Men's Health
Our Men’s Health section offers effective advice and guidance for male-specific conditions such as premature ejaculation, erectile dysfunction and trouble urinating (prostate).
These conditions can be hard to talk about face to face with your GP, but our online service provides a safe and discreet way to get the information you need.
Male sexual problems
It’s estimated that one in 10 men has a problem related to having sex, such as premature ejaculation or erectile dysfunction. Dr John Tomlinson of The Sexual Advice Association explains some of the causes, and where to seek help.
“Sexual dysfunction in a man is when he's not able to perform properly,” says Dr Tomlinson. “The main problem is being unable to get an erection. It’s much more common than people realise. In the 20-40 age group it affects around 7-8% of men, in the 40-50 age group it affects 11%. In the over-60s it affects 40%, and more than half of men over 70.”
It can affect any man, whether he is straight, gay, bisexual or transgender.
Erectile dysfunction (impotence)
This is when a man can’t get, or keep, an erection. Most men experience it at some time in their life.
“It only becomes a problem when the man or his partner considers it a problem,” says Dr Tomlinson.
What causes erectile dysfunction?
“A variety of things cause it. Some psychological and some physical,” says Dr Tomlinson. "Psychological issues tend to affect younger men, such as first night nerves and so on. Often, these problems don’t persist. But there can be more serious psychological problems about sex that need the help of a psychosexual therapist.”
Worries about work, money, your relationship, family, and even worrying about not getting an erection, can all be factors.
Physical reasons for erectile dysfunction include:
Medical conditions that cause erectile dysfunction
- heart disease
- diabetes
- raised blood pressure
- raised cholesterol: this can lead to clogging of arteries, including the arteries in the penis, which are very narrow (1-2mm in diameter compared with around 10mm in the heart artery)
- low testosterone: testosterone levels fall as men get older, but not all men are affected by it. Those who are affected will have symptoms such as feeling tired and unfit, and loss of interest in (and inability to have) sex.
Drugs that cause erectile dysfunction
- some prescription drugs: these can include medicines (such as beta-blockers) used to treat raised blood pressure, and antidepressants, antipsychotic drugs and anticonvulsant drugs
- alcohol
- recreational drugs such as cannabis and cocaine
- smoking: nicotine affects the blood supply to the areas of the penis that cause erections
What should I do if I have erectile dysfunction?
See your GP. He or she can give you a physical examination and carry out blood tests to identify the cause.
Erectile dysfunction can be an important signal to other issues.
“It's associated with raised cholesterol, diabetes and raised blood pressure. Any of these can be a warning of future heart disease,” says Dr Tomlinson. Your doctor can ensure that you get the treatment you need.
What's the treatment for impotence?
First, adjust any lifestyle factors that might be causing your problem.
“If you stop smoking, drinking too much or using recreational drugs, the problem should eventually go away. But it can take months,” says Dr Tomlinson. “There is no overnight cure.”
If you're prescribed blood pressure tablets or antidepressants, your doctor may be able to put you on a different kind.
Low testosterone can be treated with hormone replacement therapy, which should resolve erectile dysfunction as long as it's used together with erection-helping drugs. Other conditions, such as diabetes and high blood pressure, can be treated, which may improve erections. Find out more about erectile dysfunction treatment, including sildenafil cotrate (viagra). The Sexual Advice Association has useful factsheets on all of this.
Some men benefit from psychosexual therapy, which is a form of relationship therapy where you and your partner can discuss any sexual or emotional issues or concerns. You can contact the Sexual Advice Association, Relate, sexual health charity FPA or your GP to ask about psychosexual therapy.
Support options
For help with cutting down on drinking, drug use or smoking, contact:
Premature ejaculation
This is when a man ejaculates (comes) sooner than he wants to during sex. It's only a problem if it bothers him or his partner.
You can see your GP or a psychosexual therapist for help.
What causes premature ejaculation?
"Either just being very excited with a new partner, or an acute sensitivity of the local nervous system, which triggers orgasm too suddenly," says Dr Tomlinson.
It can also be linked to anxiety about sexual performance, stress, unresolved issues in a relationship, or depression.
What should I do if I have premature ejaculation?
See your GP, or a psychosexual therapist. A therapist can teach you techniques to try to delay ejaculation.
What treatment is there?
“A lot of men and their partners don’t worry, and they work around it," says Dr Tomlinson. "But if you’re very unsatisfied, there are some things you can try.”
- Have sex again soon after the man ejaculates. The second time, it will take longer to reach an orgasm. Older men might find this difficult as it may take too long to get a second erection.
- Creams (available from sex shops) can be put on the penis to numb sensation. “But this tends to transfer the numbing sensation to the partner, which they don't always like,” warns Dr Tomlinson. Some find using a condom useful.
