Sexual problems are extremely prevalent, and it is estimated that one in ten men has sexual issues. Low sex drive and Ejaculation problems are the most common sexual disorders in men.

Low libido refers to a decrease in sex drive that hinders sexual activity. It may also cause distress in a relationship, fostering guilt and doubt in the couple. But the good news is that it is manageable by addressing the underlying cause.

Some common causes include medications, chronic illness, low testosterone levels, and stress. While reduced sex drive and ejaculation problems such as erectile dysfunction often co-exist, both these conditions are different and not to be confused with each other.

For both low libido and ejaculation problems, honesty and clear communications are essential to managing them. Treatment options include hormone replacement, psychotherapy, lifestyle changes, and drug therapies.

Overview

The sexual response cycle consists of four phases: excitement, plateau, orgasm, and resolution.

Sexual dysfunction or sexual disorders refer to a problem at any phase of the sexual cycle that prevents a couple or an individual from experiencing satisfaction during the sexual activity. 

Low libido is a condition where the reduced sex drive causes distress in a relation. Various causes, including ejaculation problems, may cause a low sex drive.

Research suggests that sexual dysfunction is a common condition, but only 31% of men discuss their problems. Understandably, you may feel hesitant to talk about sexual issues with a doctor, but not discussing them will only keep you from getting the solution. 

Most cases of sexual dysfunction are treatable, and it thus essential to share your problems and concerns with your physician. They will run a physical check and advise tests to find the underlying cause and manage them accordingly.

Male Sexual Problems

Sexual problems can affect any man, whether he is gay, straight, transgender, or bisexual. The commonest issues include ejaculation disorders and low libido.

Ejaculation Problems

Premature Ejaculation

It is a condition where ejaculation occurs soon after or before penetration. It is often a result of nervousness over sexual performance. While the cause is not clear, inhibited or premature ejaculation could be due to past traumatic events, lack of attraction for a partner, and psychological factors, including the strict religious background. 

Retrograde Ejaculation

In retrograde ejaculation, the ejaculate is forced back into the bladder during the orgasm instead of going through the urethra.

It is a common condition in diabetic males suffering from diabetic neuropathy. In diabetic neuropathy nerves in the bladder and bladder neck are damaged due to high blood sugar levels, allowing ejaculation to flow backward into the bladder.

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Operations on the prostate, bladder neck, or abdomen may also cause retrograde ejaculation.  

Erectile Dysfunction

It is a condition where the man cannot maintain or get an erection firm enough for sexual intercourse. Erectile dysfunction is highly prevalent, and most men experience it at some point in time.

Low Sex Drive

Low or loss of sex drive is when a man has reduced sexual thoughts or interest in sexual activity, which affects his relationship. Losing sex drive is common. It can decline as you age and is also linked to various factors, including stress, relationship issues, and anxiety.

Causes

Some of the common causes of sexual dysfunction in men are:

Low Testosterone 

Testosterone is the primary hormone in men and produced in the testes.

The hormone is responsible for building bone mass and muscles and boosting sperm production. Besides, testosterone levels also influence your sex drive.

Normal testosterone levels may vary. However, according to the American Urological Association levels below 300 nanograms per deciliter (ng/dL) are considered low.

Declining testosterone levels is a normal part of aging. But a significant drop in testosterone levels may reduce your libido. 

If your doctor thinks low testosterone levels to be the cause for low sex drive, they may advise a blood test to confirm the same. Low levels can be managed through supplements or gels to boost your testosterone levels.

Depression

Depression can affect all aspects of an individual’s life. It is seen that depression patients experience a lack of interest or reduced interest in activities that were once pleasurable, including sex.

Besides, low sex drive is also a side effect of certain antidepressants, including:

  • Selective serotonin reuptake inhibitors (SSRIs), such as sertraline and fluoxetine
  • Serotonin-norepinephrine reuptake inhibitors (SNRIs), such as duloxetine

If these medicines cause sexual problems, switching them to other alternatives such as norepinephrine and dopamine reuptake inhibitors can help solve it.

Medications

Some medicines that can cause sexual dysfunction are:

  • Medicines to manage hypertension, such as beta-blockers and ACE inhibitors
  • Hormones used to treat prostate cancer
  • Radiation or chemotherapy used to treat cancer
  • Antifungals such as ketoconazole
  • Corticosteroids
  • Opioid pain killers such as oxycodone and morphine
  • Anabolic steroids
  • Cimetidine
  • Certain antidepressants

If you are on any medicine and notice a change in your sex drive, it is best to talk to your doctor. If they feel medications are responsible for your sexual problems, they will switch your medicines.

Health Conditions

When you are not in the best of your health, such as long-standing pain, sex might not be your priority. Moreover, conditions such as cancer may also reduce your sperm count.

Some health problems that may alter your libido are:

  • Obesity
  • High cholesterol
  • Type 2 diabetes
  • High blood pressure
  • Arthritis
  • Heart, liver, lung, or kidney failure

Talking to your partner and exploring ways to be intimate can help you feel close to them. You can also consult a sex therapist or marriage counselor to resolve your sexual problems. 

