Military personnel who have received combat injuries experience long-term consequences of severe injuries that have a significant impact on quality of life and sexual function. There is growing evidence that post-traumatic stress disorder, which develops secondary to injury, is associated with higher rates of erectile dysfunction, decreased sexual desire, and premature ejaculation. Combat-related injuries may also have significant consequences for male fertility, as they typically serve during their peak sexual activity years. The aim of the work was to comparative analysis of the International Index of Erectile Function and quality of life indicators in men with combat injuries and sexual dysfunction accompanied by chronic pelvic pain and premature ejaculation, before and after treatment.

Methods. The study was based on the results of a questionnaire survey of 76 men aged 20–53 years, injured as a result of combat operations (mostly as a result of polytraumatic injuries) before and after treatment using the International Index of Erectile Function-5 questionnaire and the SF-36 questionnaire to assess the quality of life. After establishing the appropriate diagnoses, the patients were divided into two groups. Group 1 incluted patients with erectile dysfunction of mixed genesis, accompanied by chronic pelvic pain, included combat participants with endothelial dysfunction, metabolic syndrome, dyslipidemia, hypertension, coronary artery disease, late hypogonadism (n = 48); Group 2 incluted patients with erectile dysfunction of mixed genesis and premature ejaculation combatants with endothelial dysfunction, metabolic syndrome, dyslipidemia, hypertension, coronary heart disease, late hypogonadism (n = 28).

Results. It was shown that the elimination of pelvic pain after successful etiotropic therapy of patients in group 1, along with multifaceted treatment of ED (pathogenetic therapy), leads to a significant improvement in the indicators of general health, role-physical functioning, role-emotional functioning, life activity, mental health, and the absence of pain. Elimination of the cause of erectile function through psychotherapy with potentiation of the effect by taking sildenafil leads to a significant increase in the average score of all MIEF-5 domains, and therefore an improvement in sexual function as a whole. After treatment of patients in group 2, a significant increase in the average score of the absence of pain from 84,9 to 95,1 is observed. The average score for vital activity significantly increased from 63,9 to 70,2 (p < 0,05), and there was also a trend towards improvement in the mental health domain from 68,1 to 74,3.

Conclusions. The results of the study indicate a significant prevalence of mixed forms of erectile dysfunction, accompanied by chronic pelvic pain or premature ejaculation, which bothers men after suffering combat injuries. As a result of the treatment of erectile dysfunction of mixed genesis with chronic pelvic pain, indicators of general health, role-physical functioning, role-emotional functioning, life activity, mental health, absence of pain sensation and sexual function in general improve. After comprehensive treatment of men with erectile dysfunction of mixed genesis and premature ejaculation, indicators of pain sensation, life activity, satisfaction from sexual intercourse and sexual life significantly improve, and there is also a tendency to improve mental health.

Keywords: combat trauma, erectile dysfunction, quality of life, MIEF-5 questionnaire, SF-36 questionnaire

