SEXUAL DYSFUNCTION RECAPITULATION

The three major forms of male sexual dysfunction are erectile dysfunction, ejaculatory dysfunction, and decreased libido. Erectile dysfunction is a common problem in men over the age of 40 due to hormonal abnormalities, medications, psychological problems, neurologic disease, or vascular insufficiency. Men with this disorder experience significant psychological distress, which improves if treatment successfully restores erectile function

What causes sexual dysfunction?

Causes of sexual dysfunction include:

• Physical causes — Many physical and/or medical conditions can cause problems with sexual function. These conditions include diabetes, heart and vascular (blood vessel) disease, neurological disorders, hormonal imbalances, chronic diseases such as kidney or liver failure, and alcoholism and drug abuse. In addition, the side effects of certain medications, including some antidepressants drugs, can affect sexual desire and function.
• Psychological causes — These include work-related stress and anxiety, concern about sexual performance, marital or relationship problems, depression, feelings of guilt, and the effects of a past sexual trauma.

How does sexual dysfunction affect men?  

The most common problems related to sexual dysfunction in men include ejaculation disorders, erectile dysfunction and inhibited sexual desire.

Ejaculation disorders

There are different types of ejaculation disorders, including:

• Premature ejaculation — This refers to ejaculation that occurs before or soon after penetration.
• Inhibited or retarded ejaculation —This is when ejaculation does not occur.
• Retrograde ejaculation — This occurs when, at orgasm, the ejaculate is forced back into the bladder rather than through the urethra and out the end of the penis.

In some cases, premature and inhibited ejaculation are caused by psychological factors, including a strict religious background that causes the person to view sex as sinful, a lack of attraction for a partner and past traumatic events (such as being discovered in masturbation or illicit sex, or learning one's partner is having an affair). Premature ejaculation, the most common form of sexual dysfunction in men, often is due to performance anxiety during sex. However, organic causes are sometimes present. Certain drugs, including some anti-depressants, may impair ejaculation, as can nerve damage to the spinal cord or back.
Retrograde ejaculation is most common in males with diabetes who suffer from diabetic neuropathy (nerve damage). This is due to problems with the nerves in the bladder and the bladder neck that allow the ejaculate to flow backward. In other men, retrograde ejaculation occurs after operations on the bladder neck or prostate, or after certain abdominal operations. In addition, certain medications, particularly those used to treat mood disorders, may cause problems with ejaculation.

Erectile dysfunction

Also known as impotence, erectile dysfunction is defined as the inability to attain and/or maintain an erection suitable for intercourse. Causes of erectile dysfunction include diseases affecting blood flow, such as atherosclerosis (hardening of the arteries); nerve disorders; psychological factors such as stress, depression and performance anxiety; and injury to the penis. Chronic illness, certain medications and a condition called Peyronie’s disease (scar tissue in the penis) also can cause erectile dysfunction.

Inhibited sexual desire (reduced libido)

Inhibited desire, or loss of libido, refers to a decrease in desire for or interest in sexual activity. Reduced libido can result from physical or psychological factors. It has been associated with low levels of the hormone testosterone. It also may be caused by psychological problems, such as anxiety and depression; medical illnesses such as diabetes and high blood pressure; certain medications, including some anti-depressants; and relationship difficulties.

Management

• Treatment options for ED include the following:
• Sexual counseling, if no organic causes can be found for the dysfunction
• Oral medications
• Injected, implanted, or topically applied medications
• External vacuum and constriction devices
• Surgery

Many patients with ED also have cardiovascular disease; thus, treatment of ED in these patients must take cardiovascular risks into account.