Patient Education: Sexual problems in men (Beyond the Basics)

Dr. S.K. Jain's Burlington Clinic Pvt Ltd.



Patient Education: Sexual problems in men (Beyond the Basics)

Dr. Saransh Jain 

SEXUAL PROBLEMS OVERVIEW

              For years, men believed that sexual problems were a normal part of growing older. Fortunately, modern medicine and changing attitudes have debunked this myth. As men and their health care providers become more comfortable talking about sexual problems and new treatments are developed, there is no reason why men cannot remain sexually active well into their 70s and beyond.

Sexual problems in men include:-

An inability to acquire or maintain an erection satisfactory for sexual intercourse (also called erectile dysfunction [ED])

A lack of interest in sex (diminished libido)

Premature ejaculation

Delayed or inhibited ejaculation


Penile curvature (Peyronie's disease)


ERECTILE DYSFUNCTION

Causes — Erectile dysfunction (ED) is the term used to describe men who cannot acquire or maintain an erection.

Limited blood flow — Anything that limits blood flow to the penis can cause ED. The most common conditions that limit blood flow include cigarette smoking, diabetes, high blood pressure, and normal aging. In addition, many commonly prescribed medications, such as antihypertensive medications, can interfere with male sexual function. Reduced blood flow in the penile arteries can happen before decreased blood flow to other vital organs, such as the heart, begins. Therefore, men with ED should be evaluated for any other cardiovascular risk factors.

Neurological causes — ED can be caused by a stroke, diseases such as diabetes, spinal cord injury, or prostate surgery that damage nerves to the penis.

Drugs — A large number of drugs that affect the nervous system and some that lower testosterone levels or inhibit testosterone action can cause ED. Opioids that are taken for chronic pain can also cause ED.

Psychologic causes — Depression, performance anxiety, and lack of focus are common causes of psychogenic ED.

Depression – Loss of libido and lack of interest in sexual activity are common symptoms of depression. ED is, in itself, a depressing experience for many men. Many men choose to accept a decline in sexual function as a natural consequence of aging. Because of shame or embarrassment, they do not discuss this problem with their health care provider. This is unfortunate because it is often possible to determine the cause(s) of sexual problems and many options are available to treat ED.

Performance anxiety – Performance anxiety may develop in men who suddenly experience one or more erectile failures during intercourse. The focus of the sexual act shifts from a sensual experience to one filled with anxiety. During later attempts to have sex, the inability to acquire and maintain an erection becomes the focus of the sexual experience.

Diagnosis — In order to determine the cause of the dysfunction, a health care provider will take a sexual history, perform a physical examination, and order blood tests to determine if conditions such as diabetes or low testosterone levels are contributing to the sexual problems. Sometimes more specialized tests, such as evaluating penile blood flow with ultrasound during a pharmacologically induced erection, can provide useful information. (See 'Testing' below.)

Sexual history — The clinician will ask the patient personal questions about his sex life to help determine the cause of the condition. It is important that the patient answer the questions honestly and provide as much detail as possible.

The clinician will want to know if:

ED developed slowly or happened suddenly

There are erections during the night or in the morning when he first wakes up

There is similar ED with masturbation

There are interpersonal problems with a spouse, girlfriend, or sexual partner

There are any risk factors for impotence, such as a history of smoking, diabetes, high blood pressure, high cholesterol levels, alcohol or drug abuse, or depression

Physical examination — In addition to doing a basic physical examination, the clinician may:

Check pulses in the groin and feet

Check the breasts for abnormal swelling, a condition called gynecomastia

Examine the penis

Check the testicles' size and for any abnormal testicular masses

Check the prostate



Testing — The clinician may order tests to measure levels of testosterone, prolactin, and thyroid hormones in the blood. Abnormally low testosterone, elevated prolactin, and either low or elevated levels of thyroid hormones can cause sexual problems. All men with sexual problems should have blood tests.


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