Conditions that can cause disorders of male sexual function
- Hypertension
- Sickle cell disease.
- Vascular disease (for example, Leriche syndrome)
- Diabetes.
- Neurological disease (for example, multiple sclerosis)
- Endocrine disease (for example, deficiencies of testosterone gonadotrophins, hypothyroidism, and prolactinoma)
- Alcoholism and substance abuse.
- Liver and kidney diseases.
- Adverse effects of drugs (for example, antihypertensive and antidepressant medication)
- After prostate and abdominal surgery.
Sexually transmitted infections rarely interfere directly
with sexual functions, although concerns about STIs or HIV often are expressed
by patients with dysfunction. Loss of libido and erectile dysfunction are
reported commonly by men infected with HIV and may be exacerbated by antiviral
treatment.
Once an individual has experienced sexual dysfunction,
performance anxiety readily develops, which exacerbates the problem. Reducing
performance anxiety is a key aim of psychological therapies.
Erectile dysfunction
Patients complain of failure to achieve or maintain an
erection. Psychological factors can be identified by careful history taking. If
the patient does not experience spontaneous erections on waking and cannot
masturbate to orgasm, an organic disease is more likely.
Premature ejaculation
An organic cause is unlikely to be found. Therapy is usually
behavioral and involves training the patient to delay ejaculation by using a
variety of graduated stop-start exercises first, alone, using masturbatory
exercises, and then with a partner.
