Common Male Sexual Problems

1. Erectile dysfunction
2. Diminished libido
3. Ejaculation Disorders
   • Premature ejaculation
   • Delayed or inhibited ejaculation
4. Peyronie's disease (Penile curvature)

Causes of Sexual Dysfunction in Men

• Decreased blood flow
  The reduced blood flow to the penis can result from aging, smoking, medications, and health problems such as hypertension, diabetes, and obesity. It is also the first sign of future heart attack because the reduction of the blood flow in the penile arteries can occur before the decrease of blood flow to other organs, including the heart. 
  
  
• Neurological conditions
  Health issues such as spinal cord injury, stroke, penile trauma, diabetes, or prostate surgery can cause penile nerve damage.
  
  
• Medications
  Medications such as opioids, beta-blockers, or antidepressants can interfere with the nervous system or lower testosterone levels.  
  
  
• Performance anxiety and depression
  Men can feel depressed due to a decline in sexual function from aging. They may feel too embarrassed to discuss it with a doctor and start to lose interest in sexual activities and have diminished libido.
  
  
• Penile trauma during sexual intercourse
  It can lead to the development of fibrous scar tissue causing curved and possibly painful erections. Around 7% of men experience this abnormal penile curvature which can cause pain and inability to have sexual intercourse, especially when the curvature is more than 60 degrees. 

Diagnosis

• History taking: Your doctor will ask some personal questions such as:
  • Does your sexual dysfunction happen gradually or suddenly?
  • Are there erections during the night or after waking up in the morning?
  • Do you experience erectile dysfunction with masturbation?
  • Do you have health conditions such as obesity, diabetes, hypertension, or hyperlipidemia?
  • Do you have depression or anxiety?
  • Do you smoke or drink alcohol?
    
    
• Physical examination 
  • Feel the pulses in the groin and feet
  • Check for gynecomastia 
  • Examine the penis, testicles, and prostate
    
    
• Blood tests
  Check blood sugar, cholesterol, thyroid hormones, and testosterone levels. Sexual dysfunction can result from low testosterone and low or elevated thyroid hormones. These tests can screen and identify more severe health issues, such as a growth in the pituitary gland or malfunction of the gonads.

Treatments

• Lifestyle modifications such as improving your exercise, diet, and sleep quality can help lower stress and anxiety. 
• Quit smoking and drinking alcoholic beverages.
• Vacuum-assisted erection devices increase the blood flow in the penis and create erections. 
• Collagenase injections can improve penile curvature. Collagenase is an enzyme that can break down collagen and remove scar tissue in the penis.