Problems of male sexual health: Get a hold of them before they get hold of you

Male sexual health is a cornerstone in the overall well-being of the male gender. Male sexual health disorders include a wide range of issues varying in etiology. Erectile dysfunction, premature or delayed ejaculation, and hypoactive sexual drive are the common issues under the umbrella of male sexual health disorders. It is known that the most common sexual health disorders in men are Erectile Dysfunction (in the ability to initiate and/or maintain an erection in greater than 50 % of sexual encounters) and Premature Ejaculation (ejaculating within a minute or less after penetration )^1,2. It is estimated that about one-third men of men get this during their lives³. The chances of a male experiencing these issues increase with age However there is a wide spectrum of normality on which most of the men lie in terms of optimum sexual functioning. Labeling someone as having a pathological variation along the spectrum is after the Physician does a thorough history, examination, and laboratory investigations as needed. The chances of a male experiencing these issues increase with age. It would be beyond the scope of this piece to actually go into the microscopic details of individual problems and as such we will generally outline what factors can undermine normal male sexual health.

Factors that affect male sexual health:

1. Aging: It’s quite natural to expect a decline in function in every organ system as we age, however, the sexual function in males doesn’t get hit too drastically. However, a reduced testosterone function in the body along with reduced physical capacity hamper sexual activity.

2. Psychological issues (e.g., Anxiety/Depression): Optimum sexual health is needed for good mental health and vice versa. A problem in either wreaks havoc with the other. Underlying Psychiatric/Psychological issues have a strong forbearing on the intricate system of sexual health leading to reduced libido, Erectile dysfunction (ED), and Premature Ejaculation. Work and domestic stresses go under the radar when such men are investigated for the cause. Relationship issues, childhood abuse, and hostile environments all can eventually trap the person in a relentless vicious cycle of mental health issues and sexual health disorders. Even without underlying Psych issues, we all go under the pump every once in a while which can temporarily affect our sexual health. And it is known that a male can experience difficulty in initiating and/or maintaining an erection in 20 percent of sexual encounters which can be considered normal because it returns to normal.

3. Metabolic & Vascular disorders: Disorders like poorly controlled Diabetes Mellitus, Systemic Hypertension (high blood pressure), high blood cholesterol levels, Hemochromatosis (abnormally high iron levels), and vascular diseases can affect male sexual health in many ways. From defects in the penile circulation to reduced testosterone production, the person’s sexual life starts going south.

4. Hormonal disorders: Disorders of the thyroid gland or production of testosterone by the testes are included in this category.

5. Obesity: There is increased conversion of the free testosterone to estradiol (female sex hormone) in excess body fat which leads to the effects of a reduced testosterone level in the body. According to research, a majority of people with erectile dysfunction have a BMI > 25.

6. Smoking and Alcohol: Both can hurt normal sexual function in different ways. Smoking can damage the blood vessels in our circulation generally and obviously, the penile tissue is rich with a network of blood vessels, small and large. Drinking can reduce sexual desire and function by reducing testosterone production and interfering with the signaling in the brain which is linked to sexual excitement.

7. Drug use (prescription and illicit): Prescription drugs are in every home now, and people consume a wide array of drugs belonging to different chemical classes. Unfortunately, with every drug molecule you get side effects, many of them too mundane to be actually bothered about. However, some people can get undesirable effects on their sexual function on normal doses (idiosyncratic) or on higher doses. Notorious classes of drugs leading to sexual dysfunction are beta-blockers, thiazide diuretics, and statins. And illicit drugs as all know aren’t good for us anyway with deleterious effects on many organ systems and compromised self-care and mental health leading to sexual dysfunction.

8. Injuries/Physical issues: Trauma to the genitals, scarring in the penile tissue, and problems related to the scrotal sac, all can lead to sexual dysfunction in one way or the other.

So, after that exhaustive list of causes, let’s go through what the possible solutions are to have a healthy sex life.

A healthy lifestyle!  Yes, you heard that right, healthy living will always come before disease/ailment prevention. That goes for every possible disease. Even having genetic predispositions does not mean you will eventually get the grim consequences of those bad genes. It’s the choices we make in life which essentially determine how we live out our existence.

