I recently had Ken Baker, the author of "Man Made," on my radio show. Until he was in his late 20s, Baker had an almost non-existent sex drive and was unable to have an erection. But like so many men, because of the stigma surrounding this issue, he convinced himself the problem was all in his head, until a girlfriend forced him to get a checkup.
A simple blood test revealed Baker had 150 times the normal level of the hormone prolactin and was severely deficient in testosterone. The cause was a tumor in his pituitary gland. When it was removed and he was put on medication, the effect was dramatic. Almost immediately, his sex drive went through the roof.
Not every case of male sexual dysfunction is as black and white as Baker's, but he can serve as an example. People simply do not believe the powerful effect biology has on our sex lives. But in truth, sexual functioning is an extraordinarily complex physiological process in which virtually every system of the body comes to bear. There's a huge margin for error at every point along the way, from interest and arousal to erection and ejaculation. But even more important, it is a natural physiological process and nothing to be embarrassed about.
Although psychological factors such as stress, depression and interpersonal conflict definitely can affect sexual function (and are the primary cause of premature ejaculation), most chronic male sexual dysfunction is caused by an underlying medical problem. Dysfunction more often is a symptom of a bigger problem than a disease in itself, so it should never be ignored.
Causes: No.1 is medication
Far and away, the most common cause of sexual dysfunction in my patients is medication. Almost any drug you can name -- even antibiotics and cold remedies -- can alter the sexual cycle, from diminished libido to erectile dysfunction (ED, or impotence) to retrograde ejaculation, in which semen is pushed back into the bladder rather than out through the penis. Antidepressants are especially notorious for sexual side effects.
Interestingly, men are more aware of the drug connection than are women; if one of my patients experiences ED after going on a new drug, he'll be waiting for me before the office opens in the morning, saying, "Doc, you broke me!" Women often will take inventory of their emotional life instead: "What did I do to cause this? Am I stressed? Is my husband bothering me?" Way down the list, they'll think about the medication.
Low sex drive usually is hormonal or neurological in nature. The cause might be a prolactin-secreting tumor like Baker's, an undescended testicle, thyroid disease, alcoholism, depression or a neurological condition like multiple sclerosis.
By one estimate, 20 million to 30 million U.S. men are affected by erectile dysfunction. ED can have myriad causes, including prostate problems from inflammation to cancer, vascular disease, neurological disorders, diabetes, heavy smoking, alcoholism, chronic drug use, pelvic trauma, spinal injuries and Peyronie's disease (a curvature of the penis caused by scarring).
It's amazing how effectively this information can motivate patients to make more healthful lifestyle choices. Tell a man that poor health habits might cause his penis not to work and, believe me, he'll listen. I like to point out to smokers that some research suggests the dorsal artery to the penis is about seven times more sensitive to the hardening of the arteries caused by cigarette smoking than are the arteries to the heart. It's a great reason to quit.
Don't tolerate dysfunction
Here's the good news: Sexual dysfunction, in many cases, is reversible, correctable and treatable. It is not something anyone has to tolerate anymore.
Sex is such a vital part of the human experience, and, luckily, we live in a time when there have been truly revolutionary advances in treatment. Five years ago, erectile dysfunction often was untreatable, and now it's essentially no big deal, thanks to Viagra, the first oral medication for ED. When Viagra doesn't work, there are drugs that can be injected into the penis. Between those two, no man should be unable to have a reasonable erection. And there are further options: vacuum devices, implantable penile prostheses and microvascular surgery to restore blood supply in cases of vascular disease or injury.
If you're experiencing persistent sexual dysfunction, it is essential to see your doctor for a thorough evaluation. It's crucial to get a diagnosis before accepting any kind of treatment. If Ken Baker had simply gone on Viagra rather than getting an MRI, he might not be with us today to share his story.
