Men, if you’re experiencing bedroom performance problems or any discomforts down under, don’t ignore them. Not only can trouble below the belt sideline your sex life, it may also be an early warning sign of disease.
“The penis can be the barometer of underlying health conditions,” says Daniel Kellner, MD, a Yale Medicine urologist. Health issues that can first affect your man parts (including the testicles) range from heart disease to diabetes to cancer.
Sexual problems such as erectile dysfunction, low testosterone, testicular cancer, penis injuries, premature ejaculation and sexually transmitted diseases affect men of all ages, including those not yet nearing midlife or the senior years. It’s a good idea to discuss these symptoms with a urologist—the guy’s equivalent of an obstetrician-gynecologist.
“While women are programmed to go to their Ob/Gyn once a year, a lot of times younger men will only come in if there are symptoms related to their penises,” says Stanton Honig, MD, director of Men's Health at Yale Medicine Urology. “These visits give us an opportunity to also talk about their overall health and taking better care of themselves,” he says.
Seeing your doctor regularly is important because many times health problems that are caught early are easier to treat. Below are six sexual issues that can forewarn men that they need to schedule a checkup:
Erectile dysfunction (ED)
In spite of what you see on the TV ads, this isn’t just an older man’s issue. About one in four men seeking help for erectile dysfunction is under 40, according to research in the Journal of Sexual Medicine. ED is the diagnosis when a man is unable to achieve or sustain an erection firm enough for sex more than half of the time (because, honestly, it happens to everyone sometimes).
“Often in younger men there’s a huge psychological component to ED,” Dr. Kellner says. “It’s a chicken-and-egg sort of thing. You never really know if the performance problems caused distress, or if psychological factors caused the erection problems." Psychological ED causes can include stress, such as from losing your job, relationship problems or depression. Or you may feel performance pressure.
If you have ED but still experience nocturnal erections during sleep, that may be a sign that your erectile issues have psychological roots. The reverse is also true; if you don’t have erections during sleep, then performance problems may be due to an undiagnosed health condition.
For example, heart attack or stroke can be caused by blocked blood vessels (arteriosclerosis). Since the penis has some of the smallest blood vessels in the body, “it may be the first to be affected by hardening of the arteries,” explains Dr. Honig.
Other health conditions that can cause erectile dysfunction, or that might be related to it, include:
- Kidney disease
- High cholesterol
- Alcohol and drug use
- Being overweight
- Not exercising and being out of shape
- Nerve injuries
Solutions: If there’s no underlying health condition, your urologist can suggest lifestyle, diet and exercise changes and prescribe ED medications, such as Viagra or Cialis, to help you get back in the game.
Beyond male performance pills, other treatments can also help. For instance, a penile pump is a vacuum device applied directly to the penis to increase blood flow. Topical medications are another option.
Even if you’ve just experienced ED a few times, it’s smart to see a doctor who can evaluate and treat the problem before it becomes more frequent.
If your sex drive has declined, you have low energy levels and you’re gaining weight, your body may not be producing enough testosterone. This is the case for four out of 10 men by the time they’re 45, according to the Urology Care Foundation. But, it can happen to males at any age (even babies) for a variety of reasons. For example, a blow to the testes during sports or outdoor activities can suppress testosterone production. Pituitary gland problems could be at play. In addition, chemotherapy or radiation for cancer treatment can sometimes cause a decrease in testosterone production as well.
Another potential cause of low testosterone (often called low T) is sleep apnea. “Sleep apnea is associated with low testosterone levels and low libido,” says Yale Medicine sleep expert Christine Won, MD. If you have libido issues, as well as snoring, gasping awake, unrefreshing sleep, fragmented sleep and excessive daytime sleepiness, you may consider having a sleep study to rule out sleep apnea, she says.
Testosterone production naturally drops off as men age. So as you near the big 4-0, you might experience what’s called “manopause”—also known as “andropause” or androgen deficiency of the aging male (ADAM). Just like middle-aged women, men can experience midlife hormonal imbalances that affect their sex drives, energy levels, weight and moods.
Solutions: First, talk to your doctor about your symptoms. A simple blood test can help determine if you have low T caused by an androgen deficiency.
The symptoms of low T are the same symptoms of depression, so proper treatment really depends on accurate diagnosis. Getting back to basics by exercising, eating healthy and getting enough sleep may have some positive effects for either condition. For effective treatment of low T, testosterone shots, pills, pellets or patches are often prescribed for men.
There are some risks associated with taking testosterone. Your doctor will assess your overall health before prescribing this treatment. And there’s another consideration, too. “If you’re in your reproductive years, hormone treatment will lower sperm counts, many times to zero,” Dr. Honig says. Make sure that you tell your doctor if you’re interested in having a family—or continuing to grow one—when considering hormone therapy, he advises.
A lump or mass on your testicles may be a sign of cancer, says Preston Sprenkle, MD, a Yale Medicine urologist who practices at Yale Cancer Center at Smilow Cancer Hospital. Testicular cancer is the most commonly diagnosed cancer in young men ages 18 to 40. Dr. Sprenkle recommends doing a self-check each month to feel for any new growths or lumps—or any change in the size or shape of your testicles. (It’s normal, though, for one to be slightly lower than the other.)
