MALE SEXUAL DYSFUNCTION
MALE SEXUAL DYSFUNCTION
Have you had difficulty developing an erection of your penis in the face of sexual stimulation? When you do manage to develop an erection, does your penis fail to become fully rigid, making it difficult for you to achieve vaginal penetration of your sexual partner? Alternatively, does your penis become hard when you are initially stimulated, but very rapidly lose its firmness such that the sexual encounter ends prematurely, without either partner achieving orgasm or feeling sexually fulfilled? If any of the above scenarios seems familiar to you, you may have erectile dysfunction. Erectile dysfunction is one of three sex-related conditions that commonly affect men. The second condition is premature ejaculation, which is characterized by successful development of a penile erection in the face of sexual stimulation, but the rapid, uncontrollable arrival of ejaculation of sperm shortly after the attainment of erection, either prior to, or just after vaginal penetration. Premature ejaculation is a very common disorder, and it causes a considerable amount of psychological distress. The third sex-related condition is called Hypoactive Sexual Desire Disorder, and is otherwise known as low sex drive or libido. These three conditions are collectively categorized under men’s sexual dysfunction. The purpose of this article is to provide an overview of each of these very common afflictions which have a huge impact on the quality of life of men, and are often either the cause of, or consequence of serious inter-personal difficulties between men and their spouses or partners.
Erectile Dysfunction (ED), once thought to be caused exclusively by psychological factors, is now known to be a more complex illness that can be caused by serious medical issues, but that can be made worse by psychological factors that either precede, or follow the onset of the problem. One reliable clue to a strong psychological component is the very rapid development of the problem in a previously asymptomatic patient without obvious health-related risk factors for the condition. The likelihood of largely psychological factors is increased by the observation that the patient is able to have erections while asleep, or in the early hours of the morning. When ED is caused by serious medical problems, there are usually obvious risk factors for the condition. Two of the most important medical conditions associated with an increased risk of ED are diabetes mellitus, and a history of disease of the blood vessels also known as Peripheral Vascular Disease (PVD). Age is also a risk factor, and there is about a 10 % decline in sexual function for every decade of age beyond the fifth decade of life. Other illnesses that contribute to the increased risk include hypertension, obesity, elevated levels of cholesterol, and another lipid found in the blood called triglycerides. Diabetes mellitus alone, particularly if poorly controlled, can increase the risk four-fold! Heart and blood vessel disease are common causes of ED, and sometimes the development of ED can be an early warning sign of emerging serious heart disease. Other more obvious causes include injury to the spinal cord, and operations such as removal of the prostate gland, which disrupts important nerves that facilitate erection. Lifestyle issues are also extremely important in the development of ED, with a very sedentary lifestyle, lack of exercise, obesity (especially truncal obesity; the so called “beer belly” being particularly damaging), and smoking of tobacco all contributing to increased risk. It is important to bear in mind that some commonly prescribed medications, taken for a variety of health conditions, can cause ED. Therefore, an important first step in dealing with new symptoms of ED is to review the medications you are taking with your doctor.
Patients with ED are often embarrassed, or have feelings of humiliation related to the condition, and may hesitate to volunteer information about the problem to their doctor. If you are a patient with ED, it is vitally important that you treat the condition like any other medical condition that requires an open and frank discussion with your doctor. Doctors need to ask appropriate screening questions, and take a detailed history from their patients. One useful tool is the Sexual Health Inventory for Men (SHIM), which is a standardized questionnaire available at www.erectilefunction.org/tool_kit/shim.pdf. A thorough physical examination usually focuses on the cardiovascular system, as well as the genital organs. Your physician will also order a variety of screening blood tests to try to identify a metabolic cause of your sexual dysfunction. Tests will include blood sugar and lipid levels, electrolytes, as well as liver and kidney function tests. Sex hormone levels are more controversial and are not checked routinely. If you are obese, smoke cigarettes, exercise sparingly or not at all, drink alcohol heavily, use illicit drugs, have a very unhealthy diet, or spend most of your time sedentary, it is important to initiate long lasting changes to these risk factors for ED. While the evidence linking these lifestyle changes to the improvement or resolution of ED maybe modest, there is no question that the changes will slow the development of serious health issues that may accelerate the decline in erectile function.
