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Male sexual problems

Nearly 1 in 2 Australian men have experienced a sexual difficulty. Sexual dysfunction in a man can affect any part of the sexual act, from foreplay through to attaining or maintain an erection, and also ejaculation. It can affect any man, whether he is straight, gay, bisexual or transgender.

Man in shower looking frustrated.
Most men experience impotence at some time in their life.

Erectile dysfunction (impotence)

This is when a man can't get, or keep, an erection. Most men experience this at some time in their life.

What causes erectile dysfunction?

Erectile dysfunction is a complex problem.  It may be the result of a physical problem or drugs, a psychological issue, or difficulties with relationships.

Often, such difficulties don't persist, but there can be more serious psychological problems about sex that need the help of a psychosexual therapist. Worries about work, money, your relationship, family, and even worrying about not getting an erection, can all be factors.

Physical reasons for erectile dysfunction are outlined below:

A variety of physical and psychological problems can cause erectile dysfunction.

Medical conditions

  • heart disease
  • diabetes
  • raised blood pressure  
  • raised cholesterol – this can lead to clogging of arteries, including the arteries in the penis, which are very narrow (1-2mm in diameter compared with around 10mm in the heart artery) 
  • low testosterone – testosterone levels fall as men get older, but not all men are affected by it. Those who are affected will have symptoms such as feeling tired and unfit, and loss of interest in, and inability to have, sex.

Medicines and drugs

  • some prescription medicines – these can include medicines such as beta-blockers used to treat raised blood pressure, antidepressants, antipsychotic drugs and anticonvulsant drugs
  • alcohol
  • recreational drugs such as cannabis and cocaine 
  • smoking – nicotine affects the blood supply to the areas of the penis that cause erections 

What should I do if I have erectile dysfunction?

See your doctor. They can give you a physical examination and carry out blood tests to identify the cause.

What's the treatment for erectile dysfunction?

First, adjust any lifestyle factors that might be causing your problem.

If you're prescribed blood pressure medicine or antidepressants, your doctor may be able to put you on a different kind.

Low testosterone can be treated with hormone replacement therapy, which should resolve erectile dysfunction as long as it's used together with erection-helping drugs. Other conditions, such as diabetes and high blood pressure, can be treated, which may improve erections.

Some men benefit from psychosexual therapy, which is a form of relationship therapy where you and your partner can discuss any sexual or emotional issues or concerns.

Premature ejaculation (PE)

This is when a man ejaculates sooner than he wants to during sex, or without pleasurable feelings like orgasm.

There are a number of possible physical causes that should be discussed with and investigated by your doctor. Sometimes psychological and emotional issues contribute to premature ejaculation, and talking therapy with some strategies to practice and use during sexual activity can reduce the distress and frustration that can accompany PE.

What causes premature ejaculation?

Being excited with a new partner, or an acute sensitivity of the local nervous system, can trigger ejaculation too suddenly. It can also be linked to anxiety about sexual performance, stress, unresolved issues in a relationship or depression.

What should I do if I have premature ejaculation?

See your doctor, or a psychosexual therapist. A therapist can teach you techniques to try to delay ejaculation.

What treatment is there?

  • Have sex again soon after the man ejaculates. The second time, it will take longer to reach an orgasm. Older men might find this difficult as it may take a long time to get a second erection. 
  • Creams (available from sex shops) can be put on the penis to numb sensation; however, this tends to transfer the numbing sensation to the partner as well.
  • There are squeezing techniques a man and his partner can learn that help delay ejaculation.
  • Antidepressants called 'selective serotonin reuptake inhibitors' (SSRIs) can increase the time to ejaculation, but only for a year or so. It is important to try other treatments before starting on drugs.
  • Psychotherapy might help in terms of relaxing or exploring problems in the relationship.

Need help?

Visit www.impotenceaustralia.com.au or call Impotence Australia National Helpline on 1800 800 614.

Sources: Australian Institute of Health and Welfare (Male health - health status), Impotence Australia (homepage), NHS Choices, UK (Male sexual problems)

Last reviewed: 
April, 2014