Male Sexual Problems

Male Sexual problems

(Male Sexual Dysfunction)

The male sexual problems are one of the most important health issues in modern societies. The US National Health and Social Life Survey (NHSLS) suggest that about 31% of men suffer from a sexual dysfunction in their lifetime.[1]

Male sexual dysfunction can be divided into three categories: hypogonadism, erectile dysfunction ED, and ejaculatory disorders.

Erectile Dysfunction

 Erectile dysfunction (ED) is defined as the inability to attain or maintain an erection of sufficient to permit satisfactory of sexual intercourse.[2] ED is recognized as a common male sexual problem which affects on quality of life and overall health of a man.

Symptoms of Erectile Dysfunction

Symptoms of ED include:

•       Face difficulty in obtaining an erection during sexual activity
•      Difficulty in maintaining an erection until the completion of sexual activity
•      Decrease in erectile rigidity

Major Causes of Erectile Dysfunction

•         Age factor

t is established that ED risk increases with the age. It is reported that ED incidences accrue  2% of men in aged 20–39y, [3]   53% in men aged 40 to 55 y.[4] Another study indicates overall prevalence of ED in men aged 20-75 years was 16%.

·            Smoking

 There is an association between smoking and erectile dysfunction. It is well established that smoking is one of the causes of erectile dysfunction.

·              DM (diabetes mellitus)

 Diabetes is one of an organic cause of erectile dysfunction. The rate of ED in diabetes patients is high than those without. Maybe this rate relates to age factor and poor glycogenic control.

·         Hypertension

 There is a strong relation between ED, CVD, and hypertension. It is reported that men with vascular diseases strongly associated with hypertension, 71% MD Patient also had ED. [5]

·         Psychological Factors

 The psychological factor is also one of the major causes of ED. It can play an import role to increase the risk of erectile dysfunction. Psychological factor include:

•   Anxiety
•  Depression

 Disorder of ejaculation

Ejaculation is defined as a passage of seminal (sperm) fluid from its storage location, through ejaculatory duct and out into the urethra. After that, from the urethra, the sperm are ejected into the vagina.

• Premature Ejaculation (PE)

Premature ejaculation (PE) is defined as a deficient of ejaculatory control or regularly occurs prior to vaginal penetration. It interferes with sexual or emotional satisfaction. 

• Delayed Ejaculation

Delayed ejaculation (DE) is characterized by a man’s inability to ejaculate in a reasonable period under normal sexual motivation

• Retrograde Ejaculation

Retrograde ejaculation (RE) occurs when the semen intended for propulsion out the urethral meatus is directed backwards into the urinary bladder.

•   Anorgasmia

Anorgasmia is an Inability to achieve an orgasm during conscious sexual activity. AE specifically refers to the lack of ejaculation that may or may not be coupled with an orgasm.

 Effects of Disorder of ejaculation

Ejaculatory disorders can lead to:

•  Infertility
• Sexual dysfunction
• Distress, bother
• frustration

Hypogonadism

Hypogonadism is a medical term which refers to decreased functional activity of the gonads. The gonads   play an important role in producing hormones (testosterone, progesterone, estradiol, anti-mullerian hormone, progesterone, activin inhibin b) and gametes (eggs or sperm).

Hypogonadism is a condition in which the body does not produce enough hormones which affect on the intrinsic disease of the testes primarily and on the dysfunction of the pituitary secondary.[6]. It is important to mention that male hypogonadism is also a specific condition in which the body does not produce enough testosterone hormones. It is well established that low testosterone can lead to the absence of secondary sex characteristics such as low sexual desire, reduce libido and    infertility.

Causes of Hypogonadism

There are many primary and secondary Causes of hypogonadism. Some important causes of hypogonadism include:

·         Autoimmune disorders

·         Genetic disorders

·         Infection such is HIV 

·         Liver and kidney disease

·         Radiation exposure

·         Surgery

·         pituitary disorders

·         Obesity

·         Nutritional deficiencies

It is important to discuss that male sexual problems can negative effects on quality of life. It also relates to psychological, lifestyle, cultural and emotional aspects. Treatment of sexual problems should be focused on both psychological and medical approaches.

 Keep in mind, there are many nontraditional medications/ products for sexual problems are available in markets but unfortunately, they have not been tested medically/clinically. These medications have serious side effects and we should avoid them.

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[1] Male sexual dysfunction,  P Ramlachan,1 MB ChB, MHlthSc, FECSM; M M Campbell,2 PhD,   S Afr Med J 2014;104(6):447. DOI:10.7196/SAMJ.8376

[2] NIH Consensus Development Panel on Impotence. NIH Consensus Conference. Impotence. JAMA 1993; 270: 83-90.

[3] Does vitamin D deficiency contribute to erectile dysfunction?, Marc B. Sorenson1,* and William B. Grant2, Dermato-Endocrinology 4:2, 128–136; April/May/June 2012; G 2012 Landes Bioscience

[4] Erectile Dysfunction: A Marker of Early Coronary Heart Disease, GEORGE E. VRENTZOS, KOSMAS I. PARASKEVAS, DIMITRI P. MIKHAILIDIS, Hellenic J Cardiol 48: 185-191, 2007.

[5] Erectile Dysfunction: A Marker of Early Coronary Heart Disease, GEORGE E. VRENTZOS, KOSMAS I. PARASKEVAS, DIMITRI P. MIKHAILIDIS, Hellenic J Cardiol 48: 185-191, 2007.

[6] Current Concepts in Ejaculatory Dysfunction, Jeffrey P Wolters and Wayne J. G Hellstrom, MD, FACS, ev Urol. 2006; 8(Suppl 4): S18–S25. PMCID: PMC1765044/\