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How Do I Know If I Have Male Sexual Problems?

The most important way for your healthcare provider to diagnose a sexual problem is to listen carefully to the story you tell, review the list of medications and substances you use, and try to determine whether your difficulties are recent, long-standing, or have been a permanent fixture thus far in your life. It's also important for your healthcare provider to understand your level of knowledge about your body and about sexuality. Your healthcare provider will probably encourage you to talk about your relationship with your partner, your past sexual history, any history of trauma, possible symptoms of depression, and any other stresses or concerns that may be interfering with your ability to respond sexually. Though these topics may seem extraordinarily private, they must be covered to properly evaluate sexual dysfunction and help you have a more satisfying sex life.

Your healthcare provider will give you a thorough physical examination, checking for high blood pressure, vascular disease, neurologic disorder, or obvious signs of conditions affecting your penis or testicles. You'll probably be given a blood test to check for diabetes, thyroid disease, and any other hormonal disorders your practitioner may suspect.

Because men normally have multiple erections during sleep, you'll probably be asked about whether you ever awaken with an erection. Sometimes men are asked to undergo a test in a sleep laboratory to be monitored for erections during sleep. While this information can help tell whether erectile dysfunction may be due to problems with the vascular or nervous systems, it doesn't necessarily indicate whether the erection is sufficient for sexual contact.

An ultrasound examination (called a penile Doppler) can be done to evaluate blood flow within the pelvis and to the penis. A measurement of blood pressure in the penis can be compared to blood pressure in the arm; some researchers consider this penile-brachial index to be helpful in diagnosing vascular disorders. A test dose of an erection-inducing agent called papaverine can be injected into the penis under a doctor's supervision, followed by monitoring to evaluate any subsequent erection, and to evaluate penile blood pressure during such an erection. During this examination, contrast dye may also be injected into an artery so X-rays can reveal any leaks in the vascular system that could account for erectile dysfunction.

What Are the Treatments?

Any underlying physical conditions will be treated in an effort to improve your sexual functioning. Medication may be given to increase testosterone levels, decrease prolactin, treat thyroid disease, or address high blood pressure. If your sexual dysfunction seems to be due to medications for another condition, your healthcare provider may prescribe an alternative with fewer sexual side effects. If you smoke, drink alcohol, or use any recreational drugs, you'll be asked to stop.

Premature ejaculation is commonly curbed by the "squeeze" technique, a kind of biofeedback. This method has a high success rate, and repeated practice usually leads to better natural control. When you feel that orgasm is imminent, withdraw from your partner's vagina or anus or signal your partner to stop stimulation. You (or your partner) then squeezes gently on the head of the penis with the thumb and forefinger, halting the climax. After 20 or 30 seconds, begin lovemaking again. After several cycles, proceed to ejaculation.

Medications that may delay ejaculation, such as the selective serotonin reuptake inhibitors (SSRIs), including sertraline (Zoloft), paroxitine (Paxil) and fluoxetine (Prozac), can be successfully used to help with this problem. Note that premature ejaculation may signal a more complex disorder, and any psychological aspects should be explored in therapy. To rely only on physical control may mask the symptom without resolving the cause.

Treatments for erectile dysfunction include the drug sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra), a vacuum inflation device that pulls blood into the penis, prostaglandin urethral suppositories, self-injection of medications directly into the penis, vascular surgery to correct blood vessel problems and inflatable penile implants.

Retarded ejaculation is often treated by reducing anxiety and learning to control the timing of ejaculation. Sensate focus exercises may help; you should withhold penetration until you sense that ejaculation is inevitable. A common cause of retarded or delayed ejaculation is side effects from medication. The most common drugs that cause this are antidepressant medications such as the SSRIs.

Retrograde ejaculation may be corrected through medications or surgery that allows the valve at the base of the bladder to close. This is basically a harmless disorder, causing a problem only if children are desired; in such situations, it may be possible to retrieve sperm from the bladder for artificial insemination.

Your healthcare provider may be able to help you outline strategies to address environmental considerations. If you have psychological barriers to sexual functioning, your healthcare provider may suggest that you seek individual psychotherapy, couples therapy with your partner, or consult a sex therapist. A number of techniques and therapies can help traumatized individuals become more comfortable with their sexuality. Similarly, if your healthcare provider feels that you may need more information about sexual functioning to help you achieve greater enjoyment, you may be referred to a sex therapist.