Tuesday, April 15, 2014

Male Sexual Dysfunction


Dr. Lila Z. Hakim, C. Psych

Many men don’t realize how common male sexual dysfunction is. Concerns can include decreased libido, difficulties attaining or maintaining an erection, or experiencing rapid (premature) or delayed ejaculation. Often times, men hesitate to consult a professional due to the assumption that the problem is temporary and will “fix itself”, or because of mounting embarrassment. However, if avoided and left unattended, male sexual dysfunction can result in negative effects on self-confidence, pleasure in sexual arousal, and on intimate relationships.

When assessing how best to treat male sexual dysfunction, a number of questions need to be asked. Is the condition situational or generalized over a number of different situations (e.g., different partners, locations, positions, time of day)? Is it lifelong (also referred to as primary) or acquired later in life (secondary)? Has another sexual difficulty developed as a result (for example, rapid ejaculation as a result of longstanding difficulties maintaining an erection)? A comprehensive assessment by a urologist is a necessary first step for understanding the cause and nature of difficulties.

Some factors that can contribute to male sexual dysfunction are:

1.    Medical conditions such as cardiovascular difficulties, diabetes, vascular problems, neurogenic causes or medical treatments such as chemotherapy.
2.    Lifestyle conditions such as use of substances (smoking, alcohol, recreational or prescription drug use), excessive weight, or lack of exercise.
3.    Psychological or emotional factors including difficulties with mood (e.g., depression), acute life stressors (e.g., financial problems, loss of job, relocation), fertility-related stress, general or performance anxiety, history of trauma, or sexual inhibition or over-control.
4.    Relationship factors including current relationship stress, longstanding abusive interactions or shaming, difficulties asserting self in relationships or worrying too much about partners’ pleasure.

A variety of medications can be prescribed by medical doctors for male sexual dysfunction, such as Phosphodiesterase Type 5 Inhibitors (PDE5 inhibitors) for erections, or Selective Serotinin Reuptake Inhibitors (SSRIs) for depression or mood, which can help for premature ejaculation.

Psychological treatment is another important step in addressing male sexual dysfunction and can include a number of different strategies:

1.    Understanding patterns in your lifestyle, emotional, relationship and sexual history that may be contributing to difficulties in the bedroom.
2.    Making changes in current sexual functioning with intimate partners (e.g., increasing the range of sexual behaviours engaged in, increasing genital tactile stimulation, changing time of day)
3.    Altering self-stimulation (masturbatory) activities (such as idiosyncratic techniques or an over-reliance on pornography).
4.    Anxiety reduction and desensitization (such as, relaxation and mindfulness exercises, mental rehearsals with relaxation, non-demanding bodily stimulation with partner in the absence of penetration)
5.    Cognitive and behavioural interventions (to stop “spectatoring”, and challenge underlying beliefs and fears).
6.    Identifying emotional coping and attachment styles and how these can contribute (such as pre-occupations with relationships or avoidance of negative emotions).


Psychological treatment for male sexual dysfunction can occur through individual therapy or couples counseling. Consult with one of the trained clinicians in CFIR’s Sex Therapy Service to develop the best treatment plan for overcoming sexual difficulties.

Read more about our Relationship & Sex Therapy Treatment Service.