Male Sexual Dysfunction
For males, sexual dysfunction takes four main forms: erectile dysfunction, premature ejaculation, ejaculatory incompetence and dyspareunia.
Erectile dysfunction is the inability to achieve or maintain an erection sufficiently firm to penetrate. Approximately half of the people who experience erectile dysfunction have psychological issues that are causing the problem. Other common causes are:
- diabetes (50% of male diabetics have erectile dysfunction)
- stress and fatigue
- low levels of testosterone
- vascular or circulatory problems
- general physical illness
- substance use or abuse (i.e., certain medications, alcohol and narcotics can affect sexual desire and ability)
- anxiety related to sexual performance
- a neurological disorder such as a spinal cord injury. Sexual dysfunction in someone with a spinal cord injury can be caused by neuromuscular dysfunction or obstructive changes from recurrent genitourinary infections.
Medical interventions to address physical causes include medication, penile rings, vacuum pumps, urethral suppositories and surgical insertion of flexible or inflatable rods in the body of the penis. Psychotherapy treatments, including sensate focusing, aim to decrease the individual’s anxiety related to sexual response by focusing on sensuality and intimacy without the demands of intercourse.
Premature ejaculation is the inability to voluntarily delay ejaculation. Physical causes, such as medication side effects and neurological disorders, should be investigated first. There are a number of psychological causes for this dysfunction, such as reliance on masturbating as a means of immediate gratification, traumatic sexual experience or anxiety.
The goal of treatment for premature ejaculation is to train the man to focus his sensations. Focusing teaches him to anticipate when an orgasm is going to occur and gain control over the timing of ejaculation. There are two main methods for focusing: the stop-go technique and the squeeze technique.
Ejaculatory incompetence is the inability to ejaculate after penetration despite adequate erection and arousal. This can be caused by psychological issues, such as anxiety about penetration and/or ejaculation, or it can be a side effect of medications such as antidepressants.
Once medications have been ruled out, treatment may focus on the psychological reasons for the ejaculatory incompetence. A behavioural approach such as orgasmic retraining is often useful.
Dyspareunia is a recurrent or persistent genital pain occurring before, during or after penetration. This is a rare sexual dysfunction among males and is usually associated with conditions such as herpes, prostatitis or Peyronie’s disease.
Treatment strategies focus on medical intervention to address the underlying physical cause.