Basic Facts

• Male sexual dysfunction is very common and encompasses loss of desire or libido, inability to achieve and sustain an erection satisfactory for intercourse, and ejaculation disorders and orgasmic difficulties.
• There are many potential causes of sexual dysfunction, including use of certain medications and medical conditions such as Peyronie’s disease.
• Treatment for sexual dysfunction often addresses an underlying medical condition, such as hypertension, elevated cholesterol, diabetes mellitus, nerve damage, stress, anxiety, and depression.

Male sexual dysfunction is comprised of several problems associated with a man’s sexual performance including:

• Erectile dysfunction, or the inability to experience an erection during sex;
• Decreased libido, or lowered interest in sex;
• Priapism, or long-lasting erections resulting from underlying disease or trauma, unrelated to sexual desire;
• Peyronie’s disease, a curvature of the penis during an erection;
• Premature ejaculation, the release of semen before or shortly after penetration and with minimal sexual stimulation; and
• Retrograde ejaculation, or the reverse flow of semen into the bladder during ejaculation.

Erectile dysfunction and decreased libido are often caused by stress or psychological issues surrounding sex; some of the conditions, such as priapism or Peyronie’s disease, may be a physical condition. Erectile dysfunction, often the most distressing of these problems, is also the most common.

Causes And Risk Factors

Erectile Dysfunction. Previously referred to as impotence, erectile dysfunction can arise from inhibition, stress, a medical condition or medication use.

Priapism. Priapism is a pathological condition in which the penis remains erect as a by product of:

• Trauma
• Nerve impairment
• Circulatory problems (including clot formation)
• Alcohol and drug abuse
• Sickle cell anemia
• Anesthesia
• Use of medications, such as synthetic hormones, antidepressants, and anticoagulants

Its cause, however, is unknown in about one-third of patients.

Loss of libido. Loss of libido, or sexual desire, can be caused by many factors, including:

• Stress
• Aging and a natural drop in hormonal activity
• Psychological problems
• Certain prescription medications
• Illegal drug use
• Minor illness
• Serious or chronic conditions

Peyronie’s disease. The cause of Peyronie’s disease is not fully understood, but it is believed to result from an inflammation of the tissue of the corpus cavernosa-the two columns of spongy, erectile tissue within the penis-following an injury to the area. This condition should not be confused with a slight curvature of the penis, which is natural for some men.

Many men who develop Peyronie’s disease have already been diagnosed with erectile dysfunction and diabetes mellitus.

Premature and retrograde ejaculation. Premature ejaculation is usually a problem with young men who have little sexual experience and tend to rush through sex. Retrograde ejaculation usually occurs because of prostate surgery, diabetes mellitus, or blood pressure medications.

Diagnosis

Given that there are multiple forms of male sexual dysfunction, diagnosis is necessary to distinguish between the various problems and identify underlying psychological and physical causes.

Sexual dysfunction is more likely to be physically based if the problem began gradually. By contrast, dysfunction that stems from a psychological cause is likely to begin suddenly.

To identify causes of sexual dysfunction, a physician will ask a patient about his medical and sexual history and perform a physical exam. He or she will also ask questions specific to sex, including:

• Is this a recent problem or is it long standing?
• Have you experienced it with multiple partners?
• Do you experience it all the time, or only some of the time?
• Do you have nocturnal or morning erections?
• How do you feel about sex in general?
• How do you feel about your sexual partners?

A physician may also order blood and urine tests.

To determine if a man experiences nocturnal erections, a physician may order a Regiscan, which measures how often the man experiences an erection while sleeping, as well as its size, rigidity, and duration.

Finally, the physician will review the patient’s medications and suggest substitutions for drugs that are known to cause a decreased interest in sex.

Treatment Approach

Erectile Dysfunction. Treatment for erectile dysfunction may address a wide of array of possible problems, such as:

• Inhibitions
• Fear of failure, anxiety, and depression
• Conflict within marriage or a relationship
• Feelings of guilt or sinfulness associated with sex
• Receiving treatment for underlying conditions, such as trauma, nerve loss from a cognitive impairment, or problems with circulation
• Finding appropriate substitutions for medications that cause the problem

Loss of Libido. Treating loss of libido may require treating the underlying cause, but it may also be solved through hormone replacement therapy.

Priapism. Treatment for priapism involves addressing the underlying problem.

Peyronie’s Disease. Approximately one-third of patients have a severe enough curvature to warrant surgery.

Premature ejaculation. If a man teaches himself how to control his sexual response, such as squeezing the base of the penis to delay ejaculation. Sertraline, an antidepressant, is sometimes taken for a short while as its side effect is delayed ejaculation.

Retrograde ejaculation. Depending on its severity, retrograde ejaculation can be treated with decongestants or by surgery.