If you want to keep bringing your A-game to the bedroom, sometimes you need more than just experience and time on the “field.” When facing a “batting slump” or other problems that prevents you from having sex, it’s time to call in an expert.
In addition to damaging your ego, sexual issues may signal more serious health conditions. In most cases, these can be treated. Don’t be afraid to talk to your doctor early on to determine the underlying cause, and develop a plan of action.
We talked to Culley Carson III, M.D., a urologist at the University of North Carolina School of Medicine, about the five most common sexual problems men encounter, and what you can do about them.
1. Erectile dysfunction
Erectile dysfunction, also known as impotence, involves not being able to achieve or maintain enough of an erection to have sex. This is more than just a quality of life issue, though. To sustain an erection, the penis needs good blood flow. Erectile dysfunction, therefore, “can be the first sign of significant cardiac or vascular disease,” says Dr. Carson.
According to Dr. Carson, studies have shown that the majority of men seen in the emergency room for a cardiac event—such a heart attack or stroke—suffered from erectile dysfunction three to five years earlier. Treatment for erectile dysfunction involves first determining the underlying cause. This includes dealing with obesity, smoking, cholesterol, and other risk factors for cardiovascular disease.
In addition to modifying your lifestyle, there are several drugs available to treat erectile dysfunction, including Viagra, Levitra, and Cialis.
2. Testosterone deficiency syndrome
Testosterone deficiency syndrome, or hypogonadism, can affect not only your sexual performance, but also your bone health, energy level, muscle strength, and mood.
If you are having difficulty achieving or maintaining erections, your doctor may also order a simple morning blood test to rule out low testosterone as the underlying cause. Testosterone replacement therapy—such as with a gel—can help alleviate symptoms. Regular follow-up, though, is needed to ensure that you reach a reasonable range of testosterone, not an “NFL kind of level,” says Dr. Carson.
Not all men with low testosterone, however, experience symptoms. In that case, it’s best to leave things alone.
3. Peyronie’s disease
Peyronie’s disease involves a narrowing or curvature of the penis. If severe enough, this condition can be painful, and may also prevent you from having sex.
Deformation of the penis is caused by scar tissue—possibly the result of a previous injury—that appears as a hard lump, more frequently on the upper side of the penis. In most cases, pain during erection goes away after one or two years, although the curvature usually remains.
In the past, surgery was one of the few treatment options available, with a risk of significant side effects. New methods are currently being tested, though, such as compounds that can be injected into the scar tissue to straighten the penis.
4. Prolonged erection (Priapism)
Men who experience an erection lasting more than four hours should seek help in the emergency room. Treatment needs to occur within eight hours of the start of an erection to avoid permanent damage to the penis.
One cause of prolonged erections is medication used to treat erectile dysfunction. This is a rare side effect of pills like Viagra, but occurs more frequently when this type of drug is injected directly into the penis. This condition can also occur as a result of certain psychiatric medications, cocaine use, or sickle cell disease.
Treatment options include draining excess blood from the penis with a needle, medication to limit blood flow into the penis, or surgery.
5. Ejaculatory dysfunctions
The most common type of ejaculatory dysfunction is premature ejaculation, one that occurs within two minutes of the start of sexual stimulation. Around a third of men experience this at some point.
“Premature ejaculation is actually more common in patients across the age groups than is erectile dysfunction,” says Dr. Carson. It is also the most common sexual dysfunction in men under 40. There are currently few treatments for premature ejaculation. Antidepressant medication is one option. Topical anesthetics applied to the penis may also delay ejaculation by decreasing sensation.
Tips to avoid male sexual issues
Many sexual and performance issues can be “delayed, maybe even prevented, by the usual things—diet and exercise, stopping smoking, keeping weight down,” says Dr. Carson.
Even though medication may still be needed, proper diet and exercise can boost both testosterone levels and sexual function, as well as reduce the risk of other conditions, such as prostate cancer.
Routine visits to the doctor are also important, with regular screening for risk factors of cardiovascular disease. As with many medical conditions, “psychological issues are part of [male sexual issues] no matter how physical it is,” says Dr. Carson. In this case, to keep yourself in the game, you need to address not only the body, but also the mind.