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Sexual problems
Erectile dysfunction (impotence)
Loss of sexual desire
Premature (or rapid) ejaculation
Retarded (or delayed) ejaculation
What's it like? (real comments from real people)
Have your say about sexual dysfunctions  This section deals with problems with sex. For general questions on the penis including erections, size, coming etc, try the Tool-Kit.
Erectile dysfunction (impotence)What is it?
What are the main symptoms?
What's the risk?
What causes it?
How can I prevent it?
Should I see a doctor?
What are the main treatments?
How can I help myself?
What's the outlook?
Who else can help? What is it?The persistent or recurrent inability to achieve or maintain an erection good enough to complete your chosen sexual activity satisfactorily, whether that's masturbation, oral sex or vaginal or anal intercourse. The occasional inability to achieve a satisfactory erection doesn't normally constitute a problem. Top of Page What are the main symptoms?See "What is it?". Top of Page What's the risk?- Most men will experience an erection problem at least once. This could be due to stress, exhaustion, too much alcohol or simply not feeling like sex.
- Persistent erectile dysfunction (ED) is estimated to affect about 10% of men at any one time.
- Although age itself isn't a cause of erectile dysfunction (ED), the risk nevertheless increases as you get older: 18% of 50–59 year olds have trouble with their erections compared with 7% of 18–29 year olds.
Top of Page What causes it?There are two main causes of ED: physical and psychological. Most doctors agree that the majority of cases are physical but it's also clear that many men with ED also quickly start to feel anxious, stressed or depressed. These feelings can easily make the symptoms of ED worse. The main physical causes are: - Diabetes. Up to 25% of all diabetic men aged 30–34 are affected by ED, as are 75% of diabetic men aged 60–64.
- Inadequate blood flow to the penis because arteries have got furred-up (a condition called atherosclerosis) or damaged. This causes about 40% of ED cases in men aged over 50. Smoking cigarettes, which is implicated in up to 80% of ED cases, constricts the blood vessels and is a major cause of damage to the arteries leading to the penis. One little-known cause of damage to key blood vessels is cycling.
- Regular heavy drinking. Alcohol can damage the nerves leading to the penis, reduce testosterone levels and increase levels of the female hormone oestrogen.
- The side-effects of prescribed drugs, particularly those used to treat high blood pressure, heart disease, depression, peptic ulcers and cancer. As many as 25% of ED cases may be caused by drugs taken to treat other conditions.
- Spinal cord injury. Almost a quarter of men with spinal injury are affected by ED.
- Prostate gland surgery (or other surgery around the pelvis). The risk of ED depends on the type of surgery, but up to 30% of men who have a radical prostatectomy (the complete removal of the gland affected by cancer) will experience ED.
The main psychological causes of ED are: - Relationship conflicts
- Stress and anxiety
- Depression (90% of men affected by depression also have complete or moderate ED)
- Unresolved sexual orientation
- Sexual boredom
One rough-and-ready way of working out whether your ED has a physical cause is to see whether there any circumstances in which you get an erection. If you can produce one when masturbating but not with a partner, wake up with an erection, or have erections during the night, then there's a good chance that your ED has psychological causes. Top of Page How can I prevent it?- Have a healthy lifestyle. Quitting smoking and drinking alcohol in moderation will help. Regular aerobic exercise and a low-fat diet will also reduce the risks of atherosclerosis.
- If you have diabetes, ensure it's properly controlled.