• Eat plenty of veggies (beetroot is known for its effect on potentiating increased blood flow in the vessels), fruits, nuts, and a little bit of meat (white preferred) along with dairy and poultry to boot. Eat a balanced diet with an emphasis on greens and natural whole unprocessed food. Such foods contain loads of vitamins and minerals which help maintain our hormone production and overall sexual function (zinc, vitamin E, and other antioxidants particularly)
• Your mental health is paramount to your overall well-being. We cannot but overstate the importance of a sound mind. Living in the past or contemplating the future continuously both lead to chaos in our minds and sexual function then takes the back seat. Relationship troubles should be recognized and attention should be sought regarding them. Couples should open up to each other, recognize the problems and encourage and support their partner. Try to stay calm and motivated all the while minimizing breakdowns which if go unhindered can cause downward spiraling of thoughts.
• Exercise regularly, make it a habit to be active throughout your daily routine. Small changes make tangible differences in the long run. It can be a mix of regular walks, a jog here and there, and even weight training. They say that jogging/running can be as potent a boost for your sexual performance as Viagra! Go figure! Try to lose weight if you are obese or overweight.
• Sleep well!! Never underestimate the power of a good night’s sleep. It is during sleep that our bodies heal, recover, and rejuvenate. People who go sleepless in their routines eventually are hit big time in terms of disrupted sex hormone profile.
• Cut back on the habits! Curb your smoking and drinking! This will go a long way in maintaining your sexual and overall health.
• Talk to your doc if you have concerns regarding any prescription or other meds you are on which may be contributing to your problems. While you will be thoroughly screened for any cause which is underlying. Most of the time no cause is found and it ends up being stress/psychological causes.
• Solutions such as PDE-5 inhibitors (sildenafil etc.), testosterone replacement, suction pump devices, and even penile prosthesis are used according to the severity in case of erectile dysfunction along with the measures highlighted above. The objective is the improvement of sexual performance and pleasure.
• Vitamins and mineral preparations are taken to boost sex drive and performance. However solid empirical evidence for their efficacy is not available but anecdotal evidence and individual experiences suggest that they can work for individualized cases. Zinc, Vitamin E, C, and D are famously used. Numerous preparations are available now which contain herbal products which have been used for centuries in traditional medicine in which there are claims of remedies for sexual dysfunction. Compounds like L-Arginine⁴, naturally occurring antioxidants, Ashwagandha, and Tribulus terrestris⁵ are also in demand. Such compounds are purported to work on different levels to improve sexual health. From relaxing the stressed mind to increasing blood flow to the penis and improving the output of testosterone from the testes. Do consult your physician before starting preparation especially if you are on regular allopathic medication as well.

 In a nutshell, a healthy sex life calls for healthy choices. In case you still face issues, don’t lose heart, there’s a lot that can be done to help you! 

References:

1. Laumann EO, Nicolosi A, Glasser DB, et al. Sexual problems among women and men aged 40–80 y: Prevalence and correlates identified in the Global Study of Sexual Attitudes and Behaviours. Int J Impot Res2005; 17(1): 39– 57.
2. Eardley I.The incidence, prevalence, and natural history of erectile dysfunction. Sex Med Rev 2013; 1(1): 3– 16.
3. Gerbild H, Larsen CM, Graugaard C, Areskoug Josefsson K. Physical Activity to Improve Erectile Function: A Systematic Review of Intervention Studies. Sex Med. 2018;6(2):75-89. doi:10.1016/j.esxm.2018.02.001
4. Rhim HC, Kim MS, Park YJ, Choi WS, Park HK, Kim HG, Kim A, Paick SH. The Potential Role of Arginine Supplements on Erectile Dysfunction: A Systemic Review and Meta-Analysis. J Sex Med. 2019 Feb;16(2):223-234. doi: 10.1016/j.jsxm.2018.12.002. Erratum in: J Sex Med. 2020 Mar;17(3):560. PMID: 30770070.
5. Kamenov Z, Fileva S, Kalinov K, Jannini EA. Evaluation of the efficacy and safety of Tribulus terrestris in male sexual dysfunction-A prospective, randomized, double-blind, placebo-controlled clinical trial. Maturitas. 2017 May;99:20-26. doi: 10.1016/j.maturitas.2017.01.011. Epub 2017 Feb 12. PMID: 28364864.