Male Sexual Dysfunction

Description

Male sexual dysfunction encompasses all disorders relating to male sexuality, including the ability to have an erection and proper ejaculation. Premature ejaculation and retarded ejaculation both are considered to be caused by psychological factors. Retrograde ejaculation occurs when the urinary bladder neck becomes ineffective due to complications from prostatectomy, sympathectomy, retroperitoneal lymphoidectomy, and weakening of the autonomic nervous system. The erection is a very complex and somewhat mysterious phenomenon that depends on psychological factors, the neuroendocrine system, arteries, veins, the sinusoid, and the state of the penis itself. Impotence is the most common male sexual dysfunction, and new diagnostic tools have resulted in treatment advances in recent years. Penile erection can be divided into three different types: reflexive, psychogenic, and sleep-related. A reflexive erection is controlled by the central nerves and is responsive to tactile stimulation. Psychogenic erection depends on the sense of sight, hearing, smell, and also the stimulation induced by the brain through fantasizing. Erections during sleep happen during rapid eye movement sleep and are controlled by totally different mechanisms.



Premature ejaculation



Premature ejaculation, whereby ejaculation occurs within 1 minute of entry or even before entry, is one of the most common sexual problems affecting men. If the female sexual partner only orgasms via intercourse, the problem may become even more serious. The reasons for premature ejaculation are complex and cannot be pinpointed to a specific cause. Some men may ejaculate early because they are indifferent to the satisfaction of his partner and only cares of his orgasm and satisfaction. Or, some men may suffer from premature ejaculation due to some other sexual incompatibility with his partner. Keeping any sort of psychological problem to oneself without letting it out can also be a reason. For instance, if a man has built up hostility toward his wife and is unable to let it out in any other form, this may unconsciously be manifested as premature ejaculation.


Treatment



Although there are many techniques to control ejaculation, if one is fortunate enough to have a supportive wife with enough sexual knowledge, the“compression technique?is the most effective. In this method, the woman grabs the backside of penis (the indented region just below the glans of the penis) with the thumb and the index and middle fingers for 3-5 seconds, in order to prolong the state of arousal occurring just before ejaculation. Premature ejaculation can also be treated by microsurgery, which deadens some of the nerves in the penis, decreases sensitivity and increases the time before ejaculation. Topical desensitizing creams containing serotonin, such as Sertraline, Fluoxetine, and Clomipramine, can be used to prolong erection. Psychological factors that may interfere with maintaining an erection must be eliminated, and other medical conditions that may contribute to the problem must be treated, particularly genitourinary problems affecting the prostate gland, seminal vesicle, and the urethra. In order to build stamina, eat healthy foods, exercise, and avoid excessive drinking and smoking.


Controlling ejaculation



To control ejaculation, the followings steps should be taken. During sex or masturbation, stimulation is continued until the moment just before ejaculation. Then the penis is allowed to relax until erection falls to its halfway point, before stimulation is started again. This process is repeated 3 times before ejaculating on the 4th cycle. The following squeeze technique is similar to this method.


Penile pressure method (squeeze technique)



In this method, as in the above technique, the penis is withdrawn just before the moment of ejaculation, but in this case, the penis is squeezed just below the glans of the penis with the thumb placed above and the index and middle finger below the penis. When the urge to ejaculate has subsided, sex or masturbation is resumed. This is a very simple technique of withdrawal, squeeze, and return, which is very easy to apply. If practiced regularly for more than 1 month, it can prolong the time it takes for an ejaculation.



Medications



Medications to prolong the time before ejaculation has been quite effective. As many as 70% of patients report positive results. Medications are ideal for the man whose wife is unsupportive, those without a sex partner, those with depression-related premature ejaculation, and men who have failed to correct the problem with the preceding methods. Treatment takes approximately 5-6 weeks. The spouse's support is essential and if treatment is interrupted, it will have to be restarted from the beginning. While effective, this approach has a relatively high recurrence rate.


Ejaculation difficulty



Ejaculation difficulty refers to that state of not being able to ejaculate during intercourse, or achieve orgasm. If the man is unable to ejaculate into the woman's vagina, the term ejaculatory incompetence is used. Usually these men are able to orgasm through masturbation and oral or hand stimulation by the women. Based upon the symptoms described above, the problem appears psychological rather than physical. Treatment is achieved through a number of gradual steps. First, the patient is told to practice achieving orgasm and ejaculation through masturbation. Once that has been mastered, the same is encouraged except this time it must be done in front of a sexual partner. Then, finally, the partner takes part in helping the patient reach orgasm, and inserts the penis into the vagina right before orgasm. Through this technique, the man is able to gradually get rid of his fear of ejaculating in the woman's vagina. Only through much effort and repetition will there be any improvement.


