Understanding Male Sexual Problems - the Basics

What Are Male Sexual Problems?

Sexual behavior and response requires the complicated intertwining of environmental, physical (both anatomical and hormonal), and psychological factors. Problems with sexual functioning are common, affecting more than half of all couples at some time. Though sexual dysfunction rarely threatens physical health, it can take a heavy psychological toll, bringing on depression, anxiety, and debilitating feelings of inadequacy. Many sexual problems are really symptoms of other more serious heath disorders.

Determining which factors are affecting your ability to enjoy your sexuality can be very difficult and will require great patience from you, your partner, and your healthcare provider. Problems may be difficult to resolve without expert help, especially because misinformation and embarrassment are leading causes of sexual dysfunction.

If your sexual problem only occurs under a particular set of circumstances, or only with certain sexual partners, then your condition is considered to be "situational" rather than "generalized" (occurring regardless of the circumstances or partner). If you've had normal sexual functioning in the past, but then develop a sexual problem, you have an "acquired" rather than "lifelong" difficulty.

The major categories of sexual dysfunction in men include:

• Erectile dysfunction (sometimes called impotence): the inability to have or maintain an erection sufficient for sexual functioning.
• Premature ejaculation : an inability to delay orgasm and ejaculation, such that it occurs very early in the course of sexual contact, leaving the other partner dissatisfied.
• Male orgasmic disorder: an inability to reach orgasm (climax) with a partner; or the inability to achieve orgasm without lengthy sexual contact; or the inability to have an orgasm during intercourse. In some cases, orgasm can be achieved only through masturbation or oral sex.
• Inhibited or hypoactive sexual desire: a disinterest in sexual contact or complete lack of sexual desire.
• Retrograde ejaculation, in which the semen, rather than emerging from the end of the penis, moves backward into the bladder during orgasm.
• Priapism, a prolonged erection unaccompanied by sexual desire; this rare condition is potentially dangerous and requires immediate medical attention.

Many of these sexual conditions will occur occasionally, during the course of a man's sexual life. In fact, some researchers only consider a diagnosis of sexual dysfunction if the problem occurs in 25% of all attempted sexual encounters.

What Causes Them?

Because the sexual response is so complex, involving multiple factors, there are many causes of sexual dysfunction. Sometimes simple lack of information is to blame. An erection involves the nervous and vascular systems (the network of arteries and veins) and appropriate levels of hormones, so problems with any of these systems can interfere with sexual functioning. Common problems include the following:

• Hypogonadism, in which the testicles do not produce enough testosterone
• Thyroid disorders (both hyperthyroidism and hypothyroidism)
• Adrenal lesions (Cushing's syndrome)
• Noncancerous pituitary growths that increase levels of a hormone called prolactin
• Diseases that affect the nervous system, including strokes, spinal cord injuries, multiple sclerosis, long-standing diabetes, and Parkinson's disease
• Damage following pelvic surgery (such as prostate, colon or bladder surgery)
• Conditions that affect the penis directly, such as Peyronie's disease (penile curvature) or injury to the penis itself or to the arteries, veins, or nerves that supply the penis
• Any serious and debilitating diseases that result in intense fatigue, including emphysema, chronic bronchitis, heart disease, cirrhosis, cancer, and kidney failure