Understanding erectile dysfunction

If you’re experiencing male sexual problems such as premature ejaculation or erectile dysfunction, then you are not alone. It's estimated 1 in 10 men has a problem related to having sex.

These are common problems known as sexual dysfunction - which includes any physical or mental problem that prevents you or your partner from receiving sexual satisfaction. It's more common in older men, but it can affect men of all ages. 

Whilst sexual dysfunction isn’t a direct threat to a man’s physical health, erectile dysfunction for example can be an early warning sign of underlying heart disease, which if picked up early can be prevented.

Sexual dysfunction can also have a significant mental impact, sometimes enough to cause depression, anxiety and overwhelming feelings of inadequacy. 

But what causes it, can it be prevented and what treatments are available? To understand more about what causes male sexual problems and the support available, we spoke to Mr Arie Parnham, Consultant Urologist at The Wilmslow Hospital, part of HCA Healthcare UK. 


What are the main types of sexual dysfunction?

The most common concern is erectile dysfunction, which most men experience at some time in their life. This is when men find it difficult to get and maintain an erection, preventing him from taking part in sexual intercourse or other types of sexual activity.

About 40% of men will notice some degree of problem by age 40. As men get older, their chance of experiencing erectile dysfunction increases by roughly 10% per decade. The severity of the problem also increases with age.

But whilst it’s certainly more common in older men, you can be young and still have erectile dysfunction issue problems, and more men suffer with it than you’d suspect. So if you’re under 40 and experiencing erectile dysfunction don’t worry that you are particularly unlucky, and don’t suffer in silence.

Some men also struggle with premature ejaculation, this is when a man ejaculates sooner than he wants to during sex. On the other side of that coin, and this is a rarer problem, some men experience delayed or inhibited ejaculation, this is when men reach orgasm too slowly or sometimes not at all.

What causes male sexual problems?

One of the reasons men let these problems lower their self-esteem and inhibit their sex life, is that they don’t know enough about it, and how it can be prevented and treated. 

There are lots of reasons why a man might experience sexual dysfunction, most of which fit broadly into physical or psychological causes, or sometimes a mix of the two depending on the individual and their circumstances.

Causes of erectile dysfunction

When you become sexually aroused increased blood flow in your penis creates an erection.

Erectile dysfunction is usually caused by a problem with blood flow because of hardening and narrowing of the blood vessels in your penis. As men age the muscles which line the blood vessels in the penis become firmer and less able to stretch, disrupting the blood flow needed by the penis to become erect.

Then there are other conditions such as diabetes, raised blood pressure and heart disease which can damage those blood vessels further and are also common causes of erectile dysfunction.

In addition, alcohol, smoking and illegal drugs can also cause erectile problems so it’s worth assessing your relationship with those things if you have started to experience some erectile dysfunction.

Some prescription medicines can also contribute to erectile dysfunction so please speak to your doctor if your erectile dysfunction has coincided with the start of a new drug or has gotten worse since you began the medication.

Erectile dysfunction can also be psychological, particularly in the case of younger men. Performance anxiety as well as general worries about work, money and your relationship can all be factors. Loss of sex drive (also known as libido) can also cause erectile dysfunction. Low libido is when a person has a reduced interest in sexual activity or sexual thoughts. Losing your sex drive is common. It can be linked to several factors, including relationship issues, stress, anxiety, some medical conditions and side effects of medication.

Causes of premature ejaculation

There are some physical causes of premature ejaculation, including prostate and thyroid problems, but it’s more commonly a psychological condition, caused by anxiety about sexual performance, stress, unresolved issues in a relationship or depression. Anxiety about sexual performance can be particularly prevalent at the start of a new relationship, particularly when a man has had previous problems with sexual performance).

How is male sexual dysfunction diagnosed?

Talking about sex and your private parts isn’t always easy but opening up to your doctor can help us to plan the most effective treatment for you.

After you and your doctor have discussed your medical and sexual history, they will usually perform a physical exam. This will normally include a blood pressure check, an examination of your penis and testicles, a rectal exam to check your prostate and blood tests which check your blood sugar, testosterone levels and your cholesterol.

Depending on your consultation and the results of your physical examination they may refer you to another doctor, such as an endocrinologist or therapist for further investigation and support.

How is sexual dysfunction treated?

There are lots of different treatments available and most cases of sexual dysfunction can be corrected by treating the mental or physical problems that cause it.

Treatment for erectile dysfunction

For most men, erectile dysfunction can be treated effectively with medication or talking therapy. For some men healthy choices, especially if they are implemented early on, may improve, or prevent erectile dysfunction over time.

Treating erectile dysfunction means improving the blood flow to the penis. There are multiple prescription drugs available to treat erectile dysfunction, and they all work in the same way, by relaxing the blood vessels, which allows more blood into the penis. Your doctor will discuss the different drugs available which are safe and effective for most men, with typically mild side effects.

If you have low levels of testosterone these can be raised by hormone replacement therapies that include injections, patches, or gels. This is known as hormone therapy. There are also mechanical aids available which include vacuum devices and penile implants.

Some men may benefit from psychological therapy in which a psychologist or counsellor can help you address any feelings of anxiety or depression that may be affecting you.

Treatment for premature ejaculation

There are several ways to treat premature ejaculation including psychological therapy and medication, and there are number of things you can try yourself. For example, it helps some men to masturbate until they reach orgasm 1-2 hours before sex or try using a thick condom to minimise the sensation, and taking breaks during sex.

As well as getting one to one support from a psychologist, if you are in a couple you may benefit from couples therapy where you will be able to discuss any relationship issues and receive advice and support about resolving them. They may also share practical techniques that you and your partner can practice increasing the duration of intercourse.

There are also some topical creams and medications, such as medications which are used to treat depression, and pills which have been developed specifically to treat premature ejaculation which your doctor will be able to discuss with you and advise which approach is best for you.

What piece of advice would like to leave us with?

Sexual dysfunction can be distressing for many men and their partners and can be difficult to discuss with each other or a healthcare professional, but the good news is that many of these issues can be corrected by treating the underlying causes so it’s important to seek help and support.

To see myself or one of the urology team please call The Wilmslow Hospital on 01625 545 000