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Men's Sex Problems

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 with sexual health can be treated. Therefore, it is important for a man to discuss these issues with a physician.

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.

Around 1 in 10 men experience sexual problems.

Men's sexual problems can happen at any time of life, but become more common with age.

Most sexual problems can be treated - so seek medical advice if you have concerns.

Men's sex problems include:

• Erectile dysfunction - sometimes called impotence - is a problem getting and keeping an erection for sex
• Premature ejaculation, this is coming sooner than he'd like to during sex
• Inhibited ejaculation, retarded ejaculation, when the man is slow to ejaculate
• Retrograde ejaculation, where the ejaculation goes into the bladder instead of out of the penis
• Less interest in sex, loss of sex drive or libido.

What causes men's sexual problems?

Men's sex problems may be due to:

• Physical causes, including diabetes, heart disease and other long-term health conditions
• Alcohol abuse
• Drug abuse
• Medication side-effects, including some antidepressants
• Stress
• Anxiety
• Depression
• Worries over sexual performance, unrealistic expectations about sexual performance
• Relationship problems
• Low testosterone
• Past traumatic sexual experiences.

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.

What are risk factors for low libido?

Risk factors for low libido in men include:

• Age because testosterone concentration will decrease over the years
• Alcohol consumption
• Malnourishment
• Smoking
• Drug consumption
• Conditions requiring medication that lowers testosterone, depression, benign prostatic hyperplasia (BPH), pain, and prostate cancer.

What causes low libido?

Many causes have been identified as contributing to the diminishment of sexual desire. They include:

• Medications (SSRIs, anti-androgens, 5-alpha-reductase inhibitors, opioid analgesics)
• Alcoholism
• Depression
• Fatigue
• Hypoactive sexual disorder
• Recreational drugs
• Relationship problems
• Other sexual dysfunction (fear of humiliation)
• Sexual aversion disorder
• Systemic illness
• Testosterone deficiency
• Stress
• Lack of time
• History of sexual abuse
• Hormonal problems such as hyperthyroidism

What are the symptoms of low libido?

The person that lacks sexual desire won't want to initiate the sexual relation. If the act is initiated, low libido can also present itself as the inability to attain an erection. If the patient experiences a first episode of erectile dysfunction without any previous sexual symptoms and adequate nocturnal erection, the cause is probably psychogenic and the problem is not the erection. It is also important to specify if the low libido is new in onset or if one has always felt this way about sexual relations.

What is erectile dysfunction?

Erectile dysfunction (ED) is the inability to acquire or maintain a satisfactory erection. The prevalence of erectile dysfunction varies according to the patient's age. About 18% of men from 50 to 59 years of age will suffer from erectile dysfunction and 37% of those aged 70 to 75 years will, too.

There are three types of erections -- those caused by tactile stimulation, those caused by mental stimulation, and those that men experience while sleeping. This classification can be important when the cause of erectile dysfunction is yet to be determined.

In order to have an erection, men need stimuli; they need blood arriving from the arteries and a veins capable of locking the blood in place. Each of the numerous steps in this system can fail making erectile dysfunction a complex problem for investigation

What are the risk factors for erectile dysfunction?

The risk factors for erectile dysfunction include:

• Obesity
• Smoking
• Diabetes
• High blood pressure
• High cholesterol
• Cardiovascular disease
• Medication use
• Obstructive sleep apnea
• Restless leg syndrome
• Systemic sclerosis (scleroderma)
• Peyronie's disease
• Prostate cancer treatment

What causes erectile dysfunction?

There are numerous potential causes of erectile dysfunction

Neurologic causes include:

• Stroke
• Spinal cord or back injury
• Multiple sclerosis
• Dementia
• Pelvic trauma
• Prostate surgery (even with nerve-sparing surgeries it can take up to 24 months to regain normal sexual function)
• Priapism
• Nervous system tumor
• Epilepsy
• Diabetic neuropathy
Vascular causes include:
• Arteriovenous fistula
• Diabetes
• Atherosclerosis
• Congenital anomaly
Hormonal causes include:
• Low testosterone blood level (The patient can achieve an erection but it won't always be turgid enough for vaginal penetration.)
• Hyperprolactinemia
• Hyperthyroidism
• Hypothyroidism
• Cushing's disease
• Addison's disease
Pharmacological causes include:
• Antidepressants (mainly SSRIs)
• Spironolactone
• Sympathetic blockers (clonidine, guanethidine, or methyldopa)
• Thiazide diuretics
• Ketoconazole
• Cimetidine
Penile dysfunction causes include:
• Peyronie's disease
Psychiatric causes include:
• Loss of feeling toward the other person
• Stress
• Fear of non-performance
Functional causes include:
• Bicycling irritating the nerves and tissue of the penis.

What are the symptoms of erectile dysfunction?

Erectile dysfunction will cause the penis to be unable to acquire or maintain a satisfactory erection. It is important to specify to the doctor the rapidity of onset, the presence of nocturnal erections, and the quality of the erection if it can be attained but not maintained. The quality of an erection can be judged according to the rigidity and the functionality (Is the penis erect enough to allow for vaginal penetration?).

Erectile dysfunction with sudden onset and no previous history of sexual dysfunction suggests a psychogenic cause, unless there was a previous surgery or a genital trauma. The loss of nocturnal erections will suggest a neurologic or vascular cause. Finally, when an erection is not sustained, its loss may be due to an underlying psychological cause or vascular problem. Talk to your doctor if you have noticed any problems with your erectile function.

What is premature ejaculation?

Premature ejaculation is the most common of the ejaculatory disorders; approximately 20% to 30% of men will have premature ejaculation. Ejaculation problems involve the improper discharge of sperm, prostatic, and seminal vesicle fluid through the urethra.

There are three different types of premature ejaculation:

• Premature ejaculation is ejaculation after minimal or no physical stimulation.
• Retarded ejaculation is ejaculation after a long delay of physical stimulation.
• Retrograde ejaculation is orgasm without ejaculation, also called "dry" ejaculation.

What causes premature ejaculation?

There are many potential causes of premature ejaculation. These include neurological causes that affect the following areas:

• Central control of ejaculation
• Innervations to the seminal tract
• Sensory innervation to the genitalia/prostate

Premature ejaculation may be caused by negative conditioning and penile hypersensitivity. Retarded ejaculation may be an early sign of diabetes or may develop following surgery for benign prostatic hyperplasia (BPH). Anejaculation (retrograde ejaculation) may be caused by radical prostatectomy, cystoprostatectomy (removal of the bladder and the rectum), or the use of certain medications such as alpha-blockers (tamsulosin) and antidepressants (SSRIs).

What are the symptoms of premature ejaculation?

Classically, premature ejaculation includes:

• Brief ejaculatory latency
• Loss of control
• Psychological distress in the patient and/or partner

Generally, premature ejaculators will only have about a minute or less of intravaginal time before they ejaculate.

Retarded ejaculation will present as a long delay of intravaginal time to the point where the patient will not be satisfied with the sexual relation.

Anejaculation or retrograde ejaculation is the experience of a dry orgasm. The semen doesn't go out of the urethra. It can either flow to the bladder instead or not be produced at all. Following the sexual act in the latter case, patients will notice the presence of semen in their first urine.

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