Patient Information sexual Medicine

Sexual Problems in Men

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 with sexual health can be treated. Therefore, it is important for a man to discuss these issues with a physician.

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.

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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

he treatment plan depends greatly on the precise cause of the sexual problem. If the cause is psychological, help from a psychiatrist or psychologist can be helpful. Often in this situation, cognitive behavioral therapy is the treatment used. Sometimes the treatment will include couples therapy. If the cause of the diminished libido is from medications being taken, sometimes there are alternative medications without sexual side effects. For others, hormonal replacement may be suggested. Talk to your doctor about any changes in libido you have experienced.

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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 risk factors for low libido?

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.
  • 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 causes low libido?

      Many causes have been identified as contributing to the diminishment of sexual desire. They include:

    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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