Male sexual Dysfunction

•  Erectile dysfunction.
• Diminished libido.
• Ejaculatory disorders.

A) Erectile dysfunction (ED):

ED is the consistent or recurrent inability to acquire or sustain an erection of sufficient rigidity and duration for sexual intercourse.
Causes of erectile dysfunction-

1. Psychogenic
2. Organic
   1. vascular
   2. neurologic
   3. Hormonal
   4. local penile factors
3.  Drug induced – Anti androgens ( prostate medicine),anti hypertensive.(BP medicine),psychotropics (depression medicine)

B) Low libido:

Causes-

1. Relationship issues,stress, anxiety,depression.
2. Prescription drugs(selective serotonin reuptake inhibitors (SSRIs), anti-androgens, 5-alpha reductase inhibitors and opioid analgesics)
3. Recreational drugs-marijuana, cocaine,lysergic acid diethylamide (LSD) and alcohol.
4. Endocrine –
   1. Testosterone deficiency.
   2. Hyper prolactimemia.
   3. Hypo and hyperthyroidism.
   4. Hypercortisolemia.

C) Ejaculatory disorders:

• Premature ejaculation -is characterized by ejaculation that almost always occurs within approximately one minute of vaginal penetration.
• retrograde ejaculation – Males with retrograde ejaculation can present with infertility due to azoospermia.
  Commonly seen –

1. Following prostate surgery.
2. In longstanding diabetes ( neuropathy)

• Failure to ejaculate –
  Failure to ejaculate-
  (In males with adequate erectile function)
  Can be a side effect of antidepressant medication and some alpha-adrenergic antagonists such as tamsulosin and silodosin.

1. 1. Can be a result of patient/partner conflict.