Male Sexual Dysfunction
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Hypoactive Sexual Desire
Disorder
• Affects 15% of men
• Typically associated with a medical condition, mental health issues, or
medication side effects
– hypogonadal
– depression
– antidepressant induced
2
Male Erectile Disorder
• DSM-IV
– Inability to attain or maintain adequate erection
– problem persistent or recurrent
– caused by psychogenic or combined factors
• common reason for seeking treatment
• highly distressing to men
• prevalence
3
Male Erectile Disorder (ED)
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Male Erectile Disorder
• Medical causes:
– vascular diseases (most common cause), e.g., hardening of arteries,
long term cigarette use
– diseases affecting the nervous system, e.g., multiple sclerosis,
alcoholism
– diseases affecting vascular and nervous system, e.g., diabetes,
hypothyroidism
– anything impairing penile vascular and/or nervous system:
• surgical or accidental injury
• old age
• pharmaceuticals
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Drugs Associated with ED
• Alcohol
ß-blockers
Estrogens
Psychotropics
Antiandrogens
Cigarettes
H2 receptor blockers
Cocaine
Anticholinergics
Spironolactone
Ketoconazole
Lipid-lowering agents
Antidepressants
NSAIDs
Marijuana
Cytotoxic drugs
Antihypertensives
Diuretics
Narcotics
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Male Erectile Disorder (ED)
• Psychological Causes:
– occasional episode normal (e.g., stress)
– men with ED focus on anxiety/worries rather than sexual cues -->
negative feedback loop
– normally functioning men focus on erotic cues --> positive
feedback loop
(Barlow, 1986)
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Male Erectile Disorder (ED)
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Male Erectile Disorder (ED)
• Treatment:
– Viagra (sildenafil), also, Cialis (tadalafil), Levitra (vardenafil)
– injection of vasodilating drugs (e.g., alprostadil)
– vascular surgery
– vacuum pumps and constrictive devices
– penile prosthesis or implants
9
Male Erectile Disorder (ED)
• Sildenafil: Mechanism of Action
– Nitric oxide acts through a second messenger, cGMP, in the normal
development of erections
– cGMP relaxes corpus cavernosal smooth muscle cells, promoting
blood flow into cavernosal spaces
– cGMP broken down by PDE - the predominant enzyme of this type
in the corpus cavemosum is PDE type V
– Sildenafil is a selective and potent inhibitor of PDE type V
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Vacuum Pumps and
Constrictive Devices
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Male Erectile Disorder (ED)
• Penile Implants
Two types: semirigid and multicomponent inflatable
Patient satisfaction: 81% to 97%
Average functional life: 7 to 10 years
12
Inflatable Penile Implant
13
Malleable Penile Implant
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Male Orgasmic Disorder
• DSM-IV: Inability to reach orgasm after sufficient stimulation
• often require manual/oral simulation - “hard work”
• rare disorder – 1.5/1000 general population
– 13% of those presenting for therapy
• Physiological causes
– SSRI
– dopmanine agonists
– spinal reflex abnormalities
• Psychological causes
– frustration/anxiety from previous incidents
– childhood sexual abuse
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Premature Ejaculation
• Ejaculatory inevitability
• Premature Ejaculation
– ejaculation with minimal stimulation
– before, upon, or shortly after penetration
– taking into account:
• age
• novelty of partner
– problem is persistent and recurrent
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Premature Ejaculation
• Prevalence
• Causes:
– Physiological
• neurotransmitters (dopamine, serotonin)
• touch sensation (Roland; Fanciullacci et al., 1988)
• detecting ejaculatory inevitability (Kaplan, 1974)
– Psychological
• anxiety (only in acquired types; Cooper et al., 1993)
• hostility
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Premature Ejaculation
• Treatment
– Pharmaceutical
• SSRIs
• anti-anxiety
• lidocaine
– Psychological
• pause-and-squeeze (Semens, 1956; Masters & Johnson)
• mental imagery
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