The Different Types of Male Sexual Dysfunction

Erectile dysfunction is only one kind

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Sex may be natural, but it doesn't always come easily. Both men and women can experience a wide variety of sexual problems throughout their lives. Although erectile dysfunction is the type of male sexual dysfunction most often discussed, it's not the only type of sexual difficulty men experience. Just as there are many types of sexual dysfunction in women, men can experience a variety of problems with desire, arousal, and orgasm.

Erectile dysfunction is just the beginning. 

Types of Male Sexual Dysfunction

Men can experience several different types of sexual dysfunction. Types of male sexual dysfunction tend to be broken down into the following categories.

  • Problems with interest or desire - Some men are troubled when they aren't interested in sex, or are less interested than they think they should be. If this lack of interest is severe enough, it can be diagnosed as Male Hypoactive Sexual Desire Disorder. Somewhere between 15 and 25 percent of men under the age of 60 experience problems with sexual interest or desire, mostly problems with desire. The frequency of desire difficulties increases quickly in men over 60.
  • Erectile dysfunction - Erectile dysfunction can take several forms. Men may have trouble obtaining an erection. They may have difficulty maintaining their erection. They may also have problems with keeping their erection firm enough for penetration. All these problems become more common with age. In men under 40, studies estimate that 15-17 percent of men will experience erectile dysfunction. In comparison, some studies estimate that more than three quarters of men over the age of 80 experience erectile dysfunction.
  • Premature ejaculation - Premature ejaculation, or PE,  is clinically defined as a man ejaculating within 1  minute of vaginal penetration, when that is before the man wishes to ejaculate. Men who have other forms of sex can also experience PE, but the formal diagnosis only provides a time estimate for vaginal intercourse. In general, if a man is ejaculating before he desires to, and in under 1-2 minutes, it is worth considering whether he might have PE. Studies on how common premature ejaculation is vary. Estimates are that somewhere between 8 and 30 percent of all men will experience this problem at some point during their lives.
  • Delayed ejaculation - Some men either can't ejaculate during partner sex, or it takes so long for them to ejaculate that they develop discomfort. These conditions are known as delayed ejaculation or anejaculation. (In this usage, an is a prefix meaning "not" or "without") There isn't much research on how common delayed ejaculation is. Estimates range from 1 to 10 percent of men, but scientists think the numbers are likely much higher in older men.
  • Difficulty with orgasm -  Many men don't notice a distinction between ejaculation and orgasm. Therefore it's difficult to determine how common orgasm problems are. However, some men do report problems with orgasm that are separate from their ability to ejaculate. Such problems can include a lack of pleasurable feelings during orgasm.
  • Pain during sex - Approximately 16 percent of men experience some pain during intercourse or ejaculation. Unfortunately, this condition is not well studied. However, pain can be linked to infection with certain STDs as well as to other problems, such as Peyronie's disease.

Causes of Male Sexual Problems

A number of health conditions can affect men's ability to function sexually. Probably the most well known cause of sexual problems in men is cancer.

Prostate cancer and its treatment are significant causes of sexual dysfunction in men. However, they're far from the only cause.

Aging and Lifestyle

Age is one of the biggest factors associated with sexual dysfunction. In general, men experience more sexual problems as they age. To an extent, this is due to an increased risk of cardiovascular disease and other illness, such as diabetes. However, decreased erectile function also seems to be a natural consequences of the aging process. It is just less of a problem for men who are otherwise in good health.

Cardiovascular health is a big risk factor for erectile problems, even independent of age.

This is because healthy arteries and blood flow are necessary for good erectile function. Similarly, diabetes is closely linked to the development of erectile problems. This is probably, in large part, due to the negative effects of diabetes on the cardiovascular and other systems of the body. Obesity and a sedentary lifestyle additionally elevate risk.

Recent studies suggest that cigarette smoking may increase the risk of sexual problems in men as well, but more work still needs to be done in this area. If tobacco is linked to erectile function, it may be due to its well-established effects on heart health.

Hormones

As people often think of testosterone as the "sex hormone", it's probably unsurprising to most people that hormone levels affect sexual interest and desire. What hormones are involved in sexual function? Primarily, the androgens have been implicated in sexual health, but other hormones may play a role is well. Testosterone is one type of androgen.

Androgen levels are well established as playing a big role in men's desire for sex. However, it is not clear that androgen levels have any effect on erectile function. It takes extremely low levels of testosterone to suppress nighttime erections. Furthermore, testosterone replacement has not been shown to be an effective treatment for erectile dysfunction. Therefore, except in rare circumstances, androgens probably play a much bigger role in desire than physical function.

Diseases

Several types of diseases can have an impact on sexual health. Urinary and kidney problems in particular have been shown to cause an increase in erectile dysfunction. Men with urinary symptoms have been shown to have three times the rates of erectile problems as men without them. This includes problems such as overactive bladder as well as lower urinary tract symptoms.

Chronic neurological diseases are also associated with sexual function problems in men. Increased rates of these problems are seen in men with such diverse conditions as Parkinson disease, epilepsy, stroke, and multiple sclerosis.For men with neurological problems, sexual dysfunctions can range from erectile problems to problems with desire and orgasm.

Male sexual dysfunction is also associated with a number of other medical conditions ranging from cancer to sleep apnea.

Injury

Men with spinal cord injuries have increased rates of erectile and ejaculatory problems. However, spinal cord injury does not necessary prohibit sexual function. Some people with complete spinal cord injuries still experience arousal and orgasm from non-genital stimulation. In addition, desire and interest are unlikely to be affected by spinal cord injury.

Surgery, particular prostate cancer surgery,can also cause problems with erectile function if important nerves or tissues are damaged. Radiation to the pelvis during cancer treatment can also cause injuries that lead to dysfunction. In general, any injury to the nerves, arteries, and veins of the pelvis has the potential to cause sexual problems.

Psychological and Psychiatric Problems. 

A number of psychological problems are associated with sexual function problems in men. Depression, anxiety, post traumatic stress disorder, and even anger issues can all cause problems with desire, erectile function, and ejaculation. Unfortunately, medications for these conditions can also cause sexual problems. If you have noticed your sexual function declining after starting a psychiatric medication, it may be worth discussing other options with your psychiatrist. Not all medications have the same effects on sexual function.

Medications and recreational drugs can also affect sexual function in some men. This includes both prescribed medications, such as those for heart disease, and illicit substances such as alcohol, marijuana, and narcotics. The prescribed medications most often associated with sexual problems are antidepressants and certain types of heart medication. Amphetamine abuse or misuse can also cause significant male sexual dysfunction.

Partner Problems

Finally, it's important to mention that sometimes sexual problems in men aren't about the man. They're about the relationship in which he's trying to have sex. When men aren't interested in or attracted to their partner, they may experience sexual function problems. A man's partner's sexual problems can also have an impact on his sexual function.

Treatment for Male Sexual Problems

It may surprise people that one of the biggest interventions for sexual dysfunction can be getting out of bed and out into the world. For men living a sedentary lifestyle, physical fitness can make a huge difference in sexual function. It can even help reverse the sexual effects of cardiovascular disease! Exercise has also been shown to be helpful for men experiencing sexual problems after prostate cancer.

Psychological Interventions and Sex Therapy

A number of psychological interventions have been developed to help men and women improve their sexual function. These interventions are often taught by sex therapists, and they include education on healthy sexuality and sexual function. Sex therapists are not "hands on" therapists. Instead, they're specially trained mental health clinicians who have learned how to work with people with sexual health problems. They don't touch their clients or have sex with them. Instead, they teach them skills and techniques to practice at home by themselves or with a sexual partner.

In addition to specific sex therapy techniques, mental health providers can help people improve their relationship with their partner. That's something that can make a big difference in having a healthy, enjoyable sex life. They may also be more acceptable alternatives to medical techniques for some men.

Medication

A number of medications have been used to help men with sexual problems. The most obvious are the treatments for erectile dysfunction - the PDE5 inhibitors such as Viagra, Levitra, and Cialis. (Note: some men can't take these for safety reasons.) However, medication can also be used to help with issues such as premature ejaculation. In fact, the same drugs that cause ejaculatory problems in some men are used to treat them in others. Low levels of anti-depressants can be a quick, easy fix for some men with premature ejaculation.

Holistic Therapy May Be the Best Option

For some men, the best option may be not having to choose between medical and psychological treatments. In fact, many men do best with a combination of therapies that address physical health, sexual health, and behavioral health simultaneously. Primary care doctors can address underlying health concerns. Sex therapists or counselors can educate patients about sexual function and practices. Specialists can provide more direct intervention and medications as needed, including ruling out health problems that other doctors may miss.

A Word From Verywell

Sexual problems are common, treatable, and not something to be ashamed of. The last notion can be the hardest for some men to grasp, as society often tells men that their sexuality is central to their worth. However, men aren't all about sex, and sex isn't all about the hardest erection or the most powerful ejaculation. That's why it's important to take a broader view of healthy sex and sexuality... and even more important to seek help if you need it. It may feel embarrassing to ask, but professionals can help you have an enjoyable, satisfying sexual life.

Sources:

Berry MD, Berry PD. Contemporary treatment of sexual dysfunction: reexamining the biopsychosocial model. J Sex Med. 2013 Nov;10(11):2627-43. doi:10.1111/jsm.12273.

Frühauf S, Gerger H, Schmidt HM, Munder T, Barth J. Efficacy of psychological interventions for sexual dysfunction: a systematic review and meta-analysis. Arch Sex Behav. 2013 Aug;42(6):915-33. doi: 10.1007/s10508-012-0062-0.

McCabe MP, Sharlip ID, Atalla E, Balon R, Fisher AD, Laumann E, Lee SW, Lewis R, Segraves RT. Definitions of Sexual Dysfunctions in Women and Men: A Consensus Statement From the Fourth International Consultation on Sexual Medicine 2015. J Sex Med. 2016 Feb;13(2):135-43. doi: 10.1016/j.jsxm.2015.12.019.

McCabe MP, Sharlip ID, Lewis R, Atalla E, Balon R, Fisher AD, Laumann E, Lee SW, Segraves RT. Incidence and Prevalence of Sexual Dysfunction in Women and Men: A Consensus Statement from the Fourth International Consultation on Sexual Medicine 2015. J Sex Med. 2016 Feb;13(2):144-52. doi: 10.1016/j.jsxm.2015.12.034.

McCabe MP, Sharlip ID, Lewis R, Atalla E, Balon R, Fisher AD, Laumann E, Lee SW, Segraves RT. Risk Factors for Sexual Dysfunction Among Women and Men: A Consensus Statement From the Fourth International Consultation on Sexual Medicine 2015. J Sex Med. 2016 Feb;13(2):153-67. doi: 10.1016/j.jsxm.2015.12.015.

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