Men's Sexual Functioning

There are many illnesses and conditions that can cause sexual problems for men. Our urology specialists treat many such problems, including:

Erectile dysfunction (impotence)

Impotence, also called erectile dysfunction (ED), is a common problem. At least 20 million American men experience impotence. Impotence usually means the inability to have a penile erection. Some men may have a partial erection, without full stiffness, or losing stiffness before ejaculation.

There are many causes of impotence. Medical experts used to think it had psychological causes. We now know that's the cause in less than 10 percent of serious cases. More common causes of ED include chemical mediators within the penis; a blocked artery or arteries; nerve damage caused by diabetes; a broken pelvis; or spinal cord injury. Chemical mediator problems appear to be the most common cause of erectile dysfunction, but are only recently understood. It is often difficult to figure out the exact cause of impotence, but knowing the cause is not necessary for fixing the problem.

There are many treatment options available for men dealing with erectile dysfunction.

Penile curvature

At least 1 percent of men have a curved penis. The most common symptom of penile curvature is discomfort or pain in the penis during sex. Usually the curve increases over a six-month period, then stops getting any more noticeable. Pain from inflammation with the curvature may go on for two to three months, but it always ends. Careful examination of the penis often reveals a scar that replaces the normal elastic tissue. The scar does not expand during penile erection, so the penis curves toward the side with the scar. Usually, a slight curve is not a problem. In some patients, however, the curvature may get in the way of sexual activity.

The direction of the curve is important in predicting whether it will cause problems. Curves toward the belly of 40 degrees or less usually do not require surgery. Curves of more than 40 degrees can cause severe discomfort during sex. When curvature reaches 50 degrees or more, vaginal penetration may not be possible. Lateral (to one side) and downward curves can be more problematic than upward ones. Curves of 30 degrees in those directions may make intercourse impossible.

The oral medication Potaba and Vitamin E have been used in the early stages of inflammation to slow down scarring, but there is little proof that they work. Once the penis' curvature is stable (not getting any more curved), oral medication will not change it. The main decision at that point is whether the curve interferes with sex enough to require surgery. Surgery is effective, but certain side effects are possible. During your office visit, the doctor will discuss with you the options appropriate for your situation.

Premature ejaculation

Ejaculation occurring just before or after the penis enters the vagina is called premature ejaculation. There are two main treatment options for this condition. The first method is the squeeze technique, which requires the active participation of your sex partner. The second option is a medical treatment. Medicines called serotonin re-uptake inhibitors have helped many patients. These medications were first created to treat depression. Patients taking the medications reported an increase in the amount of time before ejaculation. Patients usually try the medication for one month to see if it works and find the correct dosage.

Other conditions

Several other conditions can also cause sexual problems. The most common of these is penile warts. These lesions are caused by a sexually transmitted virus. Penile warts are unsightly and have been linked to cervical cancer in women. Because of this, we treat any visible lesions. Several treatment options are available, including vaporization with a carbon dioxide laser; or topical treatment with bichloroacetic acid.