Male sex problems – includes related articles on causes of and treatment for sexual dysfunction
Almost everyone who is sexually intimate with another person sooner or later experiences some sex problems, often resolved by better communication and closer sharing of likes and dislikes. Sexual health is defined as “the ability of two people to relate with each other sexually in a way that satisfies and rewards both.” For many people, this simple definition is coloured by unrealistic expectations. Despite a new attitude to sexual relationships, some men still equate good sex with “scoring,” “going all the way” or the speed with which they can attain erection. Failure to live up to expectations (their own or their partner’s) may produce profound anxiety. Some people define a satisfying sexual encounter solely in terms of intercourse, even though sexual pleasure can be achieved in countless other ways.
Rundown of some sexual disorders in men
* Sex problems in the desire stage involve a disinterest in sexual activity or in a specific partner, sometimes because busy, over-scheduled people don’t have the time or occasion to relax and enjoy sex. Sex aversion – an extreme form of sexual disinterest – may involve intense fear of any sexual intimacy, usually with deep-seated psychological origins.
* Sexual dystfunction in the arousal or excitement phase means the inability to become aroused, perhaps because of negative parental attitudes to sex, an unpleasant early sexual experience, sex abuse, an offputting relationship, misinformation or performance pressure. Sex therapy is usually the solution.
* Dyspareunia – genital pain before, during and after intercourse – may be due to penile vascular problems or a tight foreskin that won’t retract during intercourse. It can also arise for psychological reasons. The problem needs medical attention and is usually remediable.
* Early or premature ejaculation, afflicting 30 per cent of men at some time or other, is an orgasmic disorder where men ejaculate sooner than they wish to. It arises from inadequate control over the timing of ejaculation and the responses that trigger it or because of infrequent ejaculation – if men haven’t had sex for a while. One sex therapist explains that it often happens if men “lose touch with their orgasmic sensations” and is a common problem. She adds that: “Timing ejaculation is a learned an and takes practice.” The dysfunction is often remedied by more frequent ejaculation (whether by intercourse or masturbation) and appropriate individual or couple therapy.
* Inhibited male orgasm (IMO) is the inability to achieve orgasm during intercourse. Men with IMO often manage to ejaculate and reach orgasm by masturbation but not with vaginal intercourse. Some therapists believe IMO stems from fear of intercourse, an unwillingness to perform on demand or anxiety about not satisfying a partner. A man may find his orgasm inhibited because he fears loss of control during intercourse, because he’s put off by a woman’s touch or, in some instances, because he does not want to have sex with a particular woman. This type of sexual dysfunction is more difficult to treat than premature ejaculation, often requiring intensive psychotherapy.
* Erectile dysfunction -a common male sex problem Erectile dysfunction – previously called impotence – is a droopy denouement to many an otherwise happy relationship. Defined as the “inability or waning inability to achieve and sustain an erection for the purpose of sexual intercourse,” it afflicts many men at some time or other. (The term “impotence” has now been dropped because of its pejorative connotations.) Accurate statistics on erectile troubles are elusive. One study reports that as many as 16 per cent (another that 34 per cent) of healthy young men in their prime have occasional erectile failure. Manufacturing companies who supply erectile devices estimate that one in 10 men has erectile difficulties at some point. An array of new drugs, devices and surgical procedures can now help to overcome the problem. Once thought to be “all in the head”- or as Sigmund Freud put it, of “psychic origin”- erectile dysfunction is no longer considered to be purely psychological. Erectile difficulties don’t fit neatly into psychological versus physical pigeonholes. While organic reasons underlie many types of erectile dysfunction, the problem usually also has psychological overtones. In older men, well over half the erectile difficulties have contributory physical causes – such as diabetes. atherosclerosis, smoking, alcohol consumption, obesity or the use of certain medications. Failure to achieve erection because of a physical cause is often worsened by anxiety. Sometimes what starts out as a sporadic organic dysfunction can develop into a psychological hang-up owing to performance fears. For example. a man with atherosclerotic build-up in his penile arteries may experience occasional erectile failure, which in turn leads to anxiety about nonperformance, exacerbating the problem.
Tests for erectile capacity
For men who can’t achieve or keep an erection, the first priority is a complete medical exam and tests to rule out hormone deficiencies, treatable diseases, alcoholism or the possible influence of medications. Physicians also do a psychological work-up.
* The nocturnal penile tumescence test is a recent innovation that avoids the need for hospital investigation. It tests the occurrence and frequency of night-time erections. Most men normally have several nightly erections related to different sleep stages. The noctural penile tumescence test is a long name for the simple device of wrapping a bit of tape with small string binders around the penis while the man sleeps. If the tiny strings holding the tape together break at night, the man is clearly capable of erection, ruling out an organic cause.
