What Do We Know about Men’s Sexual Problems?

Do we pretend to know or think we know more about men’s sexual problems than we really do? The results of a recent survey among people attending an International Health Care Exhibition in Italy suggest individuals are out of touch with what’s happening in the sexual lives of men.

Men’s sexual problems: survey

The survey was conducted at Exposanita 2018 and addressed medical and non-medical professionals (most were not physicians). Two surveys were developed, one for each sex, and the questions centered on the subject’s knowledge of the causes of erectile dysfunction (ED), its prevalence, ED as an early sign of coronary heart disease, and/or myocardial infarction, which treatments are available for ED, attitudes toward penile prostheses, and reimbursement of treatments for ED.

A total of 1,094 people who attended the convention participated in the survey. The breakdown was as follows:

  • 495 men, 599 women
  • Mean age, 40.5 years in men and 39.9 years in women
  • 43% worked in health-related professions, and 5.9% were physicians

Overall, the respondents were not very knowledgeable about erectile dysfunction in men. For example:

  • Most respondents thought ED was much more prevalent than it actually is
  • Both men and women believed lifestyle and psychologic factors are the most common causes of ED
  • Most respondents did not believe ED was a possible predictor of cardiovascular problems
  • Oral ED medications were the most recognized treatment for erectile dysfunction (about 78% of respondents)
  • Psychotherapy was the second most known treatment modality
  • About half of male and female respondents said they were willing to choose or support the use of a penile prosthesis to treat severe ED
  • More than three-quarters of respondents said ED treatments should be covered by the National Health Service

Interesting survey findings

Two findings of the survey were of special interest. One was the ready acceptance of a radical treatment approach (penile prosthesis) for men with severe ED who have not responded to conservative treatment.

It also appears the public may not understand the prevalence and consequences of having erectile dysfunction, especially the relationship between ED and the cardiovascular system. Although ED does not always indicate a man has an underlying heart condition, research indicates that men with ED with no obvious cause and who have no symptoms of heart problems should be screened for cardiovascular disease before they begin treatment for ED.

Experts are currently of the opinion that the appearance of ED before heart problems is often caused by the dysfunction of the endothelium (inner lining of the blood vessels) and smooth muscle. This results in poor blood flow to the penis and to the heart.

Bottom line

Erectile dysfunction is a common health challenge, yet the general population does not appear to understand it, especially when it comes to its impact on cardiovascular health. It’s important for all men who are faced with this situation to seek out all the information they can, to consult with a medical and/or counseling expert, and to talk with their partners about the challenge and how it can be resolved together.

References

Mayo Clinic Staff. Erectile dysfunction: A sign of heart disease? Mayo Clinic

Pescatori ES et al. How much do people know about male sexual problems? A survey in a selected population sample. Archivio italiono di urologia andrologia. 2019 Oct 2

UroToday. How much do people know about male sexual problems? A survey in a selected population sample. 2019 Oct 2; 91(3)

Premature Ejaculation, Your Treatment Options

Premature ejaculation is common, affecting up to one in three men, yet, unlike erectile dysfunction, it is not a topic you see or hear much about in the media. As such, many men who experience this sexual challenge typically don’t talk about it with anyone, including their doctors, and they don’t know how to treat it.

In fact, premature ejaculation can be treated using medications, counseling, and sexual techniques designed to delay ejaculation. Sometimes a combination of these approaches provide the best results.

Premature ejaculation developments

Some people are talking about premature ejaculation, however, and it’s important for men who are experiencing it to hear what they have to say. Among those discussing the topic are experts at the Committee for Medicinal Products for Human Use of the European Medicines Agency (EMA), which recently recommended a new treatment for premature ejaculation.

Although it is currently not available in the United States, the treatment, called Senstend (Plethora Pharma Solutions Ltd) has been shown to improve “ejaculatory control and sexual satisfaction and a reduction in distress related to ejaculation,” according to the EMA.

Senstend is a spray solution that contains lidocaine and prilocaine, two common anesthetics. The medications stop the transmission of nerve impulses in the glans of the penis, which in turn reduces stimulation and helps delay ejaculation.

Use of this drug combination can cause partial loss of sensation of the penis as well as erectile dysfunction.

Another treatment for premature ejaculation under investigation is transcutaneous electrical stimulation (TES). It involves use of a neuromuscular electrical stimulation device that applies stimulation to the perineum.

In a recent study, 23 men with lifelong premature ejaculation used either TES or sham treatment. The men were allowed to masturbate in private and a stop watch was used to measure their time to ejaculation.

Of the 20 men who completed the study, 17 (85%) experienced a prolonged time to ejaculation (3.5-fold longer) when using TES compared with the sham treatment. According to the authors of the study, this approach “may have the potential to become an on-demand treatment option” for premature ejaculation.

Other treatment options for premature ejaculation

While Senstend is not yet available, there are other treatment options men can use for premature ejaculation.

