Erectile Dysfunction (Impotence)
Erectile dysfunction [ED] is defined as the inability to achieve and/or maintain an
erection that is suitable for penetration.
Causes:
ORGANIC: Problems/disorders with blood, blood vessels, nerves, neurotransmitters, penis structure, hormonal imbalance, medical conditions (like diabetes and hypertension) and certain medications.
PSYCHOGENIC: Anxiety (general or performance), depression, relationship problems, confusion with sexual orientation/identity, and past negative sexual experiences (sexual abuse).
LIFESTYLE: Smoking and alcohol use.
MIXED: All or few of the above.
Treatment options (to be used solely or in combination): Education, counseling, oral medications, external devices, penile injections and implants (vascular surgery). There is much development in treatment for erectile dysfunction currently underway.
Premature ejaculation
Premature ejaculation (PE) is the commonest male sexual dysfunction and
is defined as ejaculation before the person wishes it, often within 1 to 2 minutes after penetration though it can occur before or on penetration.
Causes: Hypersensitive ejaculatory reflex (primary disorder), performance anxiety or psychological trauma (secondary). PE resulting from anxiety often has a situational component, such as when starting a new relationship. Men with PE will usually have better control over their ejaculation time with masturbation.
Treatment: Complete sexual assessment of the individual’s concerns, partner’s expectations and relationship issues is very important. Improving communication between the partners, various bodily techniques and pharmacological therapy are the available treatment options.
Erectile dysfunction and premature ejaculation
A man can have both erectile dysfunction and premature ejaculation. In such conditions careful assessment is needed as one problem (ED) may be causing the other (PE) as a compensatory mechanism.
Libido Disorders
Libido, also known as sexual desire is a reflection of a person's desire to be sexual and engage in sexual activity. Libido arises from the effect of the hormone testosterone that is generally known as "the male hormone" but is responsible for sexual desire in men and women. Libido problems may present as hyperactive sexual desire, hypoactive sexual desire or sexual aversion. These may present as a lifelong issue that has always been present or occurring only in some situations. Another common desire issue is desire discrepancy where the difference of desire within a relationship creates problems within that relationship.
A common cause of low libido is not related to lack of production of testosterone but rather due to relationship problems. Any medical condition and excessive alcohol intake may contribute to reduced libido. Lack of sexual activity and stimulation may have a negative effect on testosterone production. Any damage to the testes in the male or ovaries in the female will affect testosterone production. This can be seen in removal of such organs or damage from chemotherapy for treatment of cancer.
An assessment of libido problems requires investigation of medical and psychological aspects. Treatment does not necessarily involve use of testosterone medication.
