Although there has been no study conducted in the Indian populace, the prevalence of sexual dysfunctions seems to be quite high. It is estimated that at least as many as one in four to five of us is likely to have had a sexual dysfunction in the previous year, as noticed in large population studies elsewhere in the world.

But it isn’t surprising that there is no data because there is a huge stigma surrounding the discussion of sex itself. Most people suffering from sexual dysfunctions see it as a sign of weakness and shame and are discouraged by family and society’s stigma to seek help.

When it comes to sexual dysfunctions, erectile dysfunction and premature ejaculation easily come to mind but there are 4 main types of dysfunctions that both men and women can suffer from. The causes can be multifactorial, falling broadly into issues related to the body, mind, medications and relationships.

Let’s first look at those which affect the male body. We will address female sexual dysfunctions in our next article.

Male sexual dysfunctions are divided into four broad categories: Inhibited desire; Erectile dysfunction also known as ED; Difficulty with ejaculation and Painful sex.

One common requirement that problems be seen as a dysfunction is that the they should be persistent or recurrent (not a one-off occurrence). It should lead to the person experiencing distress and interpersonal strain affecting the quality of sexual life.

Inhibited sexual desire

Inhibited desire includes the lack or loss of either having spontaneous sexual thoughts or the desire to initiate or respond to sexual activity.

Being overweight can also impact desire, both for physical and psychological reasons.

Getting help for inhibited desire includes seeing a relationship therapist or a sexologist. Treatment may include individual or couple therapy. Unearthing the root of the problem, which could be any one of the above reasons, may take some time following which a suitable treatment can be prescribed.

Erectile Dysfunction

Also known as impotence, erectile dysfunction as the name suggests is when a man is unable to achieve an erect penis on sexual arousal. Sometimes an erection may not be achieved due to fatigue, stress or too much alcohol. This is not unusual and erectile dysfunction is diagnosed only when it is frequent or persistent.

It is important to remember that a one-off incident can cause an unnecessary stress about achieving an erection resulting from shame around lack of performance or feeling like one’s manhood has been attacked. It is important to know that one-off incidents are normal and not let it lead to an actual problem. Anecdotally, in clinics, specialists come across young men who are worried, and are convinced about being impotent after just two or three episodes.

A diagnosis must be sought through a sexologist or a relationship therapist. It has been observed that those with a gradual onset of ED are likely to have a physiological root for the problem. Post diagnosis, treatment may include oral medication, intra urethral pellets, vacuum devices or an injection therapy. Lifestyle changes and couples-therapy may also be suggested.

Difficulty with ejaculation

There are three problems that fall under difficulty with ejaculation: Rapid ejaculation (coming too soon), Delayed ejaculation (taking too long to come) and Anejaculation (not being able to come at all). Anejaculation is very rare physical problem where some men can experience the feeling of an orgasm but lack of ejaculation.

Rapid ejaculation (pre-mature ejaculation)

While the definition of rapid is subjective, rapid ejaculation can refer to feeling like being unable to control the ejaculation and finding that is happens sooner than expected, maybe even before penetration. Most experts in the field consider ejaculation happening under two minutes of penetration all or most of the times as rapid ejaculation. It is common among younger men mostly because of psychological reasons like higher performance anxiety. It could also result from a learnt behaviour when men compulsively masturbate and learn to ejaculate quickly. It may also be due to lack of sexual experience. In some cases, it acts as a precursor to erectile dysfunction.

This condition can sometimes result from physical conditions such as thyroid gland dysfunction and problems with the prostate gland. The treatment involves helping both the individual and the couple develop a better understanding about the issue and to steer away from focussing on intercourse as being the ‘real sex’. Men with this problem are taught about controlling ejaculation through a series of graded activity called ‘stop-start technique’. In addition, there are medical treatments at a local penis level (local anaesthetic agents) and tablets that delay ejaculation. These should be taken under the supervision of a specialist. Medicines used for treating erectile problems are of not much benefit in rapid ejaculation.

Delayed Ejaculation and Anorgasmia

Delayed ejaculation is when a man takes longer than expected to achieve climax. If climax fails to occur, it is known as anorgasmia. In some men, these dysfunctions can find their root in a neurological disease or the side effect of medication like anti-depressants especially if it is a new problem. But mostly it can develop due to psychological reasons or a struggling relationship. It could be due to poor arousal from sexual boredom or insufficient stimulation by the partner (maybe due to lack of communication). It could also be the result of subconsciously feeling guilty about sexual pleasure or anxiety of a possible pregnancy and fatherhood.

Psychosexual therapy is used to discover the root of delayed ejaculation. It also enables the man to explore his sexual needs and likes and incorporate them into his sexual activity. Medications have a limited role in this condition and should be used after consulting a specialist.

Painful sex

Painful sex or dyspareunia is when a man experiences feelings of pain during an erection, penetration, ejaculation or after the sexual activity (which is when blood flows away from the area). It may be felt in the glans (tip of the penis), the shaft, the scrotum or the anus. There are multiple reasons for the pain.

While painful ejaculation is rare, it is generally associated with the inflammation of the urethra, prostate gland or the seminal vesicles. It may also be due to the obstruction of the ejaculatory duct.

Sometimes, the reason can be psychological; due to fear, anxiety or guilt around sex, a history of sexual abuse or a strict religious upbringing. In this case, sex therapy is prescribed.

A sexual dysfunction is a minor problem in the large scheme of things. The bigger problem is the stigma surrounding it that prevents many men from seeking help. So while sex therapy, medication and surgery can easily fix the above, the real problem that needs fixing is our outlook towards sex.

This is a part of the Sexual Health series bought to you by The News Minute in association with Happy Relationships. Happy Relationships is an enterprise that works in the field of sexual health and relationship wellness.