Viagra and other similar medications such as Cialis belong to a class of drugs called Phosphodiesterase-5 inhibitors, and are considered the first line of pharmacologic treatment of ED for patients who do not have contraindications to taking these drugs. This class of drugs work by increasing blood flow to the penis, which in turn causes the organ to become rigid. It is important to check with your doctor before beginning to take Viagra, or any other medication in this class, because it may be dangerous to take the medications if you have certain medical conditions. In particular, patients at high risk for a heart attack, or who are currently taking a class of drugs called nitrates should not take Viagra, or any of the other Phosphodiesterase-5 inhibitors (PDE-5) due to the risk of a dangerous drop in blood pressure levels. There is also a risk of precipitating blindness in patients with certain eye conditions. All of the commonly available PDE-5 inhibitors also have fairly strict guidelines for when and how to take them in order to maximize their effectiveness. Viagra should be taken one hour before onset of sexual activity, on an empty stomach, and without consumption of alcohol or drugs. You will still need to be stimulated sexually in order to develop and sustain an erection, as the effect of the drug is not independent of stimulation and arousal. The other drugs in the category all have slightly different guidelines for maximizing effectiveness, so it is important to get medication specific guidelines from your doctor. Patients who have contraindications to taking PDE-5 inhibitors can be treated with injections of a drug called Alprostadil (Prostaglandin E-1) directly into the penile muscle, or alternatively, into the opening at the tip of the penis called the urethra. Other approaches include using a vacuum generating device to attempt to draw blood into the penis, or the surgical implantation of a penile prosthesis. Treatment with testosterone is only appropriate for patients who have been diagnosed with abnormal production of testosterone due to diminished activity of the gonads.
Patients with premature ejaculation are able to develop a full erection, but quickly and uncontrollably ejaculate before, or shortly after penetration of the vagina. A hallmark of the condition is that the patient is dissatisfied with his sexual performance and is consequently often embarrassed or emotionally distressed. There is no effective medication-based treatment for premature ejaculation, although a variety of medications have been tried, despite a lack of official approval for their use for this indication. The mainstay of treatment is behavioral therapy, and it mainly involve techniques to modulate sensory arousal.
Hypoactive Sexual Desire Disorder (HSDD) is characterized by a decline in sexual libido that is more severe than the normal age-related decline in libido that occurs in men. Chronic disease is an important cause of this decline and includes heart failure, kidney failure, prostate cancer and hypogonadism. A number of hormonal deficiencies can also lead to a loss of libido. Depression and other psychiatric illnesses may also contribute to HSDD, but depression itself may be a consequence of the decline in sexual desire. Inter-personal difficulties between spouses or partners may exacerbate the decline. Because a high concentration of a hormone called prolactin in the blood can precipitate symptoms of HSDD, and this hormone maybe secreted by a tumor, it may be necessary for your doctor to order blood tests and a brain scan if there are other symptoms that raise concerns about a possible tumor. Other than in cases of hypogonadism where hormone replacement therapy may be appropriate, there is no specific treatment for HSDD. Occasionally a newly started medication is the culprit, and discontinuing the medication improves sexual desire.
In conclusion, male sexual dysfunction is a common condition in middle aged and older men, and it is the result of a complex interplay of organic illnesses, mental health issues, and lifestyle and wellness related inadequacies. It extracts a significant toll on the lives of men in the form of low self-esteem and depression, often aggravated by alcohol and drug abuse. Men are frequently reluctant to seek help due to fears of the associated stigma, nevertheless it is important to bring the issue up with your doctor because it may be a marker for more serious illnesses, and in some cases there may be effective treatments.
Okoronkwo Ogan
