Evaluation of Male Sexual Dysfunction

INTRODUCTION

The sexually competent male must have desire for his sexual partner (libido), divert blood from the iliac artery into the corpora cavernosa to achieve penile tumescence and rigidity (erection) adequate for penetration, then discharge sperm, and prostatic and seminal vesicle fluid through the urethra (ejaculation), and experience a sense of pleasure (orgasm). Impotence is defined as the inability to develop or sustain erection 75 percent of the time. It is a common abnormality and may be due to psychological causes, medications, hormonal abnormalities, neurologic, or vascular problems. (See "Overview of male sexual dysfunction".)

The following include some of the mechanisms that may be responsible for sexual dysfunction in men:

• Libido declines with androgen deficiency [1], depression [2], and in association with the use of prescription and recreational drugs.
• Erectile dysfunction may reflect either inadequate arterial blood flow into (failure to fill) or accelerated venous drainage out of (failure to store) the corpora cavernosae.
• Disorders of ejaculation occur if the bladder neck sphincter is damaged during prostate surgery, or if alpha adrenergic impulses responsible for clamping down the bladder neck sphincter to facilitate antegrade ejaculation fail, resulting in retrograde ejaculation. Failure to ejaculate in men with adequate erectile function is also a common side effect of antidepressant medication or a reflection of an unresolved patient/partner conflict. Male sexual dysfunction associated with antidepressant use is discussed elsewhere. (See "Sexual dysfunction associated with selective serotonin reuptake inhibitor (SSRI) antidepressants".)

This topic review will discuss the evaluation of the man with sexual dysfunction. The evaluation begins with a sexual history and physical examination. The history and physical examination have been reported to have a 95 percent sensitivity, but only a 50 percent specificity in determining the cause of impotence; as a result, additional diagnostic tests are needed to maximize specificity [3]. The normal physiology, causes, and treatment of male sexual dysfunction are presented separately. (See "Overview of male sexual dysfunction" and "Treatment of male sexual dysfunction".)

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