A Primer on Male Sexual Health
Part 2 in a 2-part series on male infertility and sexual health. Review Part 1 on Male Infertility.
Male sexual health is all about a man’s overall ability to enjoy sexual activity, as he defines it. Sexual health encompasses physical, mental and emotional health, and it may have different measures of success from man to man, says Dr. James Kashanian, Director of Male Sexual Health and Assistant Professor of Urology and Reproductive Medicine at Weill Cornell Medicine.
“Typical domains of male sexual health include libido, erectile function, ejaculation and reproductive health,” says Dr. John Masterson, who has been working in close collaboration with Dr. Kashanian during his one-year fellowship in andrology—the study of men’s health—at Weill Cornell.
In what follows, Drs. Kashanian and Masterson provide answers to your FAQs, including the prevalence and causes of sexual dysfunction, along with treatments and lifestyle recommendations to enhance the pleasure you derive from sex.
What is male sexual dysfunction?
“Male sexual dysfunction encompasses any condition that interferes with a man’s ability to enjoy sexual activity and can therefore include many scenarios,” Dr. Kashanian says.
The most common diagnoses urologists encounter are:
- low libido
- erectile dysfunction (ED)
- Peyronie’s disease (penile curvature caused by scar tissue)
- premature or delayed ejaculation
- infertility
How prevalent is it?
“Conditions like low libido and erectile dysfunction tend to become more prevalent as men age,” Dr. Masterson says, “but overall, about one-fifth of men report low libido at some point in their lives, and about one-quarter to one-third of men report some form of erectile dysfunction. Roughly 30 million men in the U.S. suffer from ED.
“Ejaculatory dysfunction is less common, affecting about 5 percent of American men,” he adds, “but that condition may be more prevalent than that, based on what men find bothersome.”
To what extent do sexual problems correlate with age? Chronic illness?
Sexual dysfunction is strongly correlated with age and certain chronic conditions.
As men age, so does the prevalence of medical conditions that can affect sexual health, says Dr. Kashanian. Specifically, hypertension, diabetes and high cholesterol can directly affect a man’s erectile function.
“Erectile dysfunction is often caused by vascular disease,” he says. “Men with ED are at higher risk for cardiovascular disease and vice versa. Urologists are often the first point of contact men have with the health-care system. We’re trained to counsel men about the cardiovascular risk associated with erectile dysfunction.”
Similarly, he says, as men age, ejaculatory function can be affected. Older men may experience declining semen volumes or decreased sensation during ejaculation and orgasm.
Testosterone levels tend to decline with increased age as well. That can affect libido and erectile function. Abnormal testosterone also is associated with a chronic ondition called metabolic syndrome, which increases a man’s risk of developing diabetes and heart disease.
According to the American Heart Association, metabolic syndrome includes the following cluster of symptoms:
- high blood sugar
- high blood pressure
- high triglyceride levels
- low levels of “good” cholesterol
- large waist circumference (an “apple”-shaped body)
What are the main causes of sexual problems in men?
Advanced age and poor health status are by far the most common causes of sexual dysfunction, says Dr. Kashanian. Additional causes include medication side effects, pelvic surgery or non-organic causes such as performance anxiety, changes in partner dynamics and changes in sexual preferences.
Which medications may exacerbate sexual dysfunction?
Several classes of medications can contribute to various aspects of male sexual dysfunction.
- Antidepressants and antipsychotics tend to negatively affect libido, erectile function, and orgasm.
- Blood pressure medications can contribute to ED.
- Hormonal medications and steroids can affect testosterone production, leading to sexual dysfunction.
- Chemotherapy medications for cancer can also exacerbate sexual problems.
How seriously should a man take sexual dysfunction?
“Given the strong correlation with erectile dysfunction and cardiovascular risk, men should take sexual dysfunction seriously--especially given the opportunity to improve their overall health,” he says. “Erectile dysfunction may be the first sign a man has that his health is at risk. Bothersome changes in sexual function should be taken seriously in any event, as sexual health is an important aspect of a high quality of life for many men.”
What are the treatment options for sexual dysfunction?
There is a wide range of treatment options for men with sexual dysfunction.
Lifestyle modifications
- eating a healthy diet
- regular exercise
- quitting smoking
- decreasing alcohol consumption
- avoiding illicit substances
- practicing good sleep habits
- stress management
Sex therapy
Sex therapy can help men whose ED is psychogenic, meaning that it isn’t traceable to an identifiable physical cause.
Medications and devices
“Pills, urethral suppositories, penile injections and vacuum erection devices are all available to help increase blood flow to the penis,” Dr. Masterson says.
Testosterone replacement, either directly or indirectly, is available to men who are diagnosed with low testosterone. For men who don’t respond to non-invasive therapies, surgery in the form a penile implant allows men to produce an erection on demand, he explains.
When should a man seek help from a specialist?
Men should seek help when they are bothered by their symptoms. Generally, earlier intervention is better. If there is no identifiable or treatable organic cause of sexual dysfunction, a mental health professional may be the best resource, but by and large a urologist will be able to rule out physical causes.
Find a doctor at Weill Cornell Medicine who can help answer your questions on male sexual health.