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Sexual Dysfunction

Understanding and treating sexual dysfunction at UC San Diego Health System

Sexual dysfunction encompasses erectile dysfunction, loss of libido (sexual desire) and difficulty achieving orgasm. The Division of Urology at UC San Diego Health System has a specialist dedicated to sexual dysfunction in men.

Erectile dysfunction (ED) occurs when a man has difficulty initiating or maintaining an erection firm enough for sexual intercourse. The National Institutes of Health estimates that ED affects as many as 30 million men in the United States.

An erection begins with sensory or mental stimulation, or both. Impulses from the brain and local nerves cause the muscles of the penis to relax, allowing blood to flow through the arteries. The penis then expands in size and maintains its rigidity by preventing the outflow of blood. The erection ends after orgasm and ejaculation as blood drains out through the penile veins.

Causes of Erectile Dysfunction

There are numerous causes of ED, including psychological conditions, such as depression, anxiety and stress.

Conditions associated with injury to the peripheral nerves or that impaired blood flow, including cardiovascular disease, high blood pressure and diabetes can cause ED.

ED can also result from neurological and neuromuscular conditions, including multiple sclerosis, stroke and brain tumors, as well as spinal cord injuries.

Many common medications used to treat a variety of chronic health conditions can have sexual side effects. These include drugs taken for Parkinson's disease, depression, high blood pressure, pain and heart disease, to name a few.

Pelvic surgeries are another contributor to ED. These include surgical treatments for prostate cancer, colorectal cancers, bladder cancer and spinal cord conditions.

Certain lifestyle factors, including excessive drinking, smoking, recreational drug use and lack of exercise can cause ED.

Individuals with low testosterone may also experience ED.

Treatments for Erectile Dysfunction at UC San Diego Health System

Erectile dysfunction in many men can be treated successfully with oral medication. Viagra, Levitra and Cialis are called phosphodiesterase (PDE) inhibitors, and work by relaxing the muscles that surround the arteries in the penis, allowing the penis to fill will blood and become erect. They are the first-line treatment for ED for most patients. Oral medications are not safe for men with certain medical conditions.

Intraurethral suppository therapy can also be used for the treatment of ED. Medication is delivered through the urethra and is an alternative for men who cannot tolerate oral medication.

Injectable medications, called intracavernous pharmacotherapy, are a highly effective means of treating ED. They are safe for men with diabetes, heart conditions and high blood pressure, and many men achieve more satisfactory erections with this treatment.

Vacuum devices use negative pressure to draw blood into the penis and cause an erection. Placing an elastic ring at the base of the penis keeps the blood from flowing out so the erection can be maintained during intercourse. It can also be used to preserve penile length during recovery from pelvic surgery.

Penile prostheses provide men suffering from ED with a definitive long-term solution and the ability to have an erection any time they choose. A penile prosthesis is implanted surgically and is under the control of the patient. Our urologic surgeons have extensive experience in penile prosthetic surgery, and our patients report high levels of satisfaction with this treatment.

Testosterone

Testosterone is the primary male sex hormone. It is responsible for the development of male reproductive tissues, sex drive, sperm production, muscle and bone mass, and the growth of body hair. Testosterone is secreted primarily from the testicles in males. Females also produce testosterone, in lesser amounts, which is secreted by the ovaries.

Understanding Testosterone Levels

Testosterone levels are measured through a regular blood test. The normal value for total testosterone in men is between 300 and 1,000 ng/dl. An optimal level has not yet been determined and should be individualized based on the person.

Low testosterone, also called low T or hypogonadism, can cause infertility, decreased sexual desire, ED and depression. Injury to the testes, chemotherapy and radiation therapy for cancer, genetic conditions, obesity, liver disease, kidney disease and aging can all lead to decreased levels of testosterone. Conditions that impact the pituitary gland and hypothalamus, which regulate testosterone levels in the body, can also cause low testosterone.

Testosterone production also declines with aging. The hormonal changes that occur in middle age cause physical and psychological changes, sometimes referred to as male menopause.

Treating low testosterone involves carefully adjusting and monitoring testosterone levels through hormone replacement therapy. Testosterone replacement therapy is available in many forms including topical gels or patches, intramuscular injections and implantation of subcutaneous pellets. Administering testosterone shuts down the body's ability to produce testosterone and sperm and is therefore not appropriate for men who still want to preserve fertility.

UC San Diego's dedicated andrologist works with patients to individualize their treatment and monitor for any side effects.

Peyronie’s disease is a condition in which abnormal scar tissue forms in the penis causing an abnormal curvature. As a result, patients may experience painful erections and erectile dysfunction. Up to 10 percent of men have a curvature of the penis preventing intercourse, although it is likely underestimated since most men do not seek therapy. UC San Diego Health System urologists are treating Peyronie’s disease by oral and injectable medications to break up the scar tissue and promote proper tissue healing, as well as unique surgical procedures. Some of the therapies offered are not available outside of academic medicine and UC San Diego is the only medical system in the region offering emerging therapies for Peyronie’s disease.

Sexual Function Preservation Program at UC San Diego Health System

We offer a comprehensive program aimed to preserve sexual function of patients undergoing treatment for cancer. Cancer therapies (radiation, surgery or chemotherapy) can have devastating side effects. Our urologists review the treatment plan with the your oncologist, identify potential sexual side effects and develop a targeted preservation program. UC San Diego Health System is dedicated to helping cancer survivors preserve their sexual function and fertility.