Men’s Reproductive and Sexual Health

Sex­u­al and repro­duc­tive issues are com­mon health con­cerns men face and can affect men at any age. Changes in lifestyle, hor­mone fluc­tu­a­tions, aging and even psy­cho­log­i­cal changes can all affect men’s sex­u­al and repro­duc­tive health. 

Here we review some of the most com­mon types of issues — ejac­u­la­to­ry dys­func­tion, erec­tile dys­func­tion, Peyronie’s dis­ease, low libido, and infer­til­i­ty– along with ways they can be treated. 

Ejac­u­la­to­ry Dys­func­tion[1]

There are three types of ejac­u­la­to­ry dys­func­tion that affect men. Pre­ma­ture ejac­u­la­tion, inhib­it­ed or delayed ejac­u­la­tion and ret­ro­grade ejaculation. 

Pre­ma­ture ejac­u­la­tion (PE) is ejac­u­la­tion that occurs before or very soon after penetration. 

Inhib­it­ed or delayed ejac­u­la­tion is when ejac­u­la­tion does not hap­pen or is slow to occur.

Ret­ro­grade ejac­u­la­tion occurs when, at the time of orgasm, the ejac­u­late is forced back into the blad­der rather than through the end of the penis. This is typ­i­cal­ly found in males suf­fer­ing from nerve dam­age caused by dia­betes, though it can also be a side effect of cer­tain med­ica­tions and surg­eries. This can also cause sig­nif­i­cant issues with repro­duc­tive health with males. 

Ejac­u­la­tion occurs via a very coor­di­nat­ed bal­ance of hor­mones, neur­al input, mus­cle relax­ation and mus­cle con­trac­tion. All the below issues can lead to ejac­u­la­to­ry dysfunction: 

• Abnor­mal hor­mone levels 
• Anx­i­ety
• Depres­sion
• Low self-con­fi­dence
• Med­ica­tion side effects
• Rela­tion­ship issues
• Sex­u­al repression
• Stress

Ejac­u­la­to­ry dys­func­tion treat­ments are depen­dent on the under­ly­ing cause of the dys­func­tion but may include tak­ing a med­ica­tion or adjust­ments to cur­rent med­ica­tions tak­en, hor­mone ther­a­py, psy­cho­log­i­cal coun­sel­ing or address­ing alco­hol or drug use.

Erec­tile Dysfunction

Erec­tile Dys­func­tion (ED) is the top issue for men’s sex­u­al med­i­cine and is defined as the ongo­ing inabil­i­ty to get or keep an erec­tion firm enough for sex. While it is more com­mon as men age, we see and treat it for men of all ages. ED can result from both phys­i­cal and psy­cho­log­i­cal issues includ­ing:[2]

• Anx­i­ety
• Clogged blood ves­sels (ath­er­o­scle­ro­sis)
• Depres­sion
• Dia­betes
• Heart dis­ease
• High cho­les­terol
• High blood pressure
• Low testos­terone
• Med­ica­tion side effects
• Mul­ti­ple sclerosis
• Obe­si­ty
• Parkin­son’s disease
• Pey­ronie’s disease 
• Rela­tion­ship problems
• Sleep dis­or­ders
• Stress
• Sub­stance abuse
• Surg­eries or injuries that affect the pelvic area or spinal cord
• Tobac­co use
• Treat­ments for prostate can­cer or enlarged prostate

Treat­ment for ED depends on the under­ly­ing cause and sever­i­ty of the case. Treat­ment options range from med­ica­tions, psy­cho­log­i­cal coun­sel­ing, exer­cise pro­grams, penile injec­tions, shock­wave, vac­u­um pumps and sur­gi­cal options includ­ing penile implants. 

Peyronie’s Dis­ease

Peyronie’s dis­ease occurs when fibrous scar tis­sue devel­ops on the penis and caus­es curved erec­tions. This can pre­vent men from hav­ing sex, pain or dis­com­fort for their part­ners or might make it dif­fi­cult to get or main­tain an erec­tion (erec­tile dys­func­tion). Pey­ronie’s dis­ease rarely goes away on its own. In most men with Pey­ronie’s dis­ease, the con­di­tion will remain as is or worsen. 