* Measuring, penile activity in men watching erotic videos, with devices attached to the penis. If an erection occurs, it suggests that the man is dysfunctional only in certain, not in all. situations, and likely has a psychological problem.
* Tests for penile blood vessel disorders and restricted blood flow -an increasingly recognized cause of erectile failure are done with ultrasound, arteriography (X-rays taken with injected dye) and cavernostomy (with saline solution infused into the penis).
* Injecting papaverine is another test lot erectile capacity, where the drug is injected into the erectile tissue of the penis. In men with normal blood flow, papaverine dilates the blood vessels and induces erection.
Treatment of erectile dysfunction
If the erectile problem is mainly physical, drugs, hormones or devices may be the answer. If it has psychological aspects. sex therapy and counselling may help. If the erectile problem can’t be traced to a definite reason the man may be offered therapy with drugs, devices and counselling, regardless of its cause. For some men, mechanical devices or drugs can restore enough confidence to sustain erections without them after a while. Since drugs and devices won’t overcome intimacy problems, sex therapy is often also suggested.
Mechanical erection-producing devices:
Penile prostheses of various kinds can restore erectile capacity without disturbing libido, ejaculation or orgasm, although they don’t enlarge the penis beyond its natural size.
Vacuum devices (such as ErectAid), placed on the flaccid penis, increase blood flow via a side arm that withdraws air and creates a vacuum into which blood flows. The basic model contains a soft plastic tube that fits over the penis and a handheld pump. A rubber band is wrapped around the bottom of the penis to stop blood flowing out. The cylinder is removed during intercourse and the blood drawn into the penis keeps it erect. “A man can get a good enough erection for penetration, but it’s not rock hard,” says one University of Toronto expert. “Some love the vacuum devices and others hate them. However, it takes practice to use them deftly.” They are rather cumbersome and may dim sensation, detracting somewhat from their popularity.
Permanent penile implants come in inflatable or non-inflatable models that are semi-rigid and can be bent down to seem more natural when not in use. The more complex the mechanical device the more likely it is to break down or mallunction.
Inflatable models – inflated for sex then deflated afterwards are the most popular and operate more like the real thing. One model is composed of two inflatable tubes put into the shaft of the penis with a fluid reservoir in the abdomen and a pump in the scrotum. Squeezing the pump moves fluid into the penis.
Penile implants are a last resort as surgical insertion destroys some erectile tissue. Candidates must be in good health, have a high sex drive, good penile sensitivity and a desirous sex partner. It is imperative that the couple be assessed for suitability and well informed about the benefits and risks. The risks include infection – requiting removal – swelling and pain.
Sex therapy also helps
Sex therapists are trained professionals such as physicians, social workers, psychologists, nurses and psychiatrists skilled in the art of helping people work through the guilts, hang-ups, worries, anger, sexual myths and misconceptions that bedevil our sex lives. Sex therapy is particularly useful for dysfunctions that involve performance fears, relationship conflicts and spectatoring (observing oneself and one’s responses rather than participating in the event).
A non-directed “sensate focus,” in which the goal is sensuous pleasure rather than intercourse, often helps couples overcome conflicts around mismatched sexual desire or a lack of “connectedness.” The couple learns to approach sexual intimacy as mutual pleasuring rather than as intercourse or orgasm. By concentrating on sensual play – neither partner being pressured or expected to become aroused – sensate locus exercises can often override performance anxieties and communication hurdles. As neither partner expects to become sexually aroused, the couple learns to relax and playfully explore what gives the other pleasure. Each shows the other what kinds of touching he or she enjoys, where the most erotic places are, communicating verbally or by directing the partner’s hand. The exercises work equally well for gay, lesbian or straight couples. The PLISSIT model of sex therapy, developed about 20 years ago, is based on the premise that many people benefit from the simplest of counselling – even just being permitted to talk about their erectile, desire or other problems. Reassurance, support and information are often enough to reverse a sex problem without intensive psychotherapy.
The acronym PLISSIT refers tarour basic stages:
* Permission Giving (P) – permitting people to talk about their sex troubles, fantasies, fears or wishes;
* Limited Information (LI) – often used together with permission giving – providing some basic information (perhaps about erotic zones and genital anatomy) but no specific advice;
* Specific Suggestions (SS) – given for specific sex problems for instance telling someone with premature ejaculation what might slow things down or suggesting that someone with performance anxiety might try sensate focus exercises;
* Intensive Therapy (IT) – required by the relatively few with deeply-rooted psychological sex problems. The first steps of permission giving and limited information are often enough to resolve a sex problem. Many of us occasionally get the feeling that what we are doing sexually is perverted, deviant or wrong. All we may need is reassurance or someone to say, “If you are comfortable with it, carry on .” Once a sex problem has been pinpointed, its solution may be obvious to those versed in human sexual behaviour.
NB: A sex therapist should never ask you:
* to take off your clothes, unless for a medical examination;
* to engage in any type of sexual activity with or without your partner in the therapist’s presence.
