AbstractBackgroundOrgasmic phase disorders in men worsen the burden of erectile dysfunction on sexual satisfaction.ObjectivesTo investigate the prevalence of and predictors of unreported orgasmic phase disorder in a cohort of men looking for their first urological assessment for new‐onset erectile dysfunction in a real‐life setting.Materials and methodsData from 1107 heterosexual, sexually active men consecutively assessed for new‐onset erectile dysfunction were analysed. Throughout a comprehensive medical and sexual history, all patients were asked to self‐report any orgasmic phase disorder and to complete the International Index of Erectile Function and the Beck's Inventory for Depression (depressive symptoms scored as Beck's Inventory for Depression ≥11). Men self‐reporting orgasmic phase disorder during the interview were excluded from further analyses. The median value of the International Index of Erectile Function‐orgasmic function domain was arbitrarily used to categorise men with (International Index of Erectile Function‐orgasmic function ≤5) and without unreported orgasmic phase disorder (International Index of Erectile Function‐orgasmic function >5). Circulating hormones were measured in every patient. Descriptive statistics and logistic regression models were used to test the association between clinical variables and unreported orgasmic phase disorder.ResultsOf 1098 patients with non‐self‐reporting orgasmic phase disorder, 314 (28.6%) had International Index of Erectile Function‐orgasmic function ≤5. Patients with erectile dysfunction + unreported orgasmic phase disorder were older (median [interquartile range]: 58 [44–66] years vs. 51 [40–60] years), had higher body mass index [25.8 (23.7–28.1) kg/m² vs. 25.2 (23.3–27.4) kg/m²], higher prevalence of type 2 diabetes (36 [11.5%] vs. 45 [5.7%]) and lower International Index of Erectile Function‐erectile function scores (6 [2–10] vs. 18 [11–24]) than men with erectile dysfunction‐only (all p < 0.05). Patients with erectile dysfunction + unreported orgasmic phase disorder depicted higher rates of severe erectile dysfunction (75.5% vs. 25%) and Beck's Inventory for Depression ≥11 (22.6% vs. 17.9%) (all p < 0.05). In the multivariable logistic regression analysis, older age (odds ratio: 1.02) and lower International Index of Erectile Function‐erectile function scores (odds ratio: 0.83) were independently associated with unreported orgasmic phase disorder (all p < 0.05).ConclusionsAlmost one in three men seeking first medical help for erectile dysfunction depicted criteria suggestive of unreported orgasmic phase disorder. Men with unreported orgasmic phase disorder were older and had higher rates of severe erectile dysfunction and concomitant depressive symptoms. These real‐life findings outline the clinical relevance of a comprehensive investigation of concomitant sexual dysfunction in men only complaining of erectile dysfunction to more effectively tailor patient management.