A Patient Journey for Sexual Dysfunction

Many men are concerned about sexual performance problems such as erectile dysfunction (impotence), premature ejaculation and retrograde ejaculation. All issues are very common with around 1 in every 10 men experiencing one or all of these problems at some point during their lifetime.

Erectile Dysfunction

Erectile dysfunction is the inability to get or maintain an erection. Most men will experience this at least once in their lives especially as they get older.

There are many reasons why you may experience issues with getting or maintaining an erection and these fall under two categories:

• Physical – a narrowing of the blood vessels going into the penis (typically because of high blood pressure, diabetes or high cholesterol); hormonal problems (such as low testosterone levels); surgery or injury to the penis.
• Psychological – anxiety, depression and nervousness can all lead to issues with impotence. Deeper, more serious issues such as sexual abuse may also cause problems. These issues can be talked about with your doctor.
• Certain drugs, such as blood pressure medicines, the nicotine in cigarettes, and certain recreational drugs including cannabis and cocaine, can also cause erectile dysfunction.

If you are experiencing erectile dysfunction which is affecting your quality of life, you should see a GP. Your doctor will ask you about your symptoms, how long they have lasted, your diet and alcohol intake and whether there is anything else physically or psychologically which is affecting your day to day life. Your doctor may also conduct a physical examination of the penis, testicles, prostate, rectum, and abdomen, and perform other tests including blood tests. A key concern of your doctor when carrying out these tests will be to exclude the possibility that your symptoms are caused by one of the medical conditions, such as heart disease, mentioned above.

If it is established that your symptoms are a result of one of these conditions, treatment will be focused on managing that condition. If they are a result of medication you are taking, your doctor may discuss alternative options with you. In many cases, your doctor can help you to identify certain lifestyle factors that are causing or exacerbating the problem – in that case, your doctor can discuss how to make lifestyle changes, such as quitting smoking, changing your diet and exercise routines or reducing your alcohol intake. If a psychological cause is identified, you may be prescribed antidepressants to help alleviate symptoms of anxiety or depression, you may also be referred for specialist treatment such as Cognitive Behavioural Therapy (CBT), which aims to deal with issues which you are finding overwhelming and allow you to deal with them in smaller more manageable parts. You can discuss local CBT options with your GP.

It is important to remember that there is very rarely an immediate ‘cure’, and that overcoming the problems potentially causing your symptoms can take time.

Ejaculation Problems

There are three main types of ejaculation problems:

• Premature ejaculation – the most common type of ejaculation problem where a male ejaculates during sex sooner than a man or his partner would like.
• Delayed ejaculation – experiencing a long delay in ejaculating or not being able to ejaculate at all.
• Retrograde ejaculation – a rarer type of ejaculation issue where the semen travels backwards into the bladder instead of through the urethra (the tube which your urine passes through).

If you are experiencing ejaculation problems, make an appointment to speak with your GP who may examine you or refer you to a specialist. As with erection dysfunction there are many different causes for issues with ejaculation ranging from physical to psychological and side effects of medicines or a poor lifestyle. With a wide range of potential causes and contributing factors, an initial visit to your doctor to discuss your specific situation will allow a correct diagnosis to be made.

Your doctor will begin by discussing your symptoms, how long you have been affected by them, how your symptoms affect your ability to have sexual intercourse and whether there are any other physical or emotional symptoms which are affecting your day to day life. Your doctor may also carry out a physical examination, as well as recommending certain measures that can help you to overcome the problem. You can try some measures yourself, such as having sex again after the premature ejaculation, squeezing the penis in a particular way to prevent climax, or using certain creams and thicker condoms which will decrease sensitivity. For persistent cases, certain medications, therapy or surgery may help, however many of these treatments are not available on the NHS and should be considered as an alternative treatment which you may have to pay for.

For sexual dysfunction concerns among young people, talkhealth suggests the charity Brook. Excellent support and advice for men’s health concerns generally can be found at our Men’s Health Forum.

You can also find support among our community on our forums - in the sexual health forum.

Sources used in writing this article are available on request.

_{Last revised: 26 August 2016}

_{Next review: 26 August 2019}