What Is Male Sexual Dysfunction?

Male sexual arousal is a complex process that involves the brain, hormones, emotions, nerves, muscles and blood vessels. The four main components of male sexual function are:

  1. Libido
  2. Erection
  3. Ejaculation 
  4. Orgasm

Male Sexual Dysfunction is problem with one of the above components that interferes with interest in sex or ability to engage in sexual intercourse. There are many physical, psychological and medication-related reasons that affect sexual function.

Here are a list of things that affect male sexual function, broken down by the components of male sexual arousal.

Male Libido:

Libido (or sex drive) is the conscious component of sexual function. Lowered libido means that there is a lack of sexual interest, a decrease in frequency or intensity of sexual thoughts. These sexual thoughts may be spontaneous or in response to erotic stimulus. Male libido is sensitive to general nutrition, overall health, drug usage and testosterone levels.

Conditions likely to decrease libido include depression, hypogonadism, and uremia. Certain medications, including SSRI's, tricyclic antidepressants and antidepressants, are also likely to decrease male libido.

Treatment will include treating underlying conditions as well as changing medications. If problems stem from relationships, counseling may be necessary.

Ejaculation:

Ejaculation is controlled by the sympathetic nervous system. Ejaculatory dysfunctions are some of the most common male sexual problems, yet are often widely overlooked. The spectrum of ejaculatory dysfunctions range from premature ejaculation to delayed ejaculation to anejaculation (an inability to ejaculate) and includes retrograde ejaculation and painful ejaculation.

Aspermia - no semen released from the penis at climax. This may become a problem when trying to reproduce. Treatment may include artificial reproductive techniques.

Ejaculatory insufficiency - reduced or absent semen volume that may result from retrograde ejaculation or interruption of sympathetic stimulation. Treatment for ejaculatory insufficiency generally involves treating the underlying cause and use of a vibrator on the base of the penis (if desire to procreate is evident).

Delayed Ejaculation - inability to ejaculate during sexual intercourse. However, a man is able to ejaculate during masturbation. This may be caused by mental issues, anxiety, the side effects of certain medication and certain diseases. Delayed ejaculation may be treated by removing the underlying cause or sex therapy.

Premature ejaculation - ejaculation occurring sooner than desired by the man or his partner. It is usually caused by sexual inexperience, anxiety, and other psychological factors instead of disease. It can be treated successfully with sex therapy and SSRI's.

Painful Ejaculation - pain upon ejaculation of semen from the penis. Painful ejaculation may be caused by a variety of physical issues (inflammation of the prostate gland, internal cystitis, sexually transmitted diseases, infections of the bladder or seminal vessicles), tricyclic antidepressants, SSRI's, and MAOI Inhibitors. Treatment includes treating underlying medical cause, switching medications and/or lowering medication dose.

Retrograde ejaculation - semen enters into the bladder rather than out through the urethra during sexual intercourse. This is common in men with diabetes and can also be caused by surgery on the neck of the bladder or transurethral resection of the prostate.

Orgasm:

An orgasm is a highly pleasurable sensation that occurs in the brain (usually) at the same time a man ejaculates.

Anorgasmia - inability to have an orgasm, can be a physical problem, caused by decreased penile sensation. Anorgasmia can often be a neuropsychologic problem due to mental illness or psychoactive drugs. Treatment for anorgasmia involves treating any underlying conditions, use of hormones and medications to improve blood flow.

Erection:

Erections occur as the result of a complex neuropsychologic process. Erectile Dysfunction (ED) is the inability to sustain or attain an erection satisfactorily for sexual intercourse. Most ED problems are related to vascular, neurological, psychological and hormonal disorders, although drug use may be a cause. Evaluation often includes a screening for underlying disorders and measuring testosterone levels.

Symptoms related to erectile dysfunction may include: trouble getting an erection, trouble keeping an erection and/or reduced sexual desire.

Causes of Male Sexual Dysfunction:

There are many causes of Male Sexual Dysfunction. Often issues such as Erectile Dysfunction occur because of physical issues such as:

  • Heart disease
  • Clogged blood vessels (atherosclerosis)
  • High blood pressure
  • Diabetes
  • Obesity
  • Parkinson's disease
  • Multiple sclerosis
  • Low testosterone
  • Peyronie's disease, development of scar tissue inside the penis
  • Some prescription medications, including antidepressants and high blood pressure medications
  • Tobacco use
  • Alcoholism and other forms of substance abuse
  • Treatments for prostate cancer or enlarged prostate
  • Surgeries or injuries that affect the pelvic area or spinal cord
  • Trauma to the genital region

Other types of dysfunction may be caused by psychological issues such as:

Diagnosis Of Male Sexual Dysfunction:

There are several possible tests that may aid a doctor in diagnosing certain types of Male Sexual Dysfunction.

Duplex ultrasound evaluates bloodflow, and may help indicate bloodflow issues, scaring, calcification of vessles and vascular dialation.

Penile nerves function testing can be conducted to determine the sensitivity of penile nerves. 

Nocturnal penile tumescence is a test that monitors how many erections a man has during sleep. It is typical to have five to six per night, and an absence of erections may signal dysfunction.

Penile biothesiometry tests the sensitivity of nerve function in the penis.

Dynamic infusion cavernosometry pumps fluid in to the penis, allowing doctors to monitor vascular pressure.

Possible Treatments For Male Sexual Dysfunction:

Treatment for Male Sexual Dysfunction is first aimed at treating any underlying physical cause for the dysfunction. Drugs that may have been related to onset of problems should be stopped or switched at the advice of your health professional. Mental issues or illness should be treated through therapy or medications. If the dysfunction is due to a hormone imbalance, medical treatments exist for that as well. 

Counseling: If your dysfunction is caused by stress, anxiety or depression, a counselor can help.

Medications: There are also medications to treat some forms of Male Sexual Dysfunction; however, many interact with other medications. Medications include oral phosphodiesterase inhibitors or apomorphine, intracavernosal or intraurethral prostaglandins.

Mechanical Devices: men who can develop - yet not maintain - an erection may use a "constriction ring" to place over the base of their penis, which prevents venous outflow. For men who cannot achieve erections, a vacuum device may draw blood into the penis, then the band is placed around the base of the penis to maintain erection. Constriction devices and vacuum pumps may be useful for men who do not respond to drug therapy.

Surgery: For men who do not respond to drug treatment, invasive treatment options include implanting a penile prosthesis.

 

Related Resource Pages on Band Back Together:

Female Sexual Dysfunction

Dyspareunia

Sexually Transmitted Diseases

Depression

Anxiety

Marriage and Partnership

Infertility

Additional Resources for Male Sexual Dysfunction:

Overcoming Ejaculation Problems - Web MD article on common ejaculatory problems and how to overcome them.

American Association of Sexuality Educators, Counselors and Therapists - not-for-profit, interdisciplinary professional organization. In addition to sexuality educators, sexuality counselors and sex therapists, AASECT members include physicians, nurses, social workers, psychologists, allied health professionals, clergy members, lawyers, sociologists, marriage and family counselors and therapists, family planning specialists and researchers, as well as students in relevant professional disciplines. These individuals share an interest in promoting understanding of human sexuality and healthy sexual behavior.

Causes of Male Sexual Dysfunction: