Prevalence, Etiopathogenesis, and Clinical Presentation of Sexual Dysfunction in Competitive Athletes Compared with the General Population: A Comprehensive Narrative Review Addressing Sport-Specific Characteristics
DOI:
https://doi.org/10.12775/QS.2026.63.73574Keywords
sexual dysfunction, competitve athletes, sports psychiatry, RED-S, hypogonadotropic hypogonadism, sports medicine, anabolic-androgenic steroids, pudendal neuropathyAbstract
Background: Although integral to overall well-being, sexual health remains a frequently overlooked component of sports medicine. Unlike the general population, the etiology of sexual dysfunction in elite athletes appears to be multifactorial and sport-specific, often involving relative energy deficiency in sport (RED-S), neuroendocrine stress, pelvic microtrauma, doping, and psychogenic burdens.
Aim & Methods: This narrative review synthesizes current evidence and international guidelines to evaluate the etiopathogenesis of sexual dysfunction across different sports and to outline multidisciplinary management strategies.
Results: Evidence indicates that the pathogenesis is markedly heterogeneous. In endurance and aesthetic disciplines, energy deficits and overtraining may suppress the hypothalamic-pituitary-gonadal axis, potentially leading to functional hypothalamic amenorrhea and related dyspareunia in women, and exercise-induced hypogonadotropic hypogonadism in men. Cycling and equestrian sports seem associated with neuromechanical injuries, particularly pudendal neuropathy, which may predispose athletes to erectile dysfunction and anorgasmia. Contact sports may increase the risk of secondary pituitary insufficiency following repetitive mild traumatic brain injury. In strength disciplines, body image disturbances and the sequelae of anabolic-androgenic steroid use appear as leading contributors. Across all sports, psychiatric morbidities and performance anxiety act as significant compounding factors, often exacerbated by systemic underreporting.
Conclusions: Sexual dysfunction in athletes is a multidimensional, underdiagnosed condition that suggests a need for an individualized, biopsychosocial approach. Effective management likely necessitates interdisciplinary collaboration to address underlying pathologies through energy optimization, targeted psychotherapy, and cautiously applied, anti-doping-compliant pharmacotherapy.
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