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. In my expe­ri­ence, it can be dif­fi­cult of men to address these issues, but it is impor­tant to real­ize that most men face at least one of these prob­lems. Also, these issues do not just affect the patient but also can cause sig­nif­i­cant dis­tress to their part­ners. Get­ting these issues fixed can lead to both patient and part­ner sat­is­fac­tion so I encour­age their part­ners to also join in the con­ver­sa­tions” says, Dr. Kansal.

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…

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  • I am fully committed to offering comprehensive urologic care to every single one of my patients. With a specialty in male infertility and sexual medicine, I believe that health care should focus on both the longevity and quality of life. I strive for a patient-centered approach with patient education being at the core of my practice philosophy. With my extensive training in the field of men's health, my goal is to educate you on the best treatments available, so we can collaborate and determine the best option for you.