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Sexual Problems in Men

What Is Erectile Dysfunction?

Also known as impotence or ED, 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 (nervousness over his ability to sexually perform); and injury to the penis. Chronic illness, certain medications, and a condition called Peyronie's disease (scar tissue in the penis) can also cause erectile dysfunction.

What Is Inhibited Sexual Desire?

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 antidepressants; and relationship difficulties.

How Are Male Sexual Problems Diagnosed?

To diagnose a man's sexual problem, the doctor likely will begin with a thorough history of symptoms. He or she may order other tests to rule out any medical problems that may be contributing to the dysfunction. The doctor may refer you to other doctors, including a urologist (a doctor specializing in the urinary tract and male reproductive system), an endocrinologist (a doctor specializing in hormonal issues), a neurologist (a doctor specializing in disorders of the nervous system), sex therapists, and other counselors.

What Tests Are Used to Evaluate Sexual Problems?

Several tests can be used to evaluate the causes and extent of male sexual problems. They include:

  • Blood tests -- These tests are done to evaluate hormone levels.
  • Vascular assessment -- This involves an evaluation of the blood flow to the penis. A blockage in a blood vessel supplying blood to the penis may be contributing to erectile dysfunction.
  • Sensory testing -- Particularly useful in evaluating the effects of diabetic neuropathy (nerve damage), sensory testing measures the strength of nerve impulses in a particular area of the body.
  • Nocturnal penile tumescence and rigidity testing -- This test is used to monitor erections that occur naturally during sleep. This test can help determine if a man's erectile problems are due to physical or psychological causes.

How Is Male Sexual Dysfunction Treated?

Many cases of male sexual dysfunction can be corrected by treating the underlying physical or psychological problems. Treatment strategies may include the following:

  • Medical treatment -- This involves treatment of any physical problem that may be contributing to a man's sexual dysfunction.
  • Medications -- Medications, such as Cialis, Viagra or Levitra, may help improve sexual function in men by increasing blood flow to the penis. Promescent is a drug used to treat premature ejaculation. The topical spray is applied to the penis and contains lidocaine, reducing sensitivity and allowing for more ejaculation control.
  • Hormones -- Men with low levels of testosterone may benefit from hormone supplementation (testosterone replacement therapy).
  • Psychological therapy -- Therapy with a trained counselor can help a person address feelings of anxiety, fear, or guilt that may have an impact on sexual function.
  • Mechanical aids -- Aids such as vacuum devices and penile implants may help men with erectile dysfunction.
  • Education and communication -- Education about sex and sexual behaviors and responses may help a man overcome his anxieties about sexual performance. Open dialogue with your partner about your needs and concerns also helps to overcome many barriers to a healthy sex life.

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