Erectile Dysfunction (ED)

What it is

The persistent inability to achieve or maintain an erection firm enough for satisfactory sexual activity.

Causes:

• Psychological: Stress, anxiety, depression, relationship issues

• Physical: Diabetes, hypertension, high cholesterol, obesity, smoking

• Hormonal imbalances

• Side effects of certain medications

• Vascular or neurological conditions

Treatment:

• Medications: Phosphodiesterase inhibitors like sildenafil or tadalafil

• Injections

• Counseling: Sex therapy or psychotherapy to address underlying psychological factors

• Lifestyle Changes: Weight loss, quitting smoking, regular exercise

• Management of underlying conditions like diabetes or cardiovascular disease

• Vacuum erection devices or penile injections in resistant cases

Premature Ejaculation (PE)

What it is

Ejaculation that occurs sooner than desired, often within one minute of penetration, leading to dissatisfaction or distress.

Types:

• Lifelong (primary) PE

• Acquired (secondary) PE due to stress, relationship issues, or medical causes

Treatment:

• Medications: SSRIs (e.g., dapoxetine), topical anesthetic creams to delay sensation

• Behavioral Techniques: Start-stop or squeeze techniques

• Pelvic Floor Exercises: To improve ejaculatory control

• Couples therapy: To address relationship or performance anxiety issues

• Counseling: To address psychological components

Low Sperm Count & Male Infertility

What it is

Difficulty in conceiving a child due to reduced sperm count, motility, or morphology.

Causes:

• Hormonal imbalances (e.g., low testosterone)

• Varicocele (enlarged veins in the scrotum)

• Infections or STIs

• Lifestyle factors: Alcohol, tobacco, heat exposure (e.g., frequent sauna), poor diet

• Genetic or anatomical issues

Treatment:

• Nutritional Supplements: Antioxidants like zinc, selenium, L-carnitine, CoQ10

• Hormonal Therapy: When endocrine issues are detected

• Lifestyle Changes: Healthy diet, weight loss, reduced alcohol and tobacco

• Surgical Treatment: For varicocele or blockages

• Assisted Reproductive Techniques (ART): Like IUI or IVF when required

Loss of Libido / Sexual Weakness

What it is

Decreased interest or desire in sexual activity; can also involve reduced sexual performance or stamina.

Causes:

• Chronic stress, anxiety, depression

• Low testosterone levels

• Poor sleep, fatigue

• Relationship problems

• Chronic illnesses like diabetes, thyroid dysfunction

Treatment:

• Holistic Approach: Tailored sexual health plans combining physical and psychological care

• Hormonal Evaluation & Replacement: Testosterone therapy when indicated

• Lifestyle Optimization: Sleep hygiene, stress management, physical activity

• Psychosexual Counseling: Individual or couples sessions to address psychological and relational barriers

• Medications: When applicable, to support arousal and energy

Peyronie’s Disease

What it is

A condition involving the development of fibrous scar tissue inside the penis, causing curved and sometimes painful erections.

Symptoms:

• Noticeable bend or curvature during erection

• Pain during erection or intercourse

• Erectile dysfunction in some cases

• Shortening or narrowing of the penis

Causes:

Often unknown, but can follow injury or repeated trauma to the penis during sex.

Treatment:

• Oral Medications: Like vitamin E, potassium para-aminobenzoate (Potaba)

• Injection Therapy: Collagenase clostridium histolyticum to break down scar tissue

• Penile Traction Therapy: Devices to gradually reduce curvature

• Surgery: In severe or refractory cases (e.g., plaque excision and grafting, penile implants)

Excessive Masturbation / Behavioral Concerns

What it is

When the frequency or compulsive nature of masturbation interferes with daily life, relationships, or causes distress. It may be linked to porn addiction, low self-esteem, or loneliness.

Signs it may be problematic:

• Inability to stop despite desire to cut down

• Neglecting responsibilities or social life

• Associated with guilt, shame, or emotional distress

• Erectile dysfunction or delayed ejaculation with a partner

Treatment:

• Psychological Counseling: Cognitive Behavioral Therapy (CBT) to address compulsive patterns and triggers

• Sex Therapy: To re-establish healthy sexual patterns and self-control

• Pharmacotherapy: SSRIs or impulse-control medications in select cases

• Supportive Interventions: Journaling, mindfulness, setting goals and limits

Delayed Ejaculation

What it is

Difficulty or inability to ejaculate despite adequate sexual stimulation and desire.

Causes:

• Psychological: Anxiety, performance pressure

• Medical: Diabetes, neurological conditions

• Medications: Especially antidepressants (SSRIs)

• Substance use or withdrawal

Treatment:

• Addressing underlying medical or psychological causes

• Medication adjustment

• Behavioral therapy and sex therapy

Retrograde Ejaculation

What it is

Semen enters the bladder instead of exiting through the penis during orgasm.

Causes:

• Diabetes-induced nerve damage

• Prostate or bladder surgery

• Certain medications (e.g., alpha-blockers)

Symptoms:

Dry orgasm, cloudy urine post-ejaculation, infertility

Treatment:

• Medication adjustment

• Alpha-agonist medications

• Fertility assistance if conception is desired

Anorgasmia (Orgasmic Dysfunction)

What it is

Inability to reach orgasm despite stimulation and desire.

Causes:

• Psychological: Anxiety, trauma, depression

• Medications (e.g., SSRIs)

• Neurological disorders or hormonal imbalances

Treatment:

• Psychological therapy

• Medication review and substitution

• Sensate focus therapy

Sexual Aversion Disorder

What it is

Extreme fear or disgust toward sexual activity, leading to avoidance.

Causes:

• History of sexual trauma or negative sexual experiences

• Anxiety disorders

• Cultural or religious conditioning

Treatment:

• Trauma-informed psychotherapy

• Gradual desensitization

• Couples counseling when needed

Compulsive Sexual Behavior / Hypersexuality

What it is:

Repeated, uncontrollable sexual urges or behaviors that interfere with daily life.

Symptoms:

• Excessive pornography use

• Unsafe sex or multiple partners despite risk

• Interference with work, relationships

Treatment:

• Cognitive Behavioral Therapy (CBT)

• Impulse control strategies

• Medication (e.g., SSRIs, naltrexone)

Nocturnal Emissions Issues (Wet Dreams)

While normal in adolescence and young adulthood, excessive or distressing nocturnal emissions may concern some men, especially in conservative societies.

Management:

• Education and reassurance

• Reducing sexual anxiety or guilt

• Sleep hygiene and behavioral techniques if distressing