Conditions that can cause disorders of male sexual function

  • Hypertension
  • Sickle cell disease.
  • Vascular disease (for example, Leriche syndrome)
  • Diabetes.
  • Neurological disease (for example, multiple sclerosis)
  • Endocrine disease (for example, deficiencies of testosterone gonadotrophins, hypothyroidism, and prolactinoma)
  • Alcoholism and substance abuse.
  • Liver and kidney diseases.
  • Adverse effects of drugs (for example, antihypertensive and antidepressant medication)
  • After prostate and abdominal surgery.

Sexually transmitted infections rarely interfere directly with sexual functions, although concerns about STIs or HIV often are expressed by patients with dysfunction. Loss of libido and erectile dysfunction are reported commonly by men infected with HIV and may be exacerbated by antiviral treatment.

Once an individual has experienced sexual dysfunction, performance anxiety readily develops, which exacerbates the problem. Reducing performance anxiety is a key aim of psychological therapies.

Erectile dysfunction
Patients complain of failure to achieve or maintain an erection. Psychological factors can be identified by careful history taking. If the patient does not experience spontaneous erections on waking and cannot masturbate to orgasm, an organic disease is more likely.

Premature ejaculation

An organic cause is unlikely to be found. Therapy is usually behavioral and involves training the patient to delay ejaculation by using a variety of graduated stop-start exercises first, alone, using masturbatory exercises, and then with a partner.
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