Many men have sexual problems. They become more common as men age. Problems can include

• Erectile dysfunction
• Reduced or lost interest in sex
• Problems with ejaculation
• Low testosterone

Stress, illness, medicines, or emotional problems may also be factors. Occasional problems with sexual function are common. If problems last more than a few months or cause distress for you or your partner, you should see your health care provider.

Men being treated for cancer may experience changes that affect their sexual life during, and sometimes after, treatment. While you may not have the energy or interest in sexual activity that you did before treatment, being intimate with and feeling close to your spouse or partner is probably still important.

Your doctor or nurse may talk with you about how cancer treatment might affect your sexual life or you may need to be proactive and ask questions such as: What sexual changes or problems are common among men receiving this type of treatment? What methods of birth control or protection are recommended during treatment?

Whether or not you’ll have problems that affect your sexual health depends on factors such as:

• the type of cancer
• the type of treatment(s)
• the amount (dose) of treatment
• the length (duration) of treatment
• your age at time of treatment
• the amount of time that has passed since treatment
• other personal health factors

Cancer Treatments May Cause Sexual Problems in Men

Many problems that affect a man’s sexual activity during treatment are temporary and improve once treatment has ended. Other side effects may be long term or may start after treatment.

Your doctor will talk with you about side effects you may have based on your treatment(s):

• Chemotherapy may lower your testosterone levels and libido during the treatment period. You may be advised to use a condom, because semen may contain traces of chemotherapy for a period of time after treatment. Chemotherapy does not usually affect your ability to have an erection.
• External-beam radiation therapy to the pelvis (such as to the anus, bladder, penis, or prostate) and brachytherapy (also called internal radiation therapy) can affect a man’s sexual function. If blood vessels or nerves are damaged, it may be difficult to get or keep an erection; this is called erectile dysfunction. If the prostate is damaged, you may have a dry orgasm.
• Hormone therapy can lower testosterone levels and decrease a man’s sexual drive. It may be difficult to get or keep an erection.
• Surgery for penile, rectal, prostate, testicular, and other pelvic cancers (such as the bladder, colon, and rectum) may affect the nerves, making it difficult to get and keep an erection. Sometimes nerve-sparing surgery can be used to prevent these problems.
• Medicines used to treat pain, some drugs used for depression, as well as medicines that affect the nerves and blood vessels may all affect your sex drive.

Health problems, such as heart disease, high blood pressure, diabetes, and smoking, can also contribute to changes in your sexual health.

Ways to Manage Sexual Health Issues

People on your health care team have helped others cope during this difficult time and can offer valuable suggestions. You may also want to talk with a sexual health expert to get answers to any questions or concerns.

Most men can be sexually active during treatment, but you’ll want to confirm this with your doctor. For example, there may be times during treatment when you are at increased risk of infection or bleeding and may be advised to abstain from sexual activity. Depending on the type of treatment you are receiving, condom use may be advised.

Your health care team can help you:

• Learn about treatments: Based on symptoms you are having, your oncologist or a urologist will advise you on treatment options. For example, there are medicines and devices that may be prescribed once a sexual health problem has been diagnosed. Medicines can be given to increase blood flow to the penis. There are also surgical procedures in which a firm rod or inflatable device (penile implant) is placed in the penis, making it possible to get and keep an erection.
• Learn about condoms and/or contraceptives: Condoms may be advised to prevent your partner’s exposure to chemotherapy drugs that may remain in semen. Based on your partner’s age, contraceptives may be advised to prevent pregnancy.
• Manage related side effects: Talk with your doctor or nurse about problems such as pain, fatigue, hair loss, loss of interest in activities, sadness, or trouble sleeping, that may affect your sex life. Speaking up about side effects can help you get the treatment and support you need to feel better.
• Get support and counseling: During this time, it will help to share your feelings and concerns with people you are close to. You may also benefit from participating in a professionally moderated or led support group. Your nurse or social worker can recommend support groups and counselors in your area.

Talking with Your Health Care Team about Sexual Health Issues

As you think about the changes that treatment has brought into your life, make a list of questions to ask your doctor, nurse, or social worker. Consider adding these to your list:

• What sexual problems are common among men receiving this treatment?
• What sexual problems might I have during treatment?
• When might these changes occur?
• How long might these problems last? Will any of these problems be permanent?
• How can these problems be prevented, treated, or managed?
• What precautions do I need to take during treatment? For example, do I need to use a condom to protect my partner?
• Should my partners and I use contraception to avoid a pregnancy? What types of contraception (birth control) do you recommend?
• Is there a support group that you recommend?
• What specialist(s) would you suggest that that I talk with to learn more?

The psychic drive or energy associated with sexual instinct in the broad sense (pleasure and love-object seeking). It may also connote the psychic energy associated with instincts in general that motivate behavior.

Summary

• Sex drive varies a lot from one person to the next and even for the same person, depending on what they prefer and their life circumstances.
• If a couple is having problems in other areas of their relationship, their sex life may be affected.
• Some medical conditions and medication can affect a person’s desire for sex.
• Treatment for a lessened libido can include treating any underlying medical condition, hormone therapy, stress management and counselling.

Libido, which means sex drive or the desire for sex, varies dramatically from one person to the next. It also varies depending on a person’s preferences and life circumstances. Libido can be affected by medical conditions, hormone levels, medications, lifestyle and relationship problems.

Many new couples will go through an early period of having a lot of sex that slows down over time. On the other hand, a busy life can leave some people too tired or preoccupied to even think about sex. Unless you are worried about your sex drive or it is causing problems between you and your partner, you do not need to seek professional help.

What is a ‘normal’ libido?

There is no ‘normal’ when it comes to how often you have sex. Some people have sex (or feel like having sex) every day, others may have sex once a year or not at all. It all depends on what you prefer and your life circumstances.

