Sexual Dysfunction In Males

Basic Information

Though most males at some point in their lives experience periods of sexual dysfunction (i.e. impotence or premature ejaculation or an inability to ejaculate), sexual dysfunction becomes a problem when it is chronic and begins to have an impact not only on the patient's sexual life but on the patient's emotional life as well.

What is known as proper sexual functioning depends on the state of desire, arousal or erection and orgasm. The orgasm in the male involves emission followed by an ejaculation. The emission or precum promises an ejaculation which is mediated by contractions of the prostate, seminal vesicles and the urethra. The orgasm is followed by a period of relaxation and regeneration, both psychological and physical. When this proper sexual functioning does not occur the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-III) refers to the problem as inhibitions in the response cycle and sexual dysfunction occurs. The dysfunction may either be primary (i.e. lifelong with proper sexual functioning never having occurred) or secondary (i.e. when disorders of sexual function occur following a period of normal sexual function). As with any other disease, the degree or frequency of the disorder and the situation of the individual male experiencing these disorders must be taken into account.

In cases of primary dysfunction there may be a fear of sex or a very rigid manly or religious background. In cases of secondary dysfunction the problem may be partner-related or a confusion about sexual orientation in which the patient attempts to have sex that they feel is not compatible with their sexual orientation.

The reasons for dysfunction can be either psychological or physiological and it is better for the patient himself not to diagnose which one is the cause. A frank and open discussion with a non-judgmental, knowledgeable health care provider can be the first step in discovering, through detailed health and sexual patient history, where the problem may lie. It is estimated that over twenty-five million men in the U.S. suffer from impotency. This is a figure researchers have come up with in lieu of the fact that only ten percent of men suffering from impotency actually seek treatment. Additionally it is estimated that ten million men suffer from premature ejaculation.

The inability to ejaculate or the inability to achieve and maintain an erection defines impotency. The problem increases with age, affecting approximately five percent of men under to over sixty-five percent of men over sixty-five. As men live longer lives this will be a problem that most men may need to address in later years.

What causes impotency? First of all, do not assume the causes are psychological. While this may well be the case, most men over fifty suffer from physiological problems, not a psychological one. These physiological causes include:

vascular
neurological
hormonal

When blockage occurs in main arteries in the penis or abdomen and pelvis, vascular insufficiency can occur. The blood is unable to flow in a sufficient amount into the erectile tissue because of the blocked artery or arteries. Nerves that are damaged often from disease can also be a cause of impotency. Diseases that have affected the lower spinal cord or the brain such as Parkinson's disease can affect the ability to achieve and maintain an erection. Diabetes is the largest cause of impotency because of the inability of the body to make the hormone insulin. It is believed that more than half of males with diabetes are affected by sexual dysfunction. Diseases in which damaged nerves can occur include:

herniated disc
spinal cord injury
multiple sclerosis

Another cause for impotency is the use of drugs, both prescribed and illicit. Blood pressure medications, antidepressants, cardiac medications and tranquilizers, especially in high dosages, may cause problems. Alcohol and illicit drugs such as cocaine and marijuana are also known to prevent erections from occurring as well as interfere with the ability to have an ejaculation.

Low levels of testosterone (hormone levels) can be responsible for many cases of impotency. Low hormone levels are often seen in patients who are HIV positive.

Premature ejaculation occurs when you ejaculate before you are ready. In the teenage male or adolescent this is a common condition. Often the teenager fears getting the girl pregnant or experiences fear of punishment if sexual activity is discovered. In the case of a gay teenage male or adolescent, fears of getting HIV infection or a sexually transmitted disease .

