Sexual dysfunction in men

Sexual dysfunction in men, such as erectile dysfunction (ED) and premature ejaculation (PE), is more widespread than you would think. The inability to have a satisfactory sexual relationship is not always related to age and is shared by a considerable number of men in the UK.

Although sexual dysfunction is not life-threatening, it can sometimes be a symptom of a serious underlying health condition, such as heart disease and diabetes. They can seriously affect the psychological wellbeing and quality of life for men and their partners, leading to emotional stresses that are often difficult to tackle.

Causes can be medical, physical, or psychological, and the majority are very closely linked to a man’s lifestyle choices. Fortunately, a variety of effective treatments exist which has helped many men who suffer from sexual dysfunction, lead healthy and enjoyable sex lives.

Symptoms can be either occasional or long-term, but the true definition of when an issue becomes a ‘dysfunction’ rests with the individual. If you consistently experience some of the problems below and are frustrated by their presence, it is highly recommended that you have a medical evaluation of your condition.

Causes of sexual dysfunction

Sexual dysfunction can be caused by a number of physical and psychological factors. Lifelong (primary) premature ejaculation, for example, has no single obvious cause, leading many medical professionals to focus on psychological causes over definitive physical ones. Previous traumatic sexual experiences and anxiety can lead to PE, as well as the novelty of a new sexual situation.

Sexual dysfunction can also be an important indicator for serious underlying health concerns, with erectile dysfunction being especially tell-tale; wider problems like diabetes and cardiovascular disease account for ED cases.

The following problems can be specifically linked to ED:

• Cardiovascular disease (CVD): since the penile blood vessels are very small, they can present the symptoms of a wider circulatory problem quite early on. Alongside smoking, high blood pressure and high cholesterol, ED is a risk factor for CVD.
• Diabetes: damage to blood vessels as a result of diabetes can lead to an insufficient flow of blood to the penis.
• High blood pressure: ED is the first symptom of high blood pressure for an estimated 20% of men. High blood pressure also accelerates atherosclerosis.
• Atherosclerosis: the hardening of the arteries is commonly due to high cholesterol levels. Atherosclerosis can result in circulatory problems which negatively impact the chances of maintaining a strong erection and raises the risk of heart attacks and strokes.

Since these serious conditions require early diagnosis, men experiencing ED are urged to speak to a medical specialist to be screened for these conditions and thoroughly explore the possible causes.

What drugs affect sexual dysfunction?

There are a number of recreational, over-the-counter and prescription drugs which may cause sexual dysfunction, affecting a man’s hormones, nerves and blood circulation. These include:

• Alcohol
• Amphetamines
• Antidepressants
• Antihistamines
• Anti-inflammatories
• Barbiturates
• Chemotherapy drugs
• Cocaine
• Marijuana
• Methadone
• Muscle relaxants
• Nicotine
• Opiates
• Parkinson’s disease medication

The list is long so, if you are worried your medication may be affecting your sexual performance, make sure you check the side effects with your GP.

How does sexual dysfunction affect men?

Sexual dysfunction can have a devastating effect on a man’s emotional health, leaving him feeling worthless and withdrawn, affecting his sexual relationships.

How sexual dysfunction affects marriage and relationships

An unfortunate outcome of sexual dysfunction is that your partner’s self-esteem can often be dented, with them blaming themselves for your lack of arousal. A study by Pfizer showed that most women, where their quality of life is concerned, ranked ED higher in importance than menopausal symptoms, infertility and insomnia.

In order to prevent sexual dysfunction taking its toll on your relationship, ensure you keep talking about the problem, avoid blaming and maintain a sense of intimacy, there’s more to sex than just intercourse.

Is sexual dysfunction permanent?

In many cases, there is a good chance of resolving sexual dysfunction. The main thing is not to ignore the symptoms as it won’t go away on its own. Premature ejaculation, for example, can be a sporadic condition and is unlikely to be permanent. ED can also be reversed. A study in the Journal of Sexual Medicine found an ED remission rate of 29% after 5 years. Even when ED cannot be cured, the right treatment can reduce symptoms. There are also many lifestyle changes that can be explored in order to overcome sexual dysfunction.

How to improve sexual dysfunction

Although it can be hard to pre-empt most male sexual dysfunctions, there are some very important lifestyle factors which could significantly help to overcome symptoms:

• Stop smoking: smoking can directly restrict the circulation of blood to the penis. It can also increase the risk of developing conditions such as CVD and high blood pressure, which can contribute to problems such as ED. Men who smoke have a 50% higher chance of developing erectile problems than non-smokers.
• Drink alcohol in moderation: along with harder drugs, prolonged excessive alcohol consumption can seriously damage the nervous system and negatively affect ejaculation and the maintenance of a strong erection. Alcohol also causes loss of erection by direct effect.
• Exercise: cardiovascular exercise will allow you to maintain good circulation and will reduce the risk of developing CVD and high blood pressure among a multitude of other conditions. Walking, running and swimming are particularly effective for this, but be aware that prolonged cycling can cause damage to the nerves.
• Lose weight: whilst the effects of a negative body image can feed into some of the psychological causes behind male sexual dysfunction, the risk of high cholesterol and diabetes that accompanies obesity is directly related to ED.
• Mindful diet: consume a well-balanced and well-portioned diet, avoiding foods that are high in salt, saturated fats, and refined starches. Foods rich in Omega-3 are especially important for a healthy diet and provide essential healthy fats.
• Mental health: consider seeking professional help for any psychological issues, such as depression, anxiety, and stress. There are a multitude of alternative channels available, such as helplines and web services, if you do not want to speak to someone face-to-face.

Despite the significance of the statistics, one of the biggest problems surrounding male sexual problems is the low level at which they are reported or evaluated.

For peace of mind, always consult your GP and get tested. Click the following links for more information about our free assessments for premature ejaculation and erectile dysfunction, as well as their respective treatments.

Erectile dysfunction treatments

One of the simplest and most popular treatments for erectile dysfunction is to take PDE-5 inhibitor tablets. These include:

• Viagra
• Viagra Connect
• Cialis
• Sildenafil
• Tadalafil
• Levitra
• Spedra

Alternative treatment

Vitaros (Alprostadil) cream may be prescribed as an alternative to tablets (PDE5 inhibitors). The cream is applied to the tip of the penis and stimulates blood flow, leading to an erection. Vitaros is a fast-acting treatment that can take effect within 5-30 minutes and last 1-2 hours.

More invasive procedures are available, such as:

• Transurethral therapy
• Intracavernous injection
• Vacuum constriction devices

Apomorphine has demonstrated some success in affecting ED related to desire and psychological causes, although it is largely deemed ineffective.

The following therapies can help treat psychologically-based ED:

• Cognitive behavioural therapy (CBT)
• Sex Therapy
• Psychosexual therapy

Premature ejaculation treatments

Selective serotonin uptake inhibitor tablets (SSRIs), such as Priligy, are the first-line treatment for premature ejaculation sexual therapy and constitute its most effective treatment. Alternative oral medications such as tramadol, terazosin, and alfuzosin have demonstrated little effect in treating PE and are not recommended.

Local anaesthetic creams, such as EMLA, are also available, which aim to desensitise the penis to prolong sexual performance before ejaculation.
If you think your PE may be more psychologically-sourced, then psychosexual counselling may help.

References
https://www.nhs.uk/conditions/erection-problems-erectile-dysfunction/
patient.info/doctor/erectile-dysfunction
www.medicalnewstoday.com/articles/322086.php
www.bhf.org.uk/
www.bssm.org.uk/
www.baus.org.uk/
hms.harvard.edu