Top of Page Should I see a doctor?Yes. Get help and advice as soon as you notice a problem. This isn't only important in terms of getting treatment for your ED: it could also be a symptom of other potentially serious conditions (such as diabetes or heart disease - click here for more information.) One study of 50 men with ED who had sought prescriptions for Viagra found that although none of them had any symptoms of heart disease, six were found to have blockages in all three major heart arteries, seven had two arteries that showed narrowing and one artery was blocked in another seven. Overall, 40% of the men were at significant risk of angina or a heart attack. If you are on treatment for a medical or psychiatric problem and you think that this treatment is affecting your sex life tell your doctor. Alternative treatments that may have less likelihood of affecting sexual function are often available. If your doctor doesn't take your problem seriously, ask to be referred to a specialist. Don't let yourself be fobbed off with comments like "What do you expect at your age?" A wide variety of treatments for ED are now available. Remember, however, that not all men are entitled to treatment through the NHS. To find out about your entitlement, click here. Top of Page What are the main treatments? Oral drugs. These are by the far the most commonly used treatments. There are now a number of oral treatments available and most work by helping to relax the blood vessels in the penis, allowing blood to flow in. They don't work unless you're also sexually stimulated. The most common side-effects are headaches and facial flushing. These oral treatments must not be taken by men who are also using medicines containing nitrates (commonly prescribed for angina). There are a number of oral treatments available including Cialis, Levitra, Uprima and Viagra. There are pros and cons with each and it is important to discuss these with your doctor. More details can be found here. - Injection therapy. This is an effective and reliable way of producing an erection with drugs but, understandably, many men don't like sticking a needle into their penis every time they have sex. When injected, the drug (most commonly alprostadil, commonly known as Caverject and Viridal), relaxes the blood vessels and muscles, allowing increased blood flow and producing an erection within 15 minutes.
- MUSE (medicated urethral system for erection). This method also uses alprostadil, but this time it's administered by means of a small pellet inserted into the urethram the opening to ther penis, via a single-dose, disposable plastic applicator.
More information about MUSE has been added here since this section was written. - Vacuum pumps. The penis is inserted into a clear plastic cylinder and the air is pumped out, creating a vacuum. The penis fills with blood and, when it's hard enough, a plastic constricting ring is placed around the base of the penis to trap the blood. There are few side-effects (apart from occasional slight bruising) and the devices work for more than 90% of men. Many men find the process too unnatural and intrusive, however, and prefer to try other methods of tackling ED.
- Hormonal supplements. Testosterone can be given to men in the relatively few cases where low levels are the cause of ED, especially if they also have low sexual desire. Before taking testosterone, always insist that your doctor measures your testosterone level to confirm that it really is low.
- Penile implants. Now that so many other effective treatments have become available, implants are only now used as a last resort. A mechanical device is surgically inserted into the penis. It can be either permanently rigid or have a hydraulic action, operated via a valve in the scrotum.
- Sex therapy. Whatever the cause or treatment of their ED, many men could benefit from counselling or therapy. In fact, the best treatment centres provide it as a matter of course. Sex therapy will be particularly necessary if the ED has psychological causes which can't actually be "cured" with physical treatments. If a man has ED as a result of emotional conflict with a partner, for example, providing him with a drug that produces an erection isn't going to resolve that conflict; in fact, it might even make it worse. Men whose ED has a physical cause may also have lost a great deal of self-esteem and sexual confidence which sex therapy could help restore. It usually makes sense to also involve any permanent partner in sex therapy since the loss, as well as the restoration, of a man's erectile functioning will almost inevitably profoundly affect their relationship.
Top of Page How can I help myself?- Share your worries. No, you don't have to tell your work colleagues about your penis problems, but it will help enormously if you can talk to someone you trust. It's particularly important to communicate with your partner. Some men try to deal with their ED by hiding it from their partner and make all sorts of excuses not to attempt sex. This can cause feelings of confusion and rejection as well as suspicions that you're having an affair. You best bet is to be as open and honest as possible with your partner and ask for support.
- Place less emphasis on intercourse and more on developing other forms of sexual intimacy. Spending time cuddling, kissing, licking and massaging can still be pleasurable and will help keep you emotionally close to your partner.
- Don't try and treat yourself by seeking out pornography, or by asking a partner to wear erotic clothing or act out your fantasies. This almost certainly won't work and could leave you feeling even more upset.
