Men's Health: Male Sexual Dysfunction

Human sexual function is complex and multidimensional, with physiologic and psychological components. The common sexual dysfunctions in men have significant overlap. Low sexual desire in men includes a lack of interest in thinking about sex or in being sexual, alone or with a partner. Sexual health counseling often is helpful. Physicians should prescribe supplemental testosterone only if it is clearly indicated. (Sexual dysfunction is an off-label use of testosterone.) Supplementation is not beneficial for men with a normal total testosterone level. Erectile dysfunction (ED) is the consistent or recurrent inability to attain or maintain a penile erection sufficient for sexual satisfaction. The cause typically is multifactorial. The oral phosphodiesterase type 5 inhibitors are the first-line pharmacotherapies for most patients with ED. Their use is contraindicated in patients taking nitrates. Peyronie disease is an acquired penile abnormality that causes curvature or other deformities of the erect penis. Premature ejaculation is defined as a lack of ejaculatory control that is associated with distress. All pharmacotherapies for premature ejaculation are used off label. First-line treatment options include daily selective serotonin reuptake inhibitors (eg, paroxetine), on-demand clomipramine, and topical penile anesthetics. Psychotherapeutic and physical therapies also have been shown to be effective.