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Sexual Problems In Men: Causes And Treatments

Sexual dysfunction is a common health issue that can affect men of all ages. A study says that around 31 per cent of men and 43 per cent of women have at least one or other kind of sexual dysfunction. [1]

Sexual functioning is governed by many factors: biological factors such as functioning of neurological, endocrine or vascular systems; psychological factors such stress and depression and psychosocial factors such as religious beliefs, ethnicity and health status. Problems in any of these factors can lead to sexual dysfunction.

Additionally, sexual disorders in men are often categorised into disorders of arousal, desire, orgasm or overlap between these disorders. Though these problems in men are prevalent, they are often under-recognised or under-diagnosed due to embarrassment for seeking medical help or even thinking it as a major problem that can affect the quality of life. [2]

In this article, we will discuss sexual problems in men followed by their causes and treatments. Take a look.

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1. Erectile dysfunction

Erectile dysfunction is the inability to maintain or achieve sufficient erection of the penis which is needed for satisfactory sexual performance. It may affect some men occasionally but prolonged failure to maintain an erection can affect the quality of life or cause relationships problems.

Main symptoms of erectile dysfunction include difficulty getting an erection, difficulty keeping an erection and reduced sexual desire. Prolonged erection is also one of the symptoms characterised by persistent erection, usually without sexual arousal.

Causes of erectile dysfunction

Organic causes of erectile dysfunction include the following: [3]

  • Cardiovascular diseases
  • High cholesterol
  • Diabetes
  • Obesity
  • Hypertension
  • Parkinson's disease
  • Peyronie diseases, an anatomical disorder of the penis
  • Surgical complications
  • Injuries in the spinal cord or penile area
  • Smoking, substance use or alcoholism
  • Prostate disease
  • Psychological causes of erectile dysfunction include the following:

    • Anxiety
    • Lack of emotional awareness
    • Stress
    • Depression
    • Fear of intimacy
    • Guilt
    • Current life stress
    • Certain prescribed medications can also cause the condition. They include medications to:

      • Manage high blood pressure
      • Lower anxiety
      • Antidepressants
      • Cancer drugs
      • Hormonal drugs
      • Treatments of erectile dysfunction

        1. Lifestyle modifications: Regular exercise, dietary changes and quitting smoking and substance use. Improving cardiovascular risk can treat around 80 per cent of the condition. [4]
        2. Medications: Prescribed phosphodiesterase-5 inhibitors such as Viagra, Stendra or Levitra.
        3. Surgery: It includes vascular surgery to correct the blood flow in the penis and penile implants in which a device is put inside the penis to get an erection.
        4. Intracavernosal Therapies: It includes injection therapies, often used when oral therapies don't work.

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2. Ejaculation disorders

Though erectile dysfunction is a well-known disorder in men, ejaculatory disorders are the most prevalent. It is a sexual problem in men related to ejaculation. A person with this disorder may experience ejaculation either too late, too soon or back to his bladder, or no ejaculation at all. It is divided into four categories: [5]

1. Premature ejaculation (PE): It is defined as ejaculation that occurs due to lack of ejaculatory control. In PE, ejaculation happens always or nearly always before or in just one minute of vaginal penetration. This causes problems in sexual satisfaction of one or both the partners and may disturb their emotional well-being.
2. Delayed ejaculation (DE): Also termed as retarded ejaculation, DE is defined as delay in ejaculation or absence of ejaculation. The condition often causes penile pain, problems during orgasm or problems in conception.
3. Retrograde ejaculation (RE): It is responsible for around 0.3-2 per cent of infertility. RE is a condition in which the semen retrogrades back to the bladder instead of coming out from the penis. A person with the condition may reach sexual satisfaction but the semen produced will be little which may cause problems in conception.
4. Anejaculation/anorgasmia: It is defined as a complete failure of achieving ejaculation. Men who often avoid sexual intercourse due to irritation or exhaustion are also placed in this section.

Causes of ejaculation disorders

Ejaculation disorders can have many potential causes such as:

  • Inadequate sexual stimulation
  • Loss of sexual excitement
  • Poor body image
  • History of traumatic masturbation
  • Relationship stress and conflicts
  • Religious taboos
  • Damage to pelvic nerves
  • Medications such as antidepressants, antipsychotics or those that increase circulating serotonin.
  • Diabetes
  • Low testosterone
  • Hypothyroidism
  • Spinal cord injuries
  • Urinary tract infection
  • Treatments of ejaculation disorders

    1. Discontinuation of drugs: Medications that interfere with orgasm or ejaculations should be stopped or modified after consulting a doctor. [6]
    2. Psychological counselling: To address mental health issues which are indirectly affecting the ability to ejaculate.
    3. Sex education: It includes relaxation techniques and various methods to get sexual satisfaction without ejaculation. It also includes behavioural modification.
    4. Surgery: It is usually carried out in RE to correct the muscles so that ejaculation can happen outside the penis.

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3. Sexual desire disorders (Loss of sexual desire)

Sexual desire disorders are among the under-diagnosed disorders due to their private and awkward nature. It is defined as recurrent or persistent lack of sexual or erotic thoughts and loss of desire for sexual activity. It includes hypoactive sexual desire and sexual aversion disorder.

Sexual response cycle includes four phases: desire, arousal, orgasm and resolution. Problems in any of these factors can cause sexual desire disorders. [7]

Causes of sexual desire disorders

Biological causes of sexual desire disorders include:

  • Low testosterone
  • Hypothyroidism
  • High levels of prolactin
  • Medications such as antidepressants
  • Neurological disorders such as multiple sclerosis
  • Inflammatory bowel disease
  • Renal failure
  • Age-related problems
  • HIV
  • Heart disease
  • Psychological causes of sexual desire disorders include:

    • Depression and anxiety
    • Having a partner with low sexual desire
    • Long term relationships
    • Negative body image
    • Performance anxiety
    • Family concerns
    • Sexual trauma
    • Lack of appropriate sexual stimulation from the partner
    • Having different preference for sexual activity
    • Feeling of negativity towards the partner
    • Religious background or rules towards sexuality
    • Treatments of sexual desire disorders

      1. Assessment: It includes private meetings with the couples individually so that they can openly discuss their suppressed desire or thoughts or any problems which can be the cause of lack of sexual desire.
      2. Testosterone replacement therapy: Low testosterone can be the primary cause of decreased sexual desire. The therapy causes testosterone levels to rise up and increases sexual desire.
      3. Psychological treatment: It includes approaching the emotional and behavioural problems which are causing interference with sexual desire.
      4. Other treatments: Include restraining the use of drugs that are causing low libido, providing communication training so as to establish connection between partners and building a strong relationship to get sexual satisfaction.

      To Conclude

      Sexual problems in men are as common as other health issues. However, discussing these problems is still a taboo in the society, which is also the main cause of a large number of under-diagnosed cases. Remember, addressing the sexual problems at an early stage can prevent the condition and improve the quality of life.

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