- Don't be tempted to buy herbal supplements or so-called aphrodisiacs through the Internet or magazine advertisements. You can't be sure what you're getting and these remedies are very unlikely to work.
- Don't blame yourself for your ED. It's a health problem and not a reflection of your masculinity. Don't be tempted to blame your partner either.
Top of Page What's the outlook?There's an excellent chance that your erections can be restored through one of the increasingly wide range of treatments now available but the psychological scars may take longer, and be more difficult, to heal. Top of Page Who else can help?Read our article for more on: InformED.org.uk
Web site: www.informED.org.uk
Pele fronted registration site run by Pfizer
Sexual Dysfunction Association
Web site: www.sda.uk.net
Suite 301 Emblem House,
London Bridge Hospital,
27 Tooley Street,
London SE1 2PR
Tel: 0870 774 3571 (open Monday to Friday, 9 am–5 pm)
For information and advice on all sexual dysfunctions. Relate
Web site: www.relate.org.uk
E-mail: enquiries@relate.org.uk
For counselling for relationship and/or sexual problems. Top of Page Loss of sexual desireWhat is it?
What are the main symptoms?
What's the risk?
What causes it?
How can I prevent it?
Should I see a doctor?
What are the main treatments?
How can I help myself?
What's the outlook?
Who else can help? What is it?A condition in which you lack interest in sex, causing concern to you and/or your partner. Top of Page What are the main symptoms?You never or rarely feel like having sex – or you feel like having sex far less often than your partner, causing relationship problems. Top of Page What's the risk?Surprisingly high – about 15% of men aged 18–59 say they lack interest in sex, according to a recent large survey. Top of Page What causes it?- There are a wide range of causes, including relationship difficulties, sexual boredom with a partner, depression, exhaustion, stress and a low level of testosterone.
- It's possible that you simply have a naturally lower level of sexual desire than your partner and that your real problem is finding a way to negotiate some sort of compromise.
Top of Page How can I prevent it?- Improve the quality of your sleep, cope better with stress, sort out any relationship problems, find ways of spicing up your sex life.
- Get help if you're depressed.
- Regular exercise may also increase your sense of well-being and feelings of sexual desire.
Top of Page Should I see a doctor?- If your low level of sexual desire concerns you or is causing problems in a relationship. You should certainly get advice if you have other symptoms, such as exhaustion, a reduction in facial hair growth or a loss of body hair, shrinking testicles or muscle weakness (these could all be signs of testosterone deficiency).
- If you would prefer not to see a doctor, you could contact a sex therapist for counselling. If s/he believes you could have an underlying medical problem, you will still be advised to get it checked out.
Top of Page What are the main treatments?Sex therapy and, in a few cases, testosterone supplements. Top of Page How can I help myself?- Talk to your partner about your feelings and find ways of developing intimacy and closeness that aren't only linked to sex.
- Avoid quack remedies, including so-called aphrodisiacs – there's no good evidence that any of them work.
Top of Page What's the outlook?Good. Top of Page Who else can help?Sexual Dysfunction Association
Web site: www.sda.uk.net
Windmill Place Business Centre,
2-4 Windmill Lane,
Southall,
Middlesex UB2 4NJ
Tel: 0870 774 3571 (open Monday to Friday, 9 am–5 pm)
For information and advice on all sexual dysfunctions. Relate
Web site: www.relate.org.uk
E-mail: enquiries@relate.org.uk
For counselling for relationship and/or sexual problems. Top of Page Premature (or rapid) ejaculationWhat is it?
What are the main symptoms?
What's the risk?
What causes it?
How can I prevent it?
Should I see a doctor?
What are the main treatments?
How can I help myself?
What's the outlook?
Who else can help? What is it?- Ejaculation which occurs more quickly than a man and his partner would wish, causing problems in a sexual relationship.
- The usual problem is that a man will come during penetration itself or very soon afterwards.
