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Disorders of sexual function are common among men of all ages, ethnicities, and cultural backgrounds. It has been recently estimated that more than 152 million men worldwide experienced erectile dysfunction in 1995, and that this number will rise by 170 million, to approximately 322 million by the year 2025.

Sex disorders of the male are classified into disorders of sexual function, sexual orientation, and sexual behavior. Disorders of sexual orientation and disorders of sexual behavior are believed to be entirely due to psychological etiologiesThe National Institutes of Health (NIH) Consensus Development Conference advocated that “erectile dysfunction” be used instead of “impotence” to describe disorders of male sexual function and defined the new terminology as the “inability to achieve an erect penis as part of the overall multifaceted process of male sexual function.” However, use of the term “erectile dysfunction” to refer to all aspects of male sexual dysfunction would be inappropriate. Major advances have been made in the last few years toward understanding the nature of various forms of male sexual dysfunction and the possible underlying organic and psychological factors. 

Let’s talk about the clinical manifestations and the most common  etiological categories for sexual dysfunction in the male. Causes of sexual dysfunction in the male classified by clinical manifestation:

  1. Disorders of desire 

E.g.: Hypoactive sexual desire (HSD)

Most Common Causes:

  1. Psychogenic (e.g., depression, marital discord leading to desire deficiency, performance anxiety leading to excitement inhibition)
  2. CNS disease (partial epilepsy, Parkinson’s, post stroke, adrenoleuko dystrophy)
  3. Androgen deficiency (primary or secondary), androgen resistance 
  4. Drugs (anti-hypertensives, psychotropics, alcohol, narcotics, dopamine blockers, anti-androgens)

E.g.: Compulsive sexual behaviors

Most Common Causes:

  1. Psychogenic (obsessive-compulsive sexuality, excessive sex-seeking in association with affective disorders, addictive sexuality, sex impulsivity)
  1. Erectile dysfunction

Most Common Causes:

  1. Drugs (antihypertensives, anticholinergics, psychotropics, cigarette smoking, substance abuse) 
  2. Systemic diseases (cardiac, hepatic, renal, pulmonary, cancer, metabolic, postorgan transplant, pelvic irradiation)
  3. Androgen deficiency (primary or secondary), androgen resistance, other endocrinopathies 
  4. Vascular insufficiency (atherosclerosis, pelvic steal, penile Raynaud’s, venous leakage)
  5. Neurological disorder (Parkinson’s, Alzheimer’s, Shy-Drager, encephalopathy, spinal cord or nerve injury)
  6. Penile disease (Peyronie’s, priapism, phimosis, smooth muscle dysfunction, trauma)
  1. Disorders of ejaculation 

E.g.: Premature ejaculation (primary or secondary)

Most Common Causes:

  1. Psychogenic (neurotic personality, anxiety/depression, partner discord or other situational factors) 
  2. Organic (increased central dopaminergic activity, increased penile sensitivity)

E.g.: Absent or retarded emission 

Most Common Causes:

  1. Sympathetic de-nervation (diabetes, surgical injury, irradiation)
  2. Drugs (sympatholytics, CNS depressants) Androgen deficiency (primary or secondary), androgen resistance

E.g.: Post-ejaculation pain 

Most Common Causes:

  1. Psychogenic
  1. Orgasmic dysfunction 

Most Common Causes:

  1. Drugs (selective serotonin reuptake inhibitors, tricyclic antidepressants, monoamine oxidase inhibitors, substance abuse)
  2. CNS disease (multiple sclerosis, Parkinson’s, Huntington’s chorea, lumbar sympathectomy) 
  3. Psychogenic (performance anxiety, conditioning factors, fear of impregnation, hypoactive sexual desire)
  1. Failure of detumescence 

E.g: Structural penile disease 

Most Common Causes:

  1. Penile structural abnormalities (Peyronie’s, phimosis) 

E.g: Priapism (primary or secondary) 

Most Common Causes:

  1. Primary priapism: idiopathic  
  1. Priapism secondary to disease: hematologic (sickle cell anemia, leukemia, multiple myeloma), infiltrative (Faber’s disease, amyloidosis), inflammatory (tularemia, mumps), and neurologic diseases, solid tumors, trauma 
  1. Priapism secondary to drugs: phenothiazines, trazodone, cocaine, intrapenile vasoactive injections

Much of the attention in the future should be directed to a number of developmental areas. These include characterization of the physiological importance, simplification and standardization of techniques used in assessing penile structure and function; and establishment of safety and efficacy of newly developed diagnostic and therapeutic drug interventions. The use of androgen supplementation of men with erectile difficulties and low-normal bio-available testosterone should be re-examined, particularly in view of the new data implicating androgens in local regulation of penile NOS production and action. Moreover, more work is needed to advance and refine the development of new therapeutic approaches and gene therapy interventions in the treatment of disorders of Male Sexual Function. So If you are diagnosed with any of these kind of disorders of Male Sexual Function, feel free to see a doctor and psychiatrist.