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The aim of the study is to investigate the impact of risk factors of sexual dysfunctions, including organic, relational, and psychological determinants of erectile function, in men living with HIV younger than 50 years old.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A cross\u2010sectional, observational study was conducted in men living with HIV\u00a0&lt;\u00a050 years. The questionnaire International Index of Erectile Function\u201015 was used to assess the prevalence and degree of erectile dysfunction. The structured interview of erectile dysfunction was used to explore the organic (Scale 1), relational (Scale 2), and psychological (Scale 3) components of erectile dysfunction. Total testosterone, estradiol, and dihydrotestosterone were measured by liquid chromatography\u2010tandem\u2010mass spectrometry; free testosterone was calculated by the Vermeulen equation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 313 consecutive men living with HIV were prospectively enrolled (median age 47.0 years; median HIV\u2010infection duration 16.2 years). 187 patients (59.7%) had erectile dysfunction, with a higher prevalence of non\u2010heterosexual (138 out of 187, 73.8%) than heterosexual patients (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.003). Patients with erectile dysfunction showed a worse score of structured interview of erectile dysfunction scale 3 compared to patients without erectile dysfunction (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.025); the International Index of Erectile Function\u201015 was inversely related to structured interview of erectile dysfunction scale 3 (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.042). No difference was found for sex steroids (total testosterone, estradiol, free testosterone, and dihydrotestosterone) between men living with HIV with and without erectile dysfunction. In the multivariate analysis sexual orientation, and lack of stable relationships were major determinants for erectile dysfunction. Only 35 of 187 patients with erectile dysfunction (18.7%) reported the use of erectile dysfunction medications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Within the multidimensional network of erectile dysfunction in men living with HIV, the psychological component is predominant, highlighting the contribution of peculiar factors related to HIV distress (e.g., fear of virus transmission, stigma) rather than gonadal status and other classical risk factors. In contrast to the high prevalence, only a few patients reported the use of erectile dysfunction medications suggesting a general under\u2010management of such issues.<\/jats:p><\/jats:sec>","DOI":"10.1111\/andr.13372","type":"journal-article","created":{"date-parts":[[2022,12,31]],"date-time":"2022-12-31T15:54:46Z","timestamp":1672502086000},"page":"954-969","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Determinants of sexual function in men living with HIV younger than 50 years old: Focus on organic, relational, and psychological issues"],"prefix":"10.1111","volume":"11","author":[{"given":"Sara","family":"De Vincentis","sequence":"first","affiliation":[{"name":"Department of Biomedical, Metabolic and Neural Sciences Unit of Endocrinology University of Modena and Reggio Emilia  Modena Italy"},{"name":"Department of Medical Specialties Unit of Endocrinology Azienda Ospedaliero\u2010Universitaria di Modena, 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