Sexual Health Issues For Men

Sexual health issues have a profound effect on a patient’s quality of life, including decreases in physical satisfaction, emotional satisfaction, and general happiness. It is estimated that 20 to 30 million American men suffer from sexual health issues. Sexual dysfunction is the inability to have a satisfactory sexual relationship. It refers to a problem during any phase of the sexual response cycle that prevents the man or couple from experiencing satisfaction from the activity. This definition depends on each person's own interpretation on what he judges satisfactory. In general, sexual dysfunction can affect the quality of life and, even more importantly, can be the first symptom of another medical or psychological problem. Any sexual complaint should be taken seriously and evaluated. Sexual dysfunction includes problems with sexual interest (libido), erectile problems, orgasmic problems, and ejaculatory problems.

Male sexual dysfunction is a common health problem affecting men of all ages, but is more common with increasing age. The most well known sexual problem in men is erectile dysfunction (ED), defined as difficulty attaining or maintaining and erection that permits satisfactory sexual intercourse. Over 50% of men between the ages of 40 and 70 have some degree of ED; this percentage increases as men get older but can occur in men of any age. While ED is the best known and most talked about male sexual problem, many other issues may interfere with a man’s enjoyment of sex, including trouble with ejaculation (such as premature or delayed ejaculation), loss of sexual desire (decreased libido) or Peyronie's disease (penile curvature).  These conditions can also cause significant disturbances in sexual life.

Despite significant progress in basic sexual medicine research and clinical therapies in recent years, sexual problems remain among the most frequently overlooked and mismanaged patient complaints. Few healthcare professionals have the opportunity to be trained in the diagnosis and treatment of sexual dysfunction. At San Diego Sexual Medicine we attempt to identify what caused the problem in order to offer the best treatment options, from regenerative therapies for disease modification such as genuine shockwave therapy (not accoustic wave) and platelet rich plasma (PRP), to oral medications and injections, to surgery, tailored to the individual patient.

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Identifying potential sexual health risk factors

There are many factors which may result in a person experiencing a sexual dysfunction. These may result from emotional or physical causes. Sometimes determining what is causing the issue is as important as treating it, in case the risk factor can be eliminated and the sexual health concern disappear.  Learning that something you are doing or a medication you are taking may cause a problem in the future may mean you want to modify the activity now or talk with your doctor about an alternative medication.  It may be helpful to let your doctor know that you have some of these risk factors because that may help in diagnosing the specifics of your desire, erection, ejaculation/orgasm and/or sexual pain issues and subsequently in treating them.  You may have none of the risk factors listed.  The causes and risk factors listed on this site are provided as information only and are not meant for self-diagnosis and treatment.
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Diagnostic Tests

To diagnose a man's sexual problem, the doctor likely will begin with a thorough history of symptoms and a physical exam. He or she may order other tests to rule out any medical problems that may be contributing to the dysfunction. Evaluation of sexual dysfunction starts with a detailed medical, sexual, and psychological history, followed by a thorough physical examination. The second step must not be overlooked because sexual dysfunction can have many causes. Sometimes, the patient's partner can also contribute to the evaluation and could provide useful information as well.

A detailed medical, psychological, and sexual history is acquired during the interview with the physician. Some of the questions that are asked can be intimate and might cause you to feel shy to answer thoroughly. It is imperative to give the proper information, even though it is understandable that it can take time to be comfortable talking about this. Having a good relationship with your physician is always helpful. Some of the questions the doctor could ask might concern the frequency of sexual relations, your sexual orientation, if the frequency or quality of sexual relations are satisfying, and your number of sexual partners, among others. They will also inquire about nonsexual-related complaints.

A complete physical examination is performed including assessing the pulses in the legs and a thorough examination of the external genitalia (penis, scrotum, and perineum) and their reflexes. One of the possible tests is a nocturnal tumescence test to evaluate nocturnal erections. Your physician might also ask for tests for penile blood vessel function or some tests of the nervous system to help differentiate between possible causes of sexual dysfunction.
31% of men report some form of sexual dysfunction

Treatment Options

Treatment of men's sexual health concerns follows a step-care process that begins with modification of reversible causes and then proceeds to first-line, second-line, and third-line treatment strategies. Maneuvers to modify reversible causes include sex therapy, cognitive behavior therapy, physical therapy, lifestyle changes including exercise and diet, alteration of prescription medications, discontinuation of recreational drugs, management of partner sexual dysfunction, and other behavior modifications such as relaxation therapy. First-time therapies include hormone therapy (androgens), dopamine agonist therapy, oral phosphodiesterase type-5 inhibitors and vacuum erection device therapy. Second-time therapies include penile self-injection therapy and intra-urethral alprostadil therapy. Third-line therapies include surgery for placement of penile prosthesis, surgery for penile revascularization, and surgery for correction of penile curvature. In addition to treating symptoms, San Diego Sexual Medicine offers regenerative therapies including genuine shockwave therapy and platelet rich plasma treatment. The most logical, efficacious way to restore sexual function in men with sexual health problems is to manage the sexual problem with multiple disciplines, proceed in a step-care process and, whenever possible, to engage the partner.
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