Journal of Andrology & Gynaecology
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Review Article
Male Sexual Dysfunction
Siniša Franjić*
Faculty of Law, International University of Brcko District, Brcko,
Bosnia and Herzegovina, Europe
*Address for Correspondence: Siniša Franjić, Faculty of Law, International University of Brcko District, Brcko, Bosnia and Herzegovina, Europe, Tel: +387-49-49-04-60; E-mail: sinisa.franjic@gmail.com
Submission: 29 April, 2019;
Accepted: 30 May, 2019;
Published: 01 June, 2019
Copyright: © 2019 Franjić S. This is an open access article distributed
under the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided
the original work is properly cited.
Abstract
Although sexual dysfunction problems are more common in
women than in men, almost everywhere in the world, men are more
likely to seek help. Most rely on their own strength, search for help over
the Internet, seek for solutions, search for charlatans, and unproven
treatments. Experts' help does not seek, as they are justified, considering
that the doctor will be embarrassed, that the doctor has no time or that
he does not actually have a cure for these problems. People know little
about how to help in the case of sexual problems and most of them
just heard for only drug registered for erectile dysfunction and often
do not know that there are other treatment options and medications
for other sexual problems. The most common sexual problems in men
are premature ejaculation, erectile dysfunction, reduced sexual desire
and postponed ejaculation. Other problems (eg different paraphilias,
anorgasms, anejaculation, sexual addiction) are much less frequent.
Keywords
Sex; Health; Dysfunction; Male
Introduction
The diagnostic investigations and treatment opportunities for
women with sexual health concerns are limited, in large part, due
to the lack of current global government-approved agents for any
sexual health concerns (desire, arousal, orgasmic and sexual painrelated
dysfunctions) of pre-menopausal women or for non-sexual
pain concerns of post-menopausal women [1]. There are, in contrast,
more than 20US government-approved treatment strategies for men
with bother some male sexual dysfunctions. The availability of safe
and effective medicaments for men with sexual health problems
has, in part, motivated clinicians to better understand the nature of
men’s sexual health concerns. This has led to more clinical diagnostic
procedures for men with sexual dysfunction.
Recent public health attention in some parts of the world to
problems like testicular and prostate cancer (especially affecting
younger and older men, respectively), erectile dysfunction (a
problem that grows with time and the appearance of pharmaceutical
solutions), and premature ejaculation address certain reproductive
health concerns by men, regardless of sexual orientation [2]. Yet
emphasizing male analogues to female gynecological problems will
only take us so far in developing our conceptual toolkit regarding
male sexualities. To give texture and vigor to the study of men,
sexuality, and reproduction we must find ways to extend and develop
the feminist and queer literatures on sexuality, including bisexuality,
so that if male hetero sexualities are no longer seen as compulsory,
neither are they necessarily and generally understood as compulsive.
The WHO (World Health Organization) defines reproductive
health as a ‘state of complete physical, mental and social well being
and not merely the absence of disease or infirmity in matters related to
the reproductive system and to its functions and processes’ [3]. Thus,
it also includes sexual health, the purpose of which is enhancement of
life and personal relations and not merely counseling and care related
to reproduction and STI (sexually transmit- ted infections]. This
holistic approach is important in the promotion of gender-sensitive
and woman-centered health.
The 12 pillars of reproductive health care include adolescent
reproductive health and sexual behavior, the status of women
in society, family planning, maternal care and safe motherhood,
abortion, reproductive tract infections, HIV/AIDS, infertility,
reproductive organ malignancies, nutrition, infant and child health
and environmental and occupational reproductive health.
The role of community gynecologists and reproductive health
care doctors in the UK is to manage the provision and delivery of such
services, to oversee and co-ordinate school sex education, co-ordinate
screening for sexually transmitted infections, deliver contraceptive
and legal abortion services, screening for breast and cervical cancer
and management of psychosexual dysfunction and menopausal
problems. This transition from providing only family planning
services to delivering a package of integrated and comprehensive
reproductive health care across the boundaries of disciplines is
gaining momentum.
Psychiatric Disorder
Many psychiatric disorders are associated with sexual
dysfunctions [4]. Impairment of sexual functioning in a person
with mental illness could be possibly part of her/his mental illness
symptomatology (e.g. lack of sexual desire in depression), adverse
reaction to medication used for treatment of her/his mental illness
(e.g. delayed ejaculation or anorgasmia associated with serotonergic
antidepressants), result of substance abuse (e.g. low sexual desire due
to chronic cocaine abuse), or due to chronic physical illness (either
independent of mental illness or as a result of adverse reaction to
medications used for mental illness, for example metabolic syndrome
or diabetes mellitus due to some antipsychotics) and/or its treatment.