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1. Mental health care in wartime. Kyiv: Nash format, 2017. In 2 volumes. Volume 1 -568 p., Volume 2 - 549 p. (In Ukrainian).
2. Castillo O, Chen IK, Amini E, Yafi FA, Barham DW. Male sexual health related complications among combat veterans. Sex Med Rev. 2022;10(4):691-697.doi.org/10.1016/j.sxmr.2022.06.002
3. Breyer BN, Cohen BE, Bertenthal D, Rosen RC, Neylan TC, Seal KH. Sexual dysfunction in male Iraq and Afghanistan war veterans: Association with posttraumatic stress disorder and other combat-related mental health disorders: A population-based cohort study. J Sex Med. 2014;11:75-83.doi.org/10.1111/jsm.12201
4. Banti M, Walter J, Hudak S, Soderdahl D. Improvised explosive device-related lower genitourinary trauma in current overseas combat operations. J Trauma Acute Care Surg.2016;80(1):131-134.doi.org/10.1097/TA.0000000000000864
5. Birowo P, Deswanto IA, Rasyid N. Epidemiology of erectile dysfunction: A cross-sectional web-based survey conducted in an Indonesian national referral hospital [version 1; peer review:2 approved with reservations]. F1000Research. 2019; 8:817. doi: 10.12688/f1000research.18930.1.doi.org/10.12688/f1000research.18930.1
6. Leslie SW, Sooriyamoorthy T. Erectile Dysfunction. [Updated 2024 Jan 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan.
7. Мa M, Yu B, Qin F, Yuan J. Current approaches to the diagnosis of vascular erectile dysfunction. Transl Androl Urol. 2020;9(2):709-721.doi.org/10.21037/tau.2020.03.10
8. Minhas AS, Goerlich E, Corretti MC, Arbab-Zadeh A, Kelle S, Leucker T, Lerman A, Hays AG. Imaging Assessment of Endothelial Function: An Index of Cardiovascular Health.Front. Cardiovasc. Med. 2022;9:778762.doi.org/10.3389/fcvm.2022.778762
9. Xing J. Metabolic syndrome/cardiovascular disease and erectile dysfunction (ED). Transl Androl Urol. 2015;4(S1):AB039.
10. Ho JH, Adam S, Azmi S, Ferdousi M, Liu Y, Kalteniece A, Dhage SS, Keevil BG, Syed AA, Ammori BJ, Ahern T, Donn R, Malik RA, Soran H. Male sexual dysfunction in obesity: The role of sex hormones and small fibre neuropathy. PLoS One. 2019;14(9):e0221992.doi.org/10.1371/journal.pone.0221992
11. Elzanaty S, Rezanezhad B, Willenheimer R, Borgquist R. Association Between ErectileFunction and Biomarkers of Subclinical Atherosclerosis: A Study Based on Middle-Aged Healthy Men from the General Population. Curr Urol. 2016;9(3):119-123.doi.org/10.1159/000442865
12. Erkan A, Balci M, Tuncel A, Yigitturk G, Aslan Y, Senel C, Guzel O. The Role of androgen receptors in erectile dysfunction due to diabetes mellitus: An experimental study. Insight Urology. 2019;40(2):19-28. https://he02.tci-thaijo.org/index.php/TJU/article/view/201728.
13. Fan D, Mao W, Wang G, Shi H, Wu Z, Xie J, Yin L, Xu T, Wang K, Peng B. Study on the relationship between sex hormone changes and erectile dysfunction in patients with chronic prostatitis/chronic pelvic pain syndrome. Ann Palliat Med. 2021;10(2):1739-1747.doi.org/10.21037/apm-20-985
14. Minhas AS, Goerlich E, Corretti MC, Arbab-Zadeh A, Kelle S, Leucker T, Lerman A, Hays AG. Imaging Assessment of Endothelial Function: An Index of Cardiovascular Health.Front. Cardiovasc. Med. 2022;9:778762.doi.org/10.3389/fcvm.2022.778762
15. Castillo O, Chen IK, Amini E, Yafi FA, Barham DW. Male sexual health related complications among combat veterans. Sex Med Rev. 2022;10(4):691-697.doi.org/10.1016/j.sxmr.2022.06.002
16. Breyer BN, Cohen BE, Bertenthal D, Rosen RC, Neylan C, Seal KH. Sexual dysfunction in male Iraq and Afghanistan war veterans: Association with posttraumatic stress disorder and other combat-related mental health disorders: A population-based cohort study. J Sex Med.2014;11:75-83.doi.org/10.1111/jsm.12201
17. Banti M, Walter, Hudak S, Soderdahl D. Improvised explosive device-related lower genitourinary trauma in current overseas combat operations. J Trauma Acute Care Surg.2016;80(1):131-134.doi.org/10.1097/TA.0000000000000864
18. Bird ER, Piccirillo M, Garcia N, Blai R, Campbell S. Relationship between posttraumatic stress disorder and sexual difficulties: A systematic review of veterans and military personnel. J Sex Med. 2021;18(8):1398-1426.doi.org/10.1016/j.jsxm.2021.05.011
19. Ho JH, Adam S, Azmi S, Ferdousi M, Liu Y, Kalteniece A, Dhage SS, Keevil BG, Syed AA, Ammori BJ, Ahern T, Donn R, Malik RA, Soran H. Male sexual dysfunction in obesity: The role of sex hormones and small fibre neuropathy. PLoS One. 2019;14(9):e0221992.doi.org/10.1371/journal.pone.0221992
