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:
- heart disease
- 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.
- some prescription drugs: these can include medicines (such as beta-blockers) used to treat raised blood pressure, and antidepressants, antipsychotic drugs and anticonvulsant drugs
- 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 for impotence?
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.
This is when a man ejaculates (comes) sooner than he wants to during sex. It's only a problem if it bothers him or his partner.
You can see your GP or a psychosexual therapist for help.
What causes premature ejaculation?
"Either just being very excited with a new partner, or an acute sensitivity of the local nervous system, which triggers orgasm too suddenly," says Dr Tomlinson.
It can also be linked to anxiety about sexual performance, stress, unresolved issues in a relationship, or depression.
What should I do if I have premature ejaculation?
See your GP, or a psychosexual therapist. A therapist can teach you techniques to try to delay ejaculation.
What treatment is there?
“A lot of men and their partners don’t worry, and they work around it," says Dr Tomlinson. "But if you’re very unsatisfied, there are some things you can try.”
- Have sex again soon after the man ejaculates. The second time, it will take longer to reach an orgasm. Older men might find this difficult as it may take too long to get a second erection.
- Creams (available from sex shops) can be put on the penis to numb sensation. “But this tends to transfer the numbing sensation to the partner, which they don't always like,” warns Dr Tomlinson. Some find using a condom useful.
- The man’s partner can squeeze his penis in a certain way to prevent him ejaculating. “A man needs an extremely willing partner to do this, and some partners don’t feel comfortable with it,” says Dr Tomlinson.
- Antidepressants called selective serotonin reuptake inhibitors (SSRIs) can slow ejaculation, but only for a year or so. “We’ll try every other treatment first before starting on drugs,” says Dr Tomlinson.
- Psychotherapy might help in terms of relaxing or exploring problems in the relationship. Find out what a sex therapist does.
Dr Tomlinson is editor of The ABC of Sexual Health (published by Wiley-Blackwell).
The Sexual Advice Association helpline is 0870 774 3571.
Find out about other sexual problems, such as retarded ejaculation and retrograde ejaculation.
If you are worried about your health have a look at the Man MOT, a confidential online surgery where you can talk to a GP anonymously.