What are sexual problems in men?
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.
What is low libido?
The definition of low libido
is when sexual desire is diminished or absent. The definition also
varies according to the patient's level of satisfaction of his own
sexual desire. Some men can be very fulfilled with what some men
consider scarce sexual activity.
Sexual desire problems affect a
small percentage of men in the general population. Libido is mainly a
hormonal and brain phenomenon. Sexual desire requires normal levels of
testosterone (male hormone) in the blood and a certain attraction for
the partner in question.
What are the risk factors for low libido?
The 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
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