(STD) or a feeling that gay sex is somehow sinful may contribute to premature ejaculation. In the adult male, of course, these same issues may still exist but with additional causes of dysfunction including:

interpersonal relationship problems
marital discord
an excessive desire to please the partner
shame
guilt
uncomfortableness with aging
stress (social, job, financial)
fear of certain sex practices
fear of losing control
fear of becoming dependent
fear of performance failure
traumatic experiences such as incest or rape

When premature ejaculation becomes chronic, there are always feelings of inadequacy, anxiety and depression. As with impotency, premature ejaculation as well as the inability or failure to ejaculate can impact the worth of the patient's manhood, whether he is homosexual or heterosexual. In most cases there are psychological components at work, and psychological reasons or implications will vary with each individual..

Orgasm without ejaculation is another form of sexual dysfunction. This is called retrograde ejaculation. This occurs when the bladder does not close off at the time of orgasm and the semen flows back into the bladder instead of coming out through the penis. This causes infertility in heterosexual males and psychological problems for gay men. This condition can occur after surgery when nerves responsible for ejaculation are destroyed. Men who have cancer surgery such as prostate cancer surgery are most likely to experience retrograde ejaculation or even no ejaculation. The inability to have an orgasm can be caused by exhaustion, drugs or illness as well as numerous psychological blocks that can prevent achieving a satisfying climax.

Symptoms

Sexual dysfunction is an embarrassing subject for most men to discuss. That is why it is important to find a health care provider who is nonjudgmental and experienced at dealing with issues of sexual dysfunction so that the patient will feel comfortable being counseled and confident that possible referrals and treatment by a urologist or therapist will help ease the burden of carrying his "guilty secret" and restore the patient's sense of virility and self-worth. The key for the patient is to describe the symptoms of his dysfunction which will be either the inability to achieve or maintain an erection or have an ejaculation that is consistent with what he desires.

Diagnosis/Treatment

As previously discussed, the reason for your sexual dysfunction must first be diagnosed in order to treat it effectively. There is no point in treating psychological issues if the cause is a physiological one, and vice versa. Taking both a complete health and sexual history may provide hints of underlying causes. Your health care provider will be on the lookout for:

neurological problems
artery blockage
anxiety
depression
in the cases of gay males, possible homophobia or uncomfortableness with self-acceptance as a gay male
loss of libido in HIV positive gay males
drug or alcohol abuse
the beginning of a newly prescribed medication
whether the dysfunction occurs only with a partner during a specific sexual activity or if it occurs during masturbation as well

In addition a physical exam must be given. Here your health care provider will be looking for:

thyroid problems
shrunken testicles
tremors
pulses that are diminished
syphilis
genital diseases
arteriosclerosis
hypopituitarism
congenital abnormalities
aortic aneurysm

In HIV negative men, sexual dysfunction occurs at around the twenty percent rate because of the stress and fears associated with having sex in the age of AIDS. If you are an HIV negative gay man it is important to find a health care provider to whom you can disclose your fears and anxieties surrounding this issue so that if this is the reason for your sexual dysfunction it can be diagnosed and treated confidentially and supportively.

Tests for hormone levels and blood sugar are usually indicated as well as measuring the blood flow to the penis. A Doppler ultrasound machine can be effective in evaluating if you have blocked arteries.

In certain cases the use of what is known as an NPT (nocturnal penile tumescence) test is helpful in evaluating the normalcy of your nocturnal erections. With the use of a portable machine called the Rigiscan in which you attach a Velcro loop around the base and head of your penis before sleep it is possible to measure the frequency as well as the hardness and amount of time you are erect. Most men have up to five erections during the night. Using that as a norm your health care provider can determine if you are having adequate erections.

This is also a good way for your health care provider to distinguish if the underlying cause of your penile dysfunction is psychological or physiological. If it is psychological your nocturnal penile tumescence will not be abnormal. If there is a physiological problem this test will usually reveal abnormal results.

The lack of erections during sleep is almost always indicative of a physiological basis for the problem but this cannot be the conclusive reason in 100% of cases. NPT works by correlating erections with REM (rapid-eye-movement) sleep. Instead of the portable home test Rigiscan your health care provider may wish the option of having you observed during sleep in a sleep laboratory. In any event, the NPT is an important diagnostic tool for erectile dysfunction.

