Sexual health

Premature ejaculation

A lot of men sometimes ejaculate sooner than they would like. Estimates vary, but around 1 out of 3 men experience premature ejaculation at some time. Usually, premature ejaculation does not need treatment. But if you often ejaculate prematurely — like before starting intercourse or just a minute or two after starting — you can get help.

Premature ejaculation has several possible causes, including:

• Emotional issues like guilt or anxiety
• Low levels of certain brain chemicals
• Being very aroused or stimulated
• Infection of the prostate or urethra

Talk to your doctor if you are concerned. There are several treatments for premature ejaculation. You first might try techniques like stopping sexual stimulation briefly and then restarting it. You also could try using topical creams or condoms to lessen excitement. The U.S. Food and Drug Administration has not approved any medications for premature ejaculation, but your doctor may prescribe antidepressants because a possible side effect is delaying ejaculation.

Open communication with your partner can help with any stress between you. And it can help you figure out ways that you can both achieve satisfaction. Working with a therapist or counselor, either by yourself or as a couple, can be very effective.

Erection problems

Some men have problems getting or keeping an erection. (An erection is when blood fills up the penis, making it firmer and larger.) This problem is called erectile dysfunction, or ED, and sometimes is called impotence. ED is fairly common. In fact, between 15 million and 30 million U.S. men are affected by it. ED can be very upsetting. It can affect self-esteem and cause frustration, anger, and sadness. But there are effective treatments for ED. And counseling can help you and your partner cope with any emotional effects of ED.

Causes of ED include:

• Clogged blood vessels, high blood pressure, and high cholesterol
• Nerve damage from diabetes
• Certain medicines, including some used to treat depression or high blood pressure
• Low testosterone
• Unhealthy habits like smoking, drinking too much alcohol, overeating, and not exercising
• Emotional factors, such as stress or depression

As men get older, ED becomes more common. By age 65, almost 25 percent of men have this problem at least one out of every four times they have sex. But ED is treatable at any age. Your doctor can offer a number of ways to treat ED. If treatment solves your ED, though, you still need to take care of any health issues that may have caused it.

Some men need to try two or three options before they find an ED treatment that works for them. Medication is one popular way to treat ED. Drugs like Viagra increase blood flow to the penis, which helps make an erection possible. Injections to the penis and medicine you put into the tip of your penis also can increase blood flow to it.

Other treatments for ED include a vacuum cylinder and pump you put on your penis to pull blood into it or inflatable rods that are put into the penis through surgery.

You may have heard of herbal products or dietary supplements that claim to treat ED or improve sexual performance. You should beware of these products even if they claim to be “natural.” They can contain dangerous ingredients, including prescription medications that are not identified on the product’s label.

Loss of sexual interest

Your interest in sex, also called libido, can vary over the course of your life. Some men may lose interest in sex during times of stress or illness. Also, your interest might not match that of your partner at times, which is normal in long-term relationships.

Reduced interest in sex can have a number of causes, including:

• A health problem
• Certain medications
• Reduced levels of male hormones
• Emotional or relationship problems

As men age, it is natural to be less interested in sex. But for a healthy man, having no interest in sex is not normal. If you have less interest in sex, talk frankly with your doctor. Treatment can help. It could include medicine, counseling, or both.

Low testosterone

Testosterone is the most important male hormone. It helps maintain sex drive, sperm production, pubic and body hair, muscle, and bone. Lower than normal levels of testosterone can affect a man’s body and mood. Signs of low testosterone in adult men can include:

• Less interest in sex
• Erection problems
• Increased breast size
• Hot flashes
• Problems with memory and concentration
• Mood problems, like irritability and depression
• Smaller and softer testicles
• Loss of muscle strength and weakened bones

Low testosterone levels can have a number of causes, including injury, disease, and certain medications. A gradual decline in testosterone is normal in men as they get older. This is sometimes called aging male syndrome (or andropause) and can cause erection problems and less sex drive. But it is not normal for healthy older men to have no interest in sex. There could be other reasons for these changes.

