Dimensions of sexual self-concept and sexual dysfunctions in middle-aged men: results of the Bavarian Men's Health-Study.

Sexual self-concept is multidimensional and a key construct in understanding people's sexuality. The etiology as well as the relationship and causal direction between its different dimensions and sexual dysfunctions are not fully understood. A population-based cohort (N = 5665) of 50-year-old men completed questionnaires on dimensions of sexual self-concept (toughness, body image, sexual self-esteem, and perceived pressure with regard to sexuality) and sexual dysfunctions. Associations were assessed using multivariable linear regression analyses. Erectile dysfunction (ED), lifelong/acquired and subjective/variable premature ejaculation (PE), and low libido (LL) were associated with a more negative body image (p < 0.001), lower sexual self-esteem (p < 0.001), and higher perceived pressure with regard to sexuality (p < 0.001). ED, lifelong/acquired and subjective/variable PE were associated with toughness (p < 0.001), an association with LL could not be shown. A negative sexual self-concept was independently associated with sexual dysfunctions in middle-aged men highlighting that sexual self-concept represents a relevant factor in the biopsychosocial conception of sexual dysfunctions. The causal direction of this relationship needs to be determined in longitudinal studies.