Sexual self-concept and sexual dysfunctions in men with fulfilled versus unfulfilled desire for children 15 years after onset: a propensity score-matched analysis from the Bavarian Men's Health-Study.

Introduction: An unmet desire for children may challenge masculine identity and therefore affect sexual self-concept and sexual functioning. The aim of this study was to examine long-term differences in sexual self-concept and sexual dysfunctions between men with fulfilled versus unfulfilled unmet desire for children. Methods: Data were derived from the Bavarian Men's Health-Study, a cross-sectional survey including middle-aged men. The unmet desire for children was defined according to the World Health Organization criteria and assessed via structured interviews. Participants completed standardized questionnaires assessing four dimensions of sexual self-concept: toughness, body image, sexual self-esteem, and perceived pressure with regard to sexuality. Sexual dysfunctions-including erectile dysfunction, low sexual desire, premature ejaculation, and delayed ejaculation-were additionally assessed. Participants were categorized according to whether their unmet desire for children had ultimately been fulfilled or remained unfulfilled. To control for potential confounders when comparing dimensions of sexual self-concept (age, body mass index, semen analysis, relationship status, education, and financial situation), a 1:1 propensity score matching was performed. Group differences were analyzed using the Wilcoxon-Mann-Whitney test. Primary outcomes were differences in sexual self-concept and sexual dysfunctions between men with fulfilled versus unfulfilled unmet desire for children. Results: The final sample comprised 1097 men (mean age 50.6 ± 0.7 years), all with a history of unmet desire for children. The mean age at onset of unmet desire for children was 35.9 ± 6.1 years. Overall, 65.5% of men who had experienced an unmet desire for children ultimately became fathers. After propensity score matching, no significant differences were observed in any dimension of sexual self-concept between men with fulfilled versus unfulfilled unmet desire for children ( Discussion: Approximately 15 years after experiencing an unmet desire for children, no differences in sexual self-concept or rates of sexual dysfunctions were observed between men with fulfilled versus unfulfilled unmet desire for children. These findings suggest that, in the long term, reproductive outcomes-such as the fulfillment or non-fulfillment of an unmet desire for children-may only have a modest impact on men's sexual self-concept and sexual functioning. The findings may contribute to counseling efforts by reducing concerns about potential long-term psychosexual consequences of an unmet desire for children.