Men’s Sexual Health: 5 Things You Need to Know

There are several sexual health issues that can affect men and interfere with a satisfying sex life, including erectile dysfunction, problems with ejaculation, infertility, and others.

Michael O’Leary, MD, MPH, a Mass General Brigham urologic surgeon, shares the top 5 things men should know about common sexual health conditions. Dr. O’Leary is director of the Men’s Health Center at Brigham and Women’s Faulkner Hospital.

If you have concerns about any conditions that may impact your sexual health, tell your primary care provider (PCP). Your PCP and men’s health specialists can ensure you get the care you need for any reproductive and sexual health concerns.

Sexual health for men

Here are the top 5 things to know about conditions that impact sexual health in men:

The most common problem is erectile dysfunction.

Erectile dysfunction (also called ED or impotence) is when a man can’t get or keep an erection firm enough for sex. This condition is very common and affects 50% percent of American men over the age of 40.

Erectile disfunction is mainly caused by blood flow problems such as high blood pressure or vascular disease, which are common among aging men. Other factors that increase the risk for developing ED include:

• Surgeries involving prostate cancer
• Smoking
• Certain medications
• Use of alcohol or drugs

According to Dr. O’Leary, many of the first-line agents for the treatment of ED involve medications that work for 50 to 70% of men. If a patient does not respond to medication, several non-surgical options exist to encourage an erection by promoting blood flow.

Occasionally, some patients need more invasive treatments. For example, doctors can place an agent into the urethra. The urethra is a tube that carries urine from the bladder to outside the body. In men, the urethra runs through the prostate gland and the penis to the outside of the body.

Patients who don’t achieve good outcomes through initial treatment also can explore surgical treatments, including penile implants or prostheses (artificial penises).

“I don’t recommend surgery as an initial treatment option for erectile dysfunction,” says Dr. O’Leary, “but for many men it’s very satisfactory.”

Psychological or emotional problems can cause erectile disfunction.

Stress, depression, and other emotional disturbances are common causes of erectile dysfunction in men. Dr. O’Leary regularly tells patients, “The most important sex organ is not below a man’s waist; it’s sitting on their shoulders.”

In cases where physiological problems don’t cause erectile dysfunction, doctors evaluate a patient’s impotence in the context of their mental or emotional well-being.

At the Men’s Health Center, a team of sex therapists works with patients and their partners in a comfortable, educational, and confidential setting to address possible psychosocial causes of ED. The aim is to restore a normal level of sexual function.

Up to 1 in 3 infertility cases may involve male infertility.

Many factors can contribute to male infertility, including:

• Low sperm production
• Anatomy
• Testicular trauma
• Genetic or immune diseases

Determining the exact cause of infertility involves a thorough physical evaluation, lab tests, imagery, and semen analysis.

Minor trauma to the penis can cause Peyronie’s disease.

Peyronie’s disease occurs when scar tissue, or plaque, forms inside the erection tissue of the penis. While the exact cause of plaque formation isn’t clear, many men with Peyronie’s disease have had a minor trauma that caused bleeding inside the penis. While the plaque is benign and noncancerous, it can cause bending of the penis upward or downward, depending on the plaque’s location. Men with Peyronie’s disease typically experience pain during an erection or difficulty performing intercourse.

To diagnose Peyronie’s, doctors perform an ultrasound to determine erectile function and anatomy. In most cases, Peyronie’s presents in a mild form and the initial pain resolves in 6 to 12 months, allowing the patient to return to healthy sexual activity. Doctors can treat plaque with a customized plan.

A vasectomy should be considered a permanent form of birth control.

A vasectomy is a simple, minimally invasive surgical procedure used as a permanent form of male birth control to prevent pregnancy. During this 30-minute procedure, a surgeon cuts the tubes that transport sperm within the male reproductive system. This procedure doesn’t affect a man’s sexual health and it's extremely effective in preventing pregnancy. It’s considered a permanent form of birth control because it is not easily reversible.