- The man’s partner can squeeze his penis in a certain way to prevent him ejaculating. “A man needs an extremely willing partner to do this, and some partners don’t feel comfortable with it,” says Dr Tomlinson.
- Antidepressants called selective serotonin reuptake inhibitors (SSRIs) can slow ejaculation, but only for a year or so. “We’ll try every other treatment first before starting on drugs,” says Dr Tomlinson.
- Psychotherapy might help in terms of relaxing or exploring problems in the relationship. Find out what a sex therapist does.
Dr Tomlinson is editor of The ABC of Sexual Health (published by Wiley-Blackwell).
The Sexual Advice Association helpline is 0207 486 7262.
Find out about other sexual problems, such as retarded ejaculation and retrograde ejaculation.
If you are worried about your health have a look at the Man MOT, a confidential online surgery where you can talk to a GP anonymously.
trouble urinating (prostate)
When the prostate is enlarged, it can press on the tube that carries urine from the bladder. This can make it hard to pass urine, which can be a sign of prostate disease, including cancer.
Prostate cancer is the most common cancer in men in the UK. More than 30,000 men are diagnosed with it every year. Other symptoms include pain or burning when you pass urine and frequently waking up in the night to pee. If you have any of these symptoms, see your GP.
KNOW YOUR PROSTATE
Every man has one, it's important for their sex life, yet few men know anything about their prostate or what can go wrong with it. According to a survey of men aged 45 and over by Prostate Cancer UK, 70% of them knew nothing about their prostate or the symptoms of prostate cancer.
John Neate, of Prostate Cancer UK, says that better knowledge about this walnut-sized gland will help men to make better choices about testing and treatment.
"We certainly don't want men to panic about getting prostate cancer, but we do want far more to be aware of their risk of this disease and their health in general."
The prostate is located below the bladder. It produces some of the fluid in semen and is crucial to a man's sex life. The prostate fluid nourishes and protects sperm during intercourse and forms the bulk of ejaculate volume.
The prostate often enlarges as men get older, but for two-thirds of men aged 50 or over this doesn't cause any problems.
In some cases, an enlarged prostate can press on the tube carrying urine from the bladder and cause urinary problems. This is known asbenign prostatic hyperplasia (BPH).
Other prostate conditions include inflammation of the gland, also known as prostatitis, which is sometimes caused by an infection. This can make urinating painful. Sometimes a single cell in the prostate starts to multiply out of control and cancer can develop.
Most common cancer
Prostate cancer is the most common cancer in men in the UK, with more than 30,000 men diagnosed annually.
Around 10,000 men die from it every year, making it the second most common cause of cancer deaths in men after lung cancer.
Most men with early prostate cancer have no symptoms at all. Some of the symptoms of prostate cancer below can also be caused by other prostate problems.
Symptoms of all prostate problems include:
- needing to urinate often, especially at night
- difficulty starting to urinate
- straining to urinate or taking a long time to finish
- pain when urinating or during sex
Other less common symptoms include:
- pain in the lower back
- blood in the urine
Many men over 70 have prostate cancer, even though most of them will never have it diagnosed or have any symptoms.
In the majority (80%) of cases, this is a slow-growing cancer and it may stay undiagnosed because it never causes any symptoms or problems.
In the other 20% of cases, the prostate cancer cells can grow quickly and move outside the prostate, spreading the cancer to other parts of the body, such as the bones.
'AT RISK' GROUPS
The risk of getting prostate cancer gets higher as you get older. Most men diagnosed with the condition are over 50.
However, survival rates of newly diagnosed prostate cancer patients have improved from 30% in the 1970s to 80% today.
If you have a father or brother diagnosed with prostate cancer, your risk of getting the disease is two-and-a-half times higher compared to the average man. The risk increases to 4.3 if the relative was diagnosed before the age of 60.
"A man is three times more likely to be diagnosed with prostate cancer if he comes from an African or African-Caribbean background," says John Neate.
Black men are three times more likely to develop prostate cancer than white men. Researchers are looking at what may be the cause of this increased risk, but genes probably play an important role.
Researchers believe a diet high in saturated animal fats and red meat may be responsible for the high incidence of prostate cancer in Western countries. It is thought that reducing your intake of animal fat and eating more fruit and vegetables may lower the risk of prostate cancer developing or spreading.
There is currently no prostate cancer screening programme on the NHS. However, the government is committed to introducing one if and when an accurate diagnosis test becomes available and there is a clear treatment process.
It's up to the individual if they want to get tested. But Neate says too many men put off going to their GP if they develop symptoms because they are afraid of a diagnosis of prostate cancer.
He says: "It's amazing that so many men have such low expectations of their quality of life as they get older. They are prepared to accept uncomfortable symptoms as normal and simply not visit their GP."
