Male Sexual Problems

Premature ejaculation—defined as ejaculation with minimal stimulation before or shortly after penetration—is the most common sexual dysfunction in men.

It is usually a lifelong problem, and most commonly has no underlying physical cause. Some men with premature ejaculation also have erectile difficulties, prostate infection, or psychological or relationship problems.

Treatment options for men with premature ejaculation include:

• Behavioral therapy, including systematic relaxation techniques and learning to recognize the sensation of inevitable ejaculation
• Topical, oral, or injectable medications

Erectile dysfunction (ED)—the inability to achieve or maintain an erection—is extremely common, affecting about 30 million American men. Many assume it’s all in their heads, and are reluctant to talk about it with their doctors.

But 90 percent of the time, there is an underlying medical or physical condition causing ED. Fortunately, the vast majority can be helped. 

At Virginia Mason Franciscan Health, our sexual health experts take a thorough history, perform a physical examination, including blood tests, to check testosterone levels. If appropriate, radiologic tests such as penile color Doppler ultrasound are also done.

We’re looking for any problems with physical or anatomical functions, including:

• Hormonal dysfunction
• Vascular dysfunction
• Neurological causes

Treatment depends on the cause of the condition.

Non-invasive treatments for ED include:

• Testosterone replacement for men if hormone levels are low
• Oral medications for those who have a vascular or neurological issue
• Sexual therapy for men suffering from psychological and relationship problems

Men who do not respond to these medications have other options, including:

• Vacuum Erection Device—a manually, or battery operated pump that helps increase blood flow to the penis
• Muse® (alprostadil)—a small suppository placed into the urethra that is rapidly absorbed and increases blood flow to the penis
• Penile injections—using medications to improve penile blood flow

ED surgery

At Virginia Mason Franciscan Health, we take a conservative approach to treating ED, starting with the least invasive treatments first. If these do not work, surgery is usually highly successful. 

We are regional experts in implanting internal penile prostheses—commonly known as the “pump.” Surgery involves placing of a penile implant with a pump. None of the components of the pump are visible, including the surgical scar. More than 90 percent of our patients and their partners are satisfied with the outcome, which restores spontaneity to sexual encounters.

Low testosterone levels, called hypogonadism, may cause low energy, a low sex drive, or erectile difficulties.
 
Testosterone can be supplemented through:

• A transdermal (through the skin) patch or gels
• Dissolving tablet placed against your gums
• Intramuscular injections

At Virginia Mason Franciscan Health, we also offer a long-term form of testosterone in pellets implanted under the skin.

Peyronie's disease causes scarring to develop in the shaft of the penis—sometimes noticeable as a hard lump. The scarring causes the penis to bend painfully when erect, which can make penetration difficult—causing psychological and physical problems.

The underlying causes of Peyronie’s disease is unknown, but is thought to sometimes result from heredity or minor injury. About 5 percent of men are affected by the disease at some point in their lives.

Symptoms of Peyronie’s disease include pain, formation of a hardened mass, and curving of the penis. 

We have a variety of options to address this condition, including physical therapy and stretching exercises. Medications such as Xiaflex can break down the buildup of collagen or plaque that can causes the penis to curve. Some patients are also considered for surgical corrections.