To find a needed sex therapist, consult:
Your family physician; the Ontario Association of Marriage am! Family Therapy (OAMFT) (416) 841-6465, or toll free 1-800-267-2638; local Medical Associations; BESTCO (Board Examiners in Sex Therapy and Counselling in Ontario); Sex Information and Education Council of Canada (SIECCAN) (416) 466-5304; Psychological Associations e.g., in Ontario (416) 961-5552. [
Drugs for erectile failure
* Testosterone replacement therapy, GnRH-analogues or other drugs can correct some male hormone deficiencies.
* Corrective surgery for venous leaks and arterial blockage can sometimes restore erectile ability.
* Yohimbine, a plant derivative that stimulates the parasympathetic nervous system and decreases blood outflow from penile tissue, is modestly successful in improving erectile capacity. Side effects of the drug include facial flushing, tachycardia (racing heart), occasional panic attacks, low blood pressure and tremors.
* Minoxidil, a vasodilatordrug sprayed onto the penis, may achieve erection in some.
* Papaverine, a self-injectable drug used since 1983, is a smooth muscle relaxant that increases arterial blood flow in the penis and restricts venous outflow. Injected directly into the side of the penis just before intercourse, it produces an erection in 5-10 minutes, without disturbing ejaculation or orgasm. Possible side effects of papaverine include dizziness, cardiac complications and a painful, prolonged erection lasting several hours – which requires medical relief measures. The efficacy of papaverine may diminish with repeated injections and it occasionally leads to scarring. Therefore, it is now often used in combination with phentolamine and perhaps also prostaglandin E1 as “triple therapy,” with greater efficacy, reduced doses and fewer side effects.
* Newer drugs such as prostaglandin El, can be as effective as papaverine therapy and may be combined with it, but some users have local discomfort with prostaglandin.
The goal of Health News is to interpret timely health information. It is not intended to provide medical advice for individual problems. A physician should be contacted for specific medical advice. Unfortunately, we cannot respond to personal inquiries.
Reasons for erectlie failure
* Medical disorders such as kidney impairment, liver cirrhosis, prostate disorders, alcoholism, Peyronie’s disease (curvature of the penis), Parkinson’s disease, multiple sclerosis and diabetes.
* Endocrine (hormonal) imbalances such as low testosterone output, thyroid disorders, hyperprolactinemia (excess prolactin hormone), Cushing’s syndrome and other adrenal gland disorders.
* Neurological problems such as spinal cord injury.
* Surgery for the prostate g/and, bladder or rectum (which may damage the nerves responsible for erection).
* Blood vessel disorders that restrict penile blood flow such as artery-narrowing due to atheroscierosis or veins that don’t clamp off to maintain erection. Penile veins that don’t close off properly allow blood to drain out and cause penile collapse – a condition sometimes repairable by surgery.
* Smoking tobacco – a major reason for erectile failure – because nicotine causes spasms in small penile arteries and also leads to atherosclerosis.
* Alcohol- another major cause – can leave a man unable to have an erection. Not realizing it’s due to alcohol, the man may fear some permanent disability or organic disease, creating intense anxiety. People who down large volumes of liquor, or come home from work to pour themselves several drinks and collapse into the comfort of mental and physical detumescence may not be the sort to develop stable sexual relationships. Drinking excess alcohol may also cause atrophy (shrinkage) of the testes and impair the mechanism that shunts blood into the penis.
* A long list of medications can dampen erections, including antihistamines, antidepressants, marijuana, minor tranquillizers, cimetidine (for stomach ulcers), muscle relaxants and especially anti-hypertensives (blood pressure medications) – major culprits in causing impotence. As many as 40 per cent of men on diuretics and other blood pressure pills have erectile problems. They should consult their family physician about it. (Perhaps other drugs can be prescribed instead.)
* Depression, anger, stress, fatigue, guilt, performance anxiety, job loss or impending exams.
* Childhood experiences of parental conflict, early sex abuse or disapproving, unjoyful attitudes to sex.
* A negative sex encounter that leaves a man full of self-doubts about his sexual competence. Even though a man may be perfectly capable of attaining erection, feelings of inadequacy may make him hesitate to attempt intercourse. The longer anxiety lingers, the greater the chance of a sex problem.
* Lack of privacy (at home or in student quarters).
* Poor communication with a partner, lack of intimacy, fear of causing pregnancy, divergent views on what constitutes a happy sex life and varying perceptions of normality. The film “Annie Hail” portrays a classic gender communication gap. When the therapist asks how often they have sex, the woman (Annie) replies: “All the time – three times a week,” while he (Woody) answers “hardly ever – only three times a week.”
COPYRIGHT 1993 Strategic Inc. Communications Ltd.
COPYRIGHT 2004 Gale Group