What are the main types of male sexual dysfunction?
There are several male sexual dysfunctions including erectile dysfunction, premature ejaculation, decreased sex drive, and difficulty ejaculating. These dysfunctions are most often due to a combination of factors, and can be as source of frustration for the man and his partner.
Male sexual dysfunction– what you need to know
Male sexual dysfunctions are characterised by difficulty having sexual relations. They can affect libido, and may underlie difficulty getting or keeping an erection, or reaching orgasm. These dysfunctions can have various causes, which may be organic and/or psychological. As sources of stress and frustration, they may contribute to sexual performance anxiety. In some cases, such dysfunctions may cause the man to have sex less often
The most frequent male sexual dysfunctions concern ejaculation, including:
- premature ejaculation
- anejaculation (i.e. inability to ejaculate)
- retrograde ejaculation.
In addition, particularly with older men, we may speak of erectile dysfunction (impotence) and decreased sex drive.
Psychological factors
Male sexual dysfunction can be caused or amplified by psychological factors. In fact, depression, stress and performance anxiety tend to be contributing factors. Problems in the relationship, such as a quarrel with one’s partner, or the fear of unwanted pregnancy can also be causes.
Moreover, traumatic sexual experiences of any kind can lead to blockage and cause sexual dysfunction. Inadequate sex education and poor knowledge of one’s own body can also contribute.
Premature ejaculation, the most frequent male sexual dysfunction
Characteristics of premature ejaculation
The most frequent male sexual dysfunction, especially under age 30, is premature ejaculation. This concerns 20% to 30% of men at some point in their life. In fact, ejaculating faster than one wants to is so widespread that some men consider themselves premature ejaculators even though they don’t actually fit the medical criteria!
- Ejaculation is considered premature when less than one minute after penetration.
- In 90% of the cases, the man feels unable to control ejaculation
- There are often negative psychological repercussions (e.g. loss of self-confidence, sexual performance anxiety).
Ejaculation often comes faster the first time one has sex, after a period of abstinence, or with a new partner. This is a perfectly normal physical reaction. It is only when the situation persists that we speak of premature ejaculation.
Types of premature ejaculation
Medical science distinguishes among four types of premature ejaculation:
- Primary premature ejaculation: the dysfunction occurs at the start of the man’s sex life and then persists until he finds a suitable treatment.
- Secondary or acquired premature ejaculation: the problem appears abruptly. This is often due to an external cause, such as illness, an emotional shock, or a sudden change in his life.
- Pseudo-premature ejaculation (PPE): ejaculation occurs after a normal IELT (intravaginal ejaculatory latency time of between 5 and 25 minutes). Despite his normalcy, the man believes he ejaculates too soon, and hence develops the same psychological symptoms as a true premature ejaculator. His misconception of sexual performance leads to anxiety.
- Natural premature ejaculation: as explained above, early ejaculation is normal in cases such as the start of one’s sex life or with a new partner. Occasionally, such normal cases may have a lasting negative impact on the man’s psyche, leading to sexual performance anxiety.
Erectile dysfunction (i.e. impotence)
Erectile dysfunction (ED), also known as impotence, is the inability to get and keep an erection firm enough for sex. ED may be occasional or systematic. Occurrence tends to increase with age.
There are two main types of ED:
- Primary ED: erectile dysfunction early in the man’s sex life. It is relatively rare.
- Secondary ED: erectile dysfunction later in the man’s life.
ED is commonly caused by hardening of the arteries, diabetes, or certain medicines. It may occur right after prostate surgery. ED may also stem from psychological blockage such as sexual performance anxiety, depression, fatigue or stress. ED is sometimes associated with specific situations, places or partners. This male sexual dysfunction has been extensively studied and is easily treated. Don’t hesitate to ask your doctor for advice.
Decreased sex drive
Libido tends to decrease as a man ages. It may also decrease due to stress or fatigue. We speak of decreased sex drive when the lack of desire is prolonged. The triggers are most often psychological (e.g. depression, anxiety, problems with one’s partner, trauma). In this case, psychological support is essential.
More rarely, loss of libido may stem from physical causes, such as low testosterone or chronic renal failure. If in doubt, see a physician, who may prescribe tests.
Coital anejaculation
Coital anejaculation is a relatively rare male sexual dysfunction. It is the inability to ejaculate during sex. Whether systematic or frequent, this condition is not associated with erectile dysfunction. Some men with this dysfunction still feel an orgasm even though they do not discharge any semen.
There are three levels of anejaculation.
- Ejaculation never occurs, regardless of the situation, the level of excitement, and the partner. This is called known as chronic anejaculation.
- Ejaculation occurs only during masturbation. This is called psychogenic or situational anejaculation.
- Ejaculation triggers only after very long penetration time.
Situational or psychogenic anejaculation is often linked to negative perception of one’s body, psychological blockage, underarousal, or performance anxiety. For this type of anejaculation, organic causes are unlikely. Psychological treatment is recommended.
Nevertheless, when anejaculation persists, organic causes may be considered, such as illness, hormonal disorder, or substance abuse.
Retrograde ejaculation
Sometimes confused with chronic anejaculation, retrograde ejaculation is when semen is redirected to the bladder. Normally, the bladder sphincter contracts before ejaculation, sealing the bladder, so that semen is discharged via the urethra. Retrograde ejaculation occurs when the bladder sphincter remains open. Although harmless, this male sexual dysfunction may be problematic for those wishing to conceive.
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Sources :
- Wisard, N. Audette, Ejaculation précoce: traitement médicamenteux ou approche sexologique? – Revue médicale Suisse
Anéjaculation : Les causes de ce trouble de l’éjaculation, [sans date]. charlescofr. [en ligne]. [Consulté le 13 juillet 2022]. Disponible à l’adresse: https://www.charles.co/blog/ejaculation-precoce/anejaculation/ Qu’est-ce que l’anéjaculation ? Est-ce fréquent ? L’anéjaculation est-elle un trouble sexuel ? Qui est concerné ? On vous dit tout !
Éjaculation rétrograde – Problèmes de santé de l’homme, [sans date]. Manuels MSD pour le grand public. [en ligne]. [Consulté le 13 juillet 2022]. Disponible à l’adresse: https://www.msdmanuals.com/fr/accueil/probl%C3%A8mes-de-sant%C3%A9-de-l%E2%80%99homme/dysfonction-sexuelle-chez-les-hommes/%C3%A9jaculation-r%C3%A9trograde Éjaculation rétrograde – En savoir plus sur les causes, les symptômes, les diagnostics et les traitements à partir des Manuels MSD, version pour le grand public.
MULHALL, John P., STAHL, Peter J. et STEMBER, Doron S., 2014. Anejaculation. In : MULHALL, John P, STAHL, Peter J. et STEMBER, Doron S., Clinical Care Pathways in Andrology. [en ligne]. New York, NY : Springer New York. pp. 11‑16. [Consulté le 13 juillet 2022]. ISBN 978-1-4614-6692-5.
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RIGOT, J.-M., MARCELLI, F. et GIULIANO, F., 2013. Troubles de l’éjaculation à l’exception de l’éjaculation prématurée, troubles de l’orgasme. Progrès en Urologie. juillet 2013. Vol. 23, n° 9, pp. 657‑663. DOI 10.1016/j.purol.2013.01.011.