Male sexual dysfunction: everything there is to know

What is male sexual dysfunction? What are its causes and symptoms?  

When men have difficulty having sexual intercourse, this is known as sexual dysfunction. Sexual dysfunction affects sexual arousal, erection without penile deformity, ejaculation and orgasm.

For an erection to occur, a man's penis needs sufficient blood supply, slowed blood drainage, proper functioning of the nerves around the penis, normal levels of testosterone and sufficient sexual desire (libido).

In men, sexual dysfunction is actually a group of conditions which includes: 

Occasional erectile dysfunction 

It is normal for men not to be able to get an erection from time to time. 

Erectile dysfunction (ED) 

Erectile dysfunction (ED), or impotence, is the inability to achieve or maintain a satisfactory erection for sexual intercourse.

Signs of ED include the absence of an erection during the night or upon waking up, numbness in the area between and around the buttocks and in the genital area, painful cramps in the leg muscles that occur during physical activity but are relieved by rest.

Priapism

Priapism is a persistent erection, often lasting several hours, which is painful and can damage the erectile tissue of the penis, resulting in erectile dysfunction (ED). It occurs without sexual desire or arousal, never leads to ejaculation, and the glans remains soft.

Priapism can be caused by medication, trauma or a blood disorder (blood clot, sickle cell anaemia, leukaemia, myeloproliferative syndrome).

Premature ejaculation

It is a uncontrolled ejaculation that occurs before or shortly after penetration. According to some specialists, premature ejaculation results almost exclusively from anxiety or other psychological causes. Others believe it is due to a particular sensitivity of the penis.

Delayed ejaculation

It happens when a man only manages to ejaculate after a very long time, experiencing persistent or recurrent difficulty in reaching orgasm, despite a phase of normal sexual arousal. 

Retrograde ejaculation

This is the ejaculation of sperm into the bladder. The part of the bladder that normally closes during ejaculation, the bladder neck, remains open. One of the most common causes is the prostate surgery. 

This condition is treated with drugs including pseudoephedrine or imipramine. Because the use of these drugs carries certain health risks, it is restricted to men with fertility problems. 

Anejaculation 

This is the inability to ejaculate. It is often linked to anorgasmia and is part of erectile dysfunction. Anejaculation is also an extreme form of delayed ejaculation.

Anorgasmia 

It is the persistent or repeated absence of orgasm after a phase of normal sexual arousal. 

The risk factors for anorgasmia are most often psychological, but can also be neurological and medical.

Low libido 

This disorder is characterised by a lack or absence of sexual desire or libido for a certain period of time. It can be general or occasional, lasting for a specific period of time or for a lifetime. 

The causes vary considerably, but include a possible drop in testosterone production, advanced age and fatigue.

What are the most common causes of male sexual dysfunction? 

There are a large number of factors that can cause male sexual dysfunction, and often it is a combination of physical and psychological factors.

Physical causes include:

• Diabetes: high blood sugar levels affect erection mechanisms, 
  
• Heart disease or atherosclerosis: the formation of plaque on the walls of the arteries narrows their diameter, 
  
• Arterial hypertension: the structure of the vessels is altered as a result of increased pressure,
  
• Excess weight and obesity: the secretion of chemical molecules in adipose tissue has an impact on the dilation of blood vessels, 
  
• Certain neurological diseases (Parkinson's disease, multiple sclerosis): the transmission of nervous information is altered,
  
• Androgen deficiency: abnormally low testosterone levels,
  
• Spinal cord injury: depending on the location and severity of the injury, there is no nerve communication, 
  
• Penis trauma (fractured corpora cavernosa, strangulation, amputation): the consequences are impotence, penile deformity and pain,
  
• Complications of prostate surgery: inflammation and contusion of the nervous and vascular tissues close to the prostate,
  
• Structural disorders of the penis (Lapeyronie's disease): penile curvature when it is erect makes penetration difficult or impossible.
  
  

In terms of psychological causes, certain behavioural disorders such as depression, anxiety and fears can cause sexual dysfunction. Emotional and relational factors, such as a lack of trust or communication between the two partners, are also important. In addition, the consequences of a possible traumatic sexual history and sexual disorders need to be taken into account. 

There are also many drug-related causes of male sexual dysfunction, for example after taking antidepressants, antipsychotics, antihypertensives, etc. Certain substances, such as alcohol and drugs, can also cause or contribute to the development of male sexual dysfunction.

How can male sexual dysfunction be diagnosed? 

To diagnose sexual dysfunction, you should see your GP at the first sign of the condition. The doctor will first ask questions about the symptoms you experience and your medical history. They will then carry out a clinical examination and look for signs of hormonal, neurological or vascular disorders.


If necessary, urine and blood tests are carried out. These include measuring testosterone levels in the blood and checking for other previously undiagnosed disorders (metabolic, thyroid, lipid). 


The doctor may prescribe an ultrasound and, in rare cases, a home monitoring device to detect and record erections during sleep.

How to treat male sexual dysfunction? 

If any medical condition associated with sexual dysfunction is diagnosed, its treatment, combined with a healthier lifestyle, can help reduce erection problems.

In the case of sexual dysfunction of psychological origin, psychotherapeutic follow-up with sexology specialists is sometimes necessary.

If erection problems persist, depending on the type of problem, the doctor may prescribe a course of medication based on sildenafil (Viagra®), tadalafil (Cialis®), avanafil (Spedra®) or vardenafil (Levitra®). These molecules increase the blood flow to the penis during sexual stimulation. Some drugs, such as alprostadil (Vitaros®, Caverject®), are injected directly into the penis.

A number of medical devices are available to treat erectile dysfunction: sexual stimulators, vacuum pumps, application of a local anaesthetic, etc. Finally, there are penile implants, inserted during surgery. 

There are also complementary approaches to treating sexual dysfunction in a more natural way. However, it is preferable to see a doctor before starting any non-conventional treatment, in order to detect the cause of sexual dysfunction.

It is important for men to know more about the disorders mentioned above so that they can be diagnosed and treated quicker. There are still some taboos surrounding male sexual dysfunction, which need to be broken in order to promote sexual health and emotional well-being. This way men would seek help more often and find solutions to their problems, which can have a positive impact on their overall quality of life.