Male sexual dysfunction and fertility problems

Male sexual dysfunction and low libido are topics often overlooked as they are many times considered taboo. Assisted reproduction in the previous years used to mainly focus on female lead fertility issues; however, nowadays, the medical community’s attention has been shifted to the male side of things. Male sexual dysfunction and its effect on fertility issues is one of the main issues investigated as it is both common and treatable in most cases.

How common is male sexual dysfunction?

In the general population, about 30% of men are affected by sexual dysfunction, with that percentage being even higher in couples undergoing fertility treatment. This can occur in males of all reproductive ages. Even though it may be commonly noted in males undergoing fertility treatment, sexual dysfunction is rarely the primary cause of infertility.

Sexual dysfunction as a cause of infertility

The cause of infertility in males mainly has to do with pre-testicular, testicular and post-testicular issues. Sexual disfunction could fall in the pre-testicular category, and the types that could affect fertility are the following:

• Erectile dysfunction: This mainly affects natural conception in severe cases when penetration is not feasible. The cause can be physiological (e.g. diabetes, cardiovascular, neurological, endocrine issues) or phycological.

• Anejaculation: Inability to ejaculate through any form of stimulation is rare. Usually is the outcome of conditions affecting the nervous system (e.g., spinal injuries, cancer), infections or psychological issues (e.g. stress, depression).

• Retrograde ejaculation: Is usually caused due to an incomplete closure of the internal sphincter; this occurs in instances when the semen enters the bladder instead of a regular ejaculation. This leads to the absence of spermatozoa in the seminal fluid following ejaculation.

• Premature ejaculation: This type mainly affects natural conception in severe cases when ejaculation occurs before or right at the moment of penetration, leading to an inability of the sperm to enter the vagina.

Possible treatments

The treatment route followed for each case heavily depends on the type of sexual dysfunction a male may be facing:

• Erectile dysfunction: Treatment depends on the primary cause and the severity of erectile dysfunction. Some of the usual treatments include: oral medications known as phosphodiesterase type-5 inhibitors (eg. Viagra), testosterone therapy in hormone-related dysfunction, vacuum erection devices, intra urethral medications (in cases oral medications are not effective), self-injection therapy, penile implants, exercise and psychological counselling.
  
  Keep in mind that erectile dysfunction does not affect sperm quality. During assisted reproduction therapy in cases where producing a segment sample through spontaneous erection is not feasible, means such as sperm aspiration techniques (PESA/TESA/TESE/micro TESE) or electroejaculation can be utilized.

• Anejaculation: Again, treatment depends on the cause of anejaculation. Just like erectile dysfunction, sperm retrieval options include sperm aspiration techniques (PESA/TESA/TESE/micro TESE) or electroejaculation.

• Retrograde ejaculation: Typically, retrograde ejaculation does not require treatment until it interferes with fertility. In assisted reproduction, we have the options of urinary sperm retrieval, surgical sperm retrieval of testicular sperm (TESE/micro TESE), or even medications in cases that are not caused by anatomical issues or in cases specific medication regimes cause retrograde ejaculation.

• Premature ejaculation: Treatment includes counselling, behavioural techniques (e.g. ejaculation an hour or two before intercourse to delay ejaculation during intercourse), pelvic floor exercises, the use of specifically designed condoms and medications. Treatment mainly focuses on establishing a healthy sex life as for assisted reproduction therapy obtaining a semen sample is, in most cases, not an issue.

Male infertility and sexual dysfunction are usually treatable; in most cases, treatment options are available. Many underlying conditions could cause male infertility and sexual dysfunction. If you require more information on this subject, you can contact us directly by clicking here