Top of Page What are the main symptoms?See "What is it?". Top of Page What's the risk?- It's a very common problem – in fact, it's the most common sexual dysfunction affecting men.
- About one in three men of all ages suffers from premature ejaculation.
Top of Page What causes it?- It's very rarely caused by a physical problem.
- The most common causes include stress, anxiety about sex (perhaps because of a fear of pregnancy, a sexually transmitted infection or failing to perform adequately), relationship difficulties and the lasting effects of teenage sexual experiences which had to be quick to avoid detection.
Top of Page How can I prevent it?There's not much you can do, except find better ways of coping with stress and resolving difficulties with your partner. Top of Page Should I see a doctor?You should see your GP if the problem is persistent and causing you anxiety or affecting your relationship. The GP may be able to advise you about self-help measures or refer you to a specialist clinic or a qualified sex therapist. Top of Page What are the main treatments?- Sex therapy. This is normally based on two techniques:
- Stop-start. You stimulate your penis (or ask your partner to do it for you) until you're near the point of ejaculation. Then stop and rest for 30–60 seconds before stimulating your penis again. You repeat this process five or six times in each "training" session.
- Squeeze. You stimulate your penis (or ask your partner to do it for you) until you're near the point of ejaculation. This time, you or your partner firmly squeeze around your penis just below the glans (head) – put your thumb on the underside of the penis in the indent where the head meets the shaft (the frenulum) and your first and second fingers on the other side of the penis, just above and below the ridge that separates the head from the shaft. The squeeze has the effect of preventing ejaculation.
The idea of both these techniques is that, over time, you'll start to recognise what it feels like to near the moment when you can't stop yourself coming. When you're able to do that during sex itself, you can then take steps to slow down or stop whatever you're doing until the feeling fades. Once you know you can control your ejaculation in this way, your confidence increases and, eventually, the whole process becomes unconscious and automatic. - Drugs. An old treatment that is still sometimes used is local anaesthetic gel or spray applied to the penis. The idea behind this is to reduce penile sensation. Although this works in some men it is not always effective and some men are allergic to the treatment. Another problem is that the gel may be transferred to your partner during sex and anaesthetise her sensitive parts.
In some cases, doctors will prescribe particular antidepressant drugs that, as a side-effect, slow down your body's progress towards ejaculation. The problems with this treatment are that you end up taking powerful medication designed to treat a completely different condition and that the drugs don't always work anyway and may have unpleasant side-effects. They are best reserved for use when sex therapy has failed to solve the problem or where the man has religious reasons not to stimulate his penis by hand.
Top of Page How can I help myself?You could try these short-term remedies (although they won't necessarily tackle the underlying problem): - Increase the frequency of ejaculations, perhaps by masturbation. This could have the effect of delaying subsequent ejaculations.
- Wear a condom, or use an anaesthetic spray (see above), to reduce the sensitivity of your penis.
- Don't focus on penetration during sex. You may be able to ease the pressure on yourself if you don't attempt penetration until your partner has already had an orgasm.
- Talk to your partner about your problem. This may help relieve some of the pressure you feel under to perform well during sex.
- Try relaxation exercises to tackle stress. One simple but effective exercise involves tensing and relaxing each of your muscle groups in turn, starting with your feet and then moving up your body. Clench each set of muscles for a few seconds, focus on the feeling and then gradually relax. Finish with your forehead. This exercise helps counteract the muscle tension that accompanies stress.
Top of Page What's the outlook?With determination and persistence, it's possible to develop good ejaculatory control. Top of Page Who else can help?Sexual Dysfunction Association
Web site: www.sda.uk.net
Windmill Place Business Centre,
2-4 Windmill Lane,
Southall,
Middlesex UB2 4NJ
Tel: 0870 774 3571 (open Monday to Friday, 9 am–5 pm)
For information and advice on all sexual dysfunctions. Relate
Web site: www.relate.org.uk
E-mail: enquiries@relate.org.uk
For counselling for relationship and/or sexual problems. Top of Page Retarded (or delayed) ejaculationWhat is it?
