Erectile dysfunction (ED) is a multifactorial condition that affects approximately 40% of Australian men. ED is strongly linked to cardiovascular disease, lack of exercise, obesity, smoking, hypercholesterolaemia and metabolic syndrome. Notably, ED may be an early sign of an emerging metabolic or cardiovascular disease. The effects of ED on men may include depression, loss of self-confidence, loss of intimacy in a relationship and reduced quality of life.
Simple advice such as reducing calorie intake, following a Mediterranean-style diet, increase physical activity and losing excess body weight have all shown to improve sexual function in men with ED.
Aetiology / Risk factors Major causative factors and risk factors that can contribute to the incidence of erectile dysfunction include:
• Alcoholism and smoking
• Atherosclerosis (and cardiovascular disease, including hypertension)
• Benign prostatic hyperplasia (BPH)
• Metabolic syndrome; including obesity, hypertension, dyslipidaemia and/or hyperglycaemia.
• Diabetes mellitus
• Drugs such as hypertensives, sedatives, tranquilisers and amphetamines
• Inflammatory diseases of the genitalia (including syphilis)
• Multiple sclerosis
• Psychological factors (e.g., depression, guilt, worry)
• Radiation therapy
• Testosterone deficiency
• Trauma to the pelvis
Libido is governed by both gonadal hormones and brain neurotransmitters and is known to gradually
decline in men after the age of 45. A reduction in libido is associated with low testosterone in men.
Aetiology / Risk factors Major risk factors that can contribute to the incidence of low libido include the following:
• Psychological influences (e.g., anger, fear, guilt)
• Interpersonal issues (e.g., marital discord and boredom)
• Alcohol and drug use
• Certain medications (e.g., SSRIs, and beta blockers)
• Neurological insult and/or biological causes (e.g., injury) can be factors in the aetiology of
• Medical problems (e.g., diabetes, pelvic cancer, genitourinary disorders, urethral strictures,
genital infections, endocrine and hormonal disorders)
• Depression, anxiety, or issues of self-esteem
• Age 65 and over
• Previous sexual trauma
• Cultural pressures and expectations
• Environmental stressors such as prolonged exposure to elevated sound levels or bright light.
• Hormonal imbalances (e.g., reduced androgen levels)
Male infertility is defined as any condition which adversely affects the chances of initiating a
pregnancy with his female partner. Most commonly, those problems arise if unable to produce or
deliver fully-functioning sperm, and problems with the production and development of sperm are the most common problems of male infertility. Sperm may be underdeveloped, abnormally shaped or unable to move properly. Otherwise, normal sperm may be produced in abnormally low numbers (oligospermia) or seemingly not at all (azoospermia).
Aetiology / Risk factors
Major causative factors and risk factors that can contribute to the incidence of male infertility include the following:
• Structural reproductive disturbances (due to trauma, genetics, mumps, etc)
• Functional reproductive disturbances, such as:
• Testosterone deficiency
• Oestrogen excess
• LH deficiency
• FSH deficiency
• Endocrine disturbances – e.g., hyperadrenalism, hyper and hypothyroidism.
• Immune dysregulation (leading to sperm antibody production)
• Age – fertility decreases as men age
• Family history of infertility and/or reproductive disturbances
• Abnormal bowel flora and/or increased gut permeability
• Increased toxic load – e.g., smoking, alcohol, recreational drugs, pharmaceutical drugs.
• Insulin resistance
• Nutritional deficiencies
• Genitourinary infection
• Systemic disease (renal failure, hepatic disease, sickle cell disease)
• Varicocoeles (dilated scrotal veins)
• Abnormalities in chromosomal numbers and structure as well as deletions on the Y chromosome
can also impact fertility.
• Certain medications can affect sperm production, function and ejaculation.
BENIGN PROSTATIC HYPERPLASIA & PROSTATITIS
Benign prostatic hyperplasia (BPH), also known as benign prostatic hypertrophy, is associated with ageing and is estimated to affect 70% of men aged ?70 years. An enlarged prostate causes obstruction of urinary flow and can result in serious medical complications, including acute urinary retention (which can lead to renal failure), recurrent urinary tract infection, bladder calculi and haematuria.
Prostatitis is an inflammatory disorder of the prostate. Prostatitis can be nonbacterial, or bacterial It commonly causes pain in the testicles and may sometimes cause problems with ejaculation, urination, or defaecation.
Aetiology / Risk factors
Major causative factors and risk factors that can contribute to the incidence of BPH/prostatitis include:
Recent urinary tract infection
• Prior sexually transmitted disease, such as gonorrhoea or Chlamydia.
• Excess alcohol consumption
• Age over 50
• Occupations that subject the prostate to strong vibrations, such as driving a truck or operating heavy machinery, may play a role.
• Prolonged periods of bike riding may irritate the prostate gland.
• Structural abnormalities of the urinary tract – e.g., narrowing (strictures) of the urethra may elevate pressure during urination and cause symptoms.