If you have symptoms of low testosterone, talk to your doctor. You can get your testosterone level checked with a simple blood test. If you do have low testosterone, your doctor will want to find out the underlying cause. Finding the cause can involve many tests. You might want to see a specialist, such as an endocrinologist or urologist.

Some men with low testosterone take testosterone replacement therapy, which they get through a skin patch or other method. But testosterone therapy is not right for everyone, and its use is controversial. One reason is that testosterone therapy has certain risks. Another reason is that experts don’t know exactly what testosterone levels are "normal" as men age. If you have low testosterone, your doctor can help you understand the benefits and risks of treatment so you can decide what’s right for you.

Male infertility

Lots of couples have trouble conceiving a child. About 30 percent of the time, the cause of their infertility is from the man.

The male fertility process involves making mature sperm and getting the sperm to reach and fertilize the egg. For this process to happen, a man must be able to have and keep an erection, have enough sperm, have enough semen to carry the sperm to the egg, and have sperm that are the right shape and move in the right way. A problem in any part of this process can lead to problems conceiving.

Many factors can affect male fertility. Some include:

• Age
• Stress
• Smoking
• Drinking too much alcohol
• Some illegal drugs, like anabolic steroids or artificial testosterone taken to increase muscle mass
• Undescended testicles or damage to the testicles
• Too much heat, like from hot tubs or, possibly, from tight underwear
• Certain medications, such as cancer medications (chemotherapy)
• Exposure to radiation
• Environmental toxins, like pesticides, at work or at home
• Genetic conditions
• Other health problems, including obesity

If your partner has not become pregnant after one year of frequent sex without birth control (or after six months if your partner is 35 or older), talk to your doctor. A semen test, which looks at the health of a man’s semen and sperm, can be a good first step for couples facing fertility problems. That’s because it is much easier and costs less than tests for female fertility. Many couples with fertility problems go on to have healthy pregnancies and babies.

Sexually transmitted infections

A sexually transmitted infection, or STI, is an infection passed from person to person through sexual contact. You can get and pass STIs through vaginal, anal, or oral sex or during genital touching. You or your partner can have an STI and not know it because you may have no symptoms. If you do have symptoms, they might include a discharge from your penis, sores on your penis, pain and swelling in your testicles, and burning in your urethra.

STI rates are very high in the United States, where there are an estimated 19 million new cases each year. HIV is an STI that is especially dangerous. Syphilis, another STI, has been spreading more in recent years, and if untreated, can harm your brain, heart, and other parts of your body.

Certain STIs are more common among men who have sex with men. If you have sex with men, talk to your doctor about steps you can take to protect your health, including getting vaccinated for hepatitis A and hepatitis B.

All men should take steps to lower their risk of STIs. You can:

• Avoid having sex. Abstain from having vaginal, oral, or anal sex.
• Be faithful. Having sex with one uninfected partner who has had sex only with you will keep you safe from STIs.
• Use condoms correctly and every time you have sex. Use male latex condoms for vaginal, anal, or oral sex. Use polyurethane if you or your partner is allergic to latex. “Natural” or lambskin condoms don't protect against STIs. Male condoms are highly protective when used correctly. Female condoms also may offer protection, but more research is necessary. For oral sex, dental dams also might offer some protection.
• Know that certain birth control methods don't protect against STIs. Birth control methods including the pill, shots, implants, IUDs, diaphragms, and spermicides will not protect you from STIs. If your partner uses one of these methods, be sure to also use a latex condom or dental dam correctly every time you have sex.
• Talk with your sex partner(s) about STIs and using condoms before having sex. Setting the ground rules about testing and condom use will avoid future misunderstandings. It's up to you to make sure you are protected.
• Get tested. If either you or your partner has now or has had other sexual partners in the past, get tested for STIs before having sex. If you have an STI, let your sexual partner(s) know so you and your partner(s) can get treatment. Otherwise, the STI can get passed to others or back to you.