20. Kim S, Cho MC, Cho SY, Chung H, Rajasekaran R. Novel emerging therapies for erectile dysfunction. World J Mens Health. 2021;39(1):48-64.doi.org/10.5534/wjmh.200007
21. Мa M, Yu B, Qin F, Yuan J. Current approaches to the diagnosis of vascular erectile dysfunction. Transl Androl Urol. 2020;9(2):709-721.doi.org/10.21037/tau.2020.03.10
22. Salman M, Shehzadi N, Khan MT, Islam M, Amjad S, Afzal O. Erectile dysfunction: prevalence, risk factors and involvement of antihypertensive drugs intervention. Trop J Pharm Res. 2016;15(4):869-876.doi.org/10.4314/tjpr.v15i4.29
23. Rosen RC, Cappelleri JC, Gendrano N. The International Index of Erectile Function (IIEF): a state-of-the-science review. International Journal of Impotence Research. 2002;14:226-244.doi.org/10.1038/sj.ijir.3900857
24. Lins L, Carvalho FM. SF-36 total score as a single measure of health-related quality of life: Scoping review. SAGE Open Med. 2016;4:2050312116671725.doi.org/10.1177/2050312116671725
25. Petkari E, Lapin B, Boehnke JR. Quality of life dimensions in people living with mental disorders: moving beyond global scores. Quality of life research, 2024.doi.org/10.1007/s11136-024-03844-4
26. Vorobets DZ, Fafula RV, Chaplyk VV, Vorobets MZ, Onufrovych OK, Besedina AS, Vorobets ZD. Erectile dysfunction and quality of life of men affected by hostilities in the Russian-Ukrainian war. Regulatory Mechanisms in Biosystems. 2024;15(1):62-66.doi.org/10.15421/022409
27. Cappelleri JC, Siegel RL, Glasser DB, Osterloh IH, Rosen RC. Relationship between patient self-assessment of erectile dysfunction and the sexual health inventory for men. Clin Ther. 2001;23(10):1707-1719.doi.org/10.1016/S0149-2918(01)80138-7
28. Kumar S, Khurana NK, Lohana S, Khamuani MK, Memon MK, Memon S, Hassan SM, Sohail H. Comparison of the Prevalence of Erectile Dysfunction Between Hypertensive and Normotensive Participants: A Case-Control Study. Cureus. 2020;12(12):e12061.doi.org/10.7759/cureus.12061
29. Leslie SW, Sooriyamoorthy T. Erectile Dysfunction. [Updated 2024 Jan 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK562253/.
30. Onufrovych OK, Fafula RV, Vorobets MZ, Besedina AS, Melnyk OV, Vorobets DZ, Vorobets ZD. Parameters of oxidative, nitrasive and anti-oxidative status in men with erectile dysfunction due to combat trauma. Regulatory Mechanisms in Biosystems. 2024;15(1):97-101.doi.org/10.15421/022414
31. Reed-Maldonado AB, Lue TF. A syndrome of erectile dysfunction in young men? Translational Andrology and Urology. 2016;5(2): 228-34.doi.org/10.21037/tau.2016.03.02
32. Xing J. Metabolic syndrome/cardiovascular disease and erectile dysfunction (ED). Transl Androl Urol. 2015;4(S1):AB039.
33. Bird ER, Piccirillo M, Garcia N, Blais R, Campbell S. Relationship between posttraumatic stress disorder and sexual difficulties: A systematic review of veterans and military personnel. J Sex Med. 2021;18(8):1398-1426.doi.org/10.1016/j.jsxm.2021.05.011
34. Vorobets DZ, Fafula RV, Chaplyk VV, Vorobets MZ, Onufrovych OK, Besedina AS, Vorobets ZD. Erectile dysfunction and quality of life of men affected by hostilities in the Russian-Ukrainian war. Regulatory Mechanisms in Biosystems. 2024;15(1);62-66.doi.org/10.15421/022409
35. Rastrelli G, Maggi M. Erectile dysfunction in fit and healthy young men: psychological or pathological? Translational Andrology and Urology. 2016;6(1):79-90.doi.org/10.21037/tau.2016.09.06
36. Andersson K-E. PDE5 inhibitors - pharmacology and clinical applications 20 years after sildenafil discovery. British Journal of Pharmacology. 2018;175:2554-2565.doi.org/10.1111/bph.14205
37. Ostroff ML. Oral PDE5 inhibitors for erectile dysfunction. US Pharm. 2018;43(6):29-33.
38. Gandhi J, Weissbart SJ, Smith NL, Kaplan SA, Dagur G, Zumbo A, Joshi G, Khan SA. The impact and management of sexual dysfunction secondary to pharmacological therapy of benign prostatic hyperplasia. Transl Androl Urol. 2017;6(2):295-304.doi.org/10.21037/tau.2017.03.57
39. Zhu LL, Wang YH, Zhoo Q. Tizanidine: Advances in pharmacology & therapeutics and drug formulations. J Pain Res. 2024;17:1257-1271.doi.org/10.2147/JPR.S461032
40. Najem MM, Mukilan D, Jayakumari S. Safety and efficacy of lornoxicam and diclofenac in patients with post traumatic pain - a review. J. Evolution Med. Dent. Sci. 2020;9(24):1827-1833.doi.org/10.14260/jemds/2020/399
41. Fink HA, MacDonald R, Rutks IR, Wilt TJ. Trazodone for erectile dysfunction: a systematic review and meta-analysis. BJU Int. 2003;92(4):441-446.doi.org/10.1046/j.1464-410X.2003.04358.x