Sexual disorders in men - causes and treatment

Sexual disorders in men - causes and treatment

In a culture where men are expected to be constantly sexually available, any difficulty in this area becomes a source of shame. A "real man" should always want it, always be able to, and should have no problems whatsoever. These beliefs have nothing to do with reality - but they cause millions of men to suffer in silence instead of seeking help. And help exists and is effective.

Sexual disorders in men are far more common than one might think. Epidemiological studies indicate that 20 to 30 percent of men of various ages experience some form of sexual dysfunction. In the age group over 40, this percentage rises to as much as 50 percent. This is not a marginal problem affecting the few - it is part of the experience of many men of every age, in every profession, and in every type of relationship.

The most common sexual disorders in men

Erectile disorders (ED). This is the most commonly diagnosed sexual disorder in men. It includes difficulty achieving an erection, maintaining an erection sufficient for intercourse, or losing an erection during sexual activity. Erectile disorders can have somatic origins (vascular, hormonal, neurological), psychogenic origins (anxiety, stress, depression), or - most commonly - mixed origins. In younger men, psychogenic causes dominate; with age, the role of somatic factors increases. It is worth knowing that occasional difficulties with erection are normal and do not indicate a disorder - the problem exists when difficulties are regular and cause distress.

Premature ejaculation (PE). This is the most common sexual disorder overall - affecting 20 to 30 percent of men regardless of age. According to the International Society for Sexual Medicine definition, premature ejaculation is ejaculation occurring too quickly, before penetration or within approximately one minute of its initiation, which the man is unable to control and which causes distress in him or his partner. A distinction is made between the lifelong form (always present - from the first sexual experiences) and the acquired form (appearing after a period of normal functioning). This disorder has the best prognosis - behavioral techniques used in sex therapy have over 50 years of evidence supporting their effectiveness.

Delayed ejaculation. The opposite problem - the man requires very prolonged stimulation to achieve orgasm, or does not achieve it at all despite arousal. This is a less commonly reported disorder because of the cultural belief that "the longer, the better." However, hours-long sexual activity without the possibility of completion is frustrating for both the man and his partner. It can lead to avoidance of sex, a sense of defectiveness, and tension in the relationship. Causes can be both psychological (suppressed emotions, fear of losing control, specific masturbation patterns) and pharmacological (SSRI medications are a common cause).

Low sexual desire. Lack of interest in sex, lack of erotic fantasies, lack of initiation of sexual activity. In men, this can be particularly difficult to accept because it conflicts with the cultural expectation that a man "always wants it." A partner may interpret the lack of initiative as a lack of love or attraction, which generates conflicts. Causes may be hormonal (low testosterone - especially after age 40), psychological (depression, stress, burnout, relationship conflict), or pharmacological (many medications, including antidepressants, blood pressure medications, and statins, lower libido).

Sexual aversion. Strong fear, disgust, or panic associated with sexual activity. This is far more than a lack of desire - it is an active avoidance of intimacy that may be accompanied by symptoms resembling a panic attack. It often has roots in traumatic past experiences - sexual abuse, violence, shaming in childhood.

Psychological causes of sexual disorders in men

Sexuality is closely linked to the psyche - and it is precisely psychological factors that play a key role in many sexual disorders, especially in younger men. Understanding these mechanisms is the first step toward change.

Performance anxiety. This is the most common psychological mechanism driving erectile disorders. A single episode of "failure" - which may result from fatigue, alcohol, or simply chance - triggers a vicious cycle: during the next sexual encounter, the man observes himself ("Will I succeed this time?", "Is the erection sufficient?"), which generates anxiety, which blocks arousal, which confirms the fear that "something is wrong." Masters and Johnson called this mechanism "spectatoring" - the man, instead of experiencing intimacy, becomes an observer and judge of his own body.

Stress and burnout. Chronic work stress, financial problems, an excess of responsibilities, career pressure - all of this lowers libido and impairs arousal. Cortisol, the stress hormone, directly inhibits testosterone production. An organism in survival mode does not treat sex as a priority - it directs energy toward coping with the threat, not toward pleasure. Many men come in with erectile disorders without connecting them to work stress - yet stress turns out to be the main culprit.

Depression and anxiety disorders. Both the conditions themselves and the medications used to treat them can affect sexuality. Depression lowers desire and the capacity to experience pleasure (anhedonia). Anxiety generates tension that blocks the relaxation necessary for arousal. SSRI medications - although very effective in treating depression and anxiety - can cause difficulty with erection, delayed ejaculation, and reduced libido. This is one of the most common reasons men discontinue psychiatric treatment - instead of talking to the psychiatrist about changing the medication.

Relationship problems. Unresolved conflicts, lack of communication, feelings of rejection, infidelity, loss of respect, chronic grievances - these are factors that directly affect sexuality. Sex does not function in isolation from the relationship. If emotional closeness is lacking in the relationship, physical closeness is difficult. If a partner feels criticized or unappreciated, their body may refuse to cooperate.

