Because problems with your sexual health and fertility can directly affect your quality of life and your intimate relationships, they often bring a great level of concern and worry to many men. If you have a problem with your sexual health or fertility, remember that you are not alone, and that if you talk with your doctor, there is a good chance you can get treatment that works.
Impotence and Loss of Libido
It might be helpful to know that many men, especially as they age, have problems with impotence (erectile dysfunction) or loss of libido (reduced or lost interest in sex). Some men also have problems with ejaculation, while others actually have a condition with which their testicles fail to make the normal amount of testosterone.
About nine percent of American men are thought to have impotence, and it is more common as men age. For example, impotence affects about 10 percent of men in their sixties, 25 percent of men in their seventies, 40 percent of men in their eighties, and more than half of those in their nineties. Many things can cause impotence, including having atherosclerosis (hardening of the arteries), high blood pressure, diabetes, depression and other emotional or psychological illnesses, pelvic surgery, kidney failure, multiple sclerosis, stroke, some types of epilepsy, and alcoholism. Some men who take medicines for heart disease or drugs that can affect the central nervous system, such as hormonal medicines or heroin and cocaine also are at risk for impotence.
Loss of libido (reduced or lost interest in sex) also can occur at different points in a man's life. It can happen for many reasons, including stress in our daily lives, from illnesses, medications, psychiatric problems, and reduced levels of male sex hormones. Also, uneven sexual desire