Sexual Problems

 

Male

What is Sexual Problem?

A sexual problem or dysfunction /malfunction, are defined as difficulty during any stage of the sexual act [which includes desire, arousal, orgasm and resolution] that prevents the individual or couple from enjoying sexual activity.

Common sexual problems in men:

  • Erectile dysfunction
  • Ejaculation disorders
  • Loss or less libido

Research suggests that sexual problem is common for
43% – of women and
31% – of men

Causes:

Sexual problems can be a result of physical or psychological disorder.

Main physical causes are

  • Diabetes- 25% diabetic men between 30-34 age and
    75% diabetic men between 60-64
  • Atherosclerosis – Inadequate blood flow to the penis because of damaged arteries.
  • Alcoholism – Alcohol can damage the nerves leading to the penis, reduce testosterone level.
  • Antidepressant Drugs – 25% of erectile dysfunction is a results of drug side effect
  • Heart and vascular [blood vessel] disease
  • Neurological disorders
  • Hormonal imbalances [low testosterone]
  • Spinal cord injury
  • Birth defects
  • Failure of various organs [heart, lung]

Psychological causes:

  • work related stress and anxiety
  • concern about sexual performance
  • marital or relationship problems
  • depression
  • guilt feeling
  • effects of post sexual trauma
  • unresolved sexual orientation
  • Sexual boredom.

Erectile dysfunction or Impotence:

Definition:

Inability to attain and or maintain an erection suitable for intercourse.

Causes:

  • Artherosclerosis [hardening of the arteries] affects blood flow.
  • Nerve disorders
  • Psychological factors
    • Stress
    • Depression
    • Performance anxiety
  • Injury to the penis
  • Chronic illness
  • Peyronie’s disease[scar tissue in the penis]
Ejaculation disorders:

There are 3 types of disorders:

  1. Premature ejaculation
  2. Inhibited or retarded ejaculation
  3. Retrograde ejaculation
  4. Anejaculation
  1. Premature Ejaculation :- It occurs before or soon after penetration
  2. Inhibited or retarded ejaculation is delayed &/or slow to occur

Causes:

  • Lack of attraction for  a partner
  • Past traumatic events
  • Psychological factors
    • Strict religious back ground
    • Nervousness
    • Drugs side effects eg.anti-depressants, antihypertensives

c. Retrograde Ejaculation

  • At orgasm the ejaculate is forced back into the bladder rather than through the urethra and out the end of penis.

Causes:

  1. Diabetic neuropathy[nerve damage]
  2. Bladder operation on the neck of bladder or prostate
  3. Certain abdominal operations
  4. Certain medicine [used for mood disorder]
Loss of Libido:

Definition: Decrease in sexual desire or interest in sexual activity.

Cause:

Physical:

  • low level of testosterone hormone
  • medical illness [diabetes, high blood pressure, drug side effects(anti depressants)]

Psychological:

  • Anxiety, depression
  • Relationship difficulties.

Diagnosis:

Counselors, sex therapists and team of doctors can make a perfect decision of sexual problems after taking a thorough history and symptoms. Team of doctors includes

Urologist – doctor specializing in the urinary tract and male reproductive system
Endocrinologist – doctor specializing in glandular disorders
Neurologist – doctor specializing in nervous system disorders

Investigations:

Few tests can be done to evaluate the causes of sexual problem and it includes :

  1. Blood test – for hormone levels
  2. Vascular assessment – To evaluate the blood flow to the penis. Blockage in blood vessel may lead to erectile dysfunction
  3. Sensory testing – for diabetic neuropathy it measures strength of nerve impulses
  4. Nocturnal penile tumescence and rigidity testing:-
    It means natural erection, which happens in the sleep. It might help to evaluate physical and psychological causes.

Treatment :

  1. Medicine / Injectables

  • There are many oral medicines available and it helps to relax the blood vessels in the penis, allowing blood to flow in.
    • Eg. cilais [Tadalafil], levitra [Vardenafil], uprima [apomorphine Hcl tablets] and Viagra [Sildenafil citrate]

These medicines are not suitable for men who are taking medicine for angina which contain nitrates.

  • Alprostadil [caverject & viridal] is injected into penis and it relaxes the blood vessels and muscles, allows increases in blood flow and as a result producing an erection with in 15 mins.
  1. Testosterone Replacement Therapy

It low level of testosterone is a cause of erectile dysfunction – this therapy is useful.

  1. Mechanical aids :

a. Vacuum pumps

It is a plastic cylinder, placed around the penis and air is pumped out to create vacuum. A rubber ring traps the blood in the penis and keeps the penis rigid upto 30 mins.

b.  Manual pumps

c.  Battery operated devices

d.  Penile implants: A mechanical device [rigid, semi rigid or malleable rods] is surgically inserted into the penis. It produces various degree of      rigidity.

  1. Psychological therapy :

Many men can be benefited from counseling or therapy. Trained counselor or therapist can help to solve the problem like anxiety, fear or guilt.

  1. Education and Communication :

Sex education and open, frank discussion with partner may help to overcome sexual problem.