The impact of pornography. An increasing body of research points to a link between intensive pornography use and sexual difficulties in young men. The mechanism is related to dopaminergic desensitization - a brain accustomed to intense, novel, constantly changing stimuli from a screen may respond less well to stimulation from a partner in reality. The term PIED (Porn-Induced Erectile Dysfunction) has even emerged. This does not mean that pornography always leads to dysfunction - but with intensive, long-term use, the risk increases.

Trauma. Experiences of sexual violence and abuse in childhood affect men too - though they speak about it less often. But also less obvious injuries can leave a mark: ridicule of penis size by peers, shaming related to the body or masturbation, humiliating comments from a partner, an unsuccessful first attempt at sex. These experiences can shape deep beliefs about one's own defectiveness.

Somatic causes - when to see a urologist

Not all sexual disorders have psychological origins. It is worth consulting a physician (urologist or andrologist) if erectile difficulties appeared suddenly without a clear emotional context, if erection is impaired both with a partner and during masturbation, if there are no morning erections, or if other hormonal symptoms are present - chronic fatigue, weight gain around the abdomen, low mood, loss of muscle mass.

The most common somatic causes include vascular diseases (atherosclerosis, hypertension - erectile disorders may be an early signal of cardiovascular problems), diabetes (which damages blood vessels and nerves), testosterone deficiency (especially after age 40), thyroid disorders, neurological diseases, and side effects of medications (antidepressants, blood pressure medications, beta-blockers, statins, antiandrogens).

Good diagnostics encompass both somatic tests (hormonal profile, lipid panel, glucose) and psychological assessment - because in practice, causes very often overlap. A man with hypertension and work stress may have erectile disorders resulting from both of these factors simultaneously.

Treatment of sexual disorders in men

Sex therapy is the primary form of treatment for sexual disorders of psychogenic origin and the most effective for mixed origins (in combination with medical treatment). The sexologist works on anxiety mechanisms, beliefs about sexuality and masculinity, communication with the partner, and specific techniques for improving sexual functioning. This may be individual therapy or couples therapy.

Behavioral techniques used in therapy for premature ejaculation - the start-stop technique (interrupting stimulation before orgasm and resuming after arousal subsides) and the squeeze technique (squeezing the glans at the moment of approaching orgasm) - have over 50 years of evidence supporting their effectiveness and allow gradually extending the time to ejaculation. For anxiety-related erectile disorders, the key is to interrupt the cycle of self-observation and restore the natural course of arousal - for which sensate focus exercises are used, among other methods.

Pharmacotherapy. Phosphodiesterase type 5 inhibitors (sildenafil - Viagra, tadalafil - Cialis) are effective for erectile disorders of vascular and mixed origin. It is worth knowing that medications alone do not treat the cause - but they can help break the vicious cycle of performance anxiety. A man who, with the help of medication, experiences several successful sexual encounters can regain self-confidence and eventually discontinue pharmacotherapy. For premature ejaculation, dapoxetine or - off-label - SSRI medications are used. The decision about pharmacotherapy is made by the physician.

Hormonal therapy is indicated for confirmed testosterone deficiency (hypogonadism) and is conducted under the supervision of an endocrinologist or andrologist. Testosterone supplementation improves libido and sexual functioning but requires regular monitoring.

Why do men delay seeking help?

Cultural expectations of masculinity cause men to seek help for sexual matters far less frequently than women. Shame, fear of judgment, the belief that "I should handle this on my own," and the worry that the problem is evidence of a "lack of masculinity" - these are barriers that maintain the problem for years or even decades. Many men try searching for solutions online, buy supplements without evidence of effectiveness, or simply avoid sex, risking the loss of their relationship.

Meanwhile, early intervention significantly increases the chances of successful therapy. Sexual disorders that persist for years tend to become entrenched - the longer the fear of failure lasts, the harder it is to break. The longer a couple does not talk about the problem, the more tension and distance builds.

It is also important to note that sexual disorders say nothing about a man's worth as a person or as a partner. These are difficulties that can be worked on - just like any other health difficulties.

Help at the Sztuka Harmonii Psychological Center

At the Sztuka Harmonii Psychological Center, sexological consultations and therapy for sexual disorders in men are provided by Anna Grys, MA - a psychologist and clinical sexologist. Ms. Grys works with men individually as well as with couples, combining an integrative approach with cognitive behavioral techniques and schema therapy. She has experience working with erectile disorders, premature ejaculation, low libido, and difficulties in intimate relationships.

We accept patients at our offices in Gdansk (Piekarnicza 5, Bergiela 4/10, Wajdeloty 28/202A) and Gdynia (10 Lutego 7/103). The first consultation is a conversation - it lasts 50 minutes, takes place in an atmosphere of complete discretion, and is free of judgment. Nothing you say will shock the specialist - it is their everyday work. Call 732 059 980 or book an appointment through our website. Sexual problems do not have to define your life - help is available and effective.