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Understanding Male Sexual Problems -- the Basics

What Causes Male Sexual Problems? continued...

Premature ejaculation (PE) is usually not due to physical causes, although the problem is sometimes linked to a neurological disorder, prostate infections, or urethritis. 

Possible psychological causes of sexual dysfunction include:

  • Anxiety
  • Guilt feelings about sex
  • Ambivalence toward women
  • Learned behavior pattern of rapid ejaculation seen with frequent masturbation or infrequent sexual activity

Erection problems can be caused by:

  • Blockages in the blood flow to the penis
  • Atherosclerosis, or hardening of the arteries leading to the penis
  • Damage to arteries or nerves after radiation treatment
  • Leaky veins
  • Low levels of the male hormone testosterone or other hormonal disturbances
  • Conditions or behaviors that increase the risk of vascular disease, such as smoking, high blood pressure, diabetes, and high cholesterol or the medications to treat these and other disorders

Painful intercourse usually has physical causes such as these:

  • An infection of the prostate, urethra, or testes, which can be initiated by sexually transmitted diseases, such as chlamydia and genital herpes
  • An allergic reaction to spermicide or condoms
  • Peyronie's disease, fibrous plaques on the upper side of the penis that often produce a painful bend during erection
  • Arthritis of the lower back

Lack of sexual desire may be due to any of these factors:

  • Physical illness
  • Hormonal abnormality (usually low testosterone levels)
  • Medications that affect libido
  • Psychological causes, including depression or interpersonal problems, which a therapist may help identify

Retrograde ejaculation may occur in men from these causes:

  • Prostate or urethral surgery
  • Medication that keeps the bladder neck open
  • Diabetes (which can injure the nerves that normally close the bladder during ejaculation)

Can Medication Cause Sexual Problems?

Many medications have been implicated in sexual dysfunction, causing inhibited sexual desire and/or erectile dysfunction, such as:

  • Drugs to treat high blood pressure
  • Diuretics (including thiazides and spironolactone)
  • Histamine blockers
  • Antidepressant medications
  • Common over-the-counter preparations (particularly antihistamines and decongestants)
  • Anti-psychotic medications
  • Sedatives
  • Medications used to treat anxiety
  • Use of drugs, including alcohol, methadone and heroin, anabolic steroids, and tobacco

Psychological Factors in Sexual Problems

Psychological factors play an important role. You may find it difficult to enjoy a sexual relationship if:

  • You are under a lot of stress
  • Your relationship is troubled
  • You have a history of traumatic sexual encounters (rape or incest)
  • You were raised in a family with strict sexual taboos
  • You're afraid of getting your partner pregnant or of contracting a sexually-transmitted disease
  • You have negative feelings (including guilt, anger, fear, low self-esteem, and anxiety)
  • You are depressed
  • You are severely fatigued

Environmental Factors in Sexual Problems

You may find it difficult to enjoy sex if there is no safe, private place to relax and allow yourself to become sexual, or if fatigue due to an overly busy work and personal life robs you of the energy to participate sexually. Parents may find it difficult to find the time to be sexually intimate, given the demands/presence of their children. 

Fear of contracting HIV (human immunodeficiency virus, which can lead to AIDS), the difficulties of striving for "safer sex," and the psychological effects of discrimination, are just a few of the factors that can cause anxieties in gay men.

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WebMD Medical Reference

Reviewed by Varnada Karriem-Norwood, MD on March 14, 2014

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