Solutions: The good news is testicular cancer is highly treatable if caught early. Treatment is easy and does not typically cause any long-term problems with sexual performance or fertility, and it cures 99 percent of men with testicular cancer. Even so, it’s a good idea to store sperm with a sperm bank before treatment, Dr. Sprenkle says, since both the surgery and chemotherapy treatments have the potential to impact fertility.
For men worried about how it will look to have just one testicle, Dr. Sprenkle says the solution is straightforward. A prosthetic can be placed within the scrotum, during or after testicular cancer treatment, to address cosmetic concerns and restore sexual confidence.
Men often have a low sex drive for a while after treatment. Some treatments can affect a man’s testosterone levels, so some men experience ED. However, most men still enjoy sex and in most cases are still able to father children.
It may be hard to read this, but (cringe) you can “break” your penis. You might not even realize it happened. The injury usually occurs during sex, by accidentally bumping against your partner’s pubic bone. It could also happen while playing sports, which is a good reason to wear a protective cup.
Though there may be no immediate symptoms (and many men don’t even recall anything happening) a lump in the penis may develop a few weeks after the injury. This is the build-up of scar tissue, called plaque. The name for this condition is Peyronie’s disease. It can cause pain during erection, ED and curvature of the penis, making sex difficult or even impossible, says Dr. Honig. “Sometimes it can be too painful to have sex, but most times it’s just a mild, achy pain or curvature,” he says.
Solutions: For mild to moderate cases of Peyronie’s disease that make intercourse difficult, an FDA-approved medication called collagenase, which is prescribed under the brand name Xiaflex, can be helpful. Xiaflex works by breaking down the scar tissue that causes the curvature. Severe cases of Peyronie’s disease require microsurgery to straighten the curvature, Dr. Honig says.
Premature ejaculation (PE)
This is the most common male sexual disorder, affecting 21 percent of men ages 18 to 59 in the United States, according to the American Urological Association. With premature ejaculation, orgasm occurs well before a man desires it, which can be frustrating and unfulfilling for both partners. (On average, sexual encounters last about 7 minutes.)
For some men PE starts with their earliest sexual encounters. For others, it comes later. The condition can cause psychological distress and, for some men, negatively impact intimate relationships. Some men experience both PE and ED.
Possible causes for PE include:
- Post-traumatic stress disorder
- Relationship problems
- Too much or too little foreplay
- Self-confidence issues
- Lack of consistent stimulation
- Alcohol consumption
Solutions: If you are experiencing PE, talk to your urologist. Your doctor can determine if it’s related to another medical condition, and, if it’s not, can coach you on how to deal with it. For example, doctors often advise that a man or his partner apply gentle pressure to the base of the penis to help delay ejaculation.
While there are no Food and Drug Administration (FDA)-approved medications for premature ejaculation, doctors sometimes prescribe an antidepressant called a selective serotonin reuptake inhibitor (SSRI) to help delay ejaculation. Over-the-counter topical desensitizing creams are another option.
Sexually transmitted diseases (STDs)
The first sign you have a sexually transmitted disease (STD, also known as a sexually transmitted infection, STI) may be discomfort down there, including burning, itching, discharge or sores. Here are some sobering facts about STDs:
- Gonorrhea is showing signs of resistance to treatment, according to the Centers for Disease Control (CDC). If resistance continues, the agency projects that 800,000 Americans a year will be at risk for untreatable gonorrhea.
- There was a 67 percent increase in syphilis from 2011 to 2015 in the United States, according to the CDC. Males account for 90 percent of new cases; the majority (82 percent) occur in men who have sex with men.
- The human papillomavirus (HPV) has become the most common sexually transmitted infection. HPV can be contracted through sexual intercourse, touching, kissing or oral sex. The virus often goes away on its own without causing health problems. But when it doesn’t, you can develop genital warts—or even cancer.
“Seventy percent of tonsil and back-of-tongue cancers are caused by HPV,” says Barbara Burtness, MD, a medical oncologist who practices at Yale Cancer Center. Also a professor of medicine (medical oncology) at Yale School of Medicine, she is researching new radiotherapeutic treatment approaches for HPV-induced oral cancers. HPV can also cause cancers to the penis or anus, and when passed to a female partner, it can cause cervical, vulva or vaginal cancers. “We expect the incidence of this kind of cancer to continue to increase for a number of years,” Dr. Burtness says.
Solutions: If you’re 26 or younger, consider getting the HPV vaccine to help protect yourself from many strains of the HPV virus.
Because HPV can be transmitted in several ways, wearing a condom during intercourse doesn’t offer full protection—but it helps guard you against many other STDs, including HIV infection, herpes, chlamydia, gonorrhea and syphilis.
Another smart move is to get tested for STDs, especially if you are starting a new relationship or if you notice discomfort (such as pain, sores or discharge) in your genital area. Your doctor can test you for STDs, and many can be treated—or managed—with medication.
No matter what male sexual health issue you may encounter, there are treatments to help get your sex life back in gear.