD = 16.9 years). CHC were present in 74.1% of men, of whom 23.2% had self-reported SD. While the internet remains the most used information source, urologists were the preferred information sources and dialogue partners for sexual health concerns. Men with mental health conditions (MH +) valued psychotherapists and psychiatrists more highly in this regard. Shame was the most cited barrier to help-seeking, particularly present in men with MH + , with 50.4%. Only 46.6% of men with SD symptoms meeting the ICD-11 criteria reported an SD diagnosis. Previous therapy was rare, with 3-4 months of waiting times. Medication was the most commonly used treatment in the past. As preferred treatment, men with CHC prioritized medication (42.6% vs. 36.7% in men without CHC), whereas men without CHC also favored relaxation methods (29.3%). Desired treatment goals included improved sexual and relationship satisfaction. Digital tools such as apps or websites were also of interest, with reimbursement considered essential. CONCLUSION: Despite the high burden, SD diagnoses remain rare, and help-seeking behaviors vary, especially between men with somatic versus mental CHC. Regular healthcare contact may offer opportunities to address sexual health in trusted settings. Interventions should target both sexual and relationship satisfaction. Digital solutions can help close treatment gaps and improve access to specialized care. However, given low interest and adherence-particularly among men with CHC-tailored approaches are essential. Reimbursement within the German healthcare system is needed to lower financial barriers.