Male Sexual Dysfunction
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This page aims to provide an introductory discussion of men's health physiotherapy with regards to male sexual dysfunction. Please note that further training is required through a reputable pelvic health education company before attempting the techniques discussed in this page. See the Resources section at the bottom of this page for links to pelvic and men's health special interest groups.
Introduction[edit | edit source]
When treating sexual dysfunction, a medical professional must look at the broader prospective of the patient's sexual activity in order to accurately diagnose and treat the underlying causes of the dysfunction. Sexual activity includes a patient's physiological sexual functioning, their sexual identity, and their sexual relationship.
It is imperative to have open and respectful conversations with the patient regarding these very personal issues order to provide quality and appropriate care. A medical professional working in this specialized field must be inclusive and make all patients feel comfortable and respected. This extends from the words a therapist uses to describe a patient's sexual orientation, gender identity, and or expression, to how the clinic is setup to provide maximal privacy during patient evaluations, treatments, and consultations. Please read this article for recommendations on how to setup a men's health clinic.
Sexuality[edit | edit source]
Sexuality is a central aspect of being human throughout life and encompasses sex, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy and reproduction. Sexuality is experienced and expressed in thoughts, fantasies, desires, beliefs, attitudes, values, behaviours, practices, roles and relationships. While sexuality can include all of these dimensions, not all of them are always experienced or expressed. Sexuality is influenced by the interaction of biological, psychological, social, economic, political, cultural, ethical, legal, historical, religious and spiritual factors.[1]
Just as an understanding of pelvic anatomy is needed for proper pelvic floor physiotherapy, an understanding of appropriate terminology to use for gender identity and sexual orientation is needed when providing pelvic health physiotherapy. It is also important to use know the appropriate pronouns to use, especially when working with gender nonbinary and transgender patients. Please read this article for more in-depth information on sexual orientation, gender identity, and gender expression.
The term sex is used to refer to a person’s biological maleness or femaleness, and the term gender to the nonphysiological aspects of being male or female– the cultural expectations and roles for femininity and masculinity.[2] This article will focus on male sexual dysfunction and how it can be addressed by men's health physiotherapy. The term “men” will refer to biological males and “women” for biological females for the remainder of this page.
Male Sexual Dysfunction[edit | edit source]
When discussing sexual dysfunction, a physiotherapy patient interview may uncover a change or alteration in one of the four basic sexual functions.[3]
Basic male sexual functions:
- Desire
- Erection
- Orgasm
- Ejaculation
The treatment of male sexual dysfunction often requires a multidisciplinary approach, involving multiple treatment techniques and interventions from various healthcare and mental health providers.[3]
Hypoactive Sexual Desire[edit | edit source]
Sexual desire relies on a variety of factors both physical and psychological. Testosterone levels play an important role in physiological libido.[4]
Erectile Dysfunction[edit | edit source]
Erectile function forms an important part of a man’s sexual function, but it is only a part of the picture. A normal erection depends on a sequence of physiological, neural, vascular, metabolic and endocrine events.
There are different types of erections; reflexogenic, psychogenic and nocturnal:
- Reflexogenic erections occur when the penis is physically stimulated
- Psychogenic erections from other stimulation such as visual, auditory or psychological inputs.
- Nocturnal erections occur in men every night with about 5-8 per night and can last up to 30 minutes each.
Erectile dysfunction (ED) is a component of male sexual dysfunction and can be defined as the persistent inability to achieve or maintain an erection firm enough or lasting long enough to participate in sexual activities.[5]
- Problems with erectile function can come from physical and psychological problems.
- When a man’s nocturnal erections stop it can be used as a diagnostic factor in determining a physical cause of the erectile dysfunction.[6]
- The pelvic floor muscles, in particular, the bulbospongiosus and ischiocavernosus, play an important role in penile rigidity and injury or weakness can play a role in erectile dysfunction.[7]
Aspects of erectile dysfunction:
- ability to achieve an erection
- ability to maintain an erection
- ability to achieve adequate erection quality e.g. hardness
Ejaculation issues[edit | edit source]
Ejaculation occurs when the smooth muscle of the prostate contract and the urethra smooth muscles relax to allow the ejaculate to enter the urethra. Thereafter a strong involuntary contraction of the bulbospongiosus expels the ejaculate.[7]
- The prostate is responsible for the production of seminal fluid which makes up the majority of the ejaculate.
- When the prostate is removed or affected by radiation there is often a significant loss or absence of ejaculate.[4]
Types of ejaculation issues:
- Retrograde ejaculation results in a reduced volume of anterograde ejaculate during sexual climax or the detection of semen in the post-ejaculatory urine.[8]Can be a consequence of a prostatectomy due to the removal of the internal urethral sphincter allowing semen to move into the bladder rather than into the urethra.[3]
- Premature ejaculation is the most common type of ejaculation dysfunction. Involves ejaculation within 30 seconds of either sexual stimulation or penetration.[3]
- Delayed ejaculation involves an extended amount of time needed prior to ejaculation.[3]
Sexual Dysfunction Risk Factors[edit | edit source]
Biopsychosocial Model and Healthcare Professional Training[edit | edit source]
Male Pelvic Floor Physiotherapy[edit | edit source]
Resources[edit | edit source]
or
- numbered list
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References[edit | edit source]
- ↑ World Health Organization. Gender and human rights. Available from: https://www.who.int/reproductivehealth/topics/gender_rights/sexual_health/en/ (accessed 14/03/2022).
- ↑ Lips HM. Sex and gender: An introduction. Waveland Press; 2020 Apr 10.
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 Roscher, P, Men's Health. Male Sexual Dysfunction. Physioplus. March 2022.
- ↑ 4.0 4.1 Elliott S, Matthew A. Sexual recovery following prostate cancer: recommendations from 2 established Canadian sexual rehabilitation clinics. Sexual medicine reviews. 2018 Apr 1;6(2):279-94.
- ↑ Hackett G, Kirby M, Wylie K, Heald A, Ossei-Gerning N, Edwards D, Muneer A. British Society for Sexual Medicine guidelines on the management of erectile dysfunction in men—2017. The journal of sexual medicine. 2018 Apr 1;15(4):430-57.
- ↑ Briganti A, Salonia A, Zanni G, Fabbri F, Saccà A, Bertini R, Suardi N, Fantini GV, Rigatti P, Montorsi F. Erectile dysfunction and radical prostatectomy: an update. EAU update series. 2004 Jun 1;2(2):84-92.
- ↑ 7.0 7.1 Cohen D, Gonzalez J, Goldstein I. The role of pelvic floor muscles in male sexual dysfunction and pelvic pain. Sexual medicine reviews. 2016 Jan 1;4(1):53-62.
- ↑ Gild P, Dahlem R, Pompe RS, Soave A, Vetterlein MW, Ludwig TA, Maurer V, Marks P, Ahyai SA, Chun FK, Lenke L. Retrograde ejaculation after holmium laser enucleation of the prostate (HoLEP)—Impact on sexual function and evaluation of patient bother using validated questionnaires. Andrology. 2020 Nov;8(6):1779-86.
