Difficulties in bed are quite common, and most people will face them at some point in their lives. Some difficulties are temporary; others require professional attention. Most are easily treated. Usually, the biggest challenge is to admit to having a problem.
You don't need to be embarrassed when you experience sexual difficulties. Many men think they would be considered by others to be less masculine. But having your issues seen to and treated is the best thing you can do for your sexual health and your relationships.
Some sexual difficulties are related to unhealthy lifestyle choices and can be prevented by leading a healthy life: eating a balanced diet, exercising, not smoking and minimizing alcohol consumption. Basically, anything that is good for your overall health is generally good for your sexual health. But of course living a healthy life does not mean you will be immune to having issues in bed – but it might reduce the risk.
When seeing a healthcare provider for issues, the doctor will likely ask you a lot of questions about your sexual, physical and emotional health. The diagnosis will be made a lot easier if you answer these questions as honestly and in-depth as you can – even though it might feel awkward. The doctor will also likely examine you. Don't be ashamed or afraid. Remember: it's very common to have problems and you are doing the right thing by getting treatment.
What you will have to do to resolve the problem depends on the sexual difficulty. Below we cover the most common conditions, their causes and their treatments.
Sexual difficulties affect both partners
There’s no doubt about it: sexual difficulties are bad news for your sex life. If a man is always worried about getting an erection or ejaculating too soon, it’s going to be difficult for him to relax and fully enjoy the experience.
But his partner will also be left unsatisfied, especially if the man is so focused on his fears that he ignores his partner’s sexual needs. As a result, both parties are left wanting. If this continues long enough the couple may begin to avoid lovemaking and even intimacy in general.
So it's good to address any issues as soon as they arise.
Premature ejaculation
One of the most common problems for men, premature ejaculation is when a man orgasms uncontrollably, either before or shortly after sexual stimulation begins. Sometimes it can even occur with little or no physical contact.
With premature ejaculation, the orgasm becomes unwanted, spoiling the sexual experience and leaving both partners unsatisfied. Premature ejaculation affects nearly every man at some point in his life.
It may result from both physical and psychological problems, though it is usually difficult to find the exact cause.
Other psychological factors that can cause premature ejaculation include a religious background in which sex is stigmatised, stress and anxiety, guilt, depression or past sexual trauma. Physical causes may include an oversensitive glans (the top part of the penis), hormonal problems, past injuries, drug side-effects or neurological disease. In some cases, it is simply caused by disinterest or lack of attraction for a sexual partner.
In many cases, it declines as a man gains sexual experience and learns to control his ejaculation. The best way to gain mastery over ejaculation is by identifying the sensations that signal an approaching orgasm and communicating with your partner to temporarily tone down stimulation.
Using a condom or numbing creams and gels, which reduce sensation, can be other options. You could also experiment with different positions, or speak to your doctor about medications that may help treat premature ejaculation. Masturbation, and understanding what excites you, can also help you learn how to control your arousal.
Delayed ejaculation and anorgasmia
The opposite of premature ejaculation, delayed ejaculation means ejaculating way later than desired – or even not at all. Not having an orgasm is also called anorgasmia. The two conditions are not the same, but are often grouped together as 'disordered orgasms'.
Disordered orgasms mostly affect older men.
They can also be caused by psychological factors. This could be fear of sex, having been abused, or thinking that sex isn't good (that it’s, for example, dirty or a sin).
When you see a doctor about this, they will ask you questions about what could be causing the problem and treat you accordingly. This may mean seeing a psychologist to discuss any issues you may have.
Erectile dysfunction
Having erectile dysfunction means being unable to get or maintain an erection. It can also refer to the quality of an erection: that the erection is not hard enough to enter the vagina.
Erectile dysfunction gets more common as men get older, but it can affect men of all ages.
Conditions such as high blood pressure, heart disease and diabetes make it more likely for a man to get erectile dysfunction. But also stress and fear of being unable to perform in bed can cause problems.
When looking for the cause of erectile dysfunction, doctors distinguish between three different types of erections: the ones men get in their sleep, the ones they get through mental stimulation (e.g. fantasising) and the ones brought on by touch.
To treat erectile dysfunction, it's very important to understand what causes it and then address that factor. This might involve lifestyle changes, such as a healthier diet or stopping smoking. Sometimes, it's possible to treat erectile dysfunction with medication such as Viagra – but it's best to also get to the root cause of the problem. Also, not all varieties of erectile dysfunctions can be treated with medication. Sometimes, surgery or injections may be required.
It's important to discuss all options with your doctor.
Low libido
Having low libido means that you have no or almost no sexual desire.
Low libido is often caused by psychological factors or by the body not producing enough of the hormone testosterone.
Low libido is more common in older men, or in men who drink a lot of alcohol and who are malnourished. Smoking and drugs can also play a role, as well as some medications used to treat conditions such as prostate cancer.
Stress, depression and relationship problems can also play a factor when it comes to low desire.
Men with low desire will often shy away from initiating any kind of sexual contact, and avoid the topic of sex with their partner. If they try to have sex, they might be having trouble getting or keeping an erection.
In order to treat low libido, a healthcare provider will first need to figure out what causes the problem before developing a treatment plan.This can involve psychological care or a change in medication.
Pain, bleeding, burning
Pain, bleeding, and burning are usually signs that something is wrong. It could be painful to get an erection, penetrate or ejaculate. You may notice blood around your penis, testicles or in your ejaculate. Burning most often happens after sex, when there has been too much friction.
The cause could be an STI or another infection, or a sign that you are allergic to something, such as lube or the condom. Burning can also be caused by a partner who was too dry or anal sex without sufficient lubrication.
If you experience any discomfort regularly, please have a healthcare professional rule out any serious problems. Find the cause of your problem and treat it.
Peyronie's disease
Peyronie's disease means that your penis is bent at an odd angle, making it painful to get an erection.
It can be the result of a previous injury. It is more common in men with certain medical conditions and seems to be hereditary.
Often, the condition goes away on its own after a couple of months to a few years without treatment. But sometimes injections, or even surgery, are required to take care of the symptoms.
Retrograde ejaculation
This means that, after a man ejaculates, the fluid will run into the bladder rather than leaving the penis.
This often affects men who have nerve damage due to diabetes. Sometimes, it's also caused by certain operations around the stomach.