Normal sexual function require correct processing of sexual cues (memories, recollection of positive experience, visual cues, auditory, olfactory, tactile sexual cues) in different part of brain. Integration of sexual cues is affected by normal brain function, hormones, overall health, stress levels among others. The nerve signals from brain are then send to spinal cord motor generator which receive and control signals from genital areas. Once threshold for activation of ejaculation and orgasm are reached, the rhythmic contractions of pelvic floor muscles result in expulsion of semen (ejaculation) and positive sensation of pleasure (orgasm).
To achieve erection more blood flow has to go inside the penis (arterial inflow) than leave penis (venous leak). The more blood stays inside penis the better erection man has.
Ability to enjoy sex is based on our internal past experiences, religious and social restrictions of recognizing importance of happiness in one’s life: hence aheadonia often seen in depression will often decrease one’s ability to experience orgasm despite of normal ejaculation.
Relatively simple issues like vision problems or decreased sensitivity in penis from diabetes may result in sexual dysfunction. Hence during initial visit doctors start with full physical examination of patients from head to feet: sexual health specialists often are first doctor man sees since high school.
Physical exam focuses on identifying disorders of thyroid, heart function, lung auscultation, checking grip of hands, performing full neurological examination, and of course detailed examination of penis, scrotum, and prostate. The penis is examined both in flaccid state and when erected.
The history taking will identify history or risk factors for diabetes mellitus, high blood pressure, peripheral vascular disease, heart disorders: again we are trying to identify if vascular issues may be culprint of sexual dysfunction.
Social habits like excessive alcohol abuse, anabolic steroids abuse, illicit and prescribed drug abuse, lack of exercise are important risk factors for sexual dysfunction.
Psycho sexual development during childhood and adolescents and early sexual experiences have powerful effect on ability to connect, bound, and trust one’s partners. Lifetime prevalence of physical and emotional abuse are relatively similar between men and women (30% and 22%) but few recognize that 23 % of men report lifetime experience with sexual abuse. Military, all-boys boarding institutions, men-only jobs, low socioeconomic status are important risk factors for sexual abuse. Most of men do not reveal such traumatic experiences to their doctors or see therapy. The patients present with often difficult to objectively confirm complaints of low sex drive, pelvic pain, prostate infections, loss of sensation in the penis. Considering high prevalence of sexual, emotional, and physical abuse among US young men our physicians are sensitive to help men to bring such painful experiences with their doctors so we can connect the patient with appropriately trained mental health expert to work with us on rehabilitating men back into developing trustful and loving relationships.
Sex brings intimacy to couple’s life and intimacy brings more sex; hence our physicians often incorporate partners in some of visits to identify how best to help the couple to achieve sexual satisfaction.
LGBT patients often present with specific sexual medicine needs and our physicians pride themselves in providing state of the art and compassion care to all of our patients regardless of their sexual identify and gender.