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Sexual Problems

Home > Men's Health Home > Sexual Health > Sexual Problems

• Erection Problems
• Loss of Sexual Interest
• Low Testosterone
• Male Infertility
• Additional Resources

Sexual problems are not uncommon among men, especially as they age. Many men have problems getting or keeping an erection. Some men have problems with ejaculation. Others have lower than normal levels of testosterone, which is the most important male sex hormone. The good news is that treatment often can help sexual problems.

Erection Problems

Problems getting or keeping an erection is called erectile dysfunction, or ED. ED used to be called impotence. It’s hard to know how many men have ED. But estimates of U.S. men affected range from 15 million to 30 million. Most of the time, ED has a physical cause. ED may mean your blood vessels are clogged. It may mean you have nerve damage from diabetes. Many health problems can lead to ED. ED is also a side effect of many common medicines, including some used to treat depression or high blood pressure. Unhealthy habits like smoking, abusing alcohol, overeating, and leading an inactive lifestyle also can lead to ED. Emotional factors, such as stress or depression, also can cause ED. Having ED can affect self-esteem and cause frustration, anger, and sadness.

The good news is that ED is treatable at any age. Your doctor can offer a number of treatments for ED. For many men, problems with ED are solved by taking a pill. Some men use an external pump and band to help the penis become and stay erect. Others are helped by penis injections or implants. Some men need to try two or three options before they find a treatment that works for them. Even if treatment solves your problems with ED, you still need to take care of other health issues that may have caused you to have ED. This may involve lifestyle changes and other treatments. Counseling also can help men and their partners cope with the emotional affects of ED.

Loss of Sexual Interest

Your interest in sex, also called libido, can vary over the course of your life. Some men have low libidos during times of stress or illness. At times, your interest and desire for sex might not match that of your partner, which is normal in long-term relationships. Still, low libido should not be ignored. It can be a sign of a health problem, such as depression. Some medicines can affect sex drive. Reduced levels of male hormones can cause men to be less interested in sex. This naturally occurs with aging. Although it is normal for men to have less interest in sex as they age, having no interest in sex is not normal. Emotional or relationship problems also can play a large role in a man’s sex drive.

If you have less interest in sex, talking frankly with your doctor is the first step toward restoring sexual health. Treatment usually is aimed at the underlying cause of low libido. A combination of factors often affects sex drive. Treatment could include medicine and counseling.

Low Testosterone

Testosterone is the most important male hormone. It helps maintain sex drive, sperm production, pubic and body hair, muscle, and bone. Lower than normal levels of testosterone can affect a man’s body and mood. Signs of low testosterone in adult men can include:

• Less interest in sex
• Erection problems
• Lowered sperm count
• Increased breast size
• Hot flashes
• Feeling irritable or angry
• Problems with memory and concentration
• Depression
• Muscle mass and hair loss
• Bone loss
• Smaller and softer testes

Adult men can have low testosterone levels for a number of reasons. In adult males of all ages, injury, disease, and using certain drugs can cause low testosterone levels. A gradual decline in testosterone level is normal in healthy males as they age. Low testosterone in aging men can cause them to be less interested in sex or have fewer erections. But it is not normal for aging men to have no interest in sex. There could be other reasons for these symptoms.

If you have any symptoms of low testosterone, talk to your doctor. You can get your testosterone level tested with a simple blood test. Get the test in the morning, when testosterone levels peak during the day. If you do have low testosterone, your doctor will want to find out the underlying cause. Finding out the cause for low testosterone can be hard and might involve many tests. You might want to see a specialist, such as an endocrinologist or urologist, who can work with you to treat this problem. Testosterone replacement is an option for some men with low testosterone. But using testosterone therapy in men with borderline low levels is a controversial issue. One reason is that the long-term effects of testosterone replacement are not known. Another reason is that we don’t know what testosterone levels are "normal" as men age. If you have low testosterone, your doctor can help you understand the benefits and risks of treatment so you can make an informed choice.

Male Infertility

Lots of couples have trouble conceiving a child. About 40 percent of the time, the cause of infertility is traced entirely or in part to the man.

The male fertility process involves making mature sperm and getting the sperm to reach and fertilize the egg. For this process to happen, a man must be able to have and sustain an erection, have enough sperm, have enough semen to carry the sperm to the egg, and have sperm that are the right shape and move in the right way. A problem in any part of this process can lead to problems conceiving.

Many factors can affect male fertility. Some include:

• Age
• Stress
• Smoking, drugs, and alcohol
• Undescended testicles or damage to the testicles
• Wearing tight underwear
• Medications
• Environmental toxins
• Genetic conditions
• Other health problems

If your partner has not become pregnant after 1 year of frequent sex without birth control (or after 6 months if your partner is 35 or older), talk to your doctor. A semen analysis can be a good first step for couples facing fertility problems because it is much easier and costs less than tests that look at female fertility. The test looks at a man’s semen and sperm. Many couples with fertility problems go on to have healthy pregnancies and babies. In some cases, the cause for infertility in the man or woman cannot be found or cannot be treated.

Additional Resources

Publications

1.   Erectile Dysfunction — This brochure discusses the causes, diagnosis, and treatment of erectile dysfunction (ED), as well as ED research underway.

   http://kidney.niddk.nih.gov/kudiseases/pubs/impotence/index.htm

2. Effects of Cancer Treatment on Male Sexuality (Copyright © ACS) — Both men and women may lose interest in sex during cancer treatment. This publication explores the effects that cancer treatment can have on men and their sex lives. It also discusses options that men and their partners can use to reclaim enjoyment and fertility.

   http://www.cancer.org/docroot/mit/content/mit_7_2x_cancer_treatments_effects_on_male_sexuality.asp?sitearea...

3. Erectile Dysfunction (Copyright © MFMER) — This site provides an overview of erectile dysfunction, including symptoms, causes, factors, treatment, prevention, and more. It also provides links to more information.

   http://www.mayoclinic.com/health/erectile-dysfunction/MC00050

4. Erectile Dysfunction: What to Expect During Your Doctor Visit (Copyright © MFMER) — This resource suggests some possible questions your doctor may ask and topics that will most likely be discussed. It also addresses the procedures that may be included during a physical exam or lab test.

   http://www.mayoclinic.com/print/erectile-dysfunction/MC00060/METHOD=print

5. Penile Implants — What To Expect and How To Prepare (Copyright © MFMER) — This Web site gives information on penile implants, which are used to treat erection problems. It reviews the procedure, the results, and risks.

   http://www.mayoclinic.com/health/penile-implants/MC00056

6. Sex After 50: How to Hold on to the Passion (Copyright © MFMER) — This publication explains the physical and psychological changes that can affect sexual function as you age and how you can improve your sex life as you grow older.

   http://www.mayoclinic.com/health/sexual-health/HA00035

7. Testosterone Therapy: Can It Help Older Men Feel Young Again? (Copyright © MFMER) — This publication discusses the potential risks and benefits of hormone replacement therapy.

   http://www.mayoclinic.com/print/testosterone-therapy/MC00030/METHOD=print

Organizations

1.   National Kidney and Urologic Diseases Information Clearinghouse, NIDDK, NIH, HHS
2. American Society for Reproductive Medicine
3. Hormone Foundation
4. Mayo Foundation for Medical Education and Research
5. Resolve
6. Yale Fertility Center

= Indicates Federal Resources

Content last updated June 1, 2009.