Male sexual dysfunction
Don't suffer in silence with erection problems or premature ejaculation: find out the causes and treatments
Introduction
Loss of libido (sex drive) is a common problem affecting up to one in five men – and even more women – at some point in their life.
It's often linked to professional and personal stress, or important life-changing events such as pregnancy, childbirth or breastfeeding.
However, an unexpected loss of libido – especially when it lasts for a long time or keeps returning – can also indicate an underlying personal, medical or lifestyle problem, which can be upsetting to both partners in a relationship.
If you're concerned about your libido, especially if your diminished sex drive distresses you or affects your relationship, make an appointment to see your GP to discuss any underlying causes and possible medical or psychological treatments.
Doctors at your nearest family planning clinic, Integrated Sexual Health clinic, or Contraceptive and Sexual Health (CASH) clinic may also be able to help.
In the meantime, you may find the following information useful. It explains some of the most common reasons for loss of libido.
Relationship problems
The first thing you should consider is whether you're happy in your relationship. Do you have any doubts or worries that may be the real reason for your loss of sexual desire?
If you've been in a relationship for a long time, you may have become overfamiliar with your partner and feel a degree of erotic dissatisfaction. This is quite common and can have a negative effect on your sex drive.
Relationship problems are among the most common causes of loss of libido. For help and advice, you may find it useful to contact the relationship support charity Relate.
Another thing to consider is whether the problem is a performance issue that makes sex difficult or unfulfilling. For example, many men experience ejaculation problems or erectile dysfunction, and women can experience painful sex or vaginismus (when the muscles around the vagina tighten involuntarily before penetration). See your GP if these problems are an issue, as they're often treatable.
Your GP may feel you will benefit from psychosexual counselling. This is a form of relationship therapy where you and your partner can discuss any sexual or emotional issues that may be contributing to your loss of libido. Read let's talk about sex for more information about this.
Stress, anxiety and exhaustion
Stress, anxiety and exhaustion can be all-consuming and have a major impact on your happiness. If you feel you're constantly tired, stressed or anxious, you may need to make some lifestyle changes or speak to your GP for advice.
For more information and advice, you may find some of the following pages useful:
- Why am I tired all the time?
- Why do I feel anxious and panicky?
- Self-help tips to fight fatigue
- Beating stress at work
- Relaxation tips to relieve stress
- 10 stress busters
Depression
Depression is very different from simply feeling unhappy, miserable or fed up for a short while. It's a serious illness where you may have feelings of extreme sadness that can last for a long time. These feelings are severe enough to interfere with your daily life, including your sex life.
You're probably depressed if you're feeling low or hopeless, or you've lost interest or pleasure in doing things you used to enjoy. In this case it's really important to see your GP. They may feel you'll benefit from antidepressants.
However, low sex drive can also be a side effect of many antidepressants. Speak to your GP if you're already taking antidepressants and think they may be causing your problems, as you may be able to switch to a different medication.
Drugs and alcohol
Drinking excess amounts of alcohol can reduce your sex drive, so it's a good idea to moderate your intake to no more than three to four units a day if you're a man, and no more than two to three units a day if you're a woman.
Read more about alcohol misuse and find out how to get support for a drinking problem.
Drug misuse is also linked to a loss of sex drive. Read more about drugs for information and advice.
Getting older
Many people lose some interest in sex as they get older, mainly as a result of falling levels of sex hormones, age-related health problems, or the side effects of medication.
Older men especially can develop low testosterone levels, which can cause fatigue, depression and a reduced sex drive.
Speak to your GP if you're concerned about this. They may carry out a blood test to check your testosterone level and can tell you about treatments if your level is low.
As women start to approach the menopause, levels of the female hormone oestrogen begin to fall, which can affect libido. Women can also suffer from low testosterone levels, especially after a hysterectomy. Testosterone is another hormone that can affect sex drive.
Speak to your GP if you're concerned the menopause may be having an effect on your libido. They may be able to offer you a trial of hormone replacement therapy (HRT) if it's suitable for you.
Hormonal problems
Less commonly, low libido may be caused by an underactive thyroid. This is where your thyroid gland (located in the neck) doesn't produce enough hormones. Common signs of an underactive thyroid are tiredness, weight gain and feeling depressed.
An underactive thyroid is easily treated by taking hormone tablets to replace the hormones your thyroid isn't making. Learn more about treating underactive thyroid.
A hormonal problem called hyperprolactinaemia can also have a negative effect on your sex drive. This is where you have a raised level of a substance called prolactin in your blood.
Contraception
Some women have reported a decreased sex drive while using some types of hormonal contraception, such as:
- combined contraception, including the combined pill, vaginal ring, or contraceptive patch
- the progestogen-only pill
- the contraceptive implant
- the Depo-Provera injection
However, side effects of these contraceptives tend to improve within a few months and they're generally well tolerated.
