Sexual Dysfunction in Men
Sexual dysfunction can occur at any age, though it is more common in individuals over 40 years old due to a decline in health. The DSM-5 defines male sexual dysfunctions as hypoactive disorder, erectile disorder, premature ejaculation, and delayed ejaculation.
Sexual dysfunction in men can occur in any part of the sexual response cycle: desire (libido), arousal, orgasm, and resolution. 8 to 18% meet the criteria for hypoactive sexual desire disorder, 10 to 40% for erectile disorder, 8 to 30% for premature ejaculation, 1 to 10% for delayed ejaculation, and 1 to 6% for genito-pelvic or penetration-related pain.
Symptoms of Sexual Dysfunction
- Inability to achieve or maintain an erection for intercourse- erectile dysfunction
- Absent or delayed ejaculation despite sexual stimulation- retarded ejaculation
- Inability to control the timing of ejaculation- early/premature ejaculation
- Lack of interest in or desire for sex
- Inability to become aroused
- Pain with intercourse
Causes of Sexual Dysfunction:
Physical causes
Many physical and/or medical conditions can cause problems with sexual function.
- Diabetes
- Undiagnosed diabetes is up to three times as likely in men with erectile dysfunction (28%) compared to non-diabetic men with normal erections (10%)
- Among men over 50 years of age, diabetics are roughly twice as likely to have ED (46%) compared to non-diabetics (24%)
- The longer a patient has diabetes and the more severe, the greater the risk of ED
- One-third of diabetic men will have hypogonadism which may partly explain the high correlation between diabetes and ED
- Heart and vascular disease
- About 40% of men with ED will have hypertension while 35% of all hypertensive men will also have ED
- Almost 50% of men with known coronary artery disease proven by cardiac catheterization have significant erectile dysfunction
- Coronary arteries and the penile cavernosal arteries are similar in size and tend to develop atherosclerotic problems
- Neurological disorders
- Hormonal imbalances
- Chronic diseases such as kidney or liver failure
- Alcohol use disorder and substance use disorder
- In smokers who quit, erectile quality improved 25% after one year.
- Heavy alcohol users also report an increased risk of ED compared to the general population. The cause is uncertain but is thought to be due to direct alcoholic toxicity to the corporal endothelium, loss of corporal smooth muscle tissue, and early neuropathy.
Some prescription medications and OTC drugs can have an impact on sexual functioning. The risk of sexual side effects is increased when an individual is taking several medications.
- Some OTC antihistamines and decongestants can cause erectile dysfunction or problems with ejaculation
- Certain antidepressants and medications to treat high blood pressure can also cause erectile dysfunction
- Hormones, such as Lupron and Zoladex, may decrease sexual desire
Psychological causes:
- Work-related stress and anxiety
- Concern about sexual performance, marital or relationship problems
- Depression
- Patients with depression are almost 40% more likely to have ED than normal men without depression. The incidence of depression in men with ED is almost three times greater
- Feelings of guilt
- Concerns about body image and the effects of a past sexual trauma
How Can PT Help?
A pelvic floor physical therapist can work with you to address any underlying musculoskeletal issues that may be contributing to sexual dysfunction. Your pelvic PT may perform an internal assessment to assess the pelvic floor muscles more specifically, checking the strength of the muscles and looking for any tight or tender areas. Your pelvic PT may then go over relaxation techniques and give you an individualized home program based on your symptoms and the examination findings.
Body Harmony Physical Therapy offers one pelvic health physical therapist to one patient evaluation and treatment sessions. Our treatment sessions last up to one hour in a private treatment room. We provide individualized home programs to every patient. We offer a quick call back option for potential patients who have questions or concerns related to physical therapy.
