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Male sexual dysfunction is a common problem I encounter in my everyday practice. It is unfortunately a very sensitive matter which is often difficult for patients to disclose and seek help.
Male sexual dysfunction is a spectrum that includes, low libido, erectile dysfunction and ejaculatory problems such as delayed ejaculation, premature ejaculation and retrograde ejaculation.
Sexual dysfunction is common in men and increases with advancing age. Decreased libido is reported in 5 to 18% of men and is often associated with other conditions of sexual dysfunction. Erectile dysfunction (ED) on the other hand is reported to be around 18% in men aged 50 to 59 years and this figure rises to 40% in those of ages 70 to 75 years. Premature ejaculation is the commonest sexual dysfunction problem with prevalence of 20 to 30%.
There are several risk factors and predictors of erectile dysfunction. The most important risk factor is cardiovascular disease (CVD), and erectile dysfunction can be used as a surrogate marker for the development of cardiovascular disease. The traditional risk factors for development of CVD such as age, hypertension, diabetes, smoking and dyslipidemia are also risk factors for the development of ED. Other risk factors include previous injuries to the penis, spinal injuries, previous stroke and conditions such as Parkinson’s Disease. Hormone problems which can be a hormone deficiency or hormone excess can result in erectile dysfunction. Drugs such as certain hypertension medications, antipsychotics, antidepressants, recreational drugs and alcohol can result in ED. ED can also occur as a result of psychogenic factors, which include but are not limited to performance anxiety, previous traumatic experiences, anxiety, stress, depression and relationship problems. Unfortunately, psychogenic factors can often cause a vicious circle and increase the problem of ED unless they are addressed.
Low libido is often associated with a decline in levels of the male sex hormone, testosterone. Other factors that may lead to low libido include, stress, relationship issues, depression and systemic illness. Factors mentioned above that cause ED, such as drugs, alcohol and use of certain medications can also lead to low libido.
Premature ejaculation which is also referred to as early ejaculation or rapid ejaculation is defined as ejaculation that nearly or always occurs with 1 minute or prior to vaginal penetration. It also includes the inability to delay ejaculation with nearly or all vaginal penetrations. It often leads to negative personal consequences such as low self-esteem, stress, embarrassment and avoidance of intimacy. A significant proportion of men who have premature ejaculation also have concurrent ED.
The management of sexual dysfunction can be complicated and often needs a multidisciplinary approach including psychologists, physicians and urologists. The important part is management is identifying the underlying cause and treating the cause. Cardiovascular risk factors must also be treated appropriately. When indicated medications can be started that assist with sustained erections. When medications are ineffective other options include surgery and vacuum assisted devices which can be arranged with the urologists.
A huge component in the management of this condition is psychotherapy to address issues such as performance anxiety, depression and anxiety.
Male sexual dysfunction can be a debilitating condition with long term psychological effects if not addressed. It is important to seek help early and get a comprehensive assessment.