What are the main symptoms?
What's the risk?
What causes it?
How can I prevent it?
Should I see a doctor?
What are the main treatments?
How can I help myself?
What's the outlook?
Who else can help? What is it?The inability to ejaculate or a long delay before ejaculation. Top of Page What are the main symptoms?See "What is it?". Top of Page What's the risk?About one man in twenty is affected. Top of Page What causes it?- Most of the causes are psychological, including performance anxiety, self-consciousness, a belief that sex is somehow dirty or immoral, stress and relationship difficulties. Some men find that they can ejaculate normally by self-masturbation but are totally unable to ejaculate when the penis is in their partner's vagina. This does not mean that the vagina is too loose and not giving adequate stimulation to the penis. The problem is psychological.
- Age. It is not unusual for men over the age of 70 to experience failure of ejaculation. This may simply be part of the ageing process. However, ageing is associated with decreased penile sensitivity, which means older men need more prolonged and direct penile stimulation to achieve ejaculation than younger men. Sometimes ejaculation fails just because they do not have sufficient penile stimulation.
- It can be the result of the side-effects of certain antidepressant drugs or of nerve damage.
- It can also be caused by physical factors such as a hormone imbalance or nerve damage resulting from pelvic injury or surgery or diabetes.
Top of Page How can I prevent it?You can't do much, except find better ways of coping with stress, of relaxing, and of resolving difficulties with your partner. Top of Page Should I see a doctor?You should see your GP if the problem is persistent and causing you anxiety or affecting your relationship. The GP may be able to advise you about self-help measures or refer you to a specialist clinic or a qualified sex therapist. Top of Page What are the main treatments?- Relaxation exercises, "superstimulation" (e.g. using a vibrator or body oil combined with vigorous rubbing), sex therapy or a large dose of a drug called yohimbine (but check this with your doctor first because there are side effects and not everyone can take yohimbine, e.g. men with high blood pressure).
- Avoid penetration until you're very near the point of ejaculation.
- It may be necessary to change any drugs that might be causing the problem.
How can I help myself?- Talk to your partner about your problem. This may help relieve some of the pressure you feel under to perform well during sex. Try to find ways together to make sex more exciting.
- Try relaxation exercises to tackle stress. One simple but effective exercise involves tensing and relaxing each of your muscle groups in turn, starting with your feet and then moving up your body. Clench each set of muscles for a few seconds, focus on the feeling and then gradually relax. Finish with your forehead. This exercise helps counteract the muscle tension that accompanies stress.
Top of Page What's the outlook?Good, with determination and persistence. Top of Page Who else can help?Sexual Dysfunction Association
Web site: www.sda.uk.net
Windmill Place Business Centre,
2-4 Windmill Lane,
Southall,
Middlesex UB2 4NJ
Tel: 0870 774 3571 (open Monday to Friday, 9 am–5 pm)
For information and advice on all sexual dysfunctions. Relate
Web site: www.relate.org.uk
Herbert Gray College
Little Church Street
Rugby CV21 3AP
Tel: 01788 573241
E-mail: enquiries@relate.org.uk
For counselling for relationship and/or sexual problems. Top of Page Back to A-Z of Health  By Peter Baker, director of the MHF and former editor of malehealth.co.uk. Have your say about sexual dysfunctionsHave you been affected by a sexual dysfunction? If so, we'd like to hear about your experience and to post it on the malehealth.co.uk site. This could be useful to other men who are also affected by this problem. Please note, we cannot answer any queries posted here. If you would like to ask a question about sexual dysfunctions that will be answered by our panel of experts, please go to Ask the Doctor. Read about other men's experiences of tackling sexual problems
Page last updated: 01/01/2005
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