Sexual Health

Assessment and Management of Male Sexual Dysfunction

Assessments for Erectile Dysfunction (ED) and Premature Ejaculation (PE)

Types of Male sexual dysfunction such as erectile dysfunction (ED) and premature ejaculation (PE) are common problems affecting men. There has been an increase in the prevalence of sexual dysfunction, which we can attribute in part to increasingly stressful and unhealthy work and lifestyles patterns which adversely affect marriages and relationships. A complete assessment of male sexual problems requires an in depth understanding of the patient's physical, psychological and family/relationship status.

A Comprehensive assessment should include:

  • Physical and Psychological Assessment
    • - To identify the exact problem
    - To identify the severity of the problem
    - To determine the predominant cause(s) of the problem
  • Neurological and vascular Assessment
    • - Biothesiometer to assess the nerve conduction to the penis
    - Vascular Doppler to assess the blood penile blood flow
    - Blood pressure/24 hour blood pressure monitoring
  • Biochemical and Hormonal Assessment
    • - Basic blood test include cholesterol, blood sugar, testosterone, prolactin
    - Other test depending on individual circumstances
  • Vascular response Assessment
    • - Intracavernous injection vascular response test

Management for Sexual Dysfunctions

There are many different options for dealing with sexual dysfunction. These will depend on what the patient wants to achieve, as well as what will work for them in their individual case.

Psychotherapy and Sex Therapy

Many men suffer from performance anxiety or situational ED. This may stem from bad experiences in the past or a lack of experience. Some men develop a fear towards sexual activity and this leads to avoidance. Avoidant behavior leads to further anxiety, and physical de-conditioning of penile blood flow if it is ignored. Erectile dysfunction can negatively impact on people’s relationships, marriages, self-esteem and their self-confidence. Ultimately this may even lead to depression and suicide. In many incidences a few brief sessions with a counselor, psychologist or sex therapist may be enough to resolve the problem and restore normal life. This is regarded as the first line of treatment in most cases.

Marriage and Relationship Counselling

Often men suffer from erectile dysfunction or other sexual dysfunction as a result of marital disharmony, the effect of extramarital relationships or as a result of poor communication and sexual skills. Relationship and marriage counselling aims to help couples repair their relationship, and to find solutions to their problems. Therefore this therapy usually requires both partners to attend sessions together, in order to work through their problems, and work towards mutually agreeable goals and solutions.

Lifestyle Modification

Lifestyle factors such as smoking, alcohol, drug abuse and lack of sleep are all contributing factors to erectile dysfunction. These may need to be modified as part of the overall management plan.

Oral Medications

Medications such Viagra, Cialis and Levitra (PDE5-inhibitors) can provide effective forms of treatment to many men who have erectile dysfunction. However, in some men, oral medications may not work initially. The failure rate on average is about 30-50% and there are many reasons for this including: an individual's physical condition, history of disease, other concurrent medications, incorrect method or timing for taking medicine or a lack of sex drive or stimulation. In all cases the cause of failure needs to be explored and assessed. In most cases after some adjustments and education medications will work.

However, sometimes even after adjustments are made other forms of treatment may be required. Usually the side effects of oral medications are very mild and include headaches, hot flushes, nausea and blue vision (i.e. everything you see appears to have turned blue). In very rare cases this has lead to blindness. PDE5 inhibitors must not be used by patients taking nitrite for ischemic heart disease.

Intracavernous Injection Therapy

Before the popularity of oral medication, intracavernous therapy was the main stream treatment for ED. It is still used by many who do not have a sufficient erection after taking oral medication. This therapy requires clients to self-inject a medicine into the penis to help the blood vessels to dilate. These injections has been made easier with the use of an auto-injector. The success rates for an adequate erection are as high as 95%. Some studies have shown that after using intracavernous injection therapy, some people erections may return to normal. However, this approach requires regular usage and a lot of persistence. The complications of injection therapy include priapism (a prolonged erection lasting over 4 hours), infection, bruising and plaque/fibrosis formation at the injection site. However all these complications are uncommon and can be minimized by following the instructions carefully.

Hormonal Replacement Therapy

Testosterone deficiency is increasingly being recognized as a cause of ED. Low testosterone levels can lead to a low sex drive, poor response to sexual stimulation and a reduced vascular response to vasodilatation. A blood test is required to confirm your testosterone level. If a deficiency in testosterone is confirmed then testosterone replacement therapy is helpful in restoring normal function. In some men a combination of a testosterone replacement and a PDE5 inhibitor will increase the effectiveness of oral medication. Testosterone comes in an oral form, which is taken daily, or as an injection which is given once every 3-12 weeks. The side effects of testosterone replacement therapy include an increase in prostate and liver problems. However there are some newer forms of testosterone medication that have shown no adverse effects on the prostate and liver after 10 years.

Growth Hormone

Growth hormone has been used increasingly in anti-aging therapy. A decline in sexual function due to aging has been associated with a reduction in the level of growth hormone. In some cases, growth hormone is used in conjunction with PDE5 inhibitors, to improve its effectiveness, and restore the overall physical condition of the patient.

Vacuum Device

Some men would prefer a non-medical treatment. For these clients a vacuum device may be an option. This requires the use of a suction device, which is operated either automatically or manually. In all cases, a constrictor ring is required to stop the blood from being drained out of the penis. However many men report that they find their erection is cold and uncomfortable.

At the HK Sexual Health Centre, we understand how sexual problems can affect one's life. We aim to provide a relaxing and private area for our patients to discuss their problems, either individually or as a couple. We also provide a comprehensive and in depth assessment of the problem(s) facing our patients. Whether it is a relationship issue, a physical problem or psychological trauma our team of professionals will provide you with tailor made solutions and support. At the end of your treatment we hope you have achieved your goals, and improved the quality of your life in some way.