Sexual Problems
Question: I am a healthy middle-age male, but just
don't have the same interest in sex that I used to. Does sexual drive decline
as men get older?
Answer: Many men report decreased interest in
sex as they age. In a national survey of adult sexual behavior, 14-17% of men
reported lack of interest in sex. Men over age 40 were two to three times as
likely to report lack of interest compared to men under age 30.
Sexual desire
("libido") is one of several ingredients of male sexual function. The
others include the ability to have and sustain an erection, to ejaculate, and
to have an orgasm. Many factors influence sexual desire. An adequate level of
the male sex hormone testosterone is necessary for normal libido. Many
medications can decrease sexual interest, including diuretics, antidepressants,
blood pressure medications, and some medications for treating ulcers.
Nonprescription drugs, including alcohol, depress libido.
Psychological factors are
thought to play a prominent role in decreased sexual desire. Conflict with your
sexual partner may decrease sexual interest and performance. Performance
anxiety commonly interferes with libido. Men who report sudden onset of sexual
problems often suffer from performance anxiety, since most organic causes of
sexual dysfunction develop gradually. Many men report decreased libido because
they are distracted by financial, work, or other sources of stress. Finally,
depression reduces sexual drive.
It is often difficult to sort
out psychological from organic sources of sexual dysfunction. Failure to
sustain an erection sufficient for intercourse can be due to a variety of
organic problems, including diabetes, atherosclerosis, hormonal problems,
medications. This, in turn, may lead to performance anxiety and depression.
Once it was thought that most cases of impotence derived from psychological
rather than organic causes, but now we know that the reverse is often the case.
If libido is a problem for you,
talk to your doctor. He or she should do an assessment that may include
laboratory studies, a physical examination, and screening for depression. If
libido and erectile problems occur together, your doctor may recommend that you
see a urologist with expertise in this area. If your doctor suspects that
psychological issues play the prominent role, he or she may recommend
evaluation by a mental health professional.
Question: Can drinking alcohol for a long time
make me impotent?
Answer: Yes. Achieving and maintaining an
erection for satisfying intercourse requires four major elements to work
together: psychological arousal, good blood circulation to the penis, the
proper male hormonal balance, and healthy nerves to conduct all the necessary
reflexes. Alcohol consumption in excess can impair any of these components:
- Psychological: Alcohol is a drug that can diminish sexual
desire and decrease the level of arousal.
- Blood circulation: Prolonged use of alcohol is linked to
cardiomyopathy, which is a disease where the muscular contractions of the
heart become weak and inefficient. Alcohol consumption is also linked to
hypertension, which is abnormally high blood pressure. Hypertension over
time can cause damage to blood vessels anywhere in the body, including the
vessels supplying the penis.
- Hormonal: A major life-threatening consequence of prolonged heavy alcohol
use is liver damage. The liver plays an important role in synthesizing the
important "building block" compounds used by the sexual organs
to make both male and female hormones.
- Neurological: A complicated set of reflexes controls the frequency and duration
of erections. Alcohol is toxic to nerves and can interfere with the chain
of nervous impulses that lead to erections.
Thus, a thorough search for the cause of impotence
includes questions about how much alcohol you drink and how often.
Question:My trouble is not getting an erection,
but maintaining one during intercourse. Is this a symptom of erectile
dysfunction?
Answer: Yes. In fact, the medical definition of
erectile dysfunction is failure to maintain an erection sufficient for
intercourse. This problem--which can be a considerable source of worry and
embarrassment--is very common. According to one study, 40% of men have sexual
problems after age 40, and an additional 10 % say they have decreased interest
or sexual performance with each passing decade.
A variety of things can cause
erectile dysfunction, including poor circulation, neurological problems,
hormone deficiencies, and psychological factors. Psychological factors often
are difficult to isolate because depression and anxiety can both cause and
result from sexual difficulties. Prescription drugs, especially those used to
treat high blood pressure, depression, and ulcers, are a major cause of
erectile dysfunction. Tobacco and alcohol can also have a negative effect on a
man's sexual performance.
In your case, the ability to get
an erection is good news since it implies that your plumbing and electrical
system are at least partly in order. To understand the cause of the problem and
identify an appropriate treatment, talk to your internist or a urologist who
specializes in male sexual disorders.
Question: Does dieting to lose weight affect male
sexual performance?
Answer: Yes. A well-planned, reduced-calorie
diet can enhance a man's sexual performance, whereas a poorly balanced
"fad" or "crash" diet can cause temporary impotence.
Being overweight can contribute
to impotence by upsetting hormone balance and interfering with circulation.
Regular exercise and proper nutrition can help maintain male hormone levels,
improve blood flow, and boost mood, which are key to enhancing sexual
performance. A good diet contains foods from all food groups and allows for
15-30% of calories from fat. The fat should preferably be the monounsaturated
type, which is found in nuts, avocados, olives, and fish. Weight loss should be
gradual to be safe: About 1-2 pounds a week is reasonable.
Fad diets that
involve periods of fasting, restrict foods from certain food groups, or
emphasize one specific food can decrease sexual performance. These diets may
give short-term satisfaction by achieving quick initial weight loss, but this
loss is hard to maintain. Testosterone levels drop when people are on diets
where less than 10% of calories are from fat. Testosterone is the major male
hormone, and low levels cause decreased sexual desire. A poorly balanced diet
may lack nutrients like calcium, potassium, magnesium, and vitamins. All of
these need to be consumed daily to maintain general health and sexual function.
Finally, trying to stick to an unsatisfying diet is very stressful
psychologically. Psychological stress can play a large role in causing
impotence.
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