SEXUAL DYSFUNCTION

Sexual dysfunction can present in many different ways, often feeling personal and isolating. Typically, sexual disorders in men will be presented as issues of erectile dysfunction (ED) or issues where there is:

Premature ejaculation (ejaculation occurs sooner than anticipated or expected)
Delayed ejaculation (a marked delay in ejaculating)
Anorgasmia (regular difficulty in reaching orgasm after adequate sexual stimulation)

There are, in reality, many different types of sexual dysfunction and can include a mix of physical issues, pharmaceutical (medication or other drugs), psychological problems or a combination of these. Once someone has an issue with sexual performance, desire etc, it can be quite difficult to get out of the destructive cycle, causing issues in a relationship or even preventing the development of new ones. This is perfectly normal and there are many different approaches to tackling these issues.

Firstly, let's look at some causes of sexual dysfunction to better understand the issue.

DRUGS/MEDICATION IMPACT ON SEXUAL DYSFUNCTION

There are many drugs that can impact someones sexual function including (but not limited to) the following:

Antidepressants: the use of antidepressants is prescribed to help someone manage their symptoms relating to depression or anxiety. These are vital for many individuals. There are, however, some that cause side-effects that your GP should warn you about. One of the most common side effects is delayed ejaculation i.e. an inability to 'cum' or a significant delay in doing so. This can often happen when someone is taking medications classed a Selective Serotonin Reuptake Inhibitors or SSRI's.
Diuretics and high blood pressure medication: drugs such as propranolol (a beta-blocker), hydrochlorothiazide (a water pill), Nifedipine (calcium channel blocker) - although there are many more examples. There is some indication that beta-blockers may impact actual testosterone levels whilst other studies found no physical impact at all. Diuretics will lower blood pressure and also potentially cause a decrease in blood flow to your penis. These in turn may lead to erectile dysfunction.
Prostate medications: this may be to support men with benign prostate hyperplasia (BPH) or men who have cancer of the prostate. In BPH, some drugs prescribed may cause difficulties in maintaining an erection or problems with ejaculation. Some men may experience a 'dry' orgasm, where no or very little ejaculate is expelled out of the penis. Alpha-blockers such as doxazosin, terazosin and tamulosin maybe some of the more common ones to cause this. Some anti-prostate cancer drugs act by inhibiting the effect of testosterone i.e. flutamide. Testosterone reduction may lead to a decrease in sexual desire and erectile dysfunction.

If you feel that the use of these drugs is making things too difficult for you, talk to your GP. They may be able to advise you on alternatives or doses (especially with antidepressant medication). The drugs you have been prescribed have been given to you by your GP and therefore it is recommended you talk to them before you make any changes.

EXAMPLES OF RECREATIONAL DRUGS

There are also many examples of recreational drugs that can cause issues. These include:

Alcohol
Marijuana ('weed')
Cocaine
Heroin
Nicotine
Methadone
Anabolic steroids (including testosterone)

It is always advisable that if you take recreational drugs you access health professionals or support groups to manage this. Sometimes, taking recreational drugs will lead to other issues such as mental health problems and physical disorders/diseases.

PHYSICAL ISSUES LEADING TO SEXUAL DYSFUNCTION

PSYCHOLOGICAL/ OTHER ISSUES

As well as the physical and induced causes of sexual dysfunction, there can be many causes of dysfunction that are attributed to other causes. This, of course, can be very personal and the list will not give justice to everyone's personal circumstances. It is there to help you understand that causes can be due to anything one may experience:

Difficulties in a relationship
Anxiety about performance
Depression
Domestic Violence
Past sexual trauma (including abuse and rape)
Body Dysmorphia (concerns about your appearance, size, adequacy)
Guilty feelings relating to upbringing or culture
Work-related stress and anxiety
Taught experiences i.e. severe edging
Dependency on drugs to have sex i.e.chemsex

These particular causes may need to have a layered approach to helping you, using specialist therapists, counsellors or healthcare workers and medicine. It will depend on you as a person and your understanding of what has caused the issues. Psychosexual Medicine Practitioners, Cognitive Behavioural Therapists (CBT) and support workers may be able to help with this.

WHAT TREATMENTS ARE OUT THERE FOR SEXUAL DYSFUNCTION?

This depends on the cause but can involve a step-by-step trial process or sometimes an approach that uses multiple sources of help. Once someone has sexual dysfunction, it can be difficult to separate the physical from the psychological issues, so don't be surprised if you are offered access to some form of mental health treatment.

Treatment for Erectile Dysfunction

Your doctor or healthcare professional may talk to you about the following:

Sildenafil, vardenafil, tadalafil orally
Vacuum pumps
Alprostadil
Penile rods
Psychosexual therapy/counselling

Treatment for Premature Ejaculation

Off-label drug use
Squeeze technique
Topical anaesthetics
Anxiety

Treatment for Loss of Desire

Habits that may contribute to the issue i.e. pornography use
Relationship issues to be rectified
Depression/anxiety treatments

WHERE TO FIND HELP

It all depends on what is going on! If you are being treated by a doctor or Consultant and symptoms have become an issue since treatment started, it is advisable to talk to them about this. You may feel embarrassed or ashamed, but please do not worry. Many men suffer from some form of sexual dysfunction. In the European Male Ageing Study, Erectile dysfunction (ED) (moderate or severe) was reported in 30% of the entire study population, with concerns being as high as 42% in men aged between 40 - 49. It is likely that if you have a disease, condition or are on treatment, the doctor will already be aware that this could be a side-effect. If you are not on treatment and do not know of any health conditions, you should book to speak with your own GP. They will be more than happy to help and advise you.

There are other healthcare professionals that may be able to help, depending on the non-medical cause and information is given below (UK based):

Links to services:

Domestic Abuse/Violence: have a look at the specific page on this website. Click here.
Institute of Psychosexual Medicine (sexual and medical combination): click here to find a specialist.
Relate (relationship counselling and sex therapy): click here to access a web page. This is for the Birmingham branch but others will be accessible.
Body Dysmorphia Clinic: this site can be accessed for body image or eating disorders. Click here to access.

REFERENCES:

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diagnosis and treatment from a sexological and interdisciplinary perspective. Dtsch Arztebl Int.

2009;106(50):821-828. doi:10.3238/arztebl.2009.0821

Abdel-Hamid IA, Ali OI. Delayed Ejaculation: Pathophysiology, Diagnosis, and Treatment. World J

Men's Health. 2018;36(1):22-40. doi:10.5534/wjmh.17051

Rosen RC, Kostis JB, Jekelis AW. Beta-blocker effects on sexual function in normal males. Arch Sex

Behav. 1988;17(3):241-255. doi:10.1007/BF01541742

https://www.issm.info/sexual-health-qa/what-types-of-drugs-have-general-sexual-side-effects/

Brough, P. and Denman, M. n.d. Introduction To Psychosexual Medicine. Croydon: Taylor & Francis.

https://www.diabetes.co.uk/diabetes-erectile-dysfunction.html

Vasan SS. Synopsis of results from European male ageing study. J Midlife Health. 2010 Jul;1(2):93-4. PMID: 21716768; PMCID: PMC3122504.