Fifty-two men with CBAVD whose treatments and follow-ups were conducted in our infertility and andrology clinic enrolled in the study. As a control group, 66 healthy fertile men were included. CBAVD is diagnosed by decreased semen volume, clinical examination, and transrectal ultrasonography/magnetic resonance imaging. Cystic fibrosis transmembrane conductance regulator (CFTR) gene analyses were also performed, and cystic fibrosis (CF) related comorbidities were questioned. Heterosexual, over 18 years of age, and have had regular sexual intercourse within the last 3 months individuals were enrolled to study. Men with cognitive disabilities or lack of ability to understand and speak the Turkish language were excluded. Participants with any comorbidity such as diabetes mellitus, hypo/hyperthyroidism, etc., and undergone urogenital surgeries except testicular and epididymal sperm extraction procedures were also excluded from the study. Patients who have previously been diagnosed with any psychiatric disorder or have ever been treated were excluded. All participants filled up the sexual and psychological questionnaires voluntarily in the voiceless room at the clinic which were asked by the same urologist with a fellow of the European Board of Urology (FEBU) certificate. Semen analysis was performed obtained by masturbation at the clinic after 3 days of sexual abstinence. Blood samples were collected from patients for hormonal analysis (sex hormone binding globulin, total testosterone, luteinizing hormone, follicle-stimulating hormone, estradiol, prolactin) at around ten o’clock am. (Flowchart).
Institutional review board approval was obtained for this study.
Questionnaire forms
Instruments
1. International index of erectile function, (IIEF)-15 [9]
The IIEF-15 questionnaire which was validated for use in Turkey was filled up to all males.
2. Male sexual health questionnaire (MSHQ-Ejd short form) [10]
Twenty-five item MSHQ was developed and validated (MSHQ-EjD Short Form) for assessing ejaculatory dysfunction (EjD). This form consists of 4 items and evaluates three ejaculatory functions at the first three items and one ejaculation bother at the last item.
3. Arabic index of premature ejaculation (AIPE) [11]
This form consists of seven items based on an assessment of erectile function, sexual desire, ejaculation latency, ejaculation control, patient satisfaction, partner satisfaction, and psychological distress. Severity of premature ejaculation (PE) was classified as; severe (7-13 pts.), moderate (14-19 pts.), mild to moderate (20-25 pts.), mild (25-30 pts.), no-PE (31-35 pts.).
4. Premature ejaculation profile (PEP) [12]
PEP is a self-reported outcome instrument for evaluating premature ejaculation (PE), notably control, distress, interpersonal difficulty, and sexual satisfaction. Each item was calculated for subjects with and without the complaint of ejaculating prematurely and their partners.
5. Premature ejaculation diagnostic tool (PEDT) [13,14]
PEDT was developed to standardize the diagnosis of PE. It was designed to capture the main elements of the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition, Text Revision (DSM-IV-TR); control, frequency, minimal sexual stimulation distress, and interpersonal difficulty. The original nine items of the PEDT are validated in the Turkish language with an items questionnaire. A score below 9 indicates a low likelihood of PE and above 11 indicate.
high likelihood PE.
6. Beck depression inventory [15]
This scale consists of a 21-item self-report instrument intended to assess the existence and severity of symptoms of depression. There is a four-point scale for each item ranging from 0 to 3. The severity of depression was classified as; minimal, mild, moderate, severe.
Statistical Analyses
To determine the appropriate sample size for our study, a power analysis was conducted using the G*Power software [16]. The power analysis aimed to estimate the minimum sample size required to achieve a statistical power of 80%, assuming an alpha level (significance level) of 0.05 and a medium effect size. The analysis revealed that a sample size of at least 47 participants for each group would be necessary to detect the expected effects with an 80% probability.
Shapiro-Wilk test was used to evaluate data normality. Mann-Whitney U test was used to determine the differences between two independent groups with continuous variables that were not normally distributed. In cases where the median values were similar and statistically significant, the mean of the rank values was given in the Mann-Whitney U test. Chi-square analysis was performed for categorical variables. All analyses were performed using the IBM SPSS Statistics 29 software package (IBM, Armonk, NY, USA). Statistical significance was set at p < 0.05.