Presenting Complaints

• Patients may be reluctant to discuss sexual matters and may sometimes instead complain of physical symptoms, depressed mood or marital problems.
• There may be culture-specific sexual disorders.

Diagnostic Features

• Common sexual disorders presenting in the male are:
  • erectile dysfunction or impotence (erection is absent or does not last long enough for satisfactory sexual relations)
  • premature ejaculation (ejaculation occurs too early for satisfactory sexual relations)
  • orgasmic dysfunction or delayed ejaculation (ejaculation if greatly delayed or absent and may occur only after the person has gone to sleep)
  • low sexual desire (more of a problem if the couple want children or if the female partner has greater sexual need)

Differential Diagnosis

• If low or sad mood is prominent, see section on Depression F32.
• Problems in marital relationships often contribute to sexual disorders, especially those of desire.
• Ejaculatory problems may be circumstancial (e.g. performance anxiety, overexcitement, ambivalence about partner) or may be caused by medication, but specific organic pathology is rare.
• Physical illnesses which may contribute to impotence include:
  • diabetes
  • hypertension
  • multiple sclerosis
  • vascular disease
  • alcohol abuse
  • prescribed drugs