[Originally published: June 23, 2017. Updated: June 27, 2022.]
The intimate moments you share in your life are important to your bond—and potentially your health. That’s because, depending on how observant both of you are regarding how the body is functioning with intimacy issues, it may lead to a better understanding of medical issues that may be causing problems in the bedroom.
If his sex drive has declined—or you notice he’s using the bathroom more frequently, is gaining weight or has other changes to his physique such as breast enlargement—he may have undiagnosed health issues. A number of common sexual and reproductive health conditions can develop at any age.
Talk with your partner about what you’re noticing, and encourage them to see a health care provider for an examination.
Statistics show American men are less likely than women to see a doctor for regular checkups. Since women make 80 percent of all health care decisions in heterosexual relationships, your influence really does matter. It could take some urging to get that appointment scheduled, but this may be exactly what needs to be done for health reasons.
It’s important to know there are effective treatments available for sexual and reproductive problems, such as prostate issues, erectile dysfunction, male infertility, a curved penis or testosterone deficiency.
“Men are fix-it people,” says Stanton Honig, MD, director of the Male Sexual Medicine and Male Reproductive Health programs at Yale Medicine. “Men need to know if they go to the doctor and have a serious problem, most of the time they can be cured."
Read on for more information on symptoms that should prompt seeing a urologist.
Changes in urinary frequency or volume
You may notice use of the bathroom more frequently. The urine stream may be less powerful, and it may take longer than usual to empty the bladder. Looking for a restroom very often during a two-hour trip? This may be a sign of an enlarging prostate treatable with medication.
“All of these observations can be important warning signs of prostate issues, which may become more common with increasing age. Prostate enlargement is observed in many men over time and can be effectively treated by a variety of approaches,” says Michael Leapman, MD, a Yale Medicine urologist who practices at Yale Cancer Center at Smilow Cancer Hospital.
There are two kinds of prostate issues that can occur and should be checked for:
Enlarged prostate: An enlarged or swollen prostate, also called benign prostatic hyperplasia (BPH), is a very common condition. It affects half of men by age 50 and 90 percent by age 80. The prostate is involved in both urinary and sexual function, and while not life-threatening, BPH can significantly impact quality of life. In addition to causing both sexual and bathroom issues, the problem can occasionally be uncomfortable for those who have it, especially when seated because of the prostate’s location (below the bladder).
“Both BPH and erectile issues are more common as men age,” says Yale Medicine urologist Thomas Buckley, MD. Although the exact nature of the relationship is unclear, recent studies show that with BPH symptoms, there is a higher incidence of erectile dysfunction (ED). “Many of the treatments for BPH can have an impact on sexual function and satisfaction,” says Dr. Buckley. “So, it is crucial to discuss sexual function with your urologist before undertaking any treatment for BPH."
Prostate cancer: Prostate cancer affects 1 in 7 men. To detect prostate cancer, a prostate-specific antigen (PSA) is measured through a blood test. PSA is a protein produced exclusively by prostate cells. "The American Urological Association suggests that men ages 55 to 69 consider prostate cancer screening via a PSA blood test, based on their individual values and preferences," says Dr. Leapman. It’s a good discussion to have with a doctor. Also, there is an increased risk of prostate cancer—in people who have prostate cancer in their families or who are African American—this population should have this talk with their doctor sooner, between ages 40 and 54.
What can be done: For symptoms from an enlarged prostate, newer BPH treatments are now available. One is called UroLift, according to Daniel Kellner, MD, a Yale Medicine urologist who performs this procedure. The minimally invasive treatment is done in the doctor’s office on an outpatient basis. It solves the problem of a blocked urethra by inserting a tiny implant that pushes the enlarged prostate out of the way. No prostate tissue is removed, and the procedure takes about an hour. The other is called HOLEP, also performed by Dr. Kellner. At present, he is the only doctor in Connecticut to perform this procedure, which essentially removes most of the prostate without an incision. It is done completely with a scope.