What causes a lowered libido?

As well as medical conditions and the side effects of some medications, there are a number of other reasons for a lessened sex drive, including:

• performance anxiety – premature ejaculation or painful sex can make a person avoid sex out of fear that it could happen again
• fatigue – feeling too tired for sex is common
• lack of time and privacy – the demands of work and home life may not leave enough time for intimacy and sex
• familiarity – a couple’s desire for sex tends to lessen over time
• sexual incompatibility – sexual desire can be affected if a person constantly wants more sex than their partner or wants a type of sexual activity that their partner is not comfortable with
• sexual turn-offs – sexual attraction to your partner may lessen if there are changes in their physical appearance, such as excessive weight gain
• depression – can cause tiredness, lack of motivation, feeling sad and withdrawing from activities, including sex
• stress – researchers have found stress hormones can lessen sexual desire and response
• exercise – either too much or too little can cause a loss of sex drive
• traumatic experience – such as sexual harassment, sexual abuse or rape, can lessen sexual desire.

Can relationship issues affect libido?

A reduced sex drive may also be caused by relationship problems. If a couple is having problems in other areas of their relationship, their sex life may be affected.

If you and your partner are not satisfied with your sex life, you can seek professional counselling to:

• learn communication skills to improve the overall quality of your relationship
• try to resolve underlying problems, such as tension
• learn how to increase intimacy and physical affection without having sex
• learn different sexual techniques
• talk about sexual desires and fantasies together
• learn strategies to boost sex drive, such as masturbating and fantasising.

Can health issues affect libido?

A reduced sex drive can be a side effect of some medication. For example, some antidepressants have a known side effect of lowering libido. Some women feel they have less interest in sex when taking contraceptives that contain hormones, such as the pill.

Some physical illnesses and medical conditions can cause a loss of sex drive, including anaemia, kidney failure, hypothyroidism (underactive thyroid gland) and depression.

If you are worried about the effect of medication on your sex drive, you can talk to a doctor about changing medication or trying alternative options.

Conditions affecting female libido

Some of the medical conditions that can cause a woman’s sex drive to lessen include:

• menopause – because of the drop in sex hormones
• dyspareunia – painful sex
• vaginismus – the involuntary (not under the woman’s conscious control) clamping of the vaginal muscles, making penetration difficult, if not impossible
• pregnancy, childbirth and breastfeeding – because of changes in hormone levels, especially the hormone prolactin
• infections – such as thrush or urinary tract infections
• problems reaching orgasm – the woman cannot reach orgasm or reach it within the time wanted by her and her partner.

Conditions affecting male libido

Some of the medical conditions that can cause a man’s sex drive to lessen include:

• hormone changes – as a man ages, his testosterone levels slowly fall, which some researchers think is linked to a lessened libido
• impotence – not being able to achieve or maintain an erection needed for sex
• premature ejaculation – a lack of control over ejaculation, causing it to happen sooner than the man or his partner would want
• retarded ejaculation – not being able to reach orgasm.

How is lowered libido diagnosed?

If you have lost interest in sex for no apparent reason, a doctor can help find the cause by carrying out a range of tests, including:

• physical examination
• medical history
• blood tests.

How is lowered libido treated?

Treatment for a lessened sex drive depends on the cause, but can include:

• treatment for any underlying medical condition, such as depression (although a side effect of some antidepressants is a lessened libido)
• counselling
• stress management
• hormone therapy.

Erectile dysfunction (ED) is a common type of male sexual dysfunction. It is when a man has trouble getting or keeping an erection. ED becomes more common as you get older. But it's not a natural part of aging.

Some people have trouble speaking with their doctors about sex. But if you have ED, you should tell your doctor. ED can be a sign of health problems. It may mean your blood vessels are clogged. It may mean you have nerve damage from diabetes. If you don't see your doctor, these problems will go untreated.

Your doctor can offer several new treatments for ED. For many men, the answer is as simple as taking a pill. Getting more exercise, losing weight, or stopping smoking may also help.

Erectile dysfunction (ED) is a condition in which you are unable to get or keep an erection firm enough for satisfactory sexual intercourse. ED can be a short-term or long-term problem. You have ED when you:

• can get an erection sometimes, but not every time you want to have sex
• can get an erection, but it does not last long enough for fulfilling or satisfactory sex
• are unable to get an erection at any time

Health care professionals, such as primary care providers and urologists, often can treat ED. Although ED is very common, it is not a normal part of aging. Talk with a health care professional if you have any ED symptoms. ED could be a sign of a more serious health problem.

You may find it embarrassing and difficult to talk with a health care professional about ED. However, remember that a healthy sex life can improve your quality of life and is part of a healthy life overall. Health care professionals, especially urologists, are trained to speak to people about many kinds of sexual problems.

ED is very common. It affects about 30 million men in the United States.

There are many myths and exaggerated expectations when it comes to sexuality. That’s also true for the question of how long it takes men to reach orgasm during sex. That depends on many factors and can vary from time to time.

Measured on a stopwatch, it takes an average of 5 to 7 minutes for a man to reach orgasm and ejaculate. But the overall range is wide, from less than one minute to over half an hour.

There are also many differences in whether and how much a relatively early orgasm affects a man, his relationship and sexual satisfaction. In studies, men tend to overestimate the time it takes until ejaculation by a quarter to one half of the actual time. So it isn't a good idea to go by what others claim.

About 4% of men have almost no control over when they ejaculate. They then always (or nearly always) "come" very early – that is, before or directly after penetration. If these early orgasms become distressful, the problem is medically diagnosed as premature ejaculation. Various treatments are possible, sometimes including medication. Sex therapy is sometimes an option as well.