Men's Health

Sexuality

Arousal disorders in men are more likely to be inadequate genital arousal disorder (erectile dysfunction) and hypersexuality, whereas women are more likely to present with inadequate mental arousal disorder. For both sexes, arousal disorders markedly affect physical and emotional satisfaction.

Erectile dysfunction (impotence) is extremely common in older men. The most common cause is atherosclerosis, resulting in poor blood flow to the penile artery and venous leaks. Other causes include medications, endocrine conditions (e.g., prolactinoma, hypothyroidism, hyperthyroidism, diabetes mellitus), neuropathy, lumbar spinal stenosis, multiple sclerosis, and epilepsy. Cigarette smoking markedly increases the likelihood of males developing erectile dysfunction. Psychological causes of erectile dysfunction are rare in older men, although performance anxiety may worsen organic disease.

Older males with erectile dysfunction are very likely to have vascular disease in other organs. Thus, it is important to screen in these men for coronary artery disease, cerebrovascular disease, and peripheral vascular disease. Because men tend not to consult physicians as often as do women, it is important that, when men present with erectile dysfunction, these and other health issues are addressed.

Current treatment for erectile dysfunction is a phosphodiesterase-5 inhibitor such as sildenafil (Viagra), tadafil (Cialis), or vardenafil (Levitra). These drugs cannot be used in males taking nitrates, and they need to be used with caution in men taking α-adrenergic blockers. Side effects include hypotension, syncope, indigestion, headache, and blindness. The response to phosphodiesterase-5 inhibitors is poor in hypogonadal (low-testosterone level) men and can be improved with testosterone replacement. Other treatments for erectile dysfunction include intracavernosal (into the penis tissues) injections with alprostadil, papaverine, or phentolamine and insertion of a penile prosthesis. Safe sex needs to be emphasized with all men undergoing treatment for erectile dysfunction. A number of studies have shown that the most frequent use of prostitutes occurs on the days Social Security checks become available.

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