Sexual health: Sexual problems in men

A sexual problem, or sexual dysfunction, refers to a problem during any phase of the sexual response cycle that prevents the individual or couple from experiencing satisfaction from the sexual activity. The sexual response cycle has four phases: excitement, plateau, orgasm and resolution.

Research suggests that sexual dysfunction is common. According to the Sexual Dysfunction Association, one in 10 men experiences sexual problems, while about 50% of women report some degree of difficulty. Yet it is a topic that many people are hesitant to discuss. Fortunately, most cases of sexual dysfunction are treatable, so it is important to share your concerns with your partner and doctor.

What causes sexual problems?

Sexual dysfunction can be a result of a physical or psychological problem.

• Physical causes: Many physical and/or medical conditions can cause problems with sexual function. These conditions include diabetes, heart and vascular (blood vessel) disease, neurological disorders, hormonal imbalances, chronic diseases such as kidney or liver failure, and alcoholism and drug abuse. In addition, the side effects of certain medicines, including some antidepressant medication, can affect sexual desire and function.
• Psychological causes: These include work-related stress and anxiety, concern about sexual performance, marital or relationship problems, depression, feelings of guilt, and the effects of a past sexual trauma.

Who is affected by sexual problems?

Both men and women are affected by sexual problems. Sexual problems occur in adults of all ages. Among those commonly affected are those in the older population, which may be related to a decline in health associated with ageing.

How do sexual problems affect men?

The most common sexual problems in men are ejaculation disorders, erectile dysfunction, and inhibited sexual desire.

What are ejaculation disorders?

There are different types of ejaculation disorders, including:

• Premature ejaculation -- This refers to ejaculation that occurs before or soon after penetration.
• Inhibited or retarded ejaculation -- This is when ejaculation is slow to occur.
• Retrograde ejaculation -- This occurs when, at orgasm, the ejaculate is forced back into the bladder rather than through the urethra and out the end of the penis.

In some cases, premature and inhibited ejaculation are caused by a lack of attraction for a partner, past traumatic events and psychological factors, including a strict religious background that causes the person to view sex as sinful. Premature ejaculation is often is due to nervousness over how well a man will perform during sex. Certain medications, including some anti-depressants, may affect ejaculation, as can nerve damage to the spinal cord.

Retrograde ejaculation is common in males with diabetes who suffer from diabetic neuropathy (nerve damage). This is due to problems with the nerves in the bladder and the bladder neck that allow the ejaculate to flow backwards and into the bladder. In other men, retrograde ejaculation occurs after operations on the bladder neck or prostate, or after certain abdominal operations. In addition, certain medicines, particularly those used to treat mood disorders, may cause problems with ejaculation. This does not generally require treatment unless it impairs fertility