Male Sexual Dysfunction
Male sexual dysfunction is a series of conditions, most notably including erectile dysfunction (ED), Peyronie’s disease (PD), and premature ejaculation (PE), defined by impaired sexual functioning. The prevalence of male sexual dysfunction increases with age and is relatively high with greater than 50% of men aged 40 to 70 describing some degree of erectile dysfunction. Risk factors for male sexual dysfunction include age, diabetes mellitus (DM), cancer, stroke, hypertension, penile trauma, depression, anxiety, and disturbance in central serotonin neurotransmission and 5-HT postsynaptic receptor functioning. Sexual questionnaires including the International Index of Erectile Dysfunction, Sexual Health Inventory for Men, and the Premature Ejaculation Diagnostic Tool are useful in screening for these disorders. Focused history and physical can establish diagnoses. For a condition to be diagnosed as male sexual dysfunction, the patient or their partner must view their sexual functioning as impaired. Treatment of male sexual dysfunction is etiology dependent. For ED, first-line therapy is a phosphodiesterase-5 inhibitor or mental health care for psychogenic ED. More complicated cases may be treated with injections, surgery, or shockwave therapy. PD is either treated with medications for pain management, collagenase clostridium histolyticum injection, corpoplasty, plication, or shockwave therapy. PE may be treated behaviorally or with SSRIs as first line medication.
1. Stringer JD. Gender and Sexual Health: Sexual Dysfunction. FP Essent. 2016;449:18-26.
2. Rew KT. Men's Health: Male Sexual Dysfunction. FP Essent. 2021;503(503):28-33.
3. Irwin GM. Erectile Dysfunction. Prim Care. 2019;46(2):249-255. doi:10.1016/j.pop.2019.02.006
4. Jenkins LC, Mulhall JP. Delayed orgasm and anorgasmia. Fertil Steril. 2015;104(5):1082-1088. doi:10.1016/j.fertnstert.2015.09.029
5. McCabe MP, Sharlip ID, Lewis R, et al. Incidence and Prevalence of Sexual Dysfunction in Women and Men: A Consensus Statement from the Fourth International Consultation on Sexual Medicine 2015. The Journal of Sexual Medicine. 2016;13(2):144-152. doi:10.1016/j.jsxm.2015.12.034
6. Irfan M, Hussain NHN, Noor NM, Mohamed M, Sidi H, Ismail SB. Epidemiology of Male Sexual Dysfunction in Asian and European Regions: A Systematic Review. Am J Mens Health. 2020;14(4). doi:10.1177/1557988320937200
7. Nguyen HMT, Gabrielson AT, Hellstrom WJG. Erectile Dysfunction in Young Men-A Review of the Prevalence and Risk Factors. Sex Med Rev. 2017;5(4):508-520. doi:10.1016/j.sxmr.2017.05.004
8. Beutel ME, Weidner W, Brahler E. Epidemiology of sexual dysfunction in the male population. Andrologia. 2006;38(4):115-121. doi:10.1111/j.1439-0272.2006.00730.x
9. Lewis RW, Fugl-Meyer KS, Corona G, et al. ORIGNAL ARTICLES: Definitions/Epidemiology/Risk Factors for Sexual Dysfunction. The Journal of Sexual Medicine. 2010;7(4):1598-1607. doi:10.1111/j.1743-6109.2010.01778.x
10. Yafi FA, Jenkins L, Albersen M, et al. Erectile dysfunction. Nat Rev Dis Primers. 2016;2(1):16003. doi:10.1038/nrdp.2016.3
11. Najari BB, Kashanian JA. Erectile Dysfunction. JAMA. 2016;316(17):1838. doi:10.1001/jama.2016.12284
12. Ferro JKDO, Lemos A, Silva CP da, et al. Predictive Factors of Male Sexual Dysfunction after Traumatic Spinal Cord Injury. Spine(Phila Pa 1976). 2019;44(17):1228-1237. doi:10.1097/brs.0000000000003049
