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    Information on sexual dysfunction in men

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

      Although sexual dysfunctions are not life-threatening in themselves, they can sometimes be symptoms of serious underlying health conditions, 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 different forms of effective treatment exists which has helped many men who suffer from the below sexual dysfunctions to 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.

      Erectile dysfunction (ED)

      An estimated 50% of men aged between 40 and 70 are affected by erectile dysfunction in the UK, with a rate of 39% for lifetime ED from the age of 18 onwards.

      What is erectile dysfunction?

      ED is the persistent inability to attain or maintain an erection sufficient for sexual performance. Physically, this means that there is insufficient blood flow to the penis necessary for an erection, and is not related to a loss in arousal or sexual feeling.

      Causes of erectile dysfunction

      ED has a whole host of possible causes and importantly can also be an indicator of problems such as diabetes, heart disease, thyroid problems, high blood pressure and cholesterol. Substance abuse, excessive alcohol consumption, smoking and obesity are all contributing factors to the development of ED.

      Physical causes can include:

      • Vascular problems (e.g. atherosclerosis and diabetes) where the penis receives an insufficient supply of blood
      • Nerve disorders such as multiple sclerosis and spinal cord injuries
      • Injury to the penis or trauma sustained from surgery or radiotherapy in the pelvic area.

      Psychological causes can include:

      • Stress
      • Performance anxiety
      • Depression
      • Guilt
      • Low self-esteem and body image
      • Previous traumatic sexual experience
      • Loss of attraction to your partner or relationship issues

      Psychological causes account for 10-20% of all incidences of ED, and are more common in younger men.

      ED can also be caused by hormonal imbalances, particularly pertaining to testosterone, prolactin and the thyroid gland. However, it should be noted that low testosterone levels (Hypogonadism) accounts for a minority of ED cases.

      Erectile dysfunction treatment

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

      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

      ED as a symptom of a larger problem

      Sexual dysfunction can 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 70% of all ED cases.

      The following problems can be specifically linked to ED:

      • Cardiovascular disease (CVD): since the penile arteries 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 as soon as possible to be screened for these conditions.

      Premature ejaculation

      Premature ejaculation (PE) is the most common of all ejaculatory problems. 20-30% of men are thought to have premature ejaculation, although less than a quarter are estimated to actually seek medical advice for their condition.

      What is premature ejaculation?

      Premature ejaculation (PE) is classed as an ejaculation that is earlier than desired, which is induced by minimal stimulation and subject to little physical control. As a continued condition, PE is usually life-long and dates back to a man’s first sexual experience. By contrast, acquired PE can develop gradually or suddenly in an individual who previously experienced normal ejaculatory control. There is a strong relationship between PE and ED, and PE can also be an indicator of an inflamed prostate.


      Causes of premature ejaculation

      • Primary PE: There is no single obvious cause for lifelong (primary) PE, 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.
      • Secondary PE: Acquired (secondary) PE can be linked to more organic causes, such as substance abuse, or prostate problems.

      Premature ejaculation treatment

      Selective serotonin uptake inhibitor tablets (SSRIs), such as Priligy, are the first-line treatment for PE 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.

      Other ejaculatory problems

      Although less common, the following ejaculatory problems can also occur:

      • Retrograde ejaculation: orgasm without ejaculation
      • Retarded ejaculation: delay of ejaculation after a period of stimulation

      Causes of painful sex

      Painful sex is an important problem in its own right and is linked to various different conditions:

      • Peyronie’s disease: this condition relates to the build-up of scar tissue as the result of trauma to the small blood vessels of the penis, which leads to curvature or ‘bending’ of the penis when erect.
      • Penile fracture: this can make experiencing an erection very painful, as well as penetration.
      • Prostatitis: this is an infection of the prostate gland. Other symptoms can include painful urination and swelling behind the penis.
      • Genital herpes: this sexually transmitted infection can often be easily recognised through the manifestation of visible sores, both on the penis and around other orifices, such as the mouth. This is a highly contagious long-term virus which remains within your body and can reoccur several times. Sex is often painful during a bout of herpes and should be avoided to prevent spread, particularly if you aren’t using a condom.
      • Foreskin problems: Although less common than the above, painful sex may be the result of your foreskin being too tight (phimosis), or being caught behind the head of the penis (paraphimosis). Both these conditions need to be diagnosed clinically and may need to be surgically treated.

      Can sexual dysfunctions be prevented?

      Although it can be hard to pre-empt most male sexual dysfunctions, there are some very important lifestyle factors which could significantly lower your risk of developing them.

      • Stop smoking: smoking can directly result 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 also result in the development of problems such as ED. Men who smoke are at 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.

      1. British Heart Foundation
      2. British Society of Sexual Medicine
      3. UK Health Centre
      4. UK Health Centre
      5. International Journal of Obesity and Related Metabolic Disorders
      6. British Association of Urological Surgeons
      7. Harvard Medical School

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