In men, sexual dysfunction refers to the difficulty in having sex. Sexual dysfunction encompasses several disorders that affect the sex drive (libido), the ability to achieve or maintain an erection (erectile dysfunction), the ability to ejaculate (premature ejaculation) and the inability to reach an orgasm.
Sexual dysfunction may result from physical or psychological factors. Many sexual problems result from a combination of physical and psychological factors.
A physical problem can lead to psychological problems (such as anxiety, depression or stress) which in turn can aggravate the physical problem. Sometimes men press themselves or feel pressured by their partner to perform well and are distressed when they fail (performance anxiety). Performance anxiety can cause problems and further worsen a man’s ability to enjoy sex.
Premature ejaculation is the most common sexual dysfunction presented by men. A ejaculation before or shortly after penetrating the vagina. Cumshaw into the bladder (retrograde ejaculation) and the inability to ejaculate (anejaculation).
Erectile dysfunction Decreased libido are also very common in middle-aged and elderly men, and affects many men.
Sexual Activity and Heart Disease
Sexual activity is generally less stressful than moderate to heavy physical activity and is therefore generally safe for men with heart disease. Although the risk of a heart attack is higher during sexual activity than during rest, the risk is still very low during sexual activity.
However, sexually active in men with cardiac and cardiovascular system disorders (including angina, high blood pressure, heart failure, abnormal heart rhythms, and aortic valve obstruction) need to be accompanied by your doctor.
Sexual activity is usually safe if the disease is mild, causes few symptoms, and if blood pressure is normal. If the disease is moderate in severity or if the man has other disorders that make heart attack likely, tests may be needed to determine how safe sexual activity is.
If the disease is severe or if the man has an enlarged heart that blocks the outflow of blood from the left ventricle (obstructive cardiomyopathy), sexual activity should be delayed until treatment reduces the severity of symptoms.
People should ask their doctor how long to wait after a heart attack before start having again sexual activity. The American Heart Association advises resuming sexual activity as early as one week after a heart attack if a person can perform mild to moderate physical activity without chest pain or shortness of breath.
The use of sildenafil, vardenafil, avanafil or tadalafil is dangerous in men taking nitroglycerin to combat sexual problems, as blood pressure can be dangerously low.
Most often, tests to determine the safety of sexual activity involve monitoring the heart for signs of poor blood supply, while the man exercises on a treadmill. If blood supply is adequate during exercise, a heart attack is unlikely to occur during sexual activity.
Normal Male Sexual Function
Normal sexual function is a complex interaction involving both mind and body. The nervous, circulatory and endocrine (hormonal) systems interact with the mind to produce a sexual response. A delicate and balanced interaction between these systems controls the male sexual response.
Desire (also called libido) is the desire to initiate sexual activity. It can be triggered by thoughts, words, images, smell or touch. Desire leads to the first stage of the sexual response cycle, arousal.
Sexual arousal is the next step.
During arousal, the brain sends nerve signals through the spinal cord to the penis. Arteries that supply blood to the erectile tissues (corpora cavernosa and spongy body) respond by opening wide (relaxation and dilation). The dilated arteries dramatically increase blood flow to these areas, which become full of blood and expand.
This expansion exerts a pressure that compresses the veins that normally drain the blood from the penis, slowing blood flow and thus raising the blood pressure inside the penis. This high pressure on the penis results in one full erection. In addition, muscle tension increases throughout the body.
At the plateau stage, arousal and muscle tension are intensified.
Orgasm is the peak or climax of sexual arousal. In orgasm, muscle tension throughout the body increases further and the pelvic muscles contract, which is followed by the ejaculation.
Ejaculation occurs when nerves stimulate muscle contractions in the male reproductive organs: the seminal vesicles, the prostate gland, the epididymis ducts, and the vas deferens. These contractions force semen into the urethra. The contraction of the muscles around the urethra further drives semen out of the penis. The bladder neck also contracts, preventing semen from returning to the bladder.
Although ejaculation and orgasm often occur almost simultaneously, they are separate events. Rarely, ejaculation can occur without orgasm. In addition, orgasm may occur in the absence of ejaculation, especially before puberty, or as a side effect of certain medications (such as antidepressants) or after surgery (removal of the colon or prostate gland). The orgasm is usually highly pleasurable.
In the resolution phase, the body returns to a state of no arousal.
As soon as ejaculation or orgasm occurs, the penile arteries contract and the smooth muscle of the corpora cavernosa and spongy body contracts, which reduces blood flow, increases blood output and makes the penis flaccid.
After orgasm, it’s not possible to have an erection for a period of time (refractory period), which can take anywhere from 30 minutes to two hours. Usually only 30 minutes or less in young men, but longer in older men. The time between erections usually increases as men get older, and the likelihood of suffering from erectile dysfunction also increases. On the other hand, premature ejaculation tends to decrease with age.