13. Wincze JP. Psychosocial aspects of ejaculatory dysfunction and male reproduction. Fertility and Sterility. 2015;104(5):1089-1094. doi:10.1016/j.fertnst ert.2015.07.1155
14. Burnett AL, Nehra A, Breau RH, et al. Erectile Dysfunction: AUA Guideline. Journal of Urology. 2018;200(3):633-641. doi:10.1016/j.juro.2018.05.004
15. Razdan S, Greer AB, Patel A, Alameddine M, Jue JS, Ramasamy R. Effect of prescription medications on erectile dysfunction. Postgrad Med J. 2018;94(1109):171-178. doi:10.1136/postgradmedj-2017-135233
16. Albersen M, Mwamukonda KB, Shindel AW, Lue TF. Evaluation and Treatment of Erectile Dysfunction. Medical Clinics of North America. 2011;95(1):201-212. doi:10.1016/j.mcna.2010.08.016
17. Althof SE, Rosen RC, Perelman MA, Rubio-Aurioles E. Standard Operating Procedures for Taking a Sexual History. The Journal of Sexual Medicine. 2013;10(1):26-35. doi:10.1111/j.1743-6109.2012.02823.X
18. Nehra A, Alterowitz R, Culkin DJ, et al. Peyronie's Disease: AUA Guideline. Journal of Urology. 2015;194(3):745-753. doi:10.1016/j.juro.2015.05.098
19. Bilgutay AN, Pastuszak AW. Peyronie's Disease: A Review of Etiology, Diagnosis, and Management. Curr Sex Health Rep. 2015;7(2):117-131. doi:10.1007/s11930-015-0045-y
20. Ziegelmann MJ, Bajic P, Levine LA. Peyronie's disease: Contemporary evaluation and management. Int J Urol. 2020;27(6):504-516. doi:10.1111/iju.14230
21. Pawlowska E, Bianek-Bodzak A. Imaging modalities and clinical assesment in men affected with Peyronie's disease. Pol J Radiol. 2011;76(3):33-37.
22. Smith JF, Walsh TJ, Lue TF. Peyronie's disease: a critical appraisal of current diagnosis and treatment. Int J Impot Res. 2008;20(5):445-459. doi:10.1038/ijir.2008.30
23. Kadioglu A, Tefekli A, Erol H, Cayan S, Kandirali E. Color Doppler ultrasound assessment of penile vascular system in men with Peyronie's disease. Int J Impot Res. 2000;12(5):263-267. doi:10.1038/sj.ijir.3900569
24. di Maida F, Cito G, Lambertini L, et al. The Natural History of Peyronie's Disease. World J Mens Health. 2021;39(3):399. doi:10.5534/wjmh.200065
25. Sexual Dysfunctions. In: Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association;2013. doi:10.1176/appi.books.9780890425596.dsm13
26. Glina S, Cohen DJ, Vieira M. Diagnosis of erectile dysfunction. Current Opinion in Psychiatry. 2014;27(6):394-399. doi:10.1097/yco.0000000000000097
27. Thompson IM, Tangen CM, Goodman PJ, Probstfield JL, Moinpour CM, Coltman CA. Erectile Dysfunction and Subsequent Cardiovascular Disease. JAMA. 2005;294(23):2996. doi:10.1001/jama.294.23.2996
28. Liu MC, Chang ML, Wang YC, Chen WH, Wu CC, Yeh SD. Revisiting the Regenerative Therapeutic Advances Towards Erectile Dysfunction. Cells. 2020;9(5):1250. doi:10.3390/cells9051250
29. Hawksworth DJ, Burnett AL. Pharmacotherapeutic Management of Erectile Dysfunction. Clin Pharmacol Ther. 2015;98(6):602-610. doi:10.1002/cpt.261
30. Lowe G, Bahnson R. Non-invasive management of primary phosphodiesterase type 5 inhibitor failure in patients with erectile dysfunction. Therapeutic Advances in Urology. 2009;1(5):235-242. doi:10.1177/1756287210362069
31. Irwin GM. Erectile Dysfunction. Primary Care: Clinics in Office Practice. 2019;46(2):249-255. doi:10.1016/j.pop.2019.02.006
