When you are experiencing male sexual dysfunction it affects both the physical and the mental
Sexual problems in men are common – up to a third of men report difficulty – and include a wide variety of problems which can affect any phase in the sex response cycle, preventing satisfaction and/or functioning. Most men experience some form of dysfunction at some time in their life, fortunately most forms of difficulty are treatable, although many men are reluctant to share with a medical professional, making it difficult to find adequate treatment.
Most Common Types
Premature, inhibited and retrograde ejaculations can be psychological in nature. Diabetes is a common cause of retrograde ejaculation, as well as past bladder neck, prostate or abdominal surgeries. Medications for mood disorders and depression commonly contribute to these problems. Erectile dysfunction is the inability to maintain an erection, and common causes include blood diseases, stress and depression, or chronic illness. Loss of libido – the desire and impulse for sexual activity – is associated with low testosterone, high blood pressure and any above mentioned psychological factors.
Causes
Broken down into physical, psychological and behavioral, causes include the following:
Physical:
- Diabetes
- Heart disease
- Neurological disorders
- Medications (more below)
- Chronic liver or kidney diseases
- Obesity
Behavioral:
- Drug and alcohol abuse
- Smoking
- Poor communication skills
- Poor sleep
- Lack of exercise
- Poor diet
Psychological:
- Anxiety
- Stress
- Relationship problems
- Depression
- Past trauma
Medications that don’t mix
Medications inhibiting function most commonly are:
- Antidepressants / Mood stabilizers
- Antipsychotics
- Antihistimines
- High blood pressure medications
- Pain killers
- Medications treating prostate conditions
Psychological roots are complex. Religious inculcation as a youth can skew perceptions of the “rightness” or “wrongness” of sex. Overthinking or becoming easily distracted as a result of nervousness can emerge from issues with self-confidence or past sexual abuses/experiences. Sex performance anxieties can be confronted through therapy with trained professionals.
Treatment
At a routine physical exam diagnosis can be made based on medical history and present body conditions (heart rate, blood pressure, etc), but opening up with the physician is the quickest path to a targeted assessment and specialized treatment plan. The doctor may examine the penis and testicles, order blood or urine tests, ultrasounds (monitors blood flow) and perform a psychological evaluation. The psychological component can be very personal. Common as well as infamous, the medications Cialis, Levitra, Stendra, Viagre and Staxyn can improve erectile function through increasing the blood flow to the penis. These treatments act by enhancing the effects of nitric oxide, which relaxes muscles in the penis, leading to increased blood flow.
Sexual stimulation is still required for an erection, contrary to popular myth. Some side effects include flushing, nasal congestion, headaches and upset stomach.
How treatments are administered
Alprostadil can be injected using a fine needle into the base or side of the penis. Generally these injections only last and hour but are not as painful as one might expect. Alprostadil also comes in suppository form, to be placed inside the penile urethra. It is very tiny and is inserted manually using a special applicator. Premature ejaculation can be treated with Promescent, a spray containing lidocaine – a topical anasthetic. Hormone therapy treats low testosterone levels but is best regulated by a doctor, not through over-the-counter supplements or steroid use. Surgically placed implants consist of inflatable or bendable rods and can be controlled manually to both initiate and maintain an erection. This method is highly successful but expensive, and risk of infection can be dangerous.
Alternative medicine, supplements and herbs
Any medications should be discussed with a doctor prior to use. Efficacy of these options are generally not proven nor thoroughly evaluated, and unpredictable side effects or drug interactions can occur. Apart from medical treatments, psychological therapy, sex education and even simple mechanical aids like vacuum devices are often beneficial. Penis pumps are hollow tubes with manual or battery powered pumps which suck air out of the tube and causes blood to be pulled into the penis. A tension ring is then applied to the base of the penis in order to hold blood in. Effectiveness is shorter in duration but often sufficiently long.
Exercise and other activities
Exercise, stress reduction activities (yoga, meditation, stretching) and proper diet are the most controllable influences, and often the most important. Maintaining low cholesterol levels by lean consumption as well as moderate sodium levels will have cumulative benefits. Cultural perceptions and standards of masculinity play a major psychological role in many cases of sexual dysfunction. A partner open to discussing these issues can aid in overcoming more than just sexual inadequacy. Professional therapy is nearly always worth the effort, in addition.
Medical Practitioner (General Practice) with postgraduate diplomas in Cape Town. My special interest is erectile dysfunction.
My biggest problem during sex was making it seem like a contest. I always wanted it to last for hours, and sometimes all a woman wants is a quickie. When I started to have performance issues the older I got, I really beat myself up over it. Sex should never be about the actual sex act, but the intimacy between two lovers. With patience and medication, my ED got better over time and I learned to just enjoy it!
I’m not a male, but my husband is. Recently during sexual intercourse he hasn’t been able to last very long. I have been patient and trying to understand, but he’s getting frustrated and upset. I can tell he is not happy and feels inadequate. We have tried some behavioral therapy and I am hoping it helps!
As men we are held to a standard that often feels unfair. We are held to the strange standard of being responsible for the pleasure of another, often without any information to assist. This is a large cause of sexual problems for men. We spend our time concerned constantly that we are going to miss the mark and be held to the worst of punishments, public shaming. Sadly this is the voice in the back of many of heads as we engage with women we find attractive. Trying to live up to a standard you cant even fully know leaves men unable to “rise” to occasion as so often happens. Combine this together with the fact that premature ejaculation is a term thrown around with wild abandon. I have spent most of my adult life thinking I suffered from premature ejaculation. As it turned out I suffered from expectations I couldnt meet causing me to over analyze and fail. As it turns out the solution to this ongoing issue is simply to let go of the expectations and just have as much fun as you can.
Having sexual problems can be a major issue for men. It can impact their self-esteem, which can impact other areas of their lives. For example, a man who is in his mid-40s begins to experience difficulties with arousal. His wife is patient, but he is embarrassed to talk about it. He’s worried she will seek sexual pleasure elsewhere since he’s unable to provide it. This leads to frustration and anger in other areas of his life. His work begins to suffer, as do his relationships with his children, because he’s angry.
I know several men who suffer from pornography-induced erectile dysfunction (PIED). The problem apparently is at epidemic levels for men under 30. They cannot perform in bed because their brains are so used to constant novelty that actual sex isn’t stimulating enough. This has led to the breakdown of innumerable relationships. What is worse, these young men are so addicted to high-speed internet porn that they can’t stop long enough (3 months in most cases) to reset their reproductive and neural reward systems. This leads to other symptoms, such as depression.
It was always talked about in Senior High School that a man was less of a man if they under performed sexually. Many of my friends found this to be absurd to judge another man about his sex life, and that any scrutiny was not something that we encouraged. We usually kept away from the people who acted in this manner. Most women I have encountered are not as worried about their sexual relations as much as they are worried about whether or not the relationship works out as a whole.
My husband of of ten years has only come on to me once in our relationship, when we were dating. All other sexual advances have been of my making. I know he loves me; he has just never been a sexual beast. All of his parts work and we have good sex, but I wonder why he isn’t more aggressive in the bedroom. Is it that he was just raise a gentleman or is it psychological?