Treatment for physiological sexual dysfunction is accomplished either by drugs or surgery. If your sexual dysfunction has been found to be of psychological causes, sensitive therapy and counseling is indicated as treatment.

The first pill for impotence treatment has become quite popular and controversial, controversial because it is being taken for reasons other than for treatment of impotency. This is Sildenasil (Viagra) which works by dilating the arteries of the penis and increasing filling of erectile tissue. Generally taken two hours before sex is initiated, Viagra dilates the blood vessels but does not stimulate any sexual desire. That you must do for yourself. In most cases it does give an erection but your sex drive is not increased. This is a breakthrough of sorts with 75% of impotent males reporting a stronger erection and lessening of performance anxiety. But this should be taken only under the supervision of your health care provider -- not as an unnecessary pill for sexual enhancement or duration of erection -- as there are side effects, some of which can be quite dangerous, associated with its use. Side effects can include:

sudden palpitations, sometimes severe
headaches, sometimes severe
reddening of the face
difficulty breathing
visual changes
dizziness

Certain medications do not react well when taken in conjunction with Viagra. You must take this pill under supervision so that you can learn what other medications may cause dangerous interactions. Some males take amyl nitrate or poppers when using Viagra and since the nitrates are also dilating the blood vessels this can be a case of overkill and be dangerous. Do not use poppers and Viagra at the same time.

When medications like Viagra fail for men with sexual dysfunction, injection therapy can be tried. The patient learns to inject drugs into the penile shaft and if successful (in which it is in over 75% of cases) an erection will occur within fifteen minutes and will usually last up to an hour. Several drugs are used and your health care provider/urologist will find which one or combinations of several and in what doses will provide the best results for you. Prostaglandin E is considered the most effective medication for injection. Possible problems associated with injection therapy include:

fear of direct injection
a scar at the injection site
burning sensation, usually not severe
priapism, a rare occurrence

Penile suppositories are sometimes used in which you put a small pellet into your urethra with an applicator, then message the urethra for approximately ten to fifteen minutes while the medication begins to work. These suppositories are generally less effective than injection therapy and certainly less effective than Viagra, giving less potent erections and burning sensations in the urethra.

A low testosterone level is the culprit in some cases of impotency. Fortunately through either transdermal patches or by injecting testosterone boosters, testosterone levels can be raised enough, at least until the next patch or injection, in order for you to achieve and maintain an erection. Low testosterone levels frequently are found in HIV positive males. If you are HIV positive you will want to be aware that low testosterone levels might well be the cause of your impotency.

In most cases of physiological sexual dysfunction medication will provide very good results. However certain patients who are allergic to certain drugs or experience adverse side effects with use of these medications or who are not helped by these medications may turn to surgery or what is known as mechanical treatment in which a semi-rigid rod or inflatable chamber are used as prosthetic devices. Usually the inflatable prosthesis is recommended over the rod because it can be inflated at any time. With the semi-rigid rod, a rod is placed on each side of the penile shaft, the penis is stretched over the rods and an erection usually occurs.

Of course when psychological causes are responsible for impotency appropriate therapy and counseling are recommended for recovery.

Most cases of premature ejaculation are caused by psychological problems as opposed to physiological problems. Antidepressants and anti-anxiety medications have been successfully used to treat premature ejaculation. Your health care provider and/or urologist will work with you to see which medication is best at delaying ejaculation.

A non-pharmacological treatment for premature ejaculation is the Masters and Johnson "squeeze technique" in which desensitization is used with the help of a partner to lengthen the time of ejaculation. This is usually successful but lessens in effectiveness after a length of time.

So sexual dysfunction can be caused by either physical or psychological problems. Be sure you work with your health care provider to find what your cause or causes might be so that successful treatment can ensue. If you feel you have a problem with sexual dysfunction, please see your health care provider promptly.