{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T09:53:50Z","timestamp":1785232430253,"version":"3.55.0"},"reference-count":42,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2023,6,22]],"date-time":"2023-06-22T00:00:00Z","timestamp":1687392000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81804092"],"award-info":[{"award-number":["81804092"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,7,31]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Men with functional anorectal pain (FARP) report having erectile dysfunction (ED) and significant changes in psychological status.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Aim<\/jats:title>\n                  <jats:p>The study sought to investigate the risk factors associated with FARP among male Chinese outpatients, alongside the impact of FARP on patients' ED, depression, and anxiety.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This case-control study included 406 male participants, divided into FARP (n = 323) and healthy control (n = 73) groups. Demographic and disease characteristics were collected from the patients, and the 5-item International Index of Erectile Function, Patient Health Questionnaire\u20139, and Generalized Anxiety Disorder 7 were used to assess erectile function, depression, and anxiety symptoms. Baseline characteristics were described using descriptive statistics, logistic regression analysis identified factors influencing FARP, and its association with ED, depression, and anxiety were analyzed using linear and ordinal logistic regression analyses. Validity was ensured through subgroup and sensitivity analyses.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Outcomes<\/jats:title>\n                  <jats:p>The primary outcome was the association between FARP and ED, depression, and anxiety; the secondary outcome was the influencing factors of FARP such as lifestyle and work habits.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Men with FARP were likely to have more serious ED (59.8% vs 32.9%), depression (20.7% vs 4.1%), and anxiety(31.5% vs 12.3%); have lower 5-item International Index of Erectile Function scores; or have higher Patient Health Questionnaire\u20139 and Generalized Anxiety Disorder 7 scores compared with unaffected participants. Alcohol intake, family relationship, high work pressure, and prolonged bowel movements were significantly associated with FARP severity. The association between FARP with ED, depression, and anxiety was statistically significant in both crude and adjusted models. FARP was associated with 2.47, 2.73, and 2.67 times higher risk for ED, depression, and anxiety, respectively. An increase pain severity increased the incidence of ED (moderate pain: 4.80 times, P &amp;lt; .000; severe pain: 3.49 times, P &amp;lt; .004), depression (moderate pain: 1.85 times, P &amp;lt; .017; severe pain: 2.04 times, P &amp;lt; .037), and anxiety (moderate pain: 1.86 times, P &amp;lt; .014).<\/jats:p>\n                  <jats:p>Clinical Implications: Changes in lifestyle and work habits can help prevent pain symptom exacerbation. Attention to erection and psychological issues in patients with FARP and interdisciplinary comprehensive treatment may improve the efficacy.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Strengths and Limitations<\/jats:title>\n                  <jats:p>The study highlights a correlation between FARP and ED, depression, and anxiety, with pain severity being a contributing factor. However, the study's limitations include a small sample size and potential recall bias, and other sexual functions were not thoroughly explored.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Patients with FARP have a higher prevalence of ED, depression, and anxiety, which increase with pain severity. Factors such as alcohol intake, work pressure, prolonged sitting, and longer defecation times are significantly correlated with FARP pain severity.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jsxmed\/qdad082","type":"journal-article","created":{"date-parts":[[2023,6,24]],"date-time":"2023-06-24T16:03:07Z","timestamp":1687622587000},"page":"1085-1093","source":"Crossref","is-referenced-by-count":5,"title":["Erectile dysfunction, depression, and anxiety in patients with functional anorectal pain: a case-control study"],"prefix":"10.1093","volume":"20","author":[{"given":"Huang Fu","family":"Ma","sequence":"first","affiliation":[{"name":"China\u2013Japan Friendship Hospital Proctology Department, , Beijing 100029 , People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying Ying","family":"Zhang","sequence":"additional","affiliation":[{"name":"Zhejiang Chinese Medical University School of Basic Medical Sciences, , Zhejiang 310053 , People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiang","family":"Yu","sequence":"additional","affiliation":[{"name":"China\u2013Japan Friendship Hospital Proctology Department, , Beijing 100029 , People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jia Nan","family":"Li","sequence":"additional","affiliation":[{"name":"China\u2013Japan Friendship Hospital Proctology Department, , Beijing 100029 , People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li Xia","family":"Lai","sequence":"additional","affiliation":[{"name":"China\u2013Japan Friendship Hospital Proctology Department, , Beijing 100029 , People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8150-4731","authenticated-orcid":false,"given":"Yan Mei","family":"Wang","sequence":"additional","affiliation":[{"name":"China\u2013Japan Friendship Hospital Proctology Department, , Beijing 100029 , People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1088-9440","authenticated-orcid":false,"given":"Jian Xiong","family":"Ma","sequence":"additional","affiliation":[{"name":"Zhejiang Chinese Medical University , Zhejiang 310053 , People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,6,22]]},"reference":[{"issue":"616","key":"2023080101551207300_ref1","first-page":"1512","article-title":"Maladies fonctionnelles digestives: mise au point concernant la classification Rome IV [functional gastrointestinal disorders: update on the Rome IV criteria]","volume":"14","author":"Marx","year":"2018","journal-title":"Rev Med Suisse"},{"issue":"6","key":"2023080101551207300_ref2","doi-asserted-by":"crossref","first-page":"1430","DOI":"10.1053\/j.gastro.2016.02.009","article-title":"Functional anorectal disorders","volume":"150","author":"Rao","year":"2016","journal-title":"Gastroenterology"},{"issue":"9","key":"2023080101551207300_ref3","doi-asserted-by":"crossref","first-page":"985","DOI":"10.1111\/j.1365-2036.2009.03964.x","article-title":"Clinical trial: effects of botulinum toxin on Levator Ani syndrome-a double-blind, placebo-controlled study","volume":"29","author":"Rao","year":"2009","journal-title":"Aliment Pharmacol Ther"},{"key":"2023080101551207300_ref4","doi-asserted-by":"crossref","first-page":"1510","DOI":"10.1053\/j.gastro.2005.11.064","article-title":"Functional anorectal disorders","volume":"130","author":"Bharucha","year":"2006","journal-title":"Gastroenterology"},{"key":"2023080101551207300_ref5","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1007\/BF02054440","article-title":"Anorectal function and morphology in patients with sporadic proctalgia fugax","volume":"39","author":"Eckardt","year":"1996","journal-title":"Dis Colon Rectum"},{"key":"2023080101551207300_ref6","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1016\/S0140-6736(79)90642-1","article-title":"Colonic motility in proctalgia fugax","volume":"2","author":"Harvey","year":"1979","journal-title":"Lancet"},{"key":"2023080101551207300_ref7","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1136\/gut.39.4.609","article-title":"Paroxysmal anal hyperkinesis: a characteristic feature of proctalgia fugax","volume":"39","author":"Rao","year":"1996","journal-title":"Gut"},{"key":"2023080101551207300_ref8","doi-asserted-by":"crossref","first-page":"4447","DOI":"10.3748\/wjg.v17.i40.4447","article-title":"Chronic proctalgia and chronic pelvic pain syndromes: new etiologic insights and treatment options","volume":"17","author":"Chiarioni","year":"2011","journal-title":"World J Gastroenterol"},{"key":"2023080101551207300_ref9","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1136\/gut.36.4.581","article-title":"Hereditary proctalgia fugax and constipation: report of a second family","volume":"36","author":"Celik","year":"1995","journal-title":"Gut"},{"key":"2023080101551207300_ref10","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1097\/00042737-199702000-00023","article-title":"Internal anal sphincter myopathy causing proctalgia fugax and constipation: further clinical and radiological characterization in a patient","volume":"9","author":"Guy","year":"1997","journal-title":"Eur J Gastroenterol Hepatol"},{"key":"2023080101551207300_ref11","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1007\/s00508-006-0741-8","article-title":"Impaired anal sphincter function in professional cyclists","volume":"119","author":"Sauper","year":"2007","journal-title":"Wien Klin Wochenschr"},{"issue":"3","key":"2023080101551207300_ref12","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1097\/00042737-200503000-00016","article-title":"Hereditary vacuolar internal anal sphincter myopathy causing proctalgia fugax and constipation: a new case contribution","volume":"17","author":"de la Fernando","year":"2005","journal-title":"Eur J Gastroenterol