Sexual dysfunction is any psychological or physical condition that prevents an individual from deriving pleasure or satisfaction from sex. Sexual dysfunction is any condition that interrupts the sexual response cycle, which is a series of emotions and bodily changes that are experienced during sex. This cycle starts with an “arousal phase,” then stagnates during the “plateau phase,” then builds up again into a climax in the “orgasm phase,” and finally ends in the “resolution phase.” Any problem in any of these phases can lead to dissatisfaction and, sometimes, even frustration.
In males, there are three main types of sexual dysfunction:
1. Erectile dysfunction
2. Ejaculatory problems
3. Low libido
Erectile dysfunction (commonly known as impotence) is the inability of the penis to become erect or to maintain erection that is ideal for intercourse. Erection happens when blood rushes to the vessels in the penis causing it to be engorged and erect. This is much like the process of filling an elongated sac with water. As water rushes into the sac, the sac springs into its shape and becomes firm.
The flow of blood to the penile vessels is largely controlled by the nervous system. However, many factors can affect this:
- Diseases of the vessels can cause them to become hard and less distensible. This is a common reason for impotence in the elderly.
- Problems with the nervous systems, like in cases of spinal injury, can result in the inability of the nerves to control the process of erection.
- Injury to the penis can destroy its anatomy and prevent the normal process of erection
- Stress and anxiety (especially about one’s sexual performance) can also lead to temporary impotence.
- Smoking and too much alcohol can damage the blood vessels and cause problems in erection.
Ejaculation is the process of ejecting semen from a man’s penis. This reflex that happens during the orgasm phase is controlled by a complex system of nerves. Problems in the coordination of this nervous control can lead to problems in ejaculation.
- Premature ejaculation is ejaculation that happens sooner than what is desired by the man or his partner. This can happen before or too soon after penetration. Most of the causes of premature ejaculation are psychological in nature. These might include anxiety over sexual performance, depression, hesitation, etc.
- Delayed or inhibited ejaculation is ejaculation that happens later than what is desired by the man or his partner. The process of ejaculation may be too slow to occur or may not happen at all. Causes of this problem are also psychological in nature like stress, marital problems, anxiety, depression, etc.
- Retrograde ejaculation is ejaculation that goes in a reverse direction. Instead of being ejected out of the penis, the ejaculate is propelled back into the urinary bladder. This is commonly seen in diabetic males whose nerves are damaged by the said condition.
Low libido is the decrease in sexual desire or the lack of interest to engage in sex. This can be due to psychological factors like stress, marital problems, depression, etc. This can also be due to hormonal changes in the body, particularly, the decrease in testosterone which commonly happens with aging.
Diagnosis of sexual dysfunction is done primarily through a comprehensive interview and history taking. For a better assessment of the sexual dysfunction, it is important that the patient seeking consult should disclose all of his symptoms, fears, problems, or issues to his doctor. If a doctor suspects an underlying physical problem, a referral to a urologist (or a doctor specializing in the male reproductive tract) could be done.
The treatment of sexual dysfunction depends on the type of the dysfunction and on the underlying cause of the dysfunction. Erectile dysfunction is usually treated with medications that promote the flow of blood to the penis. These medications include sildenafil (popularly known as Viagra), tadalafil (Cialis), and vardenafil (Levitra). Mechanical aids like vacuum and implants can also help in erectile dysfunction.
Premature ejaculation and low libido, which are mostly due to psychological problems, can benefit from counseling, psychologic therapy, or communication with the partner. Antidepressant drugs such as SSRIs (sertraline and paroxetine are examples) prolong the time between arousal and ejaculation in some men. These are regarded as the most successful treatment for premature ejaculation.
Low libido that is due to low testosterone can be treated with hormone replacement therapy that is available in the form of injection, patches or gels.
Other steps that could be helpful in addressing or preventing sexual dysfunction are the following:
- Regular exercise
- Smoking cessation
- Moderation of alcohol intake
- Open communication with the partner
- Weight loss in obese or overweight individuals