Male sexual problems

It’s estimated that one man in 10 has a problem related to having sex, such as premature ejaculation or erectile dysfunction. Dr John Tomlinson of The Sexual Advice Association explains some of the causes, and where to seek help.

“Sexual dysfunction in a man is when he's not able to perform properly,” says Dr Tomlinson. “The main problem is being unable to get an erection. It’s much more common than people realise. In the 20-40 age group it affects around 7-8% of men, in the 40-50 age group it affects 11%. In the over-60s it affects 40%, and more than half of men over 70.”

It can affect any man, whether he is straight, gay, bisexual or transgender. Read more about erectile dysfunction (impotence) and premature ejaculation.
Erectile dysfunction (impotence)

This is when a man can’t get, or keep, an erection. Most men experience it at some time in their life. “It only becomes a problem when the man or his partner considers it a problem,” says Dr Tomlinson.
What causes erectile dysfunction?

“A variety of things cause it. Some psychological and some physical,” says Dr Tomlinson. “Psychological issues tend to affect younger men, such as first night nerves and so on. Often, these problems don’t persist. But there can be more serious psychological problems about sex that need the help of a psychosexual therapist.”

Worries about work, money, your relationship, family, and even worrying about not getting an erection, can all be factors.

Physical reasons for erectile dysfunction include:

Medical conditions, such as:

* Heart disease
* Diabetes
* Raised blood pressure
* Raised cholesterol: this can lead to clogging of arteries, including the arteries in the penis, which are very narrow: 1-2mm in diameter compared with around 10mm in the heart artery
* Low testosterone: testosterone levels fall as men get older, but not all men are affected by it. Those who are affected will have symptoms such as feeling tired and unfit, and loss of interest in (and inability to have) sex

Drugs

* Some prescription drugs: these can include medicines (such as beta-blockers) used to treat raised blood pressure, and antidepressants, antipsychotic drugs and anticonvulsant drugs
* Alcohol
* Recreational drugs such as cannabis and cocaine
* Smoking: nicotine affects the blood supply to the areas of the penis that cause erections

What should I do if I have erectile dysfunction?

See your GP. He or she can give you a physical examination and carry out blood tests to identify the cause.

Erectile dysfunction can be an important signal to other issues. “It's associated with raised cholesterol, diabetes and raised blood pressure. Any of these can be a warning of future heart disease,” says Dr Tomlinson. Your doctor can ensure that you get the treatment you need.
What's the treatment?

First, adjust any lifestyle factors that might be causing your problem.

“If you stop smoking, drinking too much or using recreational drugs, the problem should eventually go away. But it can take months,” says Dr Tomlinson. “There is no overnight cure.”

If you're prescribed blood pressure tablets or antidepressants, your doctor may be able to put you on a different kind.

Low testosterone can be treated with hormone replacement therapy, which should resolve erectile dysfunction as long as it's used together with erection-helping drugs. Other conditions, such as diabetes and high blood pressure, can be treated, which may improve erections. The Sexual Advice Association has useful factsheets on all of this.

Some men benefit from psychosexual therapy, which is a form of relationship therapy where you and your partner can discuss any sexual or emotional issues or concerns. You can contact the Sexual Advice Association, Relate, sexual health charity FPA or your GP to ask about psychosexual therapy.