Sexual dysfunction prevents one from experiencing satisfaction from sexual activity. According to research, sexual dysfunction is very common but many people don’t like talking about it although treatment options are available. The most common problems that men face with sexual dysfunction are problems while ejaculating, getting and keeping an erection, and reduced sexual desire.

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Types of male sexual dysfunction 

Although sexual dysfunction can occur at any age, it is most common in older men. Often, physicians can treat sexual dysfunction in men by targeting underlying causes. Here are the four common types of male sexual dysfunction.

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Erectile dysfunction

According to the Family Practice Notebook, 38% of men aged 60-69 are diagnosed with ED, compared with 57% of men aged 70 or older. For those between the ages of 40-49, the incidence is much lower at 11%. Of note, men who have diabetes are three times more likely to develop ED than men who do not. 

Organic disease accounts for 80% of cases of ED, with arterial or venous disease-causing 70% of cases. Anxiety, depression, heart disease, obesity, endocrine disorders, neurologic diseases like multiple sclerosis and Alzheimer, and medications (eg, antihypertensives, antidepressants) can all cause ED.

Current studies have even shown that marijuana use may contribute to ED. Intriguingly, shift work sleep disorder (SWSD) is also related to ED, according to the results of a study published in the Journal of Sexual Medicine. Researchers surveyed 754 men, and after ruling out various covariates, including testosterone use, testosterone levels, PDE5 inhibitor use, and age. The researchers determined that shift workers have worse ED—with night shifts linked to the worst cases.

The authors wrote:

“These findings suggest that circadian rhythm disturbance may significantly impact erectile function. While testosterone therapy may partly reverse the effects of SWSD, shift work is a potential risk factor for ED and should be assessed for as part of the evaluation of men with ED.”

Authors publishing in Nature Reviews Urology also found that disturbances to the circadian clock contribute to ED. They wrote,

“Disruption of the circadian clock has been associated with pathological conditions including obesity, type 2 diabetes mellitus, cancer, depression and neurodegenerative diseases. Disturbed sleep patterns have now been associated with reduced erectile function. The mechanisms behind this effect are unclear but could include hypoxia signalling and low testosterone.”

“These findings suggest that circadian rhythm disturbance may significantly impact erectile function. While testosterone therapy may partly reverse the effects of SWSD, shift work is a potential risk factor for ED and should be assessed for as part of the evaluation of men with ED."

Four categories of treatment for ED are currently available.

1. The four previously mentioned oral medications (eg, sildenafil, vardenafil, tadalafil, avanafil) all have comparable efficacy.
2. In patients who are non-responders to oral medications or experience adverse effects, intracavernosal injections (alprostadil, phentolamine, papaverine, atropine), as well as intraurethral suppositories (alprostadil), may work.
3. Lastly, although penile implants are an invasive alternative, they boast the highest satisfaction rate of all treatments.

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Regenerative treatments are on the horizon and maybe an option

“There is clinical interest in employing regenerative therapies, including low-intensity extracorporeal shockwave therapy (Li-ESWT), platelet-rich plasma (PRP), and stem cell therapy (SCT), in the treatment of ED as adjunct or alternative treatments,” wrote the authors of a review published in Therapeutic Advances in Urology. 

“Results of human studies are varied, although SCT treatments did result in increased erectile rigidity with some patients recovering the ability to achieve penetration. While these regenerative therapies show potential to augment the current treatment regimen for ED, there is a paucity of evidence to support the safety and efficacy of these treatments. Further research is necessary to define the role of these alternative therapies in the treatment of ED,” they concluded.

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Decreased libido

As men age, libido can decrease. Libido can also decrease with long-term committed relationships. Sex contributes to well-being, and men with low libido often seek treatment.  In those with low libido, doctors should perform a thorough history and physical exam to assess whether drugs (eg, antidepressants, blood pressure medications, illicit substances) contribute. Furthermore, systemic diseases such as HIV and cancer can play a role. It’s also important to test for decreased levels of serum testosterone. Unfortunately, there is no magic bullet to treat decreased libido in men.

“There is no FDA approved ‘libido pill’ for men although there is a medical option for women with low sexual desire,” noted the authors of an article published by the Department of Urology at the University of California-San Francisco. “If the man has another sexual problem that led to changes in libido, treatment of that condition may lead to a secondary improvement in sexual desire. If the changes in libido are associated with a specific medication, it may be worth stopping or changing the medication to an alternative agent.”

General health conditions that may predispose to changes in libido should be managed as appropriate (eg, men with obesity and or controlled diabetes should aim to lose weight and bring blood sugar levels under control). In some cases, this may lead to improvements in libido.

The authors added,

“As low blood levels of testosterone are associated with low libido, supplementation may be appropriate in some cases. Testosterone supplementation is somewhat controversial so it should only be considered after careful consultation with a health care provider who is knowledgeable about this topic. Testosterone is helpful in many, but not all, cases of low libido.”

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Premature ejaculation

Premature ejaculation (PE) is a common male sexual dysfunction that affects between 20% and 30% of men. It can be acquired or maybe lifelong, with lifelong presentations occurring after first sexual intercourse. Lifelong PE refers to intravaginal ejaculatory latency times of 1 or 2 minutes or fewer and occurs in between 2% and 5% of men.

The cause of PE is unknown, although anxiety, penile hypersensitivity, and serotonin receptor dysfunction have all been implicated. First-line treatment for PE involves the use of SSRIs, which delay ejaculation. Topical anaesthetics can also be applied between 20 and 30 minutes before intercourse. Other options include behavioural and cognitive therapies.

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Delayed ejaculation

This condition is the most poorly understood of the male sexual dysfunctions. It can range in severity, with some men able to ejaculate while masturbating but not during vaginal intercourse. It affects between 1% and 4% of men. Causes can be psychological or physiological, including spinal cord injuries, multiple sclerosis, or diabetes. Relationship issues may also play a role. Medications that contribute to this disorder include beta-blockers, muscle relaxants, and SSRIs.

No pharmacologic treatment exists for this condition. Cognitive-behavioural sex therapy, however, may prove effective. Furthermore, penile stimulation with a vibrator may also result in ejaculation.

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Bottom line

Having occasional erection problems is not necessarily cause for concern. However, ongoing erection issues can be a sign of sexual dysfunction and possibly underlying medical attention. Clinicians should attain a robust history and physical examination and look for possible contributors. Treatment of sexual dysfunction can be complex and often requires a multidisciplinary approach. Physicians should thus have a low threshold for appropriate referral to the proper specialists.

And remember, ED can also be caused by stress, relationship conflicts, depression, or anxiety—or the ED may be contributing to these problems—notes the Mayo Clinic. In these cases, physicians should consider referral to a psychologist or counsellor. 

This story is contributed by Naveed Saleh and is a part of our Global Content Initiative, where we feature selected stories from our Global network which we believe would be most useful and informative to our doctor members.