1 Male Sexual Dysfunction

2 Hypoactive Sexual Desire Disorder Affects 15% of men Typically associated with a medical condition, mental health issues, or medication side effects –hypogonadal –depression –antidepressant induced

3 Male Erectile Disorder DSM-IV –Inability to attain or maintain adequate erection –problem persistent or recurrent –caused by psychogenic or combined factors common reason for seeking treatment highly distressing to men prevalence

4 Male Erectile Disorder (ED)

5 Male Erectile Disorder Medical causes: –vascular diseases (most common cause), e.g., hardening of arteries, long term cigarette use –diseases affecting the nervous system, e.g., multiple sclerosis, alcoholism –diseases affecting vascular and nervous system, e.g., diabetes, hypothyroidism –anything impairing penile vascular and/or nervous system: surgical or accidental injury old age pharmaceuticals

6 Drugs Associated with ED Alcohol  Estrogens  Antiandrogens  H 2 receptor blockers  Anticholinergics  Ketoconazole  Antidepressants  Marijuana  Antihypertensives  Narcotics  ß-blockers  Psychotropics  Cigarettes  Cocaine  Spironolactone  Lipid-lowering agents  NSAIDs  Cytotoxic drugs  Diuretics

7 Male Erectile Disorder (ED) Psychological Causes: –occasional episode normal (e.g., stress) –men with ED focus on anxiety/worries rather than sexual cues --> negative feedback loop –normally functioning men focus on erotic cues --> positive feedback loop (Barlow, 1986)

8 Male Erectile Disorder (ED)

9 Treatment: –Viagra (sildenafil), also, Cialis (tadalafil), Levitra (vardenafil) –injection of vasodilating drugs (e.g., alprostadil) –vascular surgery –vacuum pumps and constrictive devices –penile prosthesis or implants

10 Male Erectile Disorder (ED) Sildenafil: Mechanism of Action –Nitric oxide acts through a second messenger, cGMP, in the normal development of erections –cGMP relaxes corpus cavernosal smooth muscle cells, promoting blood flow into cavernosal spaces –cGMP broken down by PDE - the predominant enzyme of this type in the corpus cavemosum is PDE type V –Sildenafil is a selective and potent inhibitor of PDE type V

11 Vacuum Pumps and Constrictive Devices

12 Male Erectile Disorder (ED) Penile Implants  Two types: semirigid and multicomponent inflatable  Patient satisfaction: 81% to 97%  Average functional life: 7 to 10 years

13 Inflatable Penile Implant

14 Malleable Penile Implant

15 Male Orgasmic Disorder DSM-IV: Inability to reach orgasm after sufficient stimulation often require manual/oral simulation - “hard work” rare disorder - –1.5/1000 general population –13% of those presenting for therapy Physiological causes –SSRI –dopmanine agonists –spinal reflex abnormalities Psychological causes –frustration/anxiety from previous incidents –childhood sexual abuse

16 Premature Ejaculation Ejaculatory inevitability Premature Ejaculation –ejaculation with minimal stimulation –before, upon, or shortly after penetration –taking into account: age novelty of partner –problem is persistent and recurrent

17 Premature Ejaculation Prevalence Causes: –Physiological neurotransmitters (dopamine, serotonin) touch sensation (Roland; Fanciullacci et al., 1988) detecting ejaculatory inevitability (Kaplan, 1974) –Psychological anxiety (only in acquired types; Cooper et al., 1993) hostility

18 Premature Ejaculation Treatment –Pharmaceutical SSRIs anti-anxiety lidocaine –Psychological pause-and-squeeze (Semens, 1956; Masters & Johnson) mental imagery