How Primary Care Doctors Can Help Men Manage Their Sexual Health

Why sexual health is so important

What is sexual health?

Sexual health encompasses a combination of both physical and psychological factors that allow for capable and confident participation in an enjoyable sex life. Though some may think it is only about the presence or absence of sexually transmitted diseases, men's sexual health is multifaceted by definition. It includes libido, penile health, erectile function and ejaculation, reproductive health, and performance and satisfaction. Physiology plays a key role, but so do emotional, social and mental health.

Read on to learn about common sexual issues among men - including impotence, erectile dysfunction, penile lumps and more - and find out how you can maintain your sexual health by working with your primary care physician.

How sexual health impacts your overall health

Sexual health is important to men’s overall wellbeing, including physical, mental, emotional and social health. Sexually transmitted infections (STIs) can be both physically and emotionally painful and have the potential to cause serious long-term health effects. For many men, healthy sexual functioning is not just about the ability to perform well sexually, but to feel safe, satisfied, loved, confident and fulfilled.

Depression, anxiety and other mental health struggles can overshadow our ability to relax, be present and enjoy sex. Conversely, anxiety about our sexual health and capabilities can lead to issues like stress and depression.

What it means to have sexual health dysfunction

Sexual health dysfunction occurs when one's sexual function is impaired by one or more of a variety of sexual issues. These include:

• Erectile dysfunction (ED): Difficulty achieving or maintaining an erection (the most common sexual health dysfunction for men)
• Loss of libido
• Inability to become aroused
• Premature or painful ejaculation
• Persistent erection
• Dry orgasm - without ejaculation of semen
• Peyronie disease - curved and painful erections

Fast Facts

The Cleveland Clinic’s national MENtion It survey of men’s sexual health concerns found that:

• 32% of men are worried about their sexual health as they age - about the same as those concerned with cancer.
• Men's top three sexual health concerns are ED (44%), loss of sex drive (39%), and low testosterone (36%).
• 58% mistakenly believe low testosterone is the primary cause of ED.
• 71% of men impacted by sexual health issues have been diagnosed with diabetes or cardiovascular disease.
• More than half report not getting regular health screenings, despite ED affecting more than 50% of men over 40, and around 20% experiencing a sexual health issue at some point during their lifetime.
   

Common causes of male sexual health conditions

There are many causes of sexual health dysfunction, from physical sources like injury and surgery to emotional sources like anxiety, stress and PTSD. Read on to learn about some of the most common causes.

Heart disease

Sexual health issues go hand in hand with cardiovascular disease (CVD), and men with heart disease are at greater risk of developing sexual problems. Heart conditions typically cause poor blood circulation, and medications used to treat these conditions often also affect blood circulation. This commonly results in reduced blood flow to the genitals, which can lead to ED. Fatigue, shortness of breath, chest pains and other symptoms of CVD are also shown to impact sexual activity performance and enjoyment.

High blood pressure

Over time, hypertension (high blood pressure) can contribute to plaque build-up that narrows the arteries and decreases blood flow to the penis. This reduced blood flow can result in issues with ejaculation and/or an inability to maintain an erection. Certain blood pressure medications can also adversely impact libido and lower sex drive.

Diabetes

There are several sexual health problems associated with diabetes and high blood sugar, including lowered sexual desire, difficulty achieving orgasm and retrograde ejaculation (also known as dry orgasm), which causes semen to travel backward into the bladder instead of exiting through the urethra.

Drug and alcohol use

Alcohol and illicit drugs can interfere with chemical messengers in the brain that trigger arousal, causing impotence and erectile dysfunction. They can also impact blood flow to the penis and block testosterone production, limiting libido and ability to perform sexually.

Hormone Imbalance

The endocrine system consists of glands and organs that produce hormones for multiple complex body processes. Hormone production abnormalities – most often the result of an underlying condition – can impact men’s sexual health. For example, if the pituitary gland produces too much prolactin, it can cause impotence and lack of libido. This can also result from a decrease or increase of thyroid hormone, prostate cancer hormone treatment and steroid use. Although the relationship is complex and not fully understood, low testosterone (aka hypogonadism) can contribute to ED.

Aging

While older men can still enjoy a satisfying sex life, gradual decreases in sex drive and the ability to have an erection are natural parts of aging, typically occurring between ages 60 and 70. However, these decreases are often symptomatic of underlying conditions like depression or an endocrine disorder that decreases the production of male sex hormones.