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Stress

Being distracted by situations of high pressure can reduce your sexual desire. Stress can narrow your arteries and disrupt your hormone levels, which affects your erection and sex drive.

Studies have shown that stress and post-traumatic stress disorder (PTSD) can increase the risk of sexual problems.

Stress is highly prevalent and hard to avoid. Some common causes of stress that can alter your sexual drive include:

  • Divorce
  • Relationship problems
  • Death of loved ones
  • A new baby
  • Financial worries
  • A busy work environment

Stress management techniques, such as meditation, breathing exercises, and counseling, can help.

Aging

Testosterone level is at the peak when you are in your late teens, and so is your sex drive.

Some men may take long or find it difficult to ejaculate, have orgasms, or become aroused. As you age, it may take longer for the penis to become erect, and the erections may not be as hard.

But the good news is that medications are available to manage these issues.

Sleep Problems

Studies have shown that men with obstructive sleep apnea (OSA) have low testosterone levels, which results in low libido.

It is also seen that testosterone levels in healthy men drop by 10% to 15% after a sleep restriction of five hours per night.

Low Self-Esteem

Self-esteem is defined as the “general opinion a person has about their own self.” Low confidence, low self-esteem, and poor body image can affect your health and well-being.

If you feel that you are undesirable or unattractive, it might make sexual encounters less enjoyable. Not liking how you look may even make you want to avoid sex altogether.

Moreover, low self-esteem may also result in anxiety about sexual performance, resulting in reduced sexual desire and ED.

Long-standing self-esteem may also cause mental health problems such as anxiety, depression, or alcohol abuse, which are linked to low libido.

Too Much or Lack of Exercise

Too much or too little exercise can reduce sex drive in men.

Little or no exercise causes a range of health problems that affect your sexual arousal and desire.

Being active lowers the risk of long-standing conditions such as hypertension, obesity, and type 2 diabetes which are responsible for low libido. Moderate exercise reduces stress and improves cortisol levels, improving your sex drive.

However, over-exercising is seen to decrease libido in men. 

Alcohol

Excess alcohol consumption, which is more than 14 drinks in a week, is linked to low testosterone levels. Persistent excessive alcohol intake can reduce your sex drive.

To avoid this, men should have two or fewer alcoholic beverages daily.

Drug use

The use of marijuana, tobacco, and illicit drugs is seen to reduce testosterone production. This can lower your sex drive and cause other sexual problems.

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Besides, smoking also has a negative impact on sperm movement and production.

Symptoms

Some common symptoms of sexual problems in men include:

  • Difficulty in getting an erection
  • Difficulty in maintaining an erection
  • Reaching orgasm too quickly
  • Loss of sexual thoughts or fantasies
  • No orgasm at all

Effects

Ejaculation problems or low sex drive can be unsettling for many men. It can result in a vicious cycle of emotional and physical side effects, including erectile dysfunction.

Erectile dysfunction may cause men to feel anxious around sex. This can cause conflicts and tension between the couple, leading to fewer sexual encounters and further relationship problems.

Besides, failure to perform due to ED may also cause low self-esteem, depression, and poor body image.

Diagnosis

Your doctor will start by asking about the history of your symptoms. They may also run a physical check and advise blood tests to find the underlying cause of your problem.

Here are some ways of diagnosing your problems:

  • Blood tests: They include hormonal levels, high cholesterol, diabetes, and other risk factors.
  • Sensory testing: This test is useful in analyzing the effects of diabetic neuropathy. Sensory testing measures the strength of the nerve in a specific body area.
  • Vascular assessment: It includes analyzing blood flow to the penis. Blockage in the blood vessel supplying the penis may be responsible for erectile dysfunction.
  • Nocturnal penile tumescence and rigidity testing: It helps your doctor monitor erections that occur naturally at night. It aids in differentiating psychological and physical erectile problems.

Treatment

The treatment of low libido and ejaculation problems depends on the underlying cause. For instance, sexual issues due to health conditions need treating the disorder. Psychological causes may need relationship counseling or a therapist.

Available treatment options include:

  • Medications: Medicines such as sildenafil, tadalafil, and vardenafil can improve sexual function by improving blood flow to the penis.
  • Medical treatment: It involves treatment of the underlying health conditions that contribute to sexual dysfunction. 
  • Psychological therapy: Therapy can help address your feelings of fear, anxiety, or guilt that may impact sexual health.
  • Hormones: if your testosterone levels are low, you may benefit from hormone supplementation.
  • Mechanical aids: Aids such as penile implants and vacuum devices can help men with erectile dysfunction
  • Education and communication: Education about sexual behaviors and sex may help you overcome your anxieties about sexual performance. Open communication with your partner about your desires and needs can also help you overcome barriers to a healthy sexual life.

You can also take the following steps to boost your sexual health:

  • Get enough sleep
  • Lead a healthy lifestyle
  • Be physically active
  • Eat a healthier lifestyle
  • Practice stress management
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