The exact cause of this dis­ease is unknown, but it is thought that it results from repeat­ed injury to the penis through sex, ath­let­ic activ­i­ty or an acci­dent. Symp­toms may not devel­op right away, mak­ing it hard to pin­point the exact injury. Dur­ing the heal­ing process, scar tis­sue forms in a dis­or­ga­nized man­ner which caus­es dis­fig­ure­ment and pain. 

There are mul­ti­ple treat­ment options for this dis­ease depend­ing on how long symp­toms were exhib­it­ed. Treat­ment options include penile trac­tion ther­a­py, med­ica­tions, injec­tions or surgery. 

Low Libido

Low libido (sex dri­ve) is the decreased inter­est in sex­u­al activ­i­ty. Men’s libido will vary through­out their life and even day-to-day, how­ev­er low libido over an extend­ed amount of time may need to be treat­ed by a physician.

A com­mon cause for low libido is low testos­terone. Testos­terone is a hor­mone respon­si­ble for build­ing mus­cle and bone mass, stim­u­lat­ing sperm pro­duc­tion and increas­ing your sex dri­ve. While the lev­el of low testos­terone is defined as below 300 ng/​dL[3], it is impor­tant to not just treat the num­ber but treat the symp­toms. Often, patients can still have low testos­terone symp­toms with lev­els above those defined values. 

Testos­terone lev­els fac­tor into your sex dri­ve, so when those lev­els decrease, your desire for sex may also decrease. Oth­er caus­es for a low libido include:

• Chron­ic illness
• Depres­sion
• Exer­cise levels
• Low self-esteem
• Med­ica­tion side effects
• Rest­less leg syndrome
• Sleep issues
• Stress
• Sub­stance abuse

Treat­ment for low libido varies and are deter­mined by the under­ly­ing cause and sever­i­ty of the case. Health­i­er lifestyle choic­es, med­ica­tion, testos­terone replace­ment ther­a­py and phys­i­o­log­i­cal coun­sel­ing are all viable options for treat­ment. It is impor­tant for young patients to real­ize that testos­terone ther­a­py can affect sperm pro­duc­tion, so it is impor­tant to see a qual­i­fied spe­cial­ist for treatment. 

Male Infer­til­i­ty

Male infer­til­i­ty occurs when a man has an issue with his repro­duc­tive sys­tem. His­tor­i­cal­ly, fer­til­i­ty con­cerns have focused on the female part­ner, but it now well known that of all the infer­til­i­ty cas­es, approx­i­mate­ly 50 per­cent have a male fac­tor component. 

To be con­sid­ered fer­tile, men need to be able to make healthy sperm that can fer­til­ize an egg, have an erec­tion and ejac­u­late effec­tive­ly so the sperm reach­es the egg. Prob­lems in any of these areas can cause infertility. 

Addi­tion­al con­di­tions that cause infer­til­i­ty in males include:

• Block­ages in the gen­i­tal tract
• Genet­ic and birth defects of the penis
• Genet­ic diseases
• Hor­mone or pitu­itary gland problems
• Immune prob­lems in which you make anti­bod­ies against your own sperm
• Infec­tions or inflam­ma­to­ry conditions
• Scar tis­sue from surgery
• Sex­u­al­ly trans­mit­ted diseases 
• Sub­stance abuse

Com­mon treat­ments include hor­mone ther­a­pies, med­ica­tions, surgery, or sperm extrac­tion pro­ce­dures. For more severe cas­es, we often work close­ly with IVF cen­ters to coor­di­nate arti­fi­cial insem­i­na­tion or in vit­ro fer­til­iza­tion (IVF) depend­ing on under­ly­ing caus­es for infertility. 

Our high­ly skilled team of board-cer­ti­fied urol­o­gists spe­cial­izes in a wide range of male spe­cif­ic health con­cerns includ­ing ejac­u­la­to­ry dys­func­tion, erec­tile dys­func­tion, low libido, infer­til­i­ty and Peyronie’s dis­ease. If you are exhibit­ing symp­toms of a repro­duc­tive or sex­u­al health issue and would like to learn more about your symp­toms and the avail­able treat­ment options, call 630−790−1221 or sched­ule an appoint­ment online with one of our urologists. 

[1] https://​my​.cleve​land​clin​ic​.org…

[2] https://​www​.may​oclin​ic​.org/dis…

[3] https://​www​.health​line​.com/hea…