Evaluation of male sexual dysfunction
- Glenn R Cunningham, MD
Glenn R Cunningham, MD
- Distinguished Professor Emeritus, Department of Medicine
- Baylor College of Medicine
- Mohit Khera, MD, MBA, MPH
Mohit Khera, MD, MBA, MPH
- Associate Professor
- Scott Department of Urology
- Baylor College of Medicine
- Section Editors
- Peter J Snyder, MD
Peter J Snyder, MD
- Editor-in-Chief — Endocrinology
- Section Editor — Pituitary Disease; Male Reproductive Endocrinology
- Professor of Medicine
- University of Pennsylvania School of Medicine
- Alvin M Matsumoto, MD
Alvin M Matsumoto, MD
- Section Editor — Male Reproductive Endocrinology
- Professor of Medicine
- University of Washington School of Medicine
- Michael P O'Leary, MD, MPH
Michael P O'Leary, MD, MPH
- Section Editor — Urology
- Professor of Surgery, Harvard Medical School
- Senior Urologic Surgeon, Brigham and Women's Hospital
Male sexual dysfunction has long been known to be common. Of late, knowledge of normal male sexual function and the causes of sexual dysfunction have become better understood, and more effective treatments are available. Male sexual dysfunction includes erectile dysfunction (ED), diminished libido, and abnormal ejaculation.
This topic will review the evaluation of male sexual dysfunction. An overview of male sexual dysfunction, treatment of men with sexual dysfunction, and sexual dysfunction associated with selective serotonin reuptake inhibitors (SSRIs) are discussed separately. (See "Overview of male sexual dysfunction" and "Treatment of male sexual dysfunction" and "Sexual dysfunction caused by selective serotonin reuptake inhibitors (SSRIs): Management".)
The following include some of the mechanisms that may be responsible for sexual dysfunction in men:
●Libido declines with testosterone deficiency , stress, relationship issues, depression , systemic illness, and in association with the use of a number of prescription and recreational drugs. (See "Overview of male sexual dysfunction", section on 'Decreased libido'.)
●There are many causes of erectile dysfunction (ED): vascular, neurologic, local penile factors, hormonal, drug induced, and psychogenic (table 1).
- Bagatell CJ, Bremner WJ. Androgens in men--uses and abuses. N Engl J Med 1996; 334:707.
- Reynolds CF 3rd, Frank E, Thase ME, et al. Assessment of sexual function in depressed, impotent, and healthy men: factor analysis of a Brief Sexual Function Questionnaire for men. Psychiatry Res 1988; 24:231.
- Althof SE, Abdo CH, Dean J, et al. International Society for Sexual Medicine's guidelines for the diagnosis and treatment of premature ejaculation. J Sex Med 2010; 7:2947.
- Davis-Joseph B, Tiefer L, Melman A. Accuracy of the initial history and physical examination to establish the etiology of erectile dysfunction. Urology 1995; 45:498.
- Rosen RC, Riley A, Wagner G, et al. The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology 1997; 49:822.
- Cappelleri JC, Rosen RC. The Sexual Health Inventory for Men (SHIM): a 5-year review of research and clinical experience. Int J Impot Res 2005; 17:307.
- Bolt JW, Evans C, Marshall VR. Sexual dysfunction after prostatectomy. Br J Urol 1987; 59:319.
- Hawton K, Catalan J, Fagg J. Sex therapy for erectile dysfunction: characteristics of couples, treatment outcome, and prognostic factors. Arch Sex Behav 1992; 21:161.
- Leiblum SR, Rosen RC. Couples therapy for erectile disorders: conceptual and clinical considerations. J Sex Marital Ther 1991; 17:147.
- Principles and Practice of Sex Therapy, 5th ed, Binik YM, Hall KSK (Eds), The Guilford Press, New York 2014.
- Moskovic DJ, Mohamed O, Sathyamoorthy K, et al. The female factor: predicting compliance with a post-prostatectomy erectile preservation program. J Sex Med 2010; 7:3659.
- Fisher WA, Rosen RC, Eardley I, et al. Sexual experience of female partners of men with erectile dysfunction: the female experience of men's attitudes to life events and sexuality (FEMALES) study. J Sex Med 2005; 2:675.
- Slag MF, Morley JE, Elson MK, et al. Impotence in medical clinic outpatients. JAMA 1983; 249:1736.
- Spark RF, White RA, Connolly PB. Impotence is not always psychogenic. Newer insights into hypothalamic-pituitary-gonadal dysfunction. JAMA 1980; 243:750.
- Buvat J, Lemaire A. Endocrine screening in 1,022 men with erectile dysfunction: clinical significance and cost-effective strategy. J Urol 1997; 158:1764.
- Earle CM, Stuckey BG. Biochemical screening in the assessment of erectile dysfunction: what tests decide future therapy? Urology 2003; 62:727.
- Araujo AB, Esche GR, Kupelian V, et al. Prevalence of symptomatic androgen deficiency in men. J Clin Endocrinol Metab 2007; 92:4241.
- Bhasin S, Cunningham GR, Hayes FJ, et al. Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2010; 95:2536.
- Bain CL, Guay AT. Reproducibility in monitoring nocturnal penile tumescence and rigidity. J Urol 1992; 148:811.
- Kwan M, Greenleaf WJ, Mann J, et al. The nature of androgen action on male sexuality: a combined laboratory-self-report study on hypogonadal men. J Clin Endocrinol Metab 1983; 57:557.
- Lewis RW. Venous surgery for impotence. Urol Clin North Am 1988; 15:115.
- Lanigan D, Roobottom C, Choa RG. A modified papaverine test and the use of venous constriction in erectile dysfunction. Int J Impot Res 1993; 5:119.
- Rowland D, McMahon CG, Abdo C, et al. Disorders of orgasm and ejaculation in men. J Sex Med 2010; 7:1668.
- Hatzimouratidis K, Amar E, Eardley I, et al. Guidelines on male sexual dysfunction: erectile dysfunction and premature ejaculation. Eur Urol 2010; 57:804.
- Wespes E, Eardley I, Giuliano F, et al. European Association of Eurology Guidelines on Male Sexual Dysfunction: Erectile dysfunction and premature ejaculation. 2013. www.uroweb.org/gls/pdf/14_Male Sexual Dysfunction_LR.pdf (Accessed on November 24, 2013).
- Nehra A, Jackson G, Miner M, et al. The Princeton III Consensus recommendations for the management of erectile dysfunction and cardiovascular disease. Mayo Clin Proc 2012; 87:766.
- Miner M, Nehra A, Jackson G, et al. All men with vasculogenic erectile dysfunction require a cardiovascular workup. Am J Med 2014; 127:174.
- - Sexual history
- - Rapidity of onset
- - Erectile reserve
- - Assessment of interpersonal conflict
- - Role of the partner interview
- - Validated instruments to assess sexual function
- Physical examination
- Laboratory studies and diagnostic tests
- - Hormonal testing
- - Nocturnal penile tumescence testing
- - Duplex Doppler imaging
- Ejaculatory disorders
- ERECTILE DYSFUNCTION AND CARDIOVASCULAR DISEASE
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS