Sexual health is an important part of a man’s life, no matter his age, civil status, or sexual orientation. It is also an important part of a couple’s foundation and contributes to the quality of life. Sexual problems in men are very common and impact sexual health.
Many problems can be treated and therefore it is important for a man to discuss these issues with a physicians.
The definition of sexual dysfunction is the inability to have a satisfactory sexual relationship. This definition depends on each person’s own interpretation on what he judges satisfactory.
In general, sexual dysfunction can affect the quality of life and, even more importantly, can be the first symptom of another medical or psychological problem. Any sexual complaint should be taken seriously and evaluated.
What is the physiology of sexual function?
Sexual activity involves coordination between various systems of the body. Hormones and neurological pathways must be in sync for sexual desire to be present.
Blood vessels, nerves, and penile integrity must all be present for an adequate erection and its maintenance during the sexual relation. Muscles and nerves coordinate ejaculation achieved when the physiological passageway for sperm (from the testicles to the urethra) is present.
Orgasm is a complex phenomenon that isn’t completely understood but it involves the coordination of muscles and nerves. When sexual dysfunction is present, the physician must evaluate all the possible problems in this chain of events.
How are sexual problems in men diagnosed?
Evaluation of sexual dysfunction starts with a detailed medical, sexual, and psychological history, followed by a thorough physical examination.
The second step must not be overlooked because sexual dysfunction can have many causes. Sometimes, the patient’s partner can also contribute to the evaluation and could provide useful information as well.
A detailed medical, psychological, and sexual history is acquired during the interview with the physician. Some of the questions that are asked can be intimate and might cause you to feel shy to answer thoroughly.
It is imperative to give the proper information, even though it is understandable that it can take time to be comfortable talking about this. Having a good relationship with your physician is always helpful.
Some of the questions the doctor could ask might concern the frequency of sexual relations, your sexual orientation, if the frequency or quality of sexual relations are satisfying, and your number of sexual partners, among others.
They will also inquire about nonsexual-related complaints.
A complete physical examination is performed including assessing the pulses in the legs and a thorough examination of the external genitalia (penis, scrotum, and perineum) and their reflexes..
One of the possible tests is a nocturnal tumescence test to evaluate nocturnal erections. Your physician might also ask for tests for penile blood vessel function or some tests of the nervous system to help differentiate between possible causes of sexual dysfunction.
What is the treatment for sexual problems in men?
The treatment plan depends greatly on the precise cause of the problem. If the cause is psychological, help from a psychiatrist or psychologist can help.
The indicated therapy in this case will be cognitive behavioral therapy. Sometimes the treatment will include couples therapy. If the cause of the diminished libido is pharmacological, you can consult your physician and ask if he or she can suggest a medicine without sexual side effects.
Sometimes, hormonal replacement will be suggested. Talk to your doctor about any changes in libido you have experienced.
What are the different types of sexual dysfunction in men?
Types of sexual dysfunction include disorders involving sexual desire or libido, erection, ejaculation, and orgasm. They will be described separately, but understand that some medical conditions can affect two or more disorders at the same time.
A lot of men sometimes ejaculate sooner than they would like. Estimates vary, but around 1 out of 3 men experience premature ejaculation at some time.
Usually, premature ejaculation does not need treatment. But if you often ejaculate prematurely — like before starting intercourse or just a minute or two after starting — you can get help.
Premature ejaculation has several possible causes, including:
- Emotional issues like guilt or anxiety
- Low levels of certain brain chemicals
- Being very aroused or stimulated
- Infection of the prostate or urethra
Talk to your doctor if you are concerned. There are several treatments for premature ejaculation. You first might try techniques like stopping sexual stimulation briefly and then restarting it.
You also could try using topical creams or condoms to lessen excitement. The U.S. Food and Drug Administration has not approved any medications for premature ejaculation, but your doctor may prescribe antidepressants because a possible side effect is delaying ejaculation.
Open communication with your partner can help with any stress between you. And it can help you figure out ways that you can both achieve satisfaction. Working with a therapist or counselor, either by yourself or as a couple, can be very effective.