Speak to your GP or local contraceptive (or family planning) clinic if you're worried your contraception is causing a loss of libido. They may suggest trying an alternative method.
Read more about choosing a method of contraception.
Other medical conditions
Long-term (chronic) medical conditions such as cardiovascular disease, diabetes and obesity can also have a negative effect on your libido.
Medication
Certain medications can sometimes reduce libido, such as:
- medication for high blood pressure, including diuretics
- medications for depression, including SSRI antidepressants
- medications for seizures (fits)
- medications commonly used to treat psychosis (a mental condition where a person can't distinguish between reality and their imagination), such as haloperidol, as well as many other conditions
- medicines such as cimetidine, finasteride and cyproterone, which block the effects or reduce the production of testosterone
See your GP if you're worried that medication you're taking is responsible for your reduced sex drive. They can review your medication and switch your prescription to something less likely to affect your libido if necessary.
Page last reviewed: 23/01/2015
Next review due: 23/01/2017
It’s estimated that one in 10 men has a problem related to having sex, such as premature ejaculation or erectile dysfunction. Dr John Tomlinson of The Sexual Advice Association explains some of the causes, and where to seek help.
“Sexual dysfunction in a man is when he's not able to perform properly,” says Dr Tomlinson. “The main problem is being unable to get an erection. It’s much more common than people realise. In the 20-40 age group it affects around 7-8% of men, in the 40-50 age group it affects 11%. In the over-60s it affects 40%, and more than half of men over 70.”
It can affect any man, whether he is straight, gay, bisexual or transgender. Read more about erectile dysfunction (impotence) and premature ejaculation.
Erectile dysfunction (impotence)
This is when a man can’t get, or keep, an erection. Most men experience it at some time in their life. “It only becomes a problem when the man or his partner considers it a problem,” says Dr Tomlinson.
What causes erectile dysfunction?
“A variety of things cause it. Some psychological and some physical,” says Dr Tomlinson. "Psychological issues tend to affect younger men, such as first night nerves and so on. Often, these problems don’t persist. But there can be more serious psychological problems about sex that need the help of a psychosexual therapist.”
Worries about work, money, your relationship, family, and even worrying about not getting an erection, can all be factors.
Physical reasons for erectile dysfunction include:
Medical conditions that cause erectile dysfunction
- heart disease
- diabetes
- raised blood pressure
- raised cholesterol: this can lead to clogging of arteries, including the arteries in the penis, which are very narrow (1-2mm in diameter compared with around 10mm in the heart artery)
- low testosterone: testosterone levels fall as men get older, but not all men are affected by it. Those who are affected will have symptoms such as feeling tired and unfit, and loss of interest in (and inability to have) sex.
Drugs that cause erectile dysfunction
- some prescription drugs: these can include medicines (such as beta-blockers) used to treat raised blood pressure, and antidepressants, antipsychotic drugs and anticonvulsant drugs
- alcohol
- recreational drugs such as cannabis and cocaine
- smoking: nicotine affects the blood supply to the areas of the penis that cause erections
What should I do if I have erectile dysfunction?
See your GP. He or she can give you a physical examination and carry out blood tests to identify the cause.
Erectile dysfunction can be an important signal to other issues. “It's associated with raised cholesterol, diabetes and raised blood pressure. Any of these can be a warning of future heart disease,” says Dr Tomlinson. Your doctor can ensure that you get the treatment you need.
What's the treatment for impotence?
First, adjust any lifestyle factors that might be causing your problem.
“If you stop smoking, drinking too much or using recreational drugs, the problem should eventually go away. But it can take months,” says Dr Tomlinson. “There is no overnight cure.”
If you're prescribed blood pressure tablets or antidepressants, your doctor may be able to put you on a different kind.
Low testosterone can be treated with hormone replacement therapy, which should resolve erectile dysfunction as long as it's used together with erection-helping drugs. Other conditions, such as diabetes and high blood pressure, can be treated, which may improve erections. Find out more about erectile dysfunction treatment, including sildenafil cotrate (viagra). The Sexual Advice Association has useful factsheets on all of this.
Some men benefit from psychosexual therapy, which is a form of relationship therapy where you and your partner can discuss any sexual or emotional issues or concerns. You can contact the Sexual Advice Association, Relate, sexual health charity FPA or your GP to ask about psychosexual therapy.
Premature ejaculation
This is when a man ejaculates (comes) sooner than he wants to during sex. It's only a problem if it bothers him or his partner.
You can see your GP or a psychosexual therapist for help.
What causes premature ejaculation?
