Understanding how sexual health issues are caused, diagnosed, and treated can help men restore sexual function and regain confidence in their sex lives.

There are a number of sexual health issues among men that can interfere with a satisfying sex life, including erectile dysfunction, problems with ejaculation, infertility and others. The following sexual health problems are common among men and are routinely evaluated and treated at the Men’s Health Center at Brigham and Women’s Faulkner Hospital, which was recently established to meet a growing demand to address male reproduction and sexual health concerns.

#1: The most common male sexual health problem is Erectile Dysfunction (ED).

Erectile Dysfunction (ED), a difficulty obtaining or maintaining an erection firm enough for sex, affects 50 percent of American men over the age of 40. ED, or impotence, is mainly caused by blood flow problems such as high blood pressure or vascular disease, which are common among aging men. Other factors that increase the risk for developing ED include surgeries involving prostate cancer, smoking, certain medications and the use of alcohol or drugs.

According to Dr. Michael O’Leary, director of BWH Men’s Health Center at Brigham and Women’s Faulkner Hospital, many of the first-line agents for the treatment of ED involve medications that work for 50-70 percent of men. If a patient does not respond to medication, several non-surgical options exist to encourage an erection by promoting blood flow.

Occasionally, more invasive treatments are warranted for ED, such as placing an agent into the urethra. For patients who aren’t achieving favorable outcomes, physicians can also explore surgical treatments, including penile implants or prostheses. “I don’t recommend surgery as an initial treatment option for erectile dysfunction,” says Dr. O’Leary, “but for many men it’s very satisfactory.”

#2: ED can be driven by psychological or emotional problems. 

It’s quite common for stress, depression or other emotional disturbances to cause sexual dysfunction in men. Dr. O’Leary regularly tells patients, “The most important sex organ is not below a man’s waist; it’s sitting on their shoulders.” In cases where ED is not caused by detectable physiological problems, physicians will evaluate a patient’s impotence in the context of their mental or emotional well-being. At the Men’s Health Center, a team of sex therapists work with patients and their partners in a comfortable, educational and confidential setting to address possible psychosocial causes of ED with the aim of restoring a normal level of sexual functioning.

#3: Up to one third of infertility cases may involve male infertility.

Many factors can contribute to male infertility, including low sperm production, anatomical abnormalities, testicular trauma and genetic or immunological diseases, among many others. Determining the exact cause of infertility involves a thorough physical evaluation, lab tests, imagery and semen analysis. The physicians at the Men’s Health Center, as well as the Center for Infertility and Reproductive Surgery at BWH, are experts in evaluating and treating male infertility.

#4: Peyronie’s disease can be caused by minor trauma.

Peyronie’s disease occurs when scar tissue, or plaque, forms inside the erection tissue of the penis. While the exact cause of plaque formation isn’t clear, many men with Peyronie’s disease have suffered a minor trauma that caused bleeding inside the penis. While the plaque is benign and noncancerous, it can cause bending of the penis upward or downward, depending on the plaque’s location. Men with Peyronie’s typically experience pain during an erection or difficulty performing intercourse.

To diagnose Peyronie’s, physicians perform an ultrasound examination to determine erectile function and anatomy. In most cases, Peyronie’s presents in a mild form and the initial pain resolves in 6-12 months, allowing the patient to return to healthy sexual activity. The plaque can be treated with a customized treatment plan.

#5: A vasectomy is extremely effective, but it should be considered a permanent form of birth control.

A vasectomy is a simple, minimally invasive surgical procedure used as a permanent form of male birth control to prevent pregnancy. During this 30-minute procedure, a surgeon cuts the tubes that transport sperm within the male reproductive system. The sexual health of a male is not affected as a result of a vasectomy and the procedure is extremely effective in preventing pregnancy. It is considered a permanent form of birth control because it is not easily reversible.

-Dustin G.

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