Male Sexual Dysfunction 1

Question 1

What are the four broad categories of male sexual dysfunction?

Answer 1

• Disorders of libido
• Erectile dysfunction
• Ejaculatory dysfunction
• Orgasmic dysfunction

Question 2

What are disorders of libido and what are the general types of management?

Answer 2

• Organic causes
  
  • hypogonadism
• Functional causes
  
  • stress
  • anxiety
  • depression
  • relationship issues
• Differentiating organic from functional causes can be aided by an early morning serum testosterone blood test.
• For organic low libido due to hypogonadism, testosterone replacement therapy is usually an effective therapeutic maneuver
• For men with functionally low libido, counseling is recommended

Question 3

What are the major types of ejaculatory dysfunction?

Answer 3

• Premature ejaculation
• Retrograde ejaculation

Question 4

What is premature ejaculation and how is treated?

Answer 4

• Climax with minimal stimulation
• Can occur before, during, or shortly after penetration
• 20-30% prevalence
• Treatment options:
  
  • behavioral therapy
  • squeeze technique
  • pause technique
  • psychotherapy
  • medical therapy
  • selective serotonin reuptake inhibitor (SSRI) therapy
  • topical lidocaine/prilocaine cream
  • condom use

Question 5

What is retrograde ejaculation? What are the risk factors and treatment options?

Answer 5

• Risk factors
  
  • diabetes mellitus: common due to autonomic neuropathy
  • retroperitoneal/pelvic surgery: nerve injury (sympathetic)
  • prior prostate/bladder neck surgery (i.e. “TURP”)
  • use of alpha adrenergic blocking medications
• Need to consider possibility of failure of seminal emission (can verify via a postejaculate urinalysis to check for sperm)
• Treatment
  
  • cessation of alpha adrenergic antagonist agents
  • initiation of alpha adrenergic agonist agents

Question 6

What is the definition of male orgasmic dysfunction?

Answer 6

• definition: difficulty or inability of a male to reach climax/orgasm when sexually excited
  
  • ability to reach climax/orgasm but they are not satisfying.
• can be primary (no prior history of orgasm) or secondary (prior history of orgasm)

Question 7

What are the risk factors for male orgasmic dysfunction?

Answer 7

• Antidepressant drugs (SSRI agents)
• Hypogonadism
• Chronic illness
• Central and/or peripheral nervous system changes
• Boredom, monotony with sexual activity
• Negative attitudes about sex
• A history of sexual abuse, rape

Question 8

What are some good prevention methods for male orgasmic dysfunction?

Answer 8

• Partner expression of sexual desires
• Understanding that orgasm is an integrated byproduct of mind and body
• If either is not functioning normally, orgasm can be impaired

Question 9

What is involved in the diagnosis and treatment of male orgasmic dysfunction?

Answer 9

• Diagnosis:
  
  • medical history and physical exam
  • check for medications that inhibit orgasm
  • hormonal testing
• Treatment
  
  • sex therapy (trained, qualified specialist)
  • education
  • cognitive behavioral therapy