Hepatol"},{"issue":"1","key":"2023080101551207300_ref13","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1186\/s13256-018-1856-z","article-title":"Proctalgia and constipation secondary to hypertrophic polyglucosan inclusion body myopathy of the internal anal sphincter: a case report","author":"Panagiotopoulou Ioanna","year":"2018","journal-title":"J Med Case Rep"},{"key":"2023080101551207300_ref14","doi-asserted-by":"crossref","first-page":"870","DOI":"10.1007\/DCR.0b013e318217586f","article-title":"Patient characteristics and treatment outcome in functional anorectal pain","volume":"54","author":"Atkin","year":"2011","journal-title":"Dis Colon Rectum"},{"issue":"2","key":"2023080101551207300_ref15","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1111\/1751-2980.12577","article-title":"Sleep quality and functional gastrointestinal disorders. A psychological issue","volume":"19","author":"Michel","year":"2018","journal-title":"J Dig Dis"},{"issue":"4","key":"2023080101551207300_ref16","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1007\/BF02237201","article-title":"Psychologic aspects in proctalgia","volume":"43","author":"Renzi","year":"2000","journal-title":"Dis Colon Rectum"},{"key":"2023080101551207300_ref17","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/S0140-6736(81)90117-3","article-title":"Electrophysiological study of motor nerve supply of pelvic floor","volume":"1","author":"Percy","year":"1981","journal-title":"Lancet"},{"key":"2023080101551207300_ref18","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1046\/j.1439-0272.2001.00408.x","article-title":"Injured external anal sphincter in erectile dysfunction","volume":"33","author":"Shafik","year":"2001","journal-title":"Andrologia"},{"key":"2023080101551207300_ref19","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1080\/014850199263048","article-title":"Physioanatomic entirety of external anal sphincter with bulbocavernosus muscle","volume":"42","author":"Shafik","year":"1999","journal-title":"Arch Androl"},{"key":"2023080101551207300_ref20","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1024\/0040-5930\/a001307","article-title":"Anorectal and perineal pain","volume":"78","author":"Kugener","year":"2021","journal-title":"Ther Umsch"},{"key":"2023080101551207300_ref21","doi-asserted-by":"crossref","first-page":"1471","DOI":"10.1016\/j.mayocp.2016.08.011","article-title":"Anorectal and pelvic pain","volume":"91","author":"Bharucha","year":"2016","journal-title":"Mayo Clin Proc"},{"issue":"2","key":"2023080101551207300_ref22","doi-asserted-by":"crossref","first-page":"121","DOI":"10.4103\/0253-7176.116232","article-title":"How to calculate sample size for different study designs in medical research?","volume":"35","author":"Charan","year":"2013","journal-title":"Indian J Psychol Med"},{"key":"2023080101551207300_ref23","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1038\/sj.ijir.3900472","article-title":"Development and evaluation of an abridged, 5-item version of the international index of erectile function (IIEF-5) as a diagnostic tool for erectile dysfunction","volume":"11","author":"Rosen","year":"1999","journal-title":"Int J Impot Res"},{"issue":"1","key":"2023080101551207300_ref24","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1186\/1471-2490-14-52","article-title":"Comparison of the simplified international index of erectile function (IIEF-5) in patients of erectile dysfunction with different pathophysiologies","volume":"14","author":"Tang","year":"2014","journal-title":"BMC Urol"},{"key":"2023080101551207300_ref25","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1016\/S0304-3959(00)00339-0","article-title":"Defining the clinically important difference in pain outcome measures","volume":"88","author":"Farrar","year":"2000","journal-title":"Pain"},{"key":"2023080101551207300_ref26","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1046\/j.1525-1497.2001.016009606.x","article-title":"The PHQ-9: validity of a brief depression severity measure","volume":"16","author":"Kroenke","year":"2001","journal-title":"J Gen Intern Med"},{"key":"2023080101551207300_ref27","doi-asserted-by":"crossref","first-page":"E191","DOI":"10.1503\/cmaj.110829","article-title":"Optimal cut-off score for diagnosing depression with the patient health questionnaire (PHQ-9): a meta-analysis","volume":"184","author":"Manea","year":"2012","journal-title":"CMAJ"},{"issue":"5","key":"2023080101551207300_ref28","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1016\/j.genhosppsych.2014.05.021","article-title":"Reliability and validity of the Chinese version of the patient health questionnaire (PHQ-9) in the general population","volume":"36","author":"Wang","year":"2014","journal-title":"Gen Hosp