Male reproductive health is increasingly affected by environmental pollution, yet most studies focus on semen quality alone, overlooking sexual function as a relevant functional outcome. The main objective of our study is to evaluate the combined effect of the environment on men's sexual and reproductive functions by an integrated clinical-functional approach based on the International Classification of Functioning, Disability and Health (ICF). A cross-sectional study was conducted on 216 men aged 25-45 years who had lived in the areas of the Kyrgyz Republic with different environmental conditions for at least 5 years: environmentally favorable areas (control) and areas mainly exposed to pesticides, heavy metals, or radionuclides. Sexual function was assessed by the International Index of Erectile Function (IIEF), and reproductive function was determined by the integration of semen parameters assessed according to WHO guidelines. Results were explained within the ICF concept. The male inhabitants of the polluted localities exhibited markedly reduced erectile and orgasmic functions compared with the control group (p < 0.05). All the exposure groups displayed a considerable decline in semen quality, such as reduction in sperm concentration, defective progressive motility, decreased velocity, abnormal morphology, and an increased number of immature germ cells.The pesticide and heavy metal-exposed groups reflected the highest level of dysfunction. Sexual dysfunction, when interpreted through the ICF framework, might be a feature that is functionally relevant and that appears at an early stage of environmentally induced reproductive damage. This study thus points to the necessity of incorporating functional outcomes in environmental health risk assessments.