Impairment of sexual functioning could, of course, occur due to one
of the secausesora combination of two or more.
The exact diagnosis of the underlying cause of sexual impairment
is notal ways possible and thus treatment may either target the
underlying cause, or be symptomatic, for example using treatments
that work for a specific sexual dysfunction in general (e.g. using
medication such as sildenafil (Viagra) for erectile dysfunction).The
diagnosis is usually established during a careful clinical interview.
The clinician has to ask very specific questions focused on particular parts of sexual functioning, for example on sexual desire, arousal
(erection), orgasm (ejaculation) and pain associated with sexual
activity. It is imperative to obtain a baseline evaluation of the patient’s
sexual functioning during the first visit. This will be helpful later, in
cases of sexual dysfunction possibly associated with any medication
prescribed. There are no specific tests for sexual dysfunction(s).
However, certain laboratory tests may help in some clinical
situations. For instance, measuring the level of prolactin may help
confirm suspected sexual dysfunction during the treatment with an
antipsychotic drug.
The most common complaint of depressed patients is decreased
libido (up to 72% of patients in one study). It seems that the more
severe the depression, the greater the loss of libido. Impairment of
other aspects of sexual functioning, for example erectile dysfunction,
impaired arousal in women, delayed ejaculation/orgasm and
anorgasmia have also been reported in depressed individuals,
although less frequently than decreased libido. Depressed individuals
may also be anxious and anxiety is also associated with impairment
of sexual functioning. It is important to note that while their sexual
functioning may be impaired, good sexual functioning is important
for them. The situation is also complicated by the fact that most
medications used to treat depression have been associated with sexual
dysfunction.
Changes of sexual functioning also occur frequently in bipolar
patients–30–65% of manic patients may display hyper sexuality,
while some may report decreased libido. Some patients suffering from
bipolar or cyclothymic disorder (mild depression and hypomania)
may also report episodes of promiscuity or extra relationship affairs.
Drug Effects
Sexual dysfunction is typically the consequence of multiple
contributory factors, rather than of one single factor [5]. The use
of prescribed medication and recreational drugs should always be
considered in a comprehensive biopsychosocial assessment of sexual
dysfunction in both men and women. Drug effects are commonly
cited as a cause of sexual dysfunction, but the evidence for this is
limited and often anecdotal. Underlying conditions for which drug
treatments are prescribed may also cause or contribute to sexual
dysfunction.
As a general rule, if there is a temporal relationship between
the introduction of a new drug therapy, and the onset of a change
in sexual response, or sexual dysfunction or dysfunctions, then it is
more likely that the newly introduced drug is a causal or contributory
factor; where a drug has been introduced more than a month before
the onset of sexual symptoms, this is less likely. Prescribers should
enquire about their patient’s sexual function before they prescribe a
drug known to be associated with sexual dysfunction; this information
may lead them to prescribe a drug less likely to affect sexual function
in patients with pre-existing dysfunction, as well as helping them to
more readily identify drug-induced dysfunction.
Sexual Dysfunction
Male sexual disorders have been investigated to a greater extent
than FSDs [6]. The etiology of male sexual disorders includes
psychological and organic problems. Epidemiological studies have revealed that organic problems are the leading cause of sexual
dysfunction in men. Sexual disorders in men may cover a range of
areas involving ED (erectile dysfunction), orgasmic disorders, and
premature ejaculation. Impotence is defined as inability to perform
sexually in the broadest sense. It is too broad a term to be useful in
diagnosis. Libido is a term derived from psychoanalytical theory that
describes sexual desire, drive, or interest in both sexes. Lack of libido
in men may underlie many instances of impotence. ED is defined as
the consistent inability to obtain or maintain an erection of sufficient
rigidity to enable satisfactory sexual intercourse. Disorders of semen
delivery include lack of emission (deposition of seminal fluid in the
prostatic urethra), an ejaculation (lack of ejaculation), and retrograde
ejaculation (ejaculation through an incompetent bladder neck into
the bladder). Anorgasmia is the persistent inability to achieve orgasm
despite adequate sexual arousal.
