Sexual Problems in Men
Sexual health is an important part of a man’s life, no matter how old he is and his sexual orientation. Sexual problems in men are very common and impact sexual health. Sexual dysfunction can affect the quality of life and, even more importantly, be the first symptom of another medical or psychological problem. Any sexual complaint should be taken seriously and carefully evaluated.
Physiology of Sexual Function
Sexual activity involves coordination between various systems of the body. Hormones and neurological pathways must be in coordination for sexual desire to be present. Blood vessels, nerves, and penile integrity must all be present for an adequate erection. Orgasm is a complex phenomenon that isn’t completely understood but it involves the coordination of muscles and nerves.
How are Sexual Problems in Men Diagnosed?
A detailed medical, sexual, and psychological history followed by a thorough physical examination is necessary to evaluate sexual dysfunction. The second step is involving the patient’s partner to contribute to the evaluation and help get useful information as well. One of the possible tests is a nocturnal tumescence test to evaluate nocturnal erections. The physician may also ask for tests related to penile blood vessel function or some tests of the nervous system to help differentiate between possible causes of sexual dysfunction.
Symptoms of Erectile Dysfunction
Erectile dysfunction causes the penis to be unable to acquire or maintain a satisfactory erection. It is important to specify to the doctor the rapidity of onset, the presence of nocturnal erections, and the quality of the erection. The quality of an erection can be judged according to its rigidity. Erectile dysfunction with sudden onset and no previous history of sexual dysfunction suggests a psychogenic cause, unless there was a previous surgery or a genital trauma. The loss of nocturnal erections indicate a neurologic or vascular cause. When an erection is not sustained, its loss may be due to an underlying psychological cause or vascular problem.
Treatment for Erectile Dysfunction
There are several options for men who suffer from erectile dysfunction. Before suggesting pharmacological help, the doctor may suggest a change in lifestyle habits. Since many causes of erectile dysfunction are due to lifestyle disorders, addressing these issues can be helpful. Therefore, regular exercise, a healthy diet, stopping the habit of smoking, and limiting alcohol consumption can all have a positive impact on erectile function.
Oral Pharmacological Treatment
Phosphodiesterase (PDE-5) inhibitors include sildenafil (Viagra), vardenafil(Levitra), and tadalafil (Cialis), which improve the ability to attain and maintain erection. It should be taken some time before the sexual act is planned. Side effects include muscle pain, back pain, visual disturbances, and flushing. If you are consuming nitrates, phosphodiesterase inhibitors are not recommended since both medications taken simultaneously can cause severe hypotension. Several other types of oral medication such as Apomorphine is available.
Transurethral Therapy
Another type of pharmacological solution is a solution that can be applied in the urethra that helps improve erection. Erection can be maintained by applying an elastic band at the base of the penis.
Intracavernous Injection
Injections at the base of the penis (intracavernous) can help attain and sustain an erection. There are different types of solutions that can be injected — Papaverine, Alprostadil, and drug combinations. These injections are considered the most effective treatments for erectile dysfunction. They are convenient for patients who cannot tolerate oral therapies.
Side effects include priapism (prolonged and painful erection) and fibrosis (scarring) but they are rare. There are ways to prevent these side effects (especially the prolonged and painful erection). The patient has to follow the training and recommendations given at the start of this type of therapy.
Vacuum Constriction Device
This is a plastic cylinder connected to a vacuum-generating source that creates a negative pressure and draws the blood to the penis, making it erect. An elastic band must be placed at the base of the penis to maintain the rigidity. Ejaculatory problems, penile pain, and blood pooling because of ruptured blood vessels (ecchymosis or petechiae) are its side effects.
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