"Either just being very excited with a new partner, or an acute sensitivity of the local nervous system, which triggers orgasm too suddenly," says Dr Tomlinson.
It can also be linked to anxiety about sexual performance, stress, unresolved issues in a relationship, or depression.
What should I do if I have premature ejaculation?
See your GP, or a psychosexual therapist. A therapist can teach you techniques to try to delay ejaculation.
What treatment is there?
“A lot of men and their partners don’t worry, and they work around it," says Dr Tomlinson. "But if you’re very unsatisfied, there are some things you can try.”
- Have sex again soon after the man ejaculates. The second time, it will take longer to reach an orgasm. Older men might find this difficult as it may take too long to get a second erection.
- Creams (available from sex shops) can be put on the penis to numb sensation. “But this tends to transfer the numbing sensation to the partner, which they don't always like,” warns Dr Tomlinson. Some find using a condom useful.
- The man’s partner can squeeze his penis in a certain way to prevent him ejaculating. “A man needs an extremely willing partner to do this, and some partners don’t feel comfortable with it,” says Dr Tomlinson.
- Antidepressants called selective serotonin reuptake inhibitors (SSRIs) can slow ejaculation, but only for a year or so. “We’ll try every other treatment first before starting on drugs,” says Dr Tomlinson.
- Psychotherapy might help in terms of relaxing or exploring problems in the relationship. Find out what a sex therapist does.
Dr Tomlinson is editor of The ABC of Sexual Health (published by Wiley-Blackwell).
The Sexual Advice Association helpline is 0207 486 7262.
Find out about other sexual problems, such as retarded ejaculation and retrograde ejaculation.
If you are worried about your health have a look at the Man MOT, a confidential online surgery where you can talk to a GP anonymously.
Page last reviewed: 10/06/2014
Next review due: 09/06/2016
The male midlife crisis is often made fun of, but for many men it is a distressing experience.
A male midlife crisis can happen when men think they've reached life's halfway stage. Anxieties over what they've accomplished so far, either in their job or personal life, can cause a period of depression. In men, this usually happens between the ages of 35 and 50, and can last for up to 10 years.
It's a controversial syndrome that health experts think is related to the brain or hormonal changes. While it may be a great source of jokes and amusement for some, for those affected it can be quite debilitating.
Dr Derek Milne, a clinical psychologist and author of the book "Coping with a Mid-life Crisis", says it's a poorly researched topic.
"What data we do have of a scientific kind are limited in terms of the quality and the surveys that exist," he says.
"Literature on the midlife crisis mostly comes out in book form by journalists rather than trained researchers. These are sketchy, descriptive accounts that wouldn't normally be published in a scientific journal.
'A time of growth'
When it comes to the midlife crisis, Dr Milne says everyone's circumstances are different.
"I would guess it affects a significantly small amount of the population. Somewhere around 20% of people (mostly men) will have gone through this by the time they're 50.
"My book is all about coping," he says, "and if I was giving advice on how to cope, I'd suggest telling your GP you're feeling depressed, because depression makes up a significant portion of the midlife crisis."
"I would, however, recommend that you see a psychologist or counsellor and have it treated as a psychological condition and not through medication."
Dr Milne says the important thing is to thrive. "Even if there are times when all you feel you can do is survive to the next day, the goal is thriving, and I believe that we do this best when we view our current crisis as a time of growth and personal change."
The best advice is to see your GP and get help. Depression can be triggered by a major life change, such as divorce, separation, long-term illness, bereavement or job loss. Sometimes there appears to be no obvious reason.
The point is, if you feel very low for more than a couple of weeks, it is vital that you go to your GP for help. You may be prescribed antidepressants or referred to a counsellor.
Ways to help avoid depression include taking regular exercise, which can ease tension and trigger brain chemicals that improve your mood (endorphins), eating well and sleeping well. Most of all, don't bottle up your feelings.
- For tips on looking after your emotional health, read Men and emotional health.
- If you are worried about your health have a look at the Man MOT, a confidential online surgery where you can talk to a GP anonymously.
Depression is a serious illness. It is very different from the common experience of feeling unhappy, miserable or fed up for a short period of time. In this video, psychiatrist Dr Cosmo Hallstrom explains the disorder.
Tips for coping with depression
If you've been feeling depressed for a few weeks or more, make an appointment to see your GP. They discuss your symptoms with you and the tell you about treatments that could help you feel better.
It can also be helpful to try some coping techniques. David Richards, professor of mental health services research at the University of Exeter, offers these tips for coping when you're depressed.
Be more active
Don’t withdraw from life. Socialising can improve your mood. Keeping in touch with friends and family means you have someone to talk to when you feel low.