32. Yafi FA, Jenkins L, Albersen M, et al. Erectile dysfunction. Nat Rev Dis Primers. 2016;2(1):16003. doi:10.1038/nrdp.2016.3
33. Raheem OA, Natale C, Dick B, et al. Novel Treatments of Erectile Dysfunction: Review of the Current Literature. Sexual Medicine Reviews. 2021;9(1):123-132. doi:10.1016/j.sxmr.2020.03.005
34. Hansen ST, Lund M, Ostergaard LD, Lund L. Role of regenerative therapies on erectile dysfunction after radical prostatectomy. Int J Impot Res. 2021;33(4):488-496. doi:10.1038/s41443-020-00406-3
35. Alwaal A, Zaid UB, Lin CS, Lue TF. Stem cell treatment of erectile dysfunction. Advanced Drug Delivery Reviews. 2015;82-83:137-144. doi:10.1016/j.a ddr.2014.11.012
36. Nehra A, Alterowitz R, Culkin DJ, et al. Peyronie's disease: AUA guideline. Journal of Urology. 2015;194(3):745-753. doi:10.1016/j.juro.2015.05.098
37. Shindel AW, Althof SE, Carrier S, et al. Disorders of Ejaculation: An AUA/SMSNA Guideline. Journal of Urology. 2022;207(3):504-512. doi:10.1097/ju.0000000000002392
38. Otani T. Clinical review of ejaculatory dysfunction. Reprod Med Biol. 2019;18(4):331-343. doi:10.1002/rmb2.12289
39. Jannini EA, Nappi RE. Couplepause: A New Paradigm in Treating Sexual Dysfunction During Menopause and Andropause. Sexual Medicine Reviews. 2018;6(3):384-395. doi:10.1016/j.sxmr.2017.11.002
40. Gurtner K, Saltzman A, Hebert K, Laborde E. Erectile Dysfunction: A Review of Historical Treatments With a Focus on the Development of the Inflatable Penile Prosthesis. Am J Mens Health. 2017;11(3):479-486. doi:10.1177/1557988315596566
41. Palmisano F, Boeri L, Ievoli R, et al. Ten-year experience with penile prosthetic surgery for the treatment of erectile dysfunction: outcomes of a tertiary referral center and predictors of early prosthetic infection. Asian J Androl. 2022;24(1):32. doi:10.4103/aja.aja_27_21
42. Hsieh CH, Hsu GL, Chang SJ, Yang SSD, Liu SP, Hsieh JT. Surgical niche for the treatment of erectile dysfunction. Int J Urol. 2020;27(2):117-133. doi:10.1111/iju.14157
43. Trost LW, Munarriz R, Wang R, Morey A, Levine L. External Mechanical Devices and Vascular Surgery for Erectile Dysfunction. The Journal of Sexual Medicine. 2016;13(11):1579-1617. doi:10.1016/j.jsxm.2016.09.008
44. Munarriz R, Thirumavalavan N, Gross MS. Is There a Role for Vascular Surgery in the Contemporary Management of Erectile Dysfunction? Urologic Clinics of North America. 2021;48(4):543-555. doi:10.1016/j.ucl.2021.07.002
45. Sokolakis I, Dimitriadis F, Teo P, Hatzichristodoulou G, Hatzichristou D, Giuliano F. The Basic Science Behind Low-Intensity Extracorporeal Shockwave Therapy for Erectile Dysfunction: A Systematic Scoping Review of Pre-Clinical Studies. The Journal of Sexual Medicine. 2019;16(2):168-194. doi:10.1016/j.jsxm.2018.12.016
46. Porst H. Review of the Current Status of Low Intensity Extracorporeal Shockwave Therapy(Li-ESWT) in Erectile Dysfunction(ED), Peyronie's Disease(PD), and Sexual Rehabilitation After Radical Prostatectomy With Special Focus on Technical Aspects of the Different Marketed ESWT Devices Including Personal Experiences in 350 Patients. Sexual Medicine Reviews. 2021;9(1):93-122. doi:10.1016/j.sxmr.2020.01.006
47. Chen R, McCraw C, Lewis R. Plication procedures-excisional and incisional corporaplasty and imbrication for Peyronie's disease. Transl Androl Urol. 2016;5(3):318-333. doi:10.21037/tau.2016.05.01