Men’s Sexual Health: 5 Things You Need to Know

There are several sexual health issues that can affect men and interfere with a satisfying sex life, including erectile dysfunction, infertility, penile curvature (Peyronie’s disease), and others.

Michael O’Leary, MD, MPH, a Mass General Brigham urologic surgeon, shares the top 5 things men should know about common sexual health conditions. Dr. O’Leary is director of the Men’s Health Center at Brigham and Women’s Faulkner Hospital.

If you have concerns about any conditions that may impact your sexual health, tell your primary care provider (PCP). Your PCP and men’s health specialists can ensure you get the care you need for any reproductive and sexual health concerns.

Health conditions that impact men’s sexual health

Here are the top 5 things to know about conditions that impact sexual health in men:

The most common sexual health condition in men is erectile dysfunction.

Erectile dysfunction (also called ED or impotence) is when a man can’t get or keep an erection firm enough for sex. Erectile dysfunction is more common as people get older. At age 40, about 4 in 10 men have erectile dysfunction, and by age 70, 7 in 10 men have it according to National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

The most common diseases and conditions that can lead to ED include:

• Chronic health conditions, such as diabetes, chronic kidney disease, obesity and overweight, and chronic obstructive pulmonary disease (COPD)
• Heart and blood vessel diseases, such as atherosclerosis, high blood pressure, and stroke
• Hormone issues, such as low testosterone and thyroid imbalance
• Nerve damage or disorders, such as multiple sclerosis, spinal cord injuries, and damage from pelvic surgery
• Problems of the male reproductive system, such as enlarged prostate and penile curvature

According to Dr. O’Leary, many of the first-line agents for the treatment of ED involve medications that work for 50 to 70% of men. If a patient doesn’t respond to medication, several non-surgical options exist to encourage an erection by promoting blood flow.

Occasionally, some patients need more invasive treatments. For example, doctors can place an agent into the urethra. The urethra is a tube that carries urine from the bladder to outside the body. In men, the urethra runs through the prostate gland and the penis to the outside of the body.

Patients who don’t achieve good outcomes through initial treatment also can explore surgical treatments, including penile implants or prostheses (artificial penises).

“I don’t recommend surgery as an initial treatment option for erectile dysfunction,” says Dr. O’Leary, “but for many men it’s very satisfactory.”

Mental health problems can cause erectile disfunction.

Stress, depression, and other mental health conditions are common causes of erectile dysfunction in men. Dr. O’Leary regularly tells patients, “The most important sex organ is not below a man’s waist; it’s sitting on their shoulders.”

In cases where physiological problems don’t cause erectile dysfunction, doctors evaluate a patient’s impotence in the context of their mental or emotional well-being.

At the Men’s Health Center, a team of sex therapists works with patients and their partners in a comfortable, educational, and confidential setting to address possible psychosocial causes of ED. The aim is to restore a normal level of sexual function.

Male infertility is common.

Up to 1 in 3 infertility cases may involve male infertility, according to the National Institute of Child Health and Human Development.

Many factors can contribute to male infertility, including:

• Low sperm production
• Anatomy
• Trauma to the testicles
• Genetic or immune diseases

Finding the exact cause of infertility involves a thorough physical exam, lab tests, imaging, and semen analysis.

Minor trauma to the penis can cause Peyronie’s disease.

Peyronie’s disease is a disorder in which scar tissue, called plaque, forms under the skin of the penis. The plaque builds up inside the penis, in the thick elastic membrane called the tunica albuginea. The tunica albuginea helps keep the penis stiff during an erection. The plaque can develop anywhere along the penis.

The plaque pulls on the surrounding tissues as it develops and causes the penis to curve or bend, usually during an erection. Curves in the penis can make erections painful and may make sex painful, difficult, or impossible.

While the exact cause of plaque formation isn’t clear, many men with Peyronie’s disease have had a minor trauma that caused bleeding inside the penis.

To diagnose Peyronie’s, doctors perform an ultrasound to determine erectile function and anatomy. In most cases, Peyronie’s presents in a mild form and the initial pain resolves in 6 to 12 months, allowing the patient to return to healthy sexual activity. Doctors can treat plaque with a plan tailored to each patient’s condition.

A vasectomy is a permanent form of birth control.

A vasectomy is a permanent form of male birth control to prevent pregnancy. During this 30-minute, minimally invasive surgical procedure, a surgeon cuts the tubes that transport sperm within the male reproductive system. A vasectomy doesn’t affect a man’s sexual health and it's extremely effective in preventing pregnancy. It’s considered a permanent form of birth control because it’s not easily reversible.