ED may result from psychogenic and/or organic causes. In most
cases, however, the etiology of ED involves an organic problem. It is
estimated that about 80% of cases of ED result solely or predominantly
from organic causes. Organic ED is the persistent inability to achieve
or maintain satisfactory erection primarily as a result of organic or
physical factors. In contrast to psychogenic ED, there is often a gradual
deterioration of sexual function over months or years. Typically, the
patient first notes a mild decrease in penile rigidity, then a decrease
in the frequency of erections, followed by sporadic failure of erection
with fatigue. Nocturnal erections gradually disappear, as do early
morning erections on awakening. In organic impotence, full erection
may be achieved, but it frequently subsides quickly. Finally, many
patients complain of a partial erection that is insufficient for vaginal
penetration. Typically, libido and ejaculatory function are unaffected
in organic ED, at least in the early stages.
A large number of diseases and conditions may lead to organic ED,
including peripheral and central neurological lesions, hypogonadism
and other hormonal disturbances, hypercholesterolemia and pelvic
atherosclerotic disease, microvascular disease, diabetes, hypertension,
veno-occlusive dysfunction, Peyronie’s disease, and drug therapies
(especially antihypertensive agents; refs.
The normal physiological changes ageing men and ageing
women experience affecting sexual function, include in women for
example, a drop in oestrogen levels resulting in less lubrication and
possibly discomfort during sex, and in men erectile dysfunction
increases with age with both leading to changes in sexual function
[7]. However, generally the increase in sexual dysfunction observed
in some older people can be attributed to health problems rather
than ageing processes. For example, endocrine, vascular and
neurological disorders may independently interfere with optimum
sexual functioning. Pharmacological treatment or surgery for these
disorders may enhance or impair sexual drive and or performance.
Older adults with significant health problems, who are cared for in
specialist nursing homes are generally discouraged from engaging in
sexual activity or sexual expression, or through using tranquilizers.
Treatment for sexual dysfunction is relatively effortless, and can
involve pharmaceutical or behavioral interventions. Older people
with sexual dysfunction may benefit from therapeutic interventions
of, for example, hormone replacement therapy or Viagra. However,
there is some controversy over the safety of long- term hormonal therapy in women, with the American College of Physicians
recommending postmenopausal hormone treatment to alleviate bone
loss and protect against cardiovascular disease, and the Women’s
Health Initiative publishing the results of its randomized controlled
trial stating no protective effects of hormone use on cardiovascular
disease.
Sex Crimes
Some researchers suggest that certain biological factors, such as
hormones, contribute to why individuals engage in sex offending
behaviors [8]. Perhaps most common within this category is the role
of high testosterone levels, which are found to be associated with
increased sex drive and aggression. Additionally, some biological
theories suggest that certain individuals may be predisposed
toward problematic sexual behaviors because of physiologically or
biologically predetermined sexual appetites or sexual preferences.
These offenses are often viewed as opportunistic crimes committed by
individuals who could not control their behaviors or sexual desires.
Previous research on rape offenders, focusing on the role of brain
dysfunction, innate mating rituals, sex hormones, neurotransmitters,
and the limbic system in promoting sex crimes has found little
empirical support for uncontrollable sexual desires of offenders.
Findings from these studies suggest only limited support for the role
of biology in sexual offending. This biological approach provides some
understanding to causes of sex offending; however, psychologists
have offered alternative explanations for criminal rape.
In a psychological spectrum, sex offenders’ behavior originates
with issues in childhood that affect their attachments to others, social
skills development, and personality traits. These antisocial behaviors
could be products of sexual and physical abuses and neglect during
childhood, which impede the development of proper attachments to
others, and normative social skills. These experiences can also result
in uninhibited or improper responses to opportunities and situations
in which offending may occur.
Conclusion
What man can expect when he tells a doctor about a sexual
problem? First, he can expect a lot of questions. Sometimes men are
surprised not only about sex but about their health, mood, relationships
with partners, and communication. Sexuality is influenced by a
number of factors, so it is important to evaluate everything when a
problem occurs. This is called biopsychosocial approach. Namely,
different biological factors can interfere with sexual function. So lack
of testosterone, blood vessel problems, nerve damage or spinal cord
or diabetes can cause sexual problems. And numerous medicines
(antihypertensive, antidepressants, antipsychotics, antacids, etc.) can
lead to sexual difficulties. On the other hand, different psychological
moments such as anxiety, depression and chronic stress also affect
sexual function.