Men’s Sexual Health
Men who experience problems with their sexual health can be confident that they will receive treatment from Urology Associates that is based on respect, privacy, compassion and the best medical practices possible.
Major sexual health issues men can experience include:
- Erectile dysfunction (ED)
- Ejaculatory dysfunction
- Hypogonadism, or low testosterone
- Penile rehabilitation following prostate cancer
- Penile implants
- Peyronie’s disease
- Sexually transmitted diseases (STDs).
Erectile dysfunction (ED) is a man’s inability to get an erection or sustain it in order to complete sexual intercourse to climax and ejaculation. ED, which becomes more prevalent in men with age, affects an estimated 10-20 million men in the United States. Another 10 million are estimated to have partial ED.
Erectile dysfunction can be caused by illnesses (diabetes, kidney disease), medical treatments or a breakdown in the events that lead to an erection.
Diagnosis may include a physical exam, medical and sexual history, blood tests, urinalysis and/or ultrasound. Treatment for ED varies depending on the patient and the extent of his dysfunction.
Ejaculatory dysfunction occurs when the male has a problem properly ejaculating his semen, either ejaculating too soon, too late, back into his own bladder or not at all. These situations can result in poor sexual satisfaction for the man and his partner, ineffective reproduction and emotional trauma.
Though ED gets most of the attention, ejaculatory dysfunction is just as prevalent. There are four categories of ejaculatory dysfunction: premature ejaculation, delayed ejaculation, retrograde ejaculation and anejaculation (which includes anorgasmia, or no orgasm and no ejaculation).
Low testosterone (male hypogonadism)
Low testosterone, also known as male hypogonadism or andropause, affects roughly 39 percent of men over the age of 45. This prevalence of low testosterone increases with age.
There are both sexual and non-sexual signs and symptoms associated with low testosterone. Sexual symptoms include poor erectile function, low libido (desire for sex), weaker and fewer erections, and reduced sexual activity. Nonsexual symptoms include increased body fat, decreased energy, fatigue, reduced muscle mass and depression.
Treatment options for symptomatic low testosterone include hormone replacement therapy in the form of a topical gel, injections, long-acting pellets, patches or oral pills. The most common type of therapy is gel therapy.
It is important to realize that testosterone treatment is considered lifelong therapy, just like in other chronic conditions. Stopping testosterone replacement will result in a decline in a man’s testosterone level.
Up to 10 percent of men experience Peyronie’s disease, a condition causing the penis to curve when erect, due either to scar tissue or plaque that has formed inside the penis.
This produces substantial bending of the penis and pain. Although it is normal for some men’s penises to bend slightly during erection, Peyronie’s disease often causes a more sizable bend. It can also cause mental and emotional stress for men who suffer from the condition.
Peyronie’s disease can cause complications including:
- Erectile dysfunction
- Inability to have sexual intercourse
- Anxiety or stress regarding the appearance of the penis or sexual ability
- Strain on a man’s relationship or with his sexual partner
- Difficulty fathering a child, because intercourse is difficult or impossible.
For the majority of men who experience pain from Peyronie’s disease, the condition improves with time as the injury heals. For men whose situation is more severe or whose Peyronie’s disease appears to be getting worse, a physician may recommend medication, surgery or penile implants.
The incidence of male impotence following radical prostatectomy and some forms of radiation treatment for prostate cancer is around 30-70 percent. New insights into why this occurs have led to a new approach to this issue known as penile rehabilitation.
Begun in Europe in the late 1990s, penile rehabilitation involves the use of medications, either oral or injected, to enable a man to maintain erections. These medications may be used in conjunction with other treatments, with the goal of preserving sexual function before long-term damage makes that unlikely.
Traditional advice to men to wait for erectile function to return on its own after treatments is no longer applicable. That approach was based on the idea that nerve damage caused the erectile problem. New research indicates that it occurs due to scar tissue that builds up when the penis is flaccid for long periods of time, which deprives it of blood rich in needed oxygen.
Men diagnosed with prostate cancer or undergoing treatment should talk to their urologist about penile rehabilitation options.
These devices are inserted into the penis to enable a man with erectile dysfunction to achieve and maintain an erection adequate to complete sexual climax. Penile implants are usually suggested after other treatments for ED, such as medications or a penis pump, have not worked.
Penile implants are either semi-rigid rods or inflatable inserts and are put in place surgically. Urological surgeons will discuss the implant and surgical options with patients interested in this option.
Inflatable implants are the most common type used and consist of a three-piece unit that inflates the penis by pumping fluid from a sack placed in the abdomen to two cylinders inserted in the penis. The man controls pumping up the erection and deflating it.
Semi-rigid rods always maintain a firm penis adequate for sexual penetration. The penis is bent forward for sex and bent against the body at normal times for concealment.
Various types are available with degrees of firmness and length. “Positionable implants” utilizing segments with springs allow the best upward and downward positioning.
Sexually transmitted diseases (STDs)
People contract STDs from someone who already has an STD by having sex involving direct contact with the mouth, penis, vagina or anus. About half of all sexually active young adults will contract an STD. These are serious diseases requiring immediate treatment, most often antibiotics for the patient with the disease and his or her sex partner. STDs are highly preventable by practicing safe, protected sex. STDs include:
- Human papilloma virus (HPV), preventable by vaccination
- Genital herpes
- Hepatitis B
- Genital warts