Other BPH treatments your doctor may consider include:
- Other Surgical options
- Prostatic artery embolization
- GreenLight Laser
Because enlarged prostate affects men to varying degrees, a urologist can help men weigh the pros and cons of each treatment and select the right one.
For some prostate cancers that are slow-growing, doctors may recommend not treating initially because the cancer is often not life-threatening. When treatments are needed, they include surgery, radiation, or androgen deprivation therapy.
Side effects of treatment can include urinary incontinence and impotence (but there are treatments to restore these issues if they occur). This is why doctors often take a “wait and watch” approach when a man is diagnosed with prostate cancer that is classified as “low in aggressiveness.” Almost all prostate cancer is curable if identified early on.
Loss of libido
If a man is suddenly or progressively unable to get or keep an erection long enough for sex to occur, it can be concerning for both of you. While you might worry that lack of excitement means your relationship is on the rocks, there could be another explanation: a health condition called erectile dysfunction (ED) or hypogonadism (low T-testosterone).
It’s estimated that 50 percent of men ages 40 to 70 have problems with erections. Its prevalence increases with age, but young men can experience it, too. ED means a man is unable to achieve or sustain an erection firm enough for sex more than half of the time. It’s normal for a man to have a problem now and again. But he’s probably feeling embarrassment and stress about it.
“If a man fails once in the bedroom, it can happen again and may become a self-fulfilling prophecy,” says Dr. Kellner. “Because of fear of failure in the bedroom, men may even avoid sexual activity."
What shouldn’t be avoided is talking about the problem with a doctor, because it could be a symptom of some serious health concerns, including heart issues. “Some cardiac diseases affect the ability to have erections,” Dr. Kellner says.
Other conditions that commonly go hand-in-hand with ED include:
- Kidney disease
- High cholesterol
- Nerve injuries
- Lack of physical fitness
- High blood pressure
- Heart disease
What can be done: Talk about it. Chances are he’s feeling uneasy about not being able to perform—or not being the strong performer he once was. The pressure to perform is likely making it even more difficult as anxiety can make it even worse.
If erectile issues are happening frequently, see a urologist (who is like a gynecologist for the penis, testes and prostate). Urologists specialize in issues related to these organs.
ED issues can motivate a person to see a doctor for a checkup. It’s an opportunity to address not only the sexual issues, but also any underlying health problems that might be going on as well.
Medications like Viagra (generic sildenafil) and Cialis (generic tadalafil) can help improve performance. They are now generic and very affordable. Other solutions include local treatments to the penis such as tiny injections, penile pumps, or a vacuum device that increases blood flow to the penis. Testosterone therapy can be prescribed for patients with low testosterone, but this is more for sexual interest than hardness.
If the doctor determines that the sexual issues are more situational anxiety in nature, such as depression, stress or anxiety, or relationship problems, rather than health-related, counseling may be very helpful.
If you and your partner have been trying for nine to 12 months to conceive with no success, it’s time to consider infertility testing for both of you. Start with him, though, suggests Dr. Honig, because unlike for women, a semen analysis is noninvasive.
Collecting a semen sample at home and delivering it to a laboratory within one hour for analysis is the first step. In fact, there are now home sperm tests similar to ovulation kits and pregnancy home tests that are available in the drugstore or online that are pretty accurate, Dr. Honig says. Encourage your partner to have a sperm check sooner if you’ve been trying for six months and you’re approaching 35, or if something in the medical history suggests there could be male-factor fertility issues such as:
- An undescended testicle
- Enlarged veins around the testicles (called varicocele)
- An injury to the testicle
- Testicular cancer
- Previous cancer treatment with chemotherapy or radiation.
- Anabolic steroid use
All of these factors can affect sperm count and quality.
