Nowadays, with the increase in life expectancy, people want to preserve their sexual activities at later ages. In this regard, the need for centers dealing with men’s sexual health and sexual problems and experts interested in this field is increasing. Old age alone does not negatively affect sexual functions or sexual life does not end with old age. With a healthy life, it is possible to continue sexual error until old age. In this article, as someone who has been interested in men’s sexual health and sexual problems for a long time, I will talk about common sexual problems in men.

Common sexual problems in men

For a healthy sexual intercourse, both the man’s and the woman’s side must be healthy. For a healthy sexual life, it is not enough for a man or woman to be healthy. Sexual problems that men frequently encounter in varying degrees in their lives are as follows:

• Loss of sexual desire
• Inability to initiate or maintain an erection.
• Early or late orgasm
• Inability to orgasm
• Retrograde ejaculation: It is the situation where semen cannot be expelled after intercourse, leaks back into the bladder and then comes out with urine. It may occur due to damage to the nerves related to ejaculation (such as diabetes), bladder neck and prostate surgery, and some medications used in the treatment of benign prostate.
• Penile deformity (bending), such as Peyronie’s disease

Aging and sex (aging and sexual life)

Serious changes in sexual desire and performance occur due to aging. The onset of erection occurs later in older ages, more local stimulation is needed to achieve an erection in the penis, and the ability to maintain an erection for a long time also decreases with age. More time is needed for the second erection after orgasm. If more serious problems arise, it is definitely beneficial to see a specialist Urologist.

Although sexual functions decrease with aging, their treatment is possible. Getting older is not the end of sexual life. With a healthy life, sexual life is possible after the age of 70-80. A healthy life is very important for a healthy sexual life until old age. If men exercise regularly, eat healthy, and do not use alcohol and cigarettes, their sexual lives will be healthier and more regular.

Supportive treatments are also very important for patients who have erection problems in older ages. Support products and drugs that help erection (PDE5i) can be taken under the supervision of a doctor. If patients do not benefit from existing treatments, then penile prosthesis surgery (penile prosthesis implantation) is a suitable option. Penile prostheses are mainly of two types: Malleable, that is, one-piece and permanently erect prosthesis, and three-piece inflatable prostheses. The one suitable for the patient can be worn. A high level of satisfaction was reported in patients and their partners after penile prosthesis surgery.

We can summarize the changes that may occur with aging as follows:

• The onset of erection occurs later in older ages
• More local stimulation is needed for erection to occur
• The ability to maintain an erection for a long time decreases with age
• More time is needed for the second erection after orgasm

Diseases negatively affect sexual functions

Erectile dysfunction in men is often caused by organic reasons. In other words, the causes of sexual dysfunctions are often caused by some diseases. In the past, most causes of erection problems were considered psychogenic, whereas today the cause is often due to organic causes. Some diseases, known as systemic diseases, affect sexual functions in men. The important and common of these diseases are:

• Cardiovascular diseases
• Diabetes
• Hormonal imbalance
• Nervous system diseases (such as multiple sclerosis, Parkinson’s disease)
• Obesity (fatness)
• Hypertension
• High cholesterol
• Cardiovascular diseases
• Drugs used to treat depression

It is possible to prevent or delay sexual dysfunctions by treating or regular control of these diseases. Treatment and follow-up of those with systemic diseases by the relevant specialist is very important. Depending on the underlying disease, sexual problems may occur earlier and have a more severe course. Supportive treatments should be applied to patients depending on the degree of erectile dysfunction. Oral treatments, ESWT treatment, and penile injection treatment are applied to patients with mild to moderate problems. If there are hormonal disorders, treatments are given accordingly. In more serious cases, penile prosthesis surgery is performed as the last option.