Take up some form of exercise. There's evidence that exercise can help lift your mood. If you haven’t exercised for a while, start gently by walking for 20 minutes every day. Find out more about exercise for depression.
Face your fears
Don’t avoid the things you find difficult. When people feel low or anxious, they sometimes avoid talking to other people. Some people can lose their confidence about driving or travelling.
If this starts to happen, facing up to these situations will help them become easier.
Read Ten ways to fight your fears.
Don’t drink too much alcohol
For some people, alcohol can become a problem. You may drink more than usual as a way of coping with or hiding your emotions, or just to fill time. But alcohol won’t help you solve your problems. It could also make you feel more depressed.
Read these tips on cutting down the amount of alcohol you drink.
Have a routine
When people feel down, they can get into poor sleep patterns, staying up late and sleeping during the day. Try to get up at your normal time and stick to your routine as much as possible.
Not having a routine can affect your eating. You may stop cooking regular meals, eat snacks throughout the day instead or miss breakfast because you’re still in bed. Find out more about healthy eating and depression.
See How to feel happier for more tips that help make a positive difference when you're feeling down.
Seeking help for depression
If you're still feeling down or anxious after a couple of weeks, talk to your GP or call NHS 111.
If you start to feel like you can't cope, life is becoming very difficult or your life isn't worth living, get help straight away. These are signs that you need to talk to someone.
Various treatments are available for depression, including talking therapies, antidepressant medication and self-help. Find out more about treating depression.
You can also contact helplines, such as Samaritans on 08457 90 90 90, for confidential, non-judgmental emotional support.
If you've had depression or anxiety in the past, even if they weren't formally diagnosed, get help immediately. You're more likely to have an episode of depression if you've had one before.
Healthy eating and depression
Feeling down or depressed can affect both your appetite and your daily routine.
Some people don’t feel like eating when they’re depressed and are at risk of becoming underweight. Others find comfort in food and can put on excess weight. Antidepressants can also affect your appetite.
If you're concerned about weight loss, weight gain or how antidepressants are affecting your appetite, talk to your GP.
Tips for eating a healthy diet
Research into the links between diet and depression is ongoing. As yet, there is not enough evidence to say for certain that some foods help relieve symptoms of depression.
However, a healthy balanced diet is important for maintaining good general health.
“The most important thing is to eat regularly and to include the main food groups in your daily diet," says Dr Lynn Harbottle, consultant in nutrition and dietetics at the Health and Social Services Department in Guernsey.
A diet based on starchy foods, such as rice and pasta, with plenty of fruit and vegetables, some protein-rich foods such as meat, fish and lentils, and some milk and dairy foods (and not too much fat, salt or sugar) will give you all the nutrients you need.
Find out more about the five food groups by looking at the eatwell plate. Also, read more about how to have a balanced diet.
There are many simple ways to improve your diet. However, if you're more severely depressed and feel unable to shop or prepare food, see your GP to discuss the types of treatment and support that are available.
Eat regular meals
Have three meals every day, including breakfast. Breakfast can help give you the energy you need to face the day. Try a bowl of wholegrain cereal with some sliced banana and a glass of fruit juice for a healthy start to the day. If you feel hungry between meals, have a healthier snack such as a piece of fruit.
Eat more wholegrain cereals, fruit, vegetables, beans, lentils, nuts and seeds
These foods are a good source of vitamins and minerals. Try to eat at least five portions of a variety of fruit and vegetables every day.
Include some protein at every meal
Protein is essential for the growth and repair of the body. You can get it from meat, fish, eggs, milk, cheese, lentils and beans.
Don't get thirsty
We need to drink about 1.2 litres of fluid a day to stop us getting dehydrated. Even mild dehydration can affect our mood. Symptoms of dehydration include lack of energy and feeling light-headed. Find out more about how much you should drink, including how to choose healthier drinks.
If you drink alcohol, drink within the recommended daily limits
If you're a man, don't regularly drink more than three-to-four units a day. If you're a woman, don't regularly drink more than two-to-three units a day. Use our alcohol unit calculator to find out how many units there are in different types of alcoholic drinks. Don't drink alcohol if you're taking antidepressants.
When you make changes to your diet, set yourself realistic and achievable goals. Lynn warns against crash or miracle diets that might not be nutritionally balanced. Instead, make moderate changes. If you want to make major changes to your diet, see your GP, who can refer you to a registered dietitian.
Further information about diet and mental wellbeing
For general advice on healthy eating, see our food and diet section.
The energy diet has information about how healthy eating can help prevent tiredness.
Many treatment options are available for depression, including talking therapies, antidepressant medication and various self-help techniques. Find out more about treatment for depression.
If you've been feeling low for more than two weeks, see your GP to find out about treatment choices and to get advice on which might be most suitable for you.
