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Sexual dysfunction refers to difficulty having sexual intercourse. Sexual dysfunction includes a variety of conditions that affect:

• • • Sex drive (libido)
    • The ability to get and maintain an erection (erectile dysfunction or impotence)
    • The ability to ejaculate
    • The ability to achieve an erection without deformity of the penis
    • The ability to orgasm

The causes

Sexual dysfunction can have physical or psychological causes. Many sexual problems result from a combination of both. A physical problem may result in psychological problems (such as anxiety, depression, or stress), which in turn exacerbate the physical problem. Men may put pressure on themselves or feel pressured by their partner to perform at their sexual best. If this does not succeed, stress is the result (fear of failure). This anxiety can be stressful and further reduce the desire for sexual relations.

Most common sexual dysfunction

Ejaculatory disorders are the most common sexual dysfunction in men. The disorders include.

• • • Premature ejaculation before or shortly after vaginal penetration.
    • Ejaculation into the urinary bladder (retrograde ejaculation)
    • Inability to ejaculate (anejaculation)
    • Erectile dysfunction is common in middle-aged and older men. Some also suffer from decreased libido.

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Normal sexual function in men

Normal sexual function is a complex interplay of physiological and psychological factors. Nervous, circulatory, and endocrine systems interact with the psyche to elicit a sexual response. The male sexual response is controlled by a delicate and finely balanced interplay of these systems.

Sexual desire (also sex drive or libido) is the desire for sexual activity. It can be triggered by thoughts, words, visual stimuli, smells, and touch, and leads to the first stage of the sexual response cycle, which triggers sexual arousal.

During sexual arousal, the brain sends signals to the penis via the spinal cord. The arteries supplying blood to the erectile tissue (corpora cavernosa and corpus spongiosum) respond accordingly and dilate (relaxation and dilation). The dilated arteries dramatically increase the blood supply to these areas, which are now bulging and expanding. The expansion puts pressure on the veins that normally carry blood away from the penis. They are compressed, the outflow of blood is slowed, and the blood pressure in the penis increases. The increased pressure in the penis causes it to become stiff, resulting in an erection. At the same time, the muscle tension in the entire body also increases.

In the plateau phase, arousal and muscle tension are intensified.

Orgasm is the climax of sexual arousal. Here, the muscle tension in the entire body increases further and the pelvic muscles contract until ejaculation occurs.

Nerve impulses cause the muscles in the male sex organs (seminal vesicles, prostate, and epididymal ducts and vas deferens) to contract, leading to ejaculation. These contractions propel the semen into the urethra. Contraction of the muscles surrounding the urethra pushes the semen out of the penis. The bladder neck also contracts, preventing semen from flowing back into the bladder.

The male sex organs

Although orgasm and ejaculation often occur almost simultaneously, they are separate events. In rare cases, ejaculation can occur without orgasm. Similarly, there are orgasms without ejaculation; this is especially true before puberty or in the context of side effects of certain medications, such as antidepressants, or after surgery, such as removal of the colon or prostate. Orgasm is usually a highly pleasurable moment.

In the recovery phase, the body returns to the unexcited state. Once ejaculation or orgasm has occurred, the arteries in the penis and the smooth muscles of the corpora cavernosa and corpus spongiosum contract. As a result, blood supply decreases, blood outflow increases, and the penis becomes flaccid (detumescence). After orgasm, it takes a certain time before a new erection is possible (refractory period). In young men, this is about 20 minutes or less; in older men, it takes longer. The time between erections generally increases with advancing age.

Testosterone deficiency

In the case of a testosterone deficiency, those affected have too little of the male sex hormone testosterone in their bodies. A deficiency can occur primarily in men, but also in women. Important symptoms can include sexual unwillingness, reduced testicles and increased sweating.

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What testosterone levels are normal in men and in women? Men produce significantly more testosterone than women. In adult men, levels range from 3.5 to 11.5 ng/ml (12-40 nmol/l). Women have significantly less testosterone in their bodies than men. Testosterone levels in adult women range from 0.15 to 0.6 ng/ml (0.5-2.0 nmol/l). Fluctuations in the value are considered normal, as age, cycle and time of day influence the androgen level,