What is sexual dysfunction?
Sexual dysfunction refers to a problem during any phase of the sexual response cycle that prevents the individual or couple from experiencing satisfaction from the sexual activity. The sexual response cycle has four phases: excitement, plateau, orgasm and resolution.

What causes sexual dysfunction?
Causes of sexual dysfunction include:

• Physical causes — Many physical and/or medical conditions can cause problems with sexual function. These conditions include diabetes, heart and vascular (blood vessel) disease, neurological disorders, hormonal imbalances, chronic diseases such as kidney or liver failure, and alcoholism and drug abuse. In addition, the side effects of certain medications, including some antidepressants drugs, can affect sexual desire and function.
• Psychological causes — These include work-related stress and anxiety, concern about sexual performance, marital or relationship problems, depression, feelings of guilt, and the effects of a past sexual trauma.

How does sexual dysfunction affect men?
The most common problems related to sexual dysfunction in men include ejaculation disorders, erectile dysfunction and inhibited sexual desire.

Ejaculation disorders
There are different types of ejaculation disorders, including:

• Premature ejaculation — This refers to ejaculation that occurs before or soon after penetration.
• Inhibited or retarded ejaculation —This is when ejaculation does not occur.
• Retrograde ejaculation — This occurs when, at orgasm, the ejaculate is forced back into the bladder rather than through the urethra and out the end of the penis.

In some cases, premature and inhibited ejaculation are caused by psychological factors, including a strict religious background that causes the person to view sex as sinful, a lack of attraction for a partner and past traumatic events (such as being discovered in masturbation or illicit sex, or learning one's partner is having an affair). Premature ejaculation, the most common form of sexual dysfunction in men, often is due to performance anxiety during sex. However, organic causes are sometimes present. Certain drugs, including some anti-depressants, may impair ejaculation, as can nerve damage to the spinal cord or back.

Retrograde ejaculation is most common in males with diabetes who suffer from diabetic neuropathy (nerve damage). This is due to problems with the nerves in the bladder and the bladder neck that allow the ejaculate to flow backward. In other men, retrograde ejaculation occurs after operations on the bladder neck or prostate, or after certain abdominal operations. In addition, certain medications, particularly those used to treat mood disorders, may cause problems with ejaculation.

Erectile dysfunction
Also known as impotence, erectile dysfunction is defined as the inability to attain and/or maintain an erection suitable for intercourse. Causes of erectile dysfunction include diseases affecting blood flow, such as atherosclerosis (hardening of the arteries); nerve disorders; psychological factors such as stress, depression and performance anxiety; and injury to the penis. Chronic illness, certain medications and a condition called Peyronie’s disease (scar tissue in the penis) also can cause erectile dysfunction.

Inhibited sexual desire (reduced libido)
Inhibited desire, or loss of libido, refers to a decrease in desire for or interest in sexual activity. Reduced libido can result from physical or psychological factors. It has been associated with low levels of the hormone testosterone. It also may be caused by psychological problems, such as anxiety and depression; medical illnesses such as diabetes and high blood pressure; certain medications, including some anti-depressants; and relationship difficulties.

How is male sexual dysfunction diagnosed?
The doctor likely will begin with a physical exam and a thorough history of symptoms. He or she may order other diagnostic tests to rule out any medical problems that may be contributing to the dysfunction. The doctor may refer the patient for consultations with other health care professionals, including an urologist (a doctor specializing in the urinary tract and male reproductive system), an endocrinologist (a doctor specializing in glandular disorders), a neurologist (a doctor specializing in disorders of the nervous system), sex therapists and other counselors.

Tests the doctor may use to help evaluate sexual dysfunction include:

• Blood tests — These tests are done to evaluate hormone levels.
• Vascular assessment — This involves an evaluation of the blood flow to the penis. A blockage in a blood vessel supplying blood to the penis may be contributing to erectile dysfunction.
• Sensory testing — Particularly useful in evaluating the effects of diabetic neuropathy, sensory testing measures the strength of nerve impulses in a particular area of the body.
• Nocturnal penile tumescence and rigidity testing — This test is used to monitor erections that occur naturally during sleep. This test can help determine if a man’s erectile problems are due to physical or psychological causes.

How is male sexual dysfunction treated?
Many cases of sexual dysfunction can be corrected by treating the underlying physical or psychological problems. Treatment strategies may include the following:

• Medical treatment — This involves treatment of any physical problem that may be contributing to a man’s sexual dysfunction.
• Medications — New medications, such as sildenafil (Viagra™), varderafil (Levitra™), or tadalafil (Cialis™ ) may help improve sexual function in men by increasing blood flow to the penis.
• Hormones — Men with low levels of testosterone may benefit from hormone injections. The use of a testosterone patch applied to the scrotum or other parts of the body has been approved by the Food and Drug Administration to help increase testosterone levels to a normal range. Testosterone replacement by pills and implantable pellets also is being evaluated.
• Psychological therapy — Therapy with a trained counselor can help a person address feelings of anxiety, fear or guilt that may have an impact on sexual function.
• Mechanical aids — Aids such as vacuum devices and penile implants may help men with erectile dysfunction.
• Education and communication — Education about sex, and sexual behaviors and responses may help a man overcome his anxieties about sexual function. Open dialogue with your partner about your needs and concerns also helps to overcome many barriers to a healthy sex life.

Can sexual dysfunction be prevented?
While sexual dysfunction cannot be prevented, dealing with the underlying causes of the dysfunction can help you better understand and cope with the problem when it occurs. There are some things you can do to help maintain good sexual function:

• Follow your doctor’s treatment plan for any medical/health conditions.
• Limit your alcohol intake.
• Quit smoking.
• Deal with any emotional or psychological issues such as stress, depression and anxiety. Get treatment as needed.
• Increase communication with your partner.

When should I call my health care provider?
Many men experience a problem with sexual function from time to time. However, when the problems are persistent, they can cause distress for the man and his partner, and have a negative impact on their relationship. If you consistently experience sexual function problems, especially with erectile dysfunction, see your health care provider for evaluation and treatment.

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. For additional written health information, please contact the Health Information Center at the Cleveland Clinic (216) 444-3771 or toll-free (800) 223-2273 extension 43771 or visit www.clevelandclinic.org/health/.

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