ED drugs are not safe for everyone
Many men now take medications like Viagra, Levitra, and Cialis to treat erection problems. These medications are not safe for everyone. Before taking drugs to treat ED, talk to your doctor about the benefits and risks involved.
Never take Viagra, Levitra, or Cialis if you take heart medicines called nitrates. Doing so could cause a sudden — and dangerous — drop in blood pressure.
Also, tell your doctor if you take any drugs called alpha-blockers, which are used to treat prostate enlargement or high blood pressure.
Some men have problems getting or keeping an erection. (An erection is when blood fills up the penis, making it firmer and larger.)
This problem is called erectile dysfunction, or ED, and sometimes is called impotence. ED is fairly common. In fact, between 15 million and 30 million U.S. men are affected by it. ED can be very upsetting.
It can affect self-esteem and cause frustration, anger, and sadness. But there are effective treatments for ED. And counseling can help you and your partner cope with any emotional effects of ED.
Causes of ED include:
- Clogged blood vessels, high blood pressure, and high cholesterol
- Nerve damage from diabetes
- Certain medicines, including some used to treat depression or high blood pressure
- Low testosterone
- Unhealthy habits like smoking, drinking too much alcohol, overeating, and not exercising
- Emotional factors, such as stress or depression
As men get older, ED becomes more common. By age 65, almost 25 percent of men have this problem at least one out of every four times they have sex.
But ED is treatable at any age. Your doctor can offer a number of ways to treat ED. If treatment solves your ED, though, you still need to take care of any health issues that may have caused it.
Some men need to try two or three options before they find an ED treatment that works for them. Medication is one popular way to treat ED.
Drugs like Viagra increase blood flow to the penis, which helps make an erection possible. Injections to the penis and medicine you put into the tip of your penis also can increase blood flow to it.
Other treatments for ED include a vacuum cylinder and pump you put on your penis to pull blood into it or inflatable rods that are put into the penis through surgery.
You may have heard of herbal products or dietary supplements that claim to treat ED or improve sexual performance. You should beware of these products even if they claim to be “natural.”
They can contain dangerous ingredients, including prescription medications that are not identified on the product’s label.
Loss of sexual interest
Your interest in sex, also called libido, can vary over the course of your life. Some men may lose interest in sex during times of stress or illness.
Also, your interest might not match that of your partner at times, which is normal in long-term relationships.
Reduced interest in sex can have a number of causes, including:
- A health problem
- Certain medications
- Reduced levels of male hormones
- Emotional or relationship problems
As men age, it is natural to be less interested in sex. But for a healthy man, having no interest in sex is not normal. If you have less interest in sex, talk frankly with your doctor.
Treatment can help. It could include medicine, counseling, or both.
Testosterone is the most important male hormone. It helps maintain sex drive, sperm production, pubic and body hair, muscle, and bone.
Lower than normal levels of testosterone can affect a man’s body and mood. Signs of low testosterone in adult men can include:
- Less interest in sex
- Erection problems
- Increased breast size
- Hot flashes
- Problems with memory and concentration
- Mood problems, like irritability and depression
- Smaller and softer testicles
- Loss of muscle strength and weakened bones
Low testosterone levels can have a number of causes, including injury, disease, and certain medications. A gradual decline in testosterone is normal in men as they get older.
This is sometimes called aging male syndrome (or andropause) and can cause erection problems and less sex drive. But it is not normal for healthy older men to have no interest in sex. There could be other reasons for these changes.
If you have symptoms of low testosterone, talk to your doctor. You can get your testosterone level checked with a simple blood test.
If you do have low testosterone, your doctor will want to find out the underlying cause. Finding the cause can involve many tests. You might want to see a specialist, such as an endocrinologist or urologist.
Some men with low testosterone take testosterone replacement therapy, which they get through a skin patch or other method.
But testosterone therapy is not right for everyone, and its use is controversial. One reason is that testosterone therapy has certain risks.
Another reason is that experts don’t know exactly what testosterone levels are “normal” as men age. If you have low testosterone, your doctor can help you understand the benefits and risks of treatment so you can decide what’s right for you.