Male Sexual Dysfunction

What is sexual dysfunction?

Sexual dysfunction is any physical or psychological problem that prevents you or your partner from getting sexual satisfaction. Male sexual dysfunction is a common health problem affecting men of all ages, but is more common with increasing age. Treatment can often help men suffering from sexual dysfunction.

The main types of male sexual dysfunction are:

• Erectile dysfunction (difficulty getting/keeping an erection)
• Premature ejaculation (reaching orgasm too quickly)
• Delayed or inhibited ejaculation (reaching orgasm too slowly or not at all)
• Low libido (reduced interest in sex)

What causes sexual dysfunction?

Physical causes of overall sexual dysfunction may be:

• Low testosterone levels
• Prescription drugs (antidepressants, high blood pressure medicine)
• Blood vessel disorders such as atherosclerosis (hardening of the arteries) and high blood pressure
• Stroke or nerve damage from diabetes or surgery
• Smoking
• Alcoholism and drug abuse

Psychological causes might include:

• Concern about sexual performance
• Marital or relationship problems
• Depression, feelings of guilt
• Effects of past sexual trauma
• Work-related stress and anxiety

How does sexual dysfunction affect men?

The most common problems men face with sexual dysfunction are troubles with ejaculation, getting and keeping an erection, and reduced sexual desire.

Ejaculation disorders

Problems with ejaculation are:

• Premature ejaculation (PE) — ejaculation that occurs before or too soon after penetration
• Inhibited or delayed ejaculation — ejaculation does not happen or takes a very long time
• Retrograde ejaculation — at orgasm, the ejaculate is forced back into the bladder rather than through the end of the penis

The exact cause of premature ejaculation (PE) is not known. While in many cases PE is due to performance anxiety during sex, other factors may be:

• Stress
• Temporary depression
• History of sexual repression
• Low self-confidence
• Lack of communication or unresolved conflict with partner

Studies suggest that the breakdown of serotonin (a natural chemical that affects mood) may play a role in PE. Certain drugs, including some antidepressants, may affect ejaculation, as can nerve damage to the back or spinal cord.

Physical causes for inhibited or delayed ejaculation may include chronic (long-term) health problems, medication side effects, alcohol abuse, or surgeries. The problem can also be caused by psychological factors such as depression, anxiety, stress, or relationship problems.

Retrograde ejaculation is most common in males with diabetes who suffer from diabetic nerve damage. Problems with the nerves in the bladder and the bladder neck force the ejaculate to flow backward. In other men, retrograde ejaculation may be a side effect of some medications, or happen after an operation on the bladder neck or prostate.

Erectile dysfunction (ED)

Erectile dysfunction (ED) is the inability to get and keep an erection for sexual intercourse. ED is quite common, with studies showing that about one half of American men over age 40 are affected. Causes of ED include:

• Diseases affecting blood flow such as hardening of the arteries
• Nerve disorders
• Stress, relationship conflicts, depression, and performance anxiety
• Injury to the penis
• Chronic illness such as diabetes and high blood pressure
• Unhealthy habits like smoking, drinking too much alcohol, overeating, and lack of exercise

Low libido (reduced sexual desire)

Low libido means your desire or interest in sex has decreased. The condition is often linked with low levels of the male hormone testosterone. Testosterone maintains sex drive, sperm production, muscle, hair, and bone. Low testosterone can affect your body and mood.

Reduced sexual desire may also be caused by depression, anxiety, or relationship difficulties. Diabetes, high blood pressure, and certain medications like antidepressants may also contribute to a low libido.

How is male sexual dysfunction diagnosed?

Your doctor may begin the diagnosis process with a physical exam. Physical tests may include:

• Blood tests to check your testosterone levels, blood sugar (for diabetes), and cholesterol
• Blood pressure check
• Rectal exam to check your prostate
• Examination of your penis and testicles

Other tests can show if you have problems with the nerve impulses or blood flow to the penis.

Your doctor may also ask questions about your symptoms and your medical and sexual history. Though these questions may seem very personal, do not be embarrassed. It is important to answer honestly so the best treatment can be recommended. You may be sent to a different type of doctor (urologist, endocrinologist or sex therapist, for example) who can help you.

How is male sexual dysfunction treated?

Many cases of sexual dysfunction can be corrected by treating the mental or physical problems that cause it. Treatments include:

• Medications – drugs that help improve sexual function by increasing blood flow to the penis. Sildenafil (Viagra®), vardenafil (Levitra®), and tadalafil (Cialis®) are safe and effective for most men.
• Hormone therapy – low levels of testosterone raised by hormone replacement therapies that include injections, patches, or gels.
• Psychological therapy – a psychological counselor to help you address feelings of anxiety, depression, fear, or guilt that may affect sexual function.
• Mechanical aids – vacuum devices and penile implants that can help some men with erectile dysfunction.

Can male sexual dysfunction be prevented?

While male sexual dysfunction cannot be prevented, dealing with the causes of the dysfunction can help you better understand and cope with the problem when it happens. To help maintain good sexual function:

• Follow your doctor’s treatment plan for any of your medical/health conditions.
• Limit your alcohol intake.
• Quit smoking.
• Get treatment if needed for any emotional or psychological problems such as stress, depression, and anxiety.
• Communicate better and more often with your partner.