How to use a condom correctly

• Keep condoms in a cool, dry place.
• Check to make sure the wrapper isn’t torn. Check the date to make sure the condom is not too old. Open carefully.
• Examine condom: Don't use if it is gummy, brittle, or discolored, or has a tiny hole.
• Put on the condom as soon as the penis is erect, but before it touches the vagina, mouth, or anus.
• Don’t use oil-based lubricants like baby oil, lotions, or petroleum jelly because they can weaken the condom.
• After sex, pull out your penis while still erect, holding the condom firmly at the base of the penis so it does not slip off.
• Use a new condom if you want to have sex again or in a different way.

You can learn more about specific STIs at the Centers for Disease Control and Prevention website.

Prostatitis

Prostatitis is an infection or inflammation of the prostate that often causes pain or discomfort. The pain may be in the penis, around the rectum, or in the pelvic area. It may occur during urination or ejaculation. Prostatitis is the most common prostate problem for men younger than 50. Prostatitis can come on suddenly, or it can keep going away and coming back. There are different types of prostatitis. A sudden infection can give you symptoms such as:

• Fever, chills, and nausea
• Pain and burning when urinating and during ejaculation
• Strong and frequent urge to urinate, but only being able to pass small amounts of urine
• Lower back or abdominal pain
• Blood in the urine

See your doctor right away if you have any of these symptoms. An acute infection can be life-threatening, but it can be easy to diagnose and treat.

Chronic prostatitis is the most common but least understood form of prostatitis. It is also called chronic pelvic pain syndrome. It is difficult to diagnose because the symptoms are not the same for every patient, and many of the symptoms — such as painful or burning urination and incomplete emptying of the bladder — could be signs of another disease. Chronic pelvic pain cannot be cured, but treatment helps many men manage their symptoms.

Prostate enlargement

For men over 50, the most common prostate problem is prostate enlargement, also called benign prostatic hyperplasia (buh-NYN prah-STAT-ihk HEYE-pur-PLAY-zhuh). As the prostate grows, it squeezes the urethra, causing urinary problems. Some of these problems include:

• A frequent and urgent need to urinate
• Trouble starting a urine stream, even though you feel you have to rush to get to the bathroom
• A weak stream of urine
• A small amount of urine each time you go
• The feeling that you still have to go, even when you have just finished urinating
• Waking up to urinate more than once or twice a night
• Leaking or dribbling urine
• Small amounts of blood in your urine

It’s a good idea to talk to your doctor if you have symptoms of prostate enlargement. Your doctor might suggest that you "wait and see" if your symptoms don’t bother you too much. Or, you can discuss treatment options if symptoms are or become so bothersome that you can’t enjoy life.

Prostate cancer

Prostate cancer is one of the leading causes of cancer death among men. Researchers are trying to figure out what things might put a man at risk of prostate cancer. Some possibilities include eating a diet that is high in animal fat and being exposed to certain chemicals like pesticides.

The following are known risk factors for prostate cancer:

• Age: Being 50 years of age or older
• Family history: Having a brother, son, or father who had prostate cancer increases your risk (and a family history of breast or ovarian cancer may also increase your risk)
• Race: Being African-American
• Genes: Having certain genes can raise your risk

Finding prostate cancer early may save lives. But experts don’t agree about whether all men should get screened regularly for prostate cancer. Experts who don’t support regular screening point out that some prostate cancers grow very slowly and are not dangerous. And, they say, if a man gets screened, he could wind up getting treatment for cancer that he doesn’t need and that can have side effects.

Every man needs to decide if screening is right for him. Talk to your doctor about the pros and cons of routine screening for you. Some issues to discuss include your age, your overall health, your family medical history, and whether or not you feel comfortable “watching and waiting” if tests find cancer.

If you choose screening, you might have:

• A digital rectal exam (DRE), in which the doctor or nurse inserts a gloved finger into your rectum to feel your prostate.
• A prostate specific antigen (PSA) test, which is a blood test. The levels of PSA in the blood can be higher in men who have prostate cancer.

Prostate cancer usually doesn’t cause any symptoms in the beginning. If you have symptoms, they might include blood in the urine, pain or burning while urinating, not being able to urinate, and constant pain in the lower back. These symptoms could be a sign of some other condition, but see your doctor as soon as possible if you have any of them.