Erectile Insufficiency



Erectile insufficiency is the inability to sustain a continuous erection throughout intercourse. It also includes erections that are weak and not fully inflated. Erectile insufficiency occurs in more than 50% of all sexual activity, and if it persists for over 6 months, prompt medical attention is advised. Erectile insufficiency is categorized into two major groups: psychogenic and organic. Organic erectile insufficiency is further divided as neurogenic, vasculogenic (arterial, venous), and endocrine-related. If classified based upon functional abnormality, organic erectile insufficiency would be subdivided as follows: induction failure (neurogenic), improper filling (arterial), improper storage (cavernous venous), and other functional problems (endocrine related). Psychogenic erectile insufficiency is a result of overstimulation of the sympathetic nerves by psychological, mental factors, and the inadequate secretion of neurotransmitters. Psychological factors that may get in the way of proper erectile function are fear of performance, religious beliefs, an obsession, sexual fears or perversion, depression, lack of physical attraction, fear of aging, or the lack of understanding of the physical changes due to aging. Problems due to induction failure are caused by diseases of the central nerves (multiple sclerosis, spinal cord injury, tumors, etc.), and inadequate secretion of flaccid neurotransmitters, if peripheral nerve disorder (diabetes, pelvic fractures, alcoholism, vitamin deficiency, etc.) occurs in the pudendal cavernous nerves. Erectile insufficiencies due to improper filling of the blood into the penis are caused by damages to the cavernous arteries or the main artery to the penis. Most arterial damages are due to pelvic and perineal injuries, and for people who smoke, have hyperlipidemia, chronic high blood pressure, diabetes, or a history of vessel diseases, occlusive diseases may injure the cavernous artery. Lastly, erectile insufficiency due to ineffective containment of blood is a result of albugineal defects, too many veins, inadequate secretion of neurotransmitters, serious arterial diseases, and the replacement of smooth muscle tissues with fibrous tissues as an aftereffect of uncontrollable extended erections. Hypothalamus and pituitary gland tumor-related hypogonadism, estrogen and anti-androgen therapy, and orchiectomy (removal of testicles) can suppress sexual interest. Sympathetic nerve blocking agents that act on the central nerve, like antihypertensive agents, can cause erectile insufficiency. Diuretics and vasodilators can cause erectile dysfunction, and sleeping pills, marijuana, alcohol, anesthetics, and smoking can directly or indirectly (through loss of sexual desire) alter erectile function.


Overcoming erectile insufficiency



1.The problem is not in the penis. The first step toward overcoming erectile insufficiency is to realize that most erectile problems do not originate in the penis. However, most people tend to focus their attention on the penis and are unable to look for the real cause of their dysfunction. The penis is nothing more than an agent under the master controls of the brain. It can do nothing until the brain and the spinal cord has given the final word. At first glance, it would seem that the brain would have little to do with sex, however, the root of all sexual problems lie deep within our subconscious minds.

2.Examine the relationship you have with the people around you. Surprising as it may seem, there are many cases where the root of the problem may lie in the relationship one has with his wife or girlfriend. If for some reason, conscious or unconscious, one does not desire sex with another, the brain sends a message to the genitals inhibiting an erection. We must then, ask to ourselves whether we are truly in good terms with the people we care about most.

3.Analyze your mind. It may be hard for us to completely accept that erectile insufficiency is a mental disorder. However, the sooner we accept it the better off we will be, for many a patient has wasted a lot of time looking for physical causes to their problem. Many erectile dysfunctions are psychological in nature, and psychologists have been quite successful treating these dysfunctions.

4.Look for physical problems. Five to 30% of all erectile insufficiencies are due to some physical cause. Even in these cases, psychology may play are part, but it will not be the source of the problem itself but, rather, a byproduct. The most common physical ailment causing erectile dysfunction is diabetes. The elevated sugar level in the bloodstream decreases the nerve response. One-third of the men who undergo prostatectomy suffer from erectile insufficiency as an after effect. Another cause may be male menopause, for which hormonal treatments are effective.

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