Fertility

Fertility – the inability to conceive a child after one year of regular, unprotected intercourse – affects about 20% of couples, with 30% to 50% of cases stemming from male-related problems.

However, a diagnosis of infertility is not necessarily a verdict of sterility: only 1% to 2 % of infertile couples are actually sterile, and half of those who seek help can eventually bear a child.

Types of Sexual Dysfunction Include:

Erectile dysfunction (when one has difficulty in getting an erection to initiate sexual activity or maintaining an erection to fulfill sexual activity)

Premature ejaculation (when a male reaches an orgasm earlier during intercourse than he or his partner would like)

Delayed ejaculation (when the orgasm is too slow or not achievable)

Retrograde ejaculation (when the ejaculate flows into the bladder rather than through the tip of the penis). This affects men who have had prostate surgery or are on medications to improve urination.

What Causes Male Sexual Dysfunction?

There are several reasons either by itself or in conjunction which may cause this condition:

Prescription drugs such as high blood pressure medications and psychiatric medications such as antidepressants can affect erectile function.

Age and blood circulation issues such as atherosclerosis and high blood pressure may decrease blood flow to the penis.

Tobacco use, alcohol consumption, and drug abuse can decrease blood flow into the penis.

Medical conditions such as diabetes (which affects the peripheral nerves) can affect erectile function.

Certain pelvic surgical procedures or neurological problems such as a stroke can be responsible for erectile dysfunction.

Low testosterone levels can be partly responsible for erectile dysfunction.

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Psychological Causes for Erectile Dysfunction in Men

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Relationship Problems
Performance anxiety
Stress (personal, professional, financial)
Depression and other personal matters
Sexual trauma

Diagnosis of Male Erectile Dysfunction

Medical History

First of all, it is important to provide a detailed and honest history to your urologist or health care provider. *Fellowship-trained urologists are more likely to be organized and thorough in managing your problem. Sometimes a standardized form may be distributed, but when giving a history, please be precise and honest.

Physical Examination

This will involve evaluation of your genitalia, which includes the penis as well as the testicles. You may also need a rectal examination to evaluate your prostate, which may be contributing to your erectile dysfunction.

Lab work up will be ordered by your urologist.

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Penile Prosthesis for Management of Erectile Dysfunction

Patients with erectile dysfunction can respond to treatment once an appropriate diagnosis has been made by your urologist who will conduct various tests. However, some men will not respond to medications or other treatment modalities. For such patients, your experienced urologist may recommend a penile prosthesis, which is now considered an integral part of managing erectile dysfunction due to the significant improvements in technology and the functional status.

Types of Penile Prosthetic Implants:

Inflatable penile prosthesis
- This implant can be inflated to create an erection and deflated when no longer needed.

Malleable penile prosthesis
- This implant is always firm but can be manually bent and moved into the desired resting or functional position.

Details about the surgical procedures of penile implants as well as risks, preoperative preparations, postoperative care, and recovery will be discussed by your experienced urologist.