Hidden Sexual Problems in Men

It is quite common sitting in my clinic, that an average man, walks into the clinic, looking anxious, often alone and carrying a heavy load of medical prescriptions. Few things are clear straight away. He does not want anyone to know about his problem and he has been disappointed with the prescribed medical treatment so far. And then when he is asked about the purpose of his visit, he says a similar sounding phrase, “Sir, I have a sexual problem”. This man is obviously not aware what his real problem is and that explains the lack of satisfaction from the treatment received thus far.

Sexual problems can be anything, from lack of libido to infertility. It is important to take a detailed history. Often this reveals so many issues which may not be apparent on any lab test. That time given to the patient is crucial. It may help us as doctors to figure out if he needs an andrologist. In these busy times, a person stressed with earning bread and butter may lose his libido and erections.

The treatment is not medicine, it is counseling and lifestyle changes if necessary. Rarely it may also indicate a tumor on the pituitary gland but that’s the word, “RARELY”. PDE5 inhibitors are not the complete answer to erectile dysfunction. Why did we have erectile dysfunction? This needs proper evaluation. Erectile dysfunction may point towards underlying cardiac dysfunction or upcoming adverse cardiovascular or cerebrovascular events. In layman’s terms, a patient may be prone to a heart attack or stroke in the near future. Hence comes the role of a urologist/ andrologist.

A perfect work-life balance is the key, accompanied by a healthy lifestyle.

Clinical depression, thyroid disorder, liver dysfunction, diabetes mellitus, and certain routine medications, are all culprits in causing sexual dysfunction. The treatment will be satisfactory only when underlying causes are paid attention to. Otherwise, most medicines for varying degrees of sexual dysfunction are available over the counter to most people, but there must be an end goal to the treatment. Patients need to be aware about this. Medicine is the answer, but to what end? This must be clear to every doctor treating the patient. I hope I have rattled many patients and clinicians to think beyond medicine. After all, we are not treating only the organ, but the person as a whole.