Let’s talk about men’s sexual health issues

First, let’s define men’s sexual health. In the clinical senses, optimal sexual health for men includes a healthy desire for sex or having a strong libido, and then the ability to get and sustain an erection for sexual intercourse. However, besides having a strong sexual desire, physical factors also influence men’s sexual health and this is where it gets murky. 

Sometimes it’s easier to stick their heads in the sand pretending everything is okay for men.  Unfortunately, some men may choose this approach when sexual performance issues have gone awry.  But any man, who wants to keep bringing his A-game to the bedroom, will sooner or later need to broach the topic with an expert – his urologist.  

When sexual issues come up, men naturally want to resolve them as soon as possible.  However, sometimes sexual problems may signal more serious health conditions.  In most cases, these problems are treatable.  But until a man makes an appointment and has a thorough discussion with his doctor about his concerns, the problem could worsen.  

Here are the five most common sexual problems of men and how they’re treated: 

  1. Erectile dysfunction

Erectile dysfunction (ED) or impotence is when a man cannot achieve and maintain an erection firm enough for sexual intercourse.  Of the 30 million men in the U.S. suffering from ED, many refrain from talking about their ED with their primary care physician.  This hesitancy or embarrassment only leads to the problem going untreated. 

Besides putting a strain on a couple’s sex life, ED can also be the first sign of significant cardiac or vascular disease.  For men to get and maintain an erection, the penis requires good blood flow, and men with heart disease usually do not have good blood flow.  So it’s no surprise that research shows that most men seen in an emergency room for a heart attack or stroke also had ED several years prior. 

Men who’ve had ED a month or longer, need advice from a urologist. Urologists are experts in treating ED and know to successfully get a man’s sex life back on track. 

How it’s treated: To treat ED, doctors must first determine the underlying cause. A man most likely will be told to lose weight, quit smoking, eat a healthier diet, and increase exercise.   Besides lifestyle modifications, medications to treat ED may also be used including  Viagra, Levitra, and Cialis.

  1. Priapism or a prolonged erection

Think of priapism as just the opposite of erectile dysfunction. Priapism can cause men to have a prolonged erection lasting 4 hours or longer. The condition is quite painful, frustrating, and embarrassing for men who’ve ever had to experience it. If not treated, priapism can permanently damage the penis.  It is considered a medical emergency and men who have it, need medical treatment right away to avoid the inability to have erections. 

While rare, one possible cause of priapism is medication used to treat ED.  Other possible causes include certain psychiatric medications, cocaine use, or sickle cell disease.  

How it’s treated: To treat a prolonged erection, a doctor may drain the excess blood from the penis with a needle, use medication to limit blood flow into the penis, or do surgery.

  1. Peyronie’s disease

Peyronie’s disease is scar tissue or plaque formation in the penis. It predominately affects men past the age of 40, but younger men can develop it also. The plaque of Peyronie’s disease is what’s built up inside the tissues of the tunica albuginea, a thick, elastic membrane helping the penis maintain an erection.  

The distinguishing feature of Peyronie’s disease is when an erect penis, instead of being straight, has a bend or curve which is typically seen on the upper part of the penis. When erect, this curvature of the penis can be painful enough to prevent a man from having sex.   The deformation of the penis is caused by scar tissue that appears as a hard lump. In most cases, pain during an erection goes away after one or two years even though the curvature may remain.

How it’s treated: Surgery has been the main treatment option in the past.  However, new methods are being tested such as compounds that can be injected into the scar tissue to straighten the penis.

  1. Hypogonadism or testosterone deficiency

Male hypogonadism is when the testes, also called the testicles, are not making expected levels of the male sex hormone, testosterone.   A testosterone deficiency can affect sexual performance and a man’s bone health, energy level, muscle strength, and mood.

Any man having difficulty achieving or maintaining erections needs to see his doctor to have a blood draw to test testosterone levels. Testosterone levels vary throughout the day, with the highest levels in the morning and lower in the evening. For the most reliable results, testosterone is checked early in the morning, before 10 am, when levels are highest due to the circadian rhythm, a natural, internal clock regulating when we feel sleepy and awake over the course of a day.  

How it’s treated: To treat low testosterone, testosterone replacement therapy – such as with a gel or patch – will help prevent symptoms.  All men using testosterone replacement therapy will need regular follow-ups to ensure they are within a reasonable range of testosterone.  

  1. Premature ejaculation

Premature ejaculation is when men orgasm much sooner than their partner, disrupting the sexual sequence. As many as one out of every three men experiences it.  If it happens infrequently, it’s not a cause for concern.  However, if it frequently negatively affects a man’s sex life, he needs to bring this up with his doctor.

For men under 40, premature ejaculation is the most common sexual dysfunction seen. However, it’s also commonly found in men across all age groups, even considered more common than ED. 

How it’s treated: There are several methods of treating premature ejaculation including behavioral techniques, topical anesthetic creams applied to the penis right before sex to reduce sensation helping to delay ejaculation, and certain oral medications.  


Dr. David Samadi is the Director of Men’s Health and Urologic Oncology at St. Francis Hospital in Long Island. He’s a renowned and highly successful board certified Urologic Oncologist Expert and Robotic Surgeon in New York City, regarded as one of the leading prostate surgeons in the U.S., with a vast expertise in prostate cancer treatment and Robotic-Assisted Laparoscopic Prostatectomy.  Dr. Samadi is a medical contributor to NewsMax TV and is also the author of The Ultimate MANual, Dr. Samadi’s Guide to Men’s Health and Wellness, available online both on Amazon and Barnes & Noble. Visit Dr. Samadi’s websites at robotic oncolo gy and prostate cancer 911. 

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