What can be done: If a fertility issue is detected (50 percent of the time it’s related to the man), a reproductive urologist is the right doctor to see. This specialist can look for penile and testicular causes of sperm problems, as well as consider other health issues that may be involved.
“Male fertility problems can be a harbinger of other health issues such as prostate or testicular cancer, genetic issues or underlying physical problems,” says Dr. Honig. That’s why it’s important to have him evaluated and not just skip ahead to artificial insemination or in vitro fertilization. Often when the health problems are addressed, the male fertility issues get solved as well. There are many treatable and reversible causes of male fertility issues.
As a heterosexual couple, if you have decided against having children and have found you don’t need to use protection, consider consulting a urologist to discuss a vasectomy. They’re a permanent and reliable form of birth control for you. “And it’s much easier to have a vasectomy than for a woman to have her tubes tied,” says Dr. Honig. Vasectomies take about 15 minutes and require 48 hours of downtime, with little discomfort. Although this is potentially reversible, it is recommended only in situations where a permanent method of family planning is the way you want to go.
A bend or curve of the penis
If you notice the penis seems bent, it really might be. A common but little-known condition, called Peyronie’s disease, affects 1 in 11 men. It happens when the penis “breaks.” It can occur during penetration, but most of the time the actual time and specific injury is never really identified.
“Eighty percent of the time, they don’t even remember a specific time they had the injury,” says Dr. Honig. Typically, what they notice is, a couple of weeks afterward, erections start to hurt. Scar tissue called plaque begins to build, causing the penis to bend. This may result in erectile dysfunction, mostly from being very anxious about it. and the curvature can make sex difficult or even impossible.
What can be done: An FDA-approved medication called collagenase, prescribed under the brand name Xiaflex, can help by breaking down the scar tissue. When Peyronie’s disease is more severe, it is very fixable—minor surgery can straighten the curvature as well.
Weight gain all over
Just like women, men can experience hormonal changes as they get older. So in midlife, it’s worth noting that sex interest can go down, weight gain can occur, sleeping becomes more difficult and more moodiness can occur.
"Erectile dysfunction, fatigue, muscle weakness and loss of body hair, which can be signs of hormone imbalance in men," says Dr. Honig. "Most of the time it is due to testicles not working well and results in low T (testosterone).
Approximately 2 out of 100 men have a hormonal androgen deficiency called low testosterone or low T (hypogonadism), reports the Urology Care Foundation. In addition to causing all of the above symptoms, it can also make him feel frustrated both at work and at home.
What can be done: Leaner men who have body mass indexes in the normal range are less likely to experience low T. So are people who keep their alcohol consumption within the daily recommended limits (up to two drinks a day, according the National Institute on Alcohol Abuse and Alcoholism). A healthy lifestyle helps avoid low T. Eating better and exercising can improve matters for people diagnosed with the condition; many also have other health challenges, such as obesity or diabetes, which lifestyle changes can help. For every 10 pounds lost, testosterone levels will increase significantly. This all works to improve mood, sexual interest, energy, and overall a healthier outlook on life.
A simple test of early-morning testosterone levels will usually help make this diagnosis, says Silvio Inzucchi, MD, a Yale Medicine endocrinologist. A urologist, endocrinologist or primary care doctor can test for testosterone deficiency. If diagnosed with low T, the doctor will likely discuss prescription testosterone therapy. (Don’t considering using over-the-counter testosterone supplements, though, which are not proven and could be harmful, says Dr. Honig.)
Another caution: If your vision for the future includes children, he should avoid taking testosterone. It can affect sperm count and quality—sometimes permanently.
Testosterone therapy is considered safe and effective when properly prescribed by a doctor who has ruled out other causes of low T, such as pituitary gland problems or sleep apnea.
Properly prescribed hormone therapy can help build muscle mass and regain energy, reinvigorating sex drive, and evening out moodiness. “With treatment, all are so grateful,” says Dr. Honig. “They often tell me, ‘Thank you for restoring intimacy in our life.’”