Understanding Male Sexual Problems -- Diagnosis and Treatment

How Do I Know If I Have a Sexual Problem?

The most important thing you can do if you're struggling with a sexual problem is to talk honestly and openly about your symptoms with your health care provider.

Your health care provider will probably ask about your relationships, partners, past sexual history, any history of trauma, possible symptoms of depression, and any other stresses or concerns that may be interfering with your ability to respond sexually. Though these topics may seem extraordinarily private, they must be covered to properly evaluate sexual dysfunction and help you have a more satisfying sex life.

Your health care provider will give you a thorough physical exam, checking for high blood pressure, vascular disease, a neurological disorder, or obvious signs of conditions affecting your penis or testicles. You'll probably be given a blood test to check for diabetes, thyroid disease, testosterone level, kidney and liver function, and any other hormonal disorders your health provider may suspect. In addition, your health care provider will review the list of medications and substances you use (including illicit drugs and natural remedies) to track whether your sexual dysfunction is connected with them.

Because men normally have multiple erections during sleep, you'll probably be asked about whether you ever awaken with an erection. Sometimes men are asked to undergo a test in a sleep lab to be monitored for erections during sleep. While this information can help tell whether erectile dysfunction may be due to problems with the vascular or nervous systems, it doesn't necessarily indicate whether the erection is sufficient for sexual penetration. An ultrasound exam that measures the blood flow within the pelvis (a penile Doppler study) can determine whether there is enough blood flow and pressure in the penis to allow for an adequate erection.

 

What Are the Treatments for Male Sexual Problems?

Any underlying physical conditions will be treated in an effort to improve sexual functioning. Medication may be given to increase testosterone levels, decrease prolactin, treat thyroid disease or diabetes, or address high blood pressure. If sexual dysfunction seems to be due to medications for another condition, your health care provider may prescribe an alternative with fewer sexual side effects. If you smoke, drink alcohol, or use any recreational drugs, you'll be encouraged to stop. Your health care provider will also recommend you eat a healthy diet and exercise regularly. Studies have shown that these measures may slow the buildup of fats that can block the blood vessels.

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Treating Erectile Dysfunction

Treatments for erectile dysfunction include any of the following:

  • Phosphodiesterase-5 inhibitors, the first-line medication for ED, work by dilating your blood vessels to allow more blood to enter and stay in your penis, resulting in increased frequency and duration of erections.  Examples include the drugs avanafil (Stendra), sildenafil citrate (Viagra), tadalafil (Cialis), or vardenafil HCL (Levitra) and vardenafil (Staxyn)
  • A vacuum inflation device that pulls blood into the penis
  • Prostaglandin urethral suppositories
  • Self-injection of medications directly into the penis
  • Vascular surgery to correct problems involving the veins of the penis (note: this procedure has not been found to be effective.)
  • Penile prostheses, either semi-rigid or inflatable

 

Treating Premature Ejaculation

Premature ejaculation is commonly curbed by the "squeeze" technique, a kind of biofeedback. This method has a high success rate, and repeated practice usually leads to better natural control. When you feel that orgasm is imminent, withdraw from your partner's vagina or anus or signal your partner to stop stimulation. You (or your partner) then squeezes gently on the head of the penis with the thumb and forefinger, halting the climax. After 20 or 30 seconds, begin lovemaking again. Repeat the process if necessary.

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.

Other medications may delay ejaculation, such as selective serotonin reuptake inhibitors (SSRIs) including fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft). None of these drugs is specifically approved by the FDA to treat premature ejaculation.

Premature ejaculation may signal a more complex disorder, and any psychological aspects should be explored in therapy.

Treating Retarded Ejaculation

This sexual problem is often treated by reducing anxiety and learning to control the timing of ejaculation. Sensate focus exercises may help; you should withhold penetration until you sense that ejaculation is inevitable. A common cause of retarded or delayed ejaculation is side effects from medication, especially antidepressant medications such as the SSRIs.

Treating Retrograde Ejaculation

Retrograde ejaculation may be corrected through medications or surgery that allows the valve at the base of the bladder to close. This is basically a harmless disorder, causing a problem only if pregnancy is a goal; in such situations, it may be possible to retrieve sperm from the bladder for artificial insemination.

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Treating Environmental and Psychological Causes of Sexual Problems

Your health care provider may be able to help you outline strategies to address non-medical issues. If you have psychological barriers to sexual functioning, your health care provider may suggest that you seek individual psychotherapy, couples therapy with your partner, or consult a sex therapist. A number of techniques and therapies can help individuals, including those who have experienced sexual trauma, become more comfortable with their sexuality. Similarly, if your health care provider feels that you may need more information about sexual functioning to help you achieve greater enjoyment, you may be referred to a sex therapist.

WebMD Medical Reference Reviewed by Sabrina Felson, MD on March 20, 2017

Sources

SOURCES: 

WebMD Medical Reference: "Your Guide to Sexual Health." 

American Association of Clinical Endocrinologists. 

American Association of Marriage and Family Therapy. 

American Urological Association. 

News release, FDA.

Absorption Pharmaceuticals, LLC.

UpToDate.

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