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What Are Male Sexual Problems?

Sexual behavior and response requires the complicated intertwining of environmental, physical (both anatomical and hormonal), and psychological factors. Problems with sexual functioning are common, affecting more than half of all couples at some time, according to studies. Though sexual dysfunction rarely threatens physical health, it can take a heavy psychological toll, bringing on depression, anxiety, and debilitating feelings of inadequacy. Many sexual problems are really symptoms of other more serious heath disorders.

Determining which factors are affecting your ability to enjoy your sexuality can be very difficult and will require great patience from you, your partner, and your healthcare provider. Problems may be difficult to resolve without expert help, especially because misinformation and embarrassment are leading causes of sexual dysfunction.

If your sexual problem only occurs under a particular set of circumstances, or only with certain sexual partners, then your condition is considered to be "situational" rather than "generalized" (occurring regardless of the circumstances or partner). If you've had normal sexual functioning in the past, but then develop a sexual problem, you have an "acquired" rather than "lifelong" difficulty.

The major categories of sexual dysfunction in men include:

• Erectile dysfunction (sometimes called impotence): the inability to have or maintain an erection sufficient for sexual functioning.
• Premature ejaculation: an inability to delay orgasm and ejaculation, such that it occurs very early in the course of sexual contact, leaving the other partner dissatisfied.
• Male orgasmic disorder: an inability to reach orgasm (climax) with a partner; or the inability to achieve orgasm without lengthy sexual contact; or the inability to have an orgasm during intercourse. In some cases, orgasm can be achieved only through masturbation or oral sex.
• Inhibited or hypoactive sexual desire: a disinterest in sexual contact or complete lack of sexual desire.
• Retrograde ejaculation, in which the semen, rather than emerging from the end of the penis, moves backward into the bladder during orgasm.
• Priapism, a prolonged erection unaccompanied by sexual desire; this rare condition is potentially dangerous and requires immediate medical attention.

Many of these sexual conditions will occur occasionally, during the course of a man's sexual life. In fact, some researchers only consider a diagnosis of sexual dysfunction if the problem occurs in 25% of all attempted sexual encounters.

What Causes Them?

Because the sexual response is so complex, involving multiple factors, there are many causes of sexual dysfunction. Sometimes simple lack of information is to blame.

Because an erection involves the nervous and vascular systems (the network of arteries and veins) and appropriate levels of hormones, problems with any of these systems can interfere with sexual functioning, such as:

• Hypogonadism, in which the testicles do not produce enough testosterone
• Thyroid disorders (both hyperthyroidism and hypothyroidism)
• Adrenal lesions (Cushing's syndrome).
• Pituitary conditions that increase levels of a chemical called prolactin.
• Noncancerous pituitary growths that increase levels of a hormone called prolactin.
• Diseases that affect the nervous system, including strokes, spinal cord injuries, multiple sclerosis, long-standing diabetes, and Parkinson's disease.
• Damage following pelvic surgery (such as prostate, colon or bladder surgery).
• Conditions that affect the penis directly, such as Peyronie's disease (penile curvature) or injury to the penis itself or to the arteries, veins, or nerves that supply the penis.
• Any serious and debilitating diseases that result in intense fatigue, including emphysema, chronic bronchitis, heart disease, cirrhosis, cancer and kidney failure.

With premature ejaculation (PE), physical causes are rare, although the problem is sometimes linked to a neurological disorder, prostate infections or urethritis. Possible psychological causes include anxiety, guilt feelings about sex, and ambivalence toward women. Premature ejaculation is often a learned behavior pattern of rapid ejaculation seen with frequent masturbation or infrequent sexual activity.

Erection problems can be caused by:

• Blockages in the aorta (the large artery that carries oxygen-rich blood from the heart) that disturb normal blood flow to the penis (aortic occlusion).
• Atherosclerosis in arteries leading to the penis.
• Damage to arteries or nerves after radiation treatment.
• Leaky veins.
• 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.

When men experience painful intercourse, the cause is usually physical — an infection of the prostate, urethra, or testes, or an allergic reaction to spermicide or condoms. Infections can be initiated by sexually transmitted diseases, such as chlamydia and genital herpes. Painful erections may be caused by 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 can also cause pain. When a man lacks sexual desire, the cause may be physical illness, hormonal abnormality (usually low testosterone levels), or medications that affect libido. There may also be psychological causes, including depression or interpersonal problems, which a therapist may help identify.

Retrograde ejaculation occurs in men who have had prostate or urethral surgery, take medication that keeps the bladder open, or suffer from diabetes — a disease that can injure the nerves that normally close the bladder during ejaculation.

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
• The antifungal agent ketoconazole
• Antidepressant medications
• Common over-the-counter preparations (particularly antihistamines and decongestants)
• Antipsychotic medications
• Sedatives
• Medications used to treat anxiety
• Drugs of abuse, including alcohol, methadone and heroin, and tobacco.

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 may interfere with sexual functioning. 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. Knowledge about AIDS, the difficulties of striving for "safer sex," and the psychological effects of discrimination are just a few of the factors that can give rise to anxieties for gay men.