Psychiatry"},{"key":"2023080101551207300_ref29","doi-asserted-by":"crossref","first-page":"1092","DOI":"10.1001\/archinte.166.10.1092","article-title":"A brief measure for assessing generalized anxiety disorder: the GAD-7","volume":"166","author":"Spitzer","year":"2006","journal-title":"Arch Intern Med"},{"key":"2023080101551207300_ref30","doi-asserted-by":"crossref","first-page":"317","DOI":"10.7326\/0003-4819-146-5-200703060-00004","article-title":"Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection","volume":"146","author":"Kroenke","year":"2007","journal-title":"Ann Intern Med"},{"key":"2023080101551207300_ref31","first-page":"200","article-title":"Reliability and validity of a generalized anxiety scale in general hospital outpatients","volume":"12","author":"He","year":"2010","journal-title":"Shanghai Arch Psychiatry"},{"key":"2023080101551207300_ref32","doi-asserted-by":"crossref","first-page":"1569","DOI":"10.1007\/BF01303162","article-title":"U.S. householder survey of functional gastrointestinal disorders. Prevalence, sociodemography, and health impact","volume":"38","author":"Drossman","year":"1993","journal-title":"Dig Dis Sci"},{"issue":"12","key":"2023080101551207300_ref33","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1007\/BF01295979","article-title":"Proctalgia fugax","volume":"26","author":"Thompson","year":"1981","journal-title":"Dig Dis Sci"},{"key":"2023080101551207300_ref34","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1007\/BF02050352","article-title":"Manometric and radiologic investigations and biofeedback treatment of chronic idiopathic anal pain","volume":"34","author":"Grimaud","year":"1991","journal-title":"Dis Colon Rectum"},{"key":"2023080101551207300_ref35","first-page":"192","article-title":"Relationship between haemorrhoidal grade and toilet habits","volume":"91","author":"Antonio","year":"2020","journal-title":"Ann Ital Chir"},{"issue":"4","key":"2023080101551207300_ref36","first-page":"572","article-title":"Dietary habits associated with internal hemorrhoidal disease: a case-control study","volume":"97","author":"Labidi","year":"2019","journal-title":"Tunis Med"},{"key":"2023080101551207300_ref37","first-page":"41","article-title":"Etiology of thrombosed external hemorrhoids","volume":"66","author":"Wronski","year":"2012","journal-title":"Postepy Hig Med Dosw"},{"key":"2023080101551207300_ref38","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1038\/sj.ijir.3900623","article-title":"The anocavernosal erectile dysfunction syndrome. II anal fissure and erectile dysfunction","volume":"12","author":"Shafik","year":"2000","journal-title":"Int J Impot Res"},{"key":"2023080101551207300_ref39","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1111\/j.1439-0272.1996.tb02774.x","article-title":"Extrapelvic cavernous nerve stimulation in erectile dysfunction","volume":"28","author":"Shafik","year":"1996","journal-title":"Human study. Andrologia"},{"key":"2023080101551207300_ref40","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1016\/j.jsxm.2021.11.011","article-title":"The temporal association of depression and anxiety in young men with erectile dysfunction","volume":"19","author":"Manalo","year":"2022","journal-title":"J Sex Med"},{"key":"2023080101551207300_ref41","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1515\/med-2017-0015","article-title":"The clinical characteristics of patients with chronic idiopathic anal pain","volume":"12","author":"Mao","year":"2017","journal-title":"Open Med"},{"issue":"3","key":"2023080101551207300_ref42","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1080\/13548506.2020.1764598","article-title":"Pain intensity, pain-related anxiety, and somatic and mental health symptoms: a test among latinx young adults","volume":"26","author":"Zvolensky","year":"2021","journal-title":"Psychol Health Med"}],"container-title":["The Journal of Sexual Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jsm\/article-pdf\/20\/8\/1085\/51007783\/qdad082.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jsm\/article-pdf\/20\/8\/1085\/51007783\/qdad082.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,1]],"date-time":"2023-08-01T01:55:43Z","timestamp":1690854943000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jsm\/article\/20\/8\/1085\/7205314"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6,22]]},"references-count":42,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2023,6,22]]},"published-print":{"date-parts":[[2023,7,31]]}},"URL":"https:\/\/doi.org\/10.1093\/jsxmed\/qdad082","relation":{},"ISSN":["1743-6095","1743-6109"],"issn-type":[{"value":"1743-6095","type":"print"},{"value":"1743-6109","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,8]]},"published":{"date-parts":[[2023,6,22]]}}}