Male Sexual Disfunctions and Therapy

Sexual Dysfunction and Therapy

Sexual Dysfunctions such as premature ejaculation in men and Inability to have orgasms in women have been the cause of a great deal of mental anguish, not to mention marital friction. Most Americans either have a sexual dysfunction or are affected by one in their partner. However, thanks to the likes of Masters and Johnson who have written several publications to help us understand the causes of sexual dysfunction and the rapid treatment therapy for such disorders, several options are now available to help with this problem.

A sexual dysfunction is any one of various disturbances or impairments of sexual functioning (Janet Shibley Hyde 1990). Although this definition may seem fairly simple, in practice it can be very difficult to determine exactly when something is a sexual dysfunction. No one knows the exact number of people with sexual dysfunctions, what is known though, is the number of people who actually go out and seek some kind of treatment for the problem, and these are fewer than those of people who have a dysfunction but suffer quietly and never seek therapy because of ignorance or embarrassment.

In this paper I am going to discuss the various kinds of sexual dysfunctions found in men: erectile dysfunction (impotence), premature ejaculation and inhibited ejaculation their causes and also the various treatment methods available for such disorders.

Erectile dysfunction (Impotence)

In 1992, the National Institutes of Health defined erectile dysfunction as the inability to attain or sustain an erection adequate for satisfactory sexual intercourse. "Erectile Dysfunction" is more precise than impotence, a term that some associate with being sterile or lacking strength, vigor, or power. The condition is called primary sexual dysfunction if a man has never in his life achieved or maintained an erection for coitus. If a man has previously had at least one successful coitus and then subsequent failure his condition is called secondary sexual dysfunction (Bernard Goldstein 1976). Masters and Johnson also classified a man as secondarily dysfunctional if he has erection problems 25% or more of the time in sexual encounters.

Among men seeking sex therapy, erectile dysfunction is the most common problem and secondary cases are more common than primary ones. It has been estimated that half of the general male population has experienced occasional episodes of erectile dysfunction, and this is certainly well within the range of normal sexual response (Kaplan, 1974). Erectile difficulties affect men of all ages, from teenagers to the elderly.

Some physicians have suggested that Erectile dysfunction is on the increase (Liddick). They further claim that female liberation and the increased demand for male performance are the primary causes of the increase, while other physicians and psychologists believe that numerous factors are involved. Fear of failure during intercourse represents the most common cause of Erectile Dysfunction in the United States (Masters and Johnson 1970). Ninety percent of all cases of Erectile dysfunction are caused by psychological factors, including past inhibitory experiences and negative reinforcement leading to "fear of coital failure" (Bernard Goldstein). Recent evidence indicates that continued heavy use of marijuana or alcohol may also cause erectile dysfunction. About 10% of the cases of ED are caused by biological diseases and malfunctions. 50% of diabetic (mellitus) men have ED, apparently due to the effects diabetes has on that part of the nervous system which controls both the urinary bladder and genital functions (Ellenberg). Other biological causes include a low testosterone level, disturbances in the circulatory and nervous systems, and abnormalities of genital anatomy.

Treatment of ED depends upon the cause. Ellenberg reports that in some cases of partial impotence a rubber band is wound around the base of the penis to help trap blood in the erectile tissues and thereby maintaining and erection. Drugs for treating ED can be taken orally, injected directly into the penis, or inserted into the urethra at the tip of the penis. In March 1998, the Food and Drug Administration approved Viagra, the first pill to treat ED. In August 2003, the FDA gave approval to a second oral medicine, vardenafil hydrochloride (Levitra). Additional oral medicines are being tested for safety and effectiveness.

Taken an hour before sexual activity, Viagra and Levitra work by enhancing the effects of nitric oxide, a chemical that relaxes smooth muscles in the penis during sexual stimulation and allows increased blood flow.

While oral medicines improve the response to sexual stimulation, they do not trigger an automatic erection as injections do. The recommended dose for Viagra is 50 mg, and the physician may adjust this dose to 100 mg or 25 mg, depending on the patient. The recommended dose for Levitra is 10 mg, and the physician may adjust this dose to 20 mg if 10 mg is insufficient. Lower doses of 5 mg and 2.5 mg are available for patients who take other medicines or have conditions that may decrease the body's ability to use Levitra.

Neither Viagra nor Levitra should be used more than once a day. Men who take nitrate-based drugs such as nitroglycerin for heart problems should not use either drug because the combination can cause a sudden drop in blood pressure. Also, Levitra should not be taken with any of the drugs called alpha-blockers, which are used to treat prostate enlargement or high blood pressure. (http://kidney.niddk.nih.gov/kudiseases/pubs/impotence/index.htm#treatment)

Oral testosterone can reduce ED in some men with low levels of natural testosterone, but it is often ineffective and may cause liver damage. Patients also have claimed that other oral drugs--including yohimbine hydrochloride, dopamine and serotonin agonists, and trazodone--are effective, but the results of scientific studies to substantiate these claims have been inconsistent. Improvements observed following use of these drugs may be examples of the placebo effect, that is, a change that results simply from the patient's believing that an improvement will occur.

Many men achieve stronger erections by injecting drugs into the penis, causing it to become engorged with blood. Drugs such as papaverine hydrochloride, phentolamine, and alprostadil (marketed as Caverject) widen blood vessels. These drugs may create unwanted side effects, however, including persistent erection (known as priapism) and scarring. Nitroglycerin, a muscle relaxant, can sometimes enhance erection when rubbed on the penis.

A system for inserting a pellet of alprostadil into the urethra is marketed as Muse. The