Male sexual health

Erectile dysfunction is the persistent inability to either achieve or sustain an erection. About 5-20% of men have moderate or severe erectile dysfunction. There are many causes and risk factors including lack of exercise, smoking, diabetes, raised cholesterol, obesity and the metabolic syndrome. Sometimes it relates to previous pelvic surgery or to penile deformities. Investigations include careful history and examination and blood tests. Treatment depends on the cause. Pro-erectile drugs (phosphodiesterase type 5 inhibitors eg Viagra) are often the first line, but these need to used carefully and correctly. If these fail, other treatments are available including vacuum constriction devices, penile injections or surgery using penile prostheses.

We have extensive experience in assessing this sometimes embarrassing problem and initiating appropriate treatments.

Peyronies disease causes lumps in the penis, a bend in the erection and often painful erections.

It is not uncommon for the penis to bend slightly when erect. Sometimes the amount of bend can be excessive which may cause pain or difficulty having sex. The reasons why this condition develops are not fully understood

The disease usually progresses over a period of several months, then stops getting worse. The pain settles, but the lumps and the bend remain as they are. No drug or other treatment has been shown to reliably treat the problem. However, once the disease has stopped progressing the bend in the erection can be straightened by surgery. There are, however, risks of side effects and complications from surgery. We will conduct a careful assessment to advise you on which operation may be the best option for you.

Low testosterone, also known as hypogonadism or Andropause, affects roughly 40% of men over the age of 45 and increases with age.

What are the signs of low testosterone in men?

There are both sexual and non-sexual signs and symptoms associated with low testosterone. Sexual symptoms include poor erectile function, low libido (desire for sex) together with weaker and fewer erections.

Nonsexual symptoms include increased body fat, decreased energy and fatigue, reduced muscle mass, and depression.

Roughly 40% of men with high blood pressure and 40% of men with high cholesterol levels will have low testosterone levels.

What are the treatment options for men with hypogonadism?

There are many treatment options for low testosterone if it is causing problems. Testosterone replacement therapy may be in the form of skin gel, injections, long acting pellets, or patches. The most common type of therapy is gel therapy, which is used by approximately 70% of patients. Men simply rub a gel onto their shoulders or upper arms after taking a shower.

Men treated with testosterone may be at an increased risk for the development or worsening of urinary symptoms.

Long-term treatment with testosterone may impair a man’s fertility as it suppresses some of the remaining natural function of the testes. Testosterone should not be used in men with known or suspected prostate cancer. It is important to carry out regular blood tests to monitor the treatment.

When couples want a permanent form of contraception a vasectomy is an option that may be considered.

A vasectomy is an operation to cut and seal off the tubes (called the vasa deferentia) that carry sperm from the testicles to the penis. Having a vasectomy means you will not be able to father any more children. The operation can be done with you either asleep under general anaesthesia or awake under local anaesthesia. It is important to provide two semen samples after at 3 and 4 months following the operation to determine that it has been successful.

Vasectomy can be reversed but it should be considered a permanent form of contraception. Mr McAcallister carries out the operation of vasectomy reversal at the Chelmsford Urology Partnership.