Male Sexual Issues - Part 1

Sexual issues are multi-dimensional and tend to combine elements of biological, psychological and social causes. 1 in 5 people (male or female) who is in a relationship reports having sexual difficulties, according to the National Survey of Sexual Attitudes. Sexual dysfunction of any nature can be the source of great distress and can have a major impact on quality of life and on partner relationships. It is not uncommon to find that experiencing sexual issues can lead to other mental health issues such as depression or loss of self-esteem.

There are 4 main categories of male sexual issues: Erectile Disorder (ED), Premature Ejaculation (PE), Delayed Ejaculation (DE) and Anejaculation, and Low Sexual Desire.

In this blog, the focus will be on ED specifically as it is an issue with a high prevalence. This will help provide an understanding in a bit more details of what it is and what to look for. Another post, will look into the other male sexual issues.

ED – a systematic or quasi systematic experience during sexual activity of either obtaining or maintaining erectile function, or noticing a marked decrease in erectile rigidity.

A key study done in the US around prevalence of ED, has showed that roughly 1 in 2 male aged between 40 and 70 can experience ED either completely, moderately or minimally. Prevalence of ED shows a direct correlation with increase in age. This can be link with the change in levels of testosterone or other issues link to the cardiovascular system. ED may be a pre-cursor indicating issues with heart conditions. This is because erectile function happens as a result of blood flow.

Another study in Europe, showed that ED can also be experienced at any stage in life, including a younger age (1 in 4 male under the age of 40 can experience ED).

The risks factors for ED are similar to those associated with heart disease conditions. The arteries in the penile shaft are smaller than the arteries elsewhere in the body and will therefore indicate issues with blood flow much earlier.

ED can have 2 types of categories of causes:

-          Organic : these are physical causes. These may manifest through the loss of the morning erection, or after surgery (prostate cancer for example), or when a broader cardiovascular issue is developing.

-          Psychogenic: these are psychological causes. There are some key differences with the organic causes as this type of causes will tend to be triggered by a particular event and therefore the loss of erectile function will appear suddenly or in an intermittent way. The morning erection will still be present and the problem may be present in partnered sex but not in solo sex.

Low testosterone is common in ED. Blood tests can be done to measure levels of ED.

The ADAM questionnaire can also be taken to have an indication.

ADAM questionnaire:

1.      Do you have a decrease in libido (sex drive)?

2.      Do you have a lack of energy?

3.      Do you have a decrease in strength and/or endurance?

4.      Have you lost height?

5.      Have you noticed a decreased "enjoyment of life"

6.      Are you sad and/or grumpy?

7.      Are your erections less strong?

8.      Have you noticed a recent deterioration in your ability to play sports?

9.      Are you falling asleep after dinner?

10. Has there been a recent deterioration in your work performance?

If you answer Yes to number 1 or 7 or if you answer Yes to more than 3 questions, you may have low Testosterone.

There are various possible treatments for ED. It is important to determine the causes to take the appropriate course of action.

-          PDE5-I, better known as Cialis, Viagra and others. These only work if the sexual process has already been initiated and there is an arousal and desire for sexual activity. These may be ineffective if the cause of ED is psychogenic in nature and there are issues to trigger arousal.

-          Injections are another options. These are done on the penis directly. The injection works by injecting a substance which will help relax some smooth muscle. It is effective but it is also very invasive.

-          MUSE therapy consists of pacing a suppository into the urethra. It is invasive and less effective than injections but avoids the need for a needle and works very quickly (within 5 to 10 mins).

-          Vacuum constriction devices or pumps . These are a safe way to work on erectile function. They are often used after medical issues which affect erectile function such as prostate cancer. However, the constriction doesn’t allow for the erection to last for more than 30 minutes and can feel uncomfortable. Sensations may be impaired

-          Penile implants may be a last resort. They require surgery and can come with some risk of infection but they have a high success rate.

-          Therapy when the causes are psychogenic.

Taking a holistic approach to explore all the aspects which may be interacting with sexual functions is critical to resolving the issues and finding sexual wellbeing.