Urological diseases associated with male sexual health

In addition to cardiovascular diseases and endocrine system diseases that negatively affect male sexual health, there are also some urological diseases. As a result of detailed evaluation of the patients, if there are such problems, they must be treated. Some urological diseases that negatively affect the sexual life of men and need to be treated are listed below:

• Varicocele
• •Sexually transmitted diseases
• Penis and foreskin diseases
• Testicular diseases
• Hydrocele, spermatocele,
• Testicular and epididymis infections
• Chronic prostatitis
• Urethral diseases (such as urethral stricture)
• Male infertility

Effects on lifestyle and sexual functions

Lifestyle is very important for a healthy sexual life. People who pay attention to their lifestyle have better general and sexual health. When it comes to lifestyle, we can list the main issues that come to mind and need to be considered as follows:

• Excessive smoking
• Excessive alcohol use
• A sedentary life (still life)
• A stress-free life

Excessive alcohol use, smoking, a sedentary, stressful life are serious risk factors for cardiovascular diseases and general health. These also negatively affect sexual life. In this regard, we recommend our patients not to smoke or consume alcohol or to reduce it significantly. Obesity (overweight) is an important health problem in our age. It poses a serious risk for cardiovascular diseases and sexual health. It is possible to prevent this problem with regular exercise and a healthy and balanced diet. We recommend the Mediterranean diet to our patients because it has a positive effect on sexual functions.

Effects of mental and emotional problems on sexual life

Mental and emotional problems (spiritual problems) negatively affect sexual health in both men and women. It is a fact that sexual life is negatively affected today due to the work environment and family problems. Patients in this situation must be evaluated by a relevant specialist. The main treatment for the problem is to eliminate the cause. Mental and emotional problems that can often cause sexual problems include:

• Stress
• Anxiety
• Depression
• Doubts: whether there will be an erection or not, etc.
• Fears: The possibility of the other party getting pregnant, etc.
• Traumatic sexual experiences

Which departments does sexual dysfunction concern?

Patients with sexual dysfunction should be evaluated by a Urologist. A Urologist, especially one experienced in the field of Andrology, evaluates these patients in detail and plans the appropriate treatment. In addition to urology, sometimes these patients need to be evaluated by other medical disciplines. In general, male sexual dysfunction concerns the following fields of medicine:

• Urology
• Psychiatry
• Cardiology (cardiovascular diseases)
• Endocrinology

Chech up in people with sexual dysfunction

Patients complaining of sexual dysfunction should be evaluated with radiological and biochemical tests along with urological examination. These tests may vary depending on the degree of the disease. The tests that should be requested for these patients are as follows:

• Fasting blood sugar
• Hormones (Testosterone, FSH, LH, prolactin)
• Liver function tests
• Kidney function tests
• Lipid profile
• Routine blood tests
• Vitamin B12
• Vitamin D3
• Penile color doppler ultrasonography (penile color doppler USG)

Sexual dysfunction treatment options

Sexual dysfunctions cover a broad spectrum. Many problems, from psychological factors to organic causes, negatively affect sexual functions. The definitive and most effective treatment of the problem is to identify the cause and apply the correct treatment. Treatment of sexual problems concerns many medical fields, especially Urology. Treatment varies depending on the cause and the extent of the disease. Treatment may range from simple lifestyle changes to surgery. What kind of treatment will be given to which patient is determined as a result of detailed evaluation. In general, we can list the treatment principles for sexual dysfunction in men as follows:

• Treatment of heart disease, diabetes, obesity and depression
• Lifestyle change: Cutting out excessive alcohol and smoking, regular exercise if sedentary lifestyle.
• Consultation from relevant departments if there is anxiety, depression, stress or fear.
• Oral treatments such as Cialis, Levitra and Viagra are the first choice
• Penile injection treatments
• Testosterone replacement therapy: If there is hypogonadism, that is, low testosterone level, this must be corrected.
• Vacuum device: It is a cylindrical device that is placed inside the penis and provides erection with negative pressure.
• Penile prosthesis and surgery: Penile prosthesis is the last option for men with erection problems. In cases that do not respond to oral drug treatments and other options, a surgical prosthesis should be placed on the penis.
• Treatment of penile deformity: If there is penile curvature and plaque, that is, deformity, it should be corrected surgically. This condition is often seen in Peyronie’s disease. If the penile deformity is serious enough to prevent intercourse and the patient is not happy with this situation, the deformity must be corrected with surgery. In addition, congenital penile curvature also causes curvature in the penis. This is a disease that can be corrected with surgery.
• Other treatment options

In summary: Sexual dysfunction in men is one of the problems we frequently encounter. The problem may be due to many reasons. The real cause must be revealed and effective treatment must be carried out. Such disorders need to be treated by experts in their field. We have been successfully treating these patients for a long time in our center.

Prof. Dr. Emin ÖZBEK

Urology Specialist

Istanbul- TURKEY