  • Other topical treatments. Various other sprays and anesthetic creams also contain lidocaine, benzocaine, or prilocaine. These products are applied to the penis 10 to 15 minutes before sex. Like Senstend, these items can cause temporary loss of sensitivity and lower sexual effects.
  • Kegel exercises. Also known as pelvic floor muscle exercises, Kegels are not just for women. Regular (daily) practice of Kegels can improve a man’s ability to delay ejaculation. Identify your pelvic floor muscles by tightening the muscles that prevent you from passing gas. Tighten those muscles, hold for three seconds, then relax for three seconds. Repeat this several times. Once you are comfortable doing the exercise, do at least three sets of 10 repetitions three times a day.
  • Behavioral techniques. Some sex therapists recommend men masturbate an hour or two before intercourse to help delay ejaculation during sex. Another recommendation is to avoid sexual intercourse for some time and instead focus on foreplay and other forms of sexual pleasure to help reduce the stress associated with premature ejaculation.
  • Certain types of condoms contain numbing substances that can help delay ejaculation. Typically they contain lidocaine or benzocaine or they are made of thicker latex. These are available over-the-counter.
  • One of the side effects of some antidepressants is delayed orgasm. Therefore, some doctors may recommend selective serotonin reuptake inhibitors (SSRIs), which you may know as Lexapro (escitalopram), Zoloft (paroxetine), or Prozac (fluoxetine). It can take up to two weeks or longer before you will notice the full impact from these medications on premature ejaculation.
  • Phosphodiesterase-5 inhibitors. Known as drugs that treat erectile dysfunction, these drugs (e.g., sildenafil [Viagra], tadalafil [Cialis], or vardenfil [Levitra] might also help premature ejaculation. They seem to work better when combined with SSRIs.
  • Talking with a counselor who is familiar with the challenges of premature ejaculation can be helpful, especially if the man’s partner attends the sessions as well. Sex therapists and relationship counselors are usually the most qualified. Typically, working with a counselor and adopting one or more of the other treatment options works the best.
  • Although there are limited studies of the impact of yoga on premature ejaculation, results have been promising. To experience results, it takes about one hour daily of yoga practice, which requires a great deal of discipline. The yoga poses should be taught and monitored by an experienced yoga teacher, and men should be cleared by their doctor before engaging in this practice, since it can be quite rigorous.

Bottom line

Many men who suffer with premature ejaculation don’t talk about their condition or seek treatment. Yet there are a variety of treatment options available and a few more in the pipeline. If you have premature ejaculation, seek help through one or more of the therapeutic avenues available.

References

European Medicines Agency. Senstend 2019 Sep 19

Joshi AM et al. Role of yoga in the management of premature ejaculation. World Journal of Men’s Health 2019; 37:e54

Mayo Clinic. Premature ejaculation

Naftulin J. I can only last 20 seconds in bed before I ejaculate and I fear it’s ruining my sex life. Is there any permanent fix to this problem? Insider 2019 Sep 17

Shechter A et al. Transcutaneous functional electrical stimulation—a novel therapy for premature ejaculation: results of a proof of concept study. International Journal of Impotence Research 2019 Sep 30

Effects of Marijuana on Men’s Sexual Health

As more and more states legalize cannabis for medicinal and/or recreational use, there’s a rising interest in how marijuana affects men’s sexual health. The truth may lie somewhere between the lofty claims made by some men who use weed and the more cautious reports from a few research studies.

In addition to the impact of marijuana on erectile function, there are also questions about how occasional or chronic use may affect fertility. Let’s begin with erectile function.

Marijuana and erectile function

A few small studies have suggested cannabis use can put a damper on erectile function. However, one of the most recent studies of the impact of cannabis on erectile function conducted in Australia did not come to that conclusion.

The 92-study meta-analysis looked at the impact of six lifestyle choices (cigarette smoking, cannabis use, alcohol use, diet, caffeine, and physical activity) on erectile dysfunction, premature ejaculation, and female sexual dysfunction.

Although there was compelling evidence that alcohol, physical activity, and cigarettes were related to sexual dysfunction, the experts could not find sufficient evidence for cannabis use.

It is possible, however, that use of both marijuana and tobacco may increase a man’s risk of experiencing erectile dysfunction. Tobacco restricts blood flow to arteries and veins, while the cannabinoid receptors in the smooth muscle tissue of the penis may respond to the THC and cause penile dysfunction. This is theoretical, however, and has not been proven.

Despite interest in the topic of marijuana and erectile dysfunction, there is very little research in humans. It is believed this will change as the availability and acceptance of cannabis for both medicinal and recreational use increases.

Marijuana and male fertility

For young men who may want to start a family, use of marijuana can take on a different meaning. In a 2019 review, investigators looked at data from studies that examined the impact of cannabis on male fertility.

Research supports the idea that use of marijuana can have a significant impact on male fertility. In short, cannabis use can reduce sperm count and concentration, lower sperm motility and viability, inhibit the ability of the sperm to fertilize eggs, and induce abnormalities in sperm shape and size. All of these factors can have a negative impact on fertility.

In addition, cannabis in animal models has been shown to reduce libido and sexual function and cause testicular atrophy, although these results have not been replicated in human studies. Thus far there is inconclusive evidence that marijuana use affects testosterone levels or lowers levels of luteinizing hormone, which is needed to produce testosterone and sperm.

These findings suggest cannabis has a negative impact on male fertility. However, further research is needed in humans to validate animal findings and further explore the range of impact of marijuana on male sexual health.

Other effects of marijuana on sexual health

According to the National Institute of Drug Abuse, marijuana use can cause drowsiness and slowed reaction times, which may manifest as lower libido. An Australian study in the Journal of Sexual Medicine noted that daily use of cannabis was associated with men’s difficulty in reaching orgasm.

Bottom line

How marijuana affects men’s sexual health is still a study in progress. While it appears to have a detrimental effect on sperm and male fertility, the impact on erectile function remains debatable. Limited research indicates marijuana use may reduce libido and also the ability to reach orgasm.

References

Allen MS, Walter EE. Health-related lifestyle factors and sexual dysfunction: a meta-analysis of population-based research Journal of Sexual Medicine 2018; 15:458-75

Payne KS et al. Cannabis and male fertility: a systematic review. Journal of Urology 2019 Mar 27

Smith AMA et al. Cannabis use and sexual health. Journal of Sexual Medicine 2010; 7:787-93

Wu B. Does marijuana cause erectile dysfunction? MedicalNewsDaily 2018 Aug 9