Male Sexual Dysfunction

Introduction:

Male sexual dysfunction is a common problem that can stop a man from desiring and enjoying sexual activity. There are many factors that can contribute to (or cause) male sexual dysfunction – some may have a physical cause, while others can be down to psychological reasons.

The increased attention on male sexual dysfunction, due to the popularisation of the drug Viagra ®, has helped men to start talking about the problem and seeking treatment.

It’s important not to feel worried about seeking help from your doctor. There’s been nothing short of a revolution in the treatment of erectile dysfunction (ED) in recent years thanks to the development of ED drugs and the resulting discussion of male sexual dysfunction in the media.

1. What is sexual dysfunction?
2. What causes sexual dysfunction?
3. Erectile dysfunction
4. Premature ejaculation (PE)
5. Psychological impotence or performance anxiety

What is sexual dysfunction?

Sexual dysfunction in men includes common problems, such as:

• Premature ejaculation (PE) and ejaculation disorders
  
• Erectile dysfunction (impotence)
  
• Loss of sexual interest
  
• Anorgasmia – inability to reach orgasm during penetrative sex

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What causes sexual dysfunction?

There are certain physical conditions and psychological problems that may be the root cause of sexual dysfunction.

Physical conditions include:

• Alcoholism, drug abuse and smoking
  
• Medical conditions, such as diabetes, cardiovascular disease, prostate disorders, neurological disorders and chronic disease (for example kidney failure)
  
• Prescribed drugs, such as antidepressants and beta blockers

Psychological causes can include:

• Depression
  
• Anxiety and stress
  
• Worries about sexual performance

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Erectile dysfunction

In many cases, erectile dysfunction can be treated with oral medication, such as sildenafil (Viagra ®), vardenafil (Levitra ®) and tadalafil (Cialis ®).

These medications are called PDE5-inhibitor drugs. When a man becomes sexually stimulated, his brain sends out nerve signals, which cause a release of a chemical called nitric oxide. This chemical relaxes muscles in the penis to allow more blood to flow in, causing a hard, erect penis. These drugs help enhance the effects of the nitric acid.

Doctors say you should take Viagra ® and Levitra ® 30 to 60 minutes before sexual activity, while Cialis ® should be taken about 30 minutes before. Viagra ® and Levitra ® may be effective for up to four hours. Cialis ® may be effective for 24 to 36 hours.

Chronic health conditions may reduce the efficacy of ED drugs and they cannot be used in people with the following medical conditions:

• Poorly controlled diabetes
  
• Heart problems, including a recent heart attack (in the last six months), or heart pain (angina) during sex
• Heart failure, heart rhythm problems (arrhythmias)
  
• Poorly controlled high or low blood pressure
  
• A history of stroke within the last six months
• Family history of retina disorders, including retinitis pigmentosa
• Sickle cell anaemia, leukaemia or other conditions which can lead to permanent erection (priapism)

There is no controlled clinical data on safety or efficacy in the above groups of patients, so you should always obtain ED drugs through your GP and not online without a prescription.

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Premature ejaculation (PE)

If premature ejaculation has no medical cause and does not happen too quickly, you should be able to solve the problem by distracting yourself by thinking about something totally unrelated to sex.

PE may also be controlled by a self-help method based on a special 'penis grip' developed by the American therapists Masters and Johnson. The finger-grip stops the climax reaction, so if the couple takes careful instruction and use it over a period of weeks, they can usually re-train the man so he can last much longer.

Ask your doctor about this method first, as the Masters and Johnson grip should be demonstrated to you personally by an expert. Most couples who try to copy it from the Internet or a book get it wrong.

Some quack remedies for PE claim that anaesthetic gels and creams work to reduce sexual sensation in the penis. This is not recommended as the local anaesthetic can also reduce sensation for the partner, while also causing a skin sensitivity reaction.

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Psychological impotence or performance anxiety

Talking therapies are most useful here, depending on the specific problem. Talking to a counsellor or sex therapist may help certain types of sexual dysfunction due to anxiety or depression.

If you are taking certain selective serotonin reuptake inhibitor (SSRI) antidepressants, side-effects can include erectile problems.

Clickthrough information and support links:

Sexual Dysfunction Association
British Association for Sexual and Relationship Therapy
Relate
British Association for Sexual and Relationship Therapy (BASRT)
British Association for Behavioural and Cognitive Psychotherapy
Sexual Dysfunction Association (SDA)
Family Planning Association (FP) clinics offer free treatment, but waiting lists are long.

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  References:

This article has been written for PruHealth by Dr Foster Research. All Dr Foster Research (DFR) health content is provided for general information only, and should not be treated as a substitute for the medical advice of your own doctor or any other health care professional.