Understanding Male Sexual Problems -- Diagnosis and Treatment
How Do I Know If I Have Sexual Problems?
The most important way for your health care provider to diagnose a
sexual problem is to listen carefully to the story you tell, review the
list of
medications
and substances you use (including natural remedies) to track whether
your sexual dysfunction is connected with them, and try to determine
whether your difficulties are recent or long-standing. It's also
important for your health care provider to understand your level of
knowledge about your body and about sexuality.
The health care
provider will probably encourage talking about relationships, partners,
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.
Recommended Related to Sexual Conditions
Don't try to treat a sexually transmitted disease, or
STD, yourself. These diseases are contagious and serious. You must see a
doctor.
Bacterial STDs can be cured with antibiotics if treatment begins early
enough. Viral STDs cannot be cured, but you can manage symptoms with
medications. There is a vaccine against hepatitis B, but it will not
help if you already have the disease.
If you are given antibiotics to treat a STD, it is important that you
take all of the drug prescribed to you, even if...
Your health care provider will give you a thorough physical exam, checking for
high blood pressure,
vascular disease, a neurological 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 lab 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
penetration.
An ultrasound exam that measures the blood flow within the pelvis
(a penile Doppler study) can determine whether there is enough blood
flow and pressure in the penis to allow for an adequate erection.
A measurement of blood pressure in the penis, called the
penile-brachial index, may be helpful in diagnosing penile vascular
disorders. A test dose of an erection-inducing agent, such as
papaverine, is injected into the penis under a doctor's supervision,
followed by monitoring for a subsequent erection. Also, penile blood
pressure can be measured during the erection. During this exam, 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.
Surgery to correct the leaks has not been found to be effective.
What Are the Treatments for Sexual Problems?
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 health care provider may
prescribe an alternative with fewer sexual side effects. If you smoke,
drink alcohol, or use any recreational drugs, you'll be encouraged to
stop. If you avoid tobacco, you will provide more oxygen to the vascular
tissues of the penis.
What Are the Treatments for Sexual Problems? continued...
If you live a sedentary lifestyle, your provider may suggest that
you start an exercise program and eat healthy foods. Studies have shown
that these measures may slow the buildup of fats that can block the
blood vessels. Importantly,
Treating premature ejaculation: 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. Repeat the process if necessary.
Medications may delay ejaculation, such as selective serotonin
reuptake inhibitors (SSRIs), including sertraline (Zoloft), paroxitine
(Paxil), and fluoxetine (Prozac). None of these drugs is specifically
approved by the FDA to treat premature ejaculation.
Treatments for erectile dysfunction include any of the following:
- The drugs sildenafil (Viagra), tadalafil (Cialis), avanafil (Stendra), or vardenafil (Levitra, Staxyn)
- 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 problems involving the veins of the penis (a procedure that has not been found to be effective)
- Inflatable penile implants
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.
Treating retarded ejaculation: This sexual problem 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, especially antidepressant medications such as the SSRIs.
Treating retrograde ejaculation: 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 pregnancy is a goal; in such situations, it
may be possible to retrieve sperm from the bladder for artificial
insemination.
Dealing with Environment and Psychological Causes of Sexual Problems
Your health care provider may be able to help you outline
strategies to address non-medical issues. If you have psychological
barriers to sexual functioning, your health care 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 health care 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.
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