Medications

A long list of prescription and over-the-counter medications have potential side effects that can lower libido and impact men’s sexual performance, arousal ability and sex drive. These side effects often lead to drug-induced ED but can also cause painful or persistent erection or painful ejaculation. These include high-blood pressure meds, painkillers, lipid-lowering agents, heartburn medications, antihistamines, and drugs that treat cancer and Parkinson’s disease. (The National Library of Medicine offers a comprehensive list).

Antidepressants are a common culprit causing sexual dysfunction, including decreased desire and sexual excitement, loss of sensation, delayed or decreased orgasm or persistent arousal. Different classes of antidepressants cause this dysfunction in different ways. For example, selective serotonin reuptake inhibitors (SSRIs like Prozac) increase the “happy” hormone serotonin to help alleviate depression and anxiety symptoms, which can somewhat counterintuitively inhibit sex drive and sexual pleasure. Science also theorizes that antidepressants decrease dopamine production, which is needed to feel stimulated.

Cancer treatment

Many cancer treatments, including chemotherapy, radiation, hormone therapy and surgery can impact sexual desire and performance ability. They can alter sex hormone balance, damage blood vessels and nerves, cause scar tissue and necessitate the removal of organs and glands that are vital to sexual health.
 

Signs and symptoms of sexual health dysfunction

Any notable changes that impact intimacy and ability to perform sexually and feel satisfied can be indicators of a sexual health issue for which you may need to seek treatment. They can include the following, many of which are also ED symptoms:

• Loss of interest in sex and lack of libido
• Inability to achieve erection even with desired stimulation and arousal
• Penis pain or anatomical changes
• Testicular pain or swelling
• Inability to achieve orgasm
• Post-intercourse feelings of dissatisfaction
• Weight gain
• Changes in urinary volume or frequency
• Changes to the appearance or color of the penis, including painful or non-painful penile lumps and rashes, penile bruising or penile discomfort
• Increased fatigue
• Loss of appetite
   

Sexual health and your heart

Concerns

Despite the common myth that rigorous sex — especially for older men — can cause a heart attack, the American Heart Association reports this as rare. However, having sex does increase heart rate, so if you suffer from high blood pressure, cardiovascular disease or have had a heart attack or stroke, it’s wise to ask your primary care doctor if you need to take any precautions in your sex life.

Benefits

Positive sexual health can actually benefit and even protect heart health. Having sex is a form of exercise: it can help lower your blood pressure, improve sleep, reduce stress and, most importantly, strengthen your heart muscles. Studies show that men who have satisfying sex twice weekly or more are less likely to suffer a heart attack. Enjoying intimacy that increases relationship bonding can also help reduce loneliness, anxiety and depression, all of which are linked to an increased risk of cardiovascular disease.
 

Treatment

Lifestyle changes

The key to living a healthy lifestyle for improved sexual health is being aware if your sexual health suffers after changing any lifestyle health habits. These lifestyle habits can help you work toward optimal sexual health:

• Maintain a healthy weight: being overweight not only impacts physical ability to perform sex but can also contribute to sexual dysfunction, including ED.
• Exercise regularly: sexual health requires heart strength and stamina. Strive for 150 minutes (2.5 hours) of exercise per week, including two days of strength training exercises if possible.
• Eating a well-balanced diet low in saturated fats and sugar and rich in vegetables, fruits and lean proteins can help prevent hormonal irregularities and metabolic syndrome, which can impact libido and sexual function. Foods high in zinc help regulate testosterone levels; oysters earned their reputation as an aphrodisiac because they have the most zinc of any food, providing 673% of the daily recommended intake for zinc per serving.
• Reduce stress: Stress causes blood flow restriction, including to the genitals and can play a large part in ED. High stress levels have also been found to potentially negate the positive effects of sexual performance medications Cialis and Viagra.
• Drink in moderation: Alcohol is proven to worsen ED in both the short and long term.
• Quit smoking: Studies show that erectile dysfunction correlates proportionally to smoking. Nicotine restricts blood vessels and blood flow, including to the penis, and can damage blood vessels, all adding to the risk of ED.

Medication adjustments

Because many medications — in particular antidepressants and blood pressure management drugs – can have side effects that cause sexual dysfunction, you should be aware of these risks if you take such drugs. If you’re concerned about side effects, talk to your doctor about potentially adjusting your dose or switching to a different prescription. You can also explore the option of being prescribed a sexual health performance medication, such as the “Blue Pill” Viagra, Cialis or Stendra. They work by increasing the body’s production of the chemical nitric oxide, which boosts blood flow to and relaxes muscles in the penis, enabling erection.

Many men want to know the benefits of Viagra vs Cialis. Viagra lasts for four to six hours while Cialis lasts about 36 hours; both work only when a man is already sexually aroused; both are taken about an hour before sex; food may decrease the effectiveness of Viagra but does not affect Cialis; Cialis is also effective for treating benign prostatic hyperplasia (BPH).

Caring for your mental health

Worry, stress and depression can have a negative impact on sexual health, especially performance confidence, so taking care of your mental health is an important aspect of sexual health. Therapy can help you talk through your concerns and issues and unearth potential underlying psychological causes that can be addressed. Sex therapy is a specialized talk therapy conducted by psychologists with expertise in helping people talk through how their physical, emotional and mental issues are negatively impacting their sex life. Sex therapists work with you to develop ways to overcome these issues so you can have a more pleasurable and satisfying sex life and overall sexual health.
 

How your primary care doctor can help you manage your sexual health

To get the best care and start feeling better, be open with your physician about your sexual health concerns. Share your health history, your current lifestyle habits and any specific sexual health-related symptoms you’re experiencing. Discuss any health problems or medication side effects that may be affecting your sexual health, and be open to medication changes and new treatments. The key is to be honest and transparent with your doctor so he or she can guide you to your goal.

Be completely honest with your doctor

Sometimes, it’s tempting to be less than truthful with our doctors, especially when it comes to intimate topics like your sex life. American society does not have a strong history of encouraging open dialogue around sex and sexual health, so it’s common to find it difficult to talk about sex with your doctor. It’s understandable and common to feel embarrassed or even ashamed if you’re struggling with issues related to your sexual health.

But your doctor has seen it all: You won’t be their first patient to struggle with ED or sexual dysfunction. You can also communicate to your doctor that you are anxious or embarrassed about these topics and that you could use reassurance.

Make a list of your questions and concerns

It’s easy to forget important questions at the doctor, especially if your appointment is short or rushed. A simple solution is to write out your questions and concerns ahead of time. You could even keep a list on your phone or a pocket notebook and add to it whenever you think of something else you want to bring up.

If you are planning to make (or have already made) major lifestyle changes, it’s recommended that you check with your doctor to ensure these changes are safe and appropriate for you. Good general questions to ask include:

• What steps do you recommend for managing symptoms?
• Should I be tested for any diseases that can impact sexual health, like heart disease or diabetes?
• Do you have patients who successfully reversed their ED or other sexual dysfunction?
• Is there any medication I should try?
• Are there male sexual health books, podcasts or literature I should check out?
• What lifestyle changes do you recommend?

Bring a spouse or trusted friend

Not everyone knows that you are allowed to bring someone with you when you go to the doctor. Having a confidante by your side can make you feel more secure and help you remember what you want to talk about with your doctor. It also shows your doctor that you have a strong support system and research has shown that strong social and emotional support are associated with better health.

Take notes

Doctor’s appointments can be overwhelming. In order to remember your doctor’s recommendations, it can be helpful to take notes during your appointment. If you bring someone with you, you can ask them ahead of time to take notes for you. You should also get a visit summary from your doctor after each appointment. If you are not sure how to access this summary, ask your doctor or a member of their front desk staff.
 

Conclusion

Sexual health is core to our existence, not only to successfully procreate but for our quality of life. Nurture and treat it with the same importance as your overall physical and mental health and seek help from your primary care physician if you have concerns.
 

FAQs About Men's Sexual Health

Does masturbation cause erectile dysfunction?

The consensus among researchers is that masturbation does not cause erectile dysfunction. An erection may not be possible immediately after masturbating, due to what’s known as the male refractory period.

Is there an injection for erectile dysfunction?

There are three types of ED injection drugs – alprostadil, papaverine and phentolamine – considered potentially effective treatment when oral ED medications are not effective.

What is the latest treatment for erectile dysfunction?

In 2023, the FDA approved the over-the-counter sale of a topical gel for erectile dysfunction called MED3000 (Eroxon), dispensed in single-use tubes for application on the head of the penis.

Can high blood pressure cause erectile dysfunction?

High blood pressure can cause damage to blood vessels which then restricts blood flow, including to the penis, which can increase or cause erectile dysfunction.

What is sexual dysfunction?

Sexual dysfunction includes any of a variety of issues that impairs a man’s ability to achieve erection and enjoy sexual pleasure and satisfaction.

Do penis pumps work?

A penis pump is a hand or battery-operated vacuum pump that attaches over the penis with a securing ring at the base and has been shown to be a helpful temporary treatment for some men suffering from erectile dysfunction.