Intended for healthcare professionals

Clinical Review ABC of sexual health

Male sexual problems

BMJ 1999; 318 doi: (Published 23 January 1999) Cite this as: BMJ 1999;318:245
  1. Alain Gregoire

    Many men would agree with Woody Allen's implication that their penis is their favourite organ. This is certainly apparent to clinicians who deal with human sexuality and who see men whose penises are not behaving as they should. However, professionals can become as fixated on this organ as their patients and forget that it has a multiplicity of connections within the man's mind and body—and, indeed, outside it. Our concepts of sexual problems and their assessment and treatment must reflect this fact if we are to effectively deliver the help that our patients desperately seek.

    • “My brain? It's my second favourite organ.” Woody Allen, Sleeper, 1993

    Embedded Image

    For many men, a properly functioning penis is fundamental to their self esteem. (Priapus weighing his penis—from a fresco in the Villa dei Vetii, Pompeii, first century)

    It is convenient to consider sexual problems as dichotomies (organic or psychogenic, primary or secondary, male or female), but such distinctions are often inaccurate and unhelpful. The presence of a problem is a subjective perception influenced by many factors. However, there is no doubt that for most men sexuality is a highly rated aspect of their quality of life.

    Physical causes of male sexual problems

    • Peripheral vascular disease

    • Diabetes

    • Multiple sclerosis

    • Spinal injury

    • Spinal or brain surgery

    • Hormonal or endocrine abnormalities

    • Pelvic disease, trauma, or surgery

    • Genital abnormality, disease, or surgery

    • Consumption of alcohol, tobacco, and prescribed and illicit drugs

    From various studies in the general population and primary care it seems that 15-20% of men describe some sort of sexual problem. The proportion of men who actually seek help is unknown. For many men this is difficult, and their presentation may be hesitant or disguised in terms of another complaint. The first and crucial step in managing a sexual problem is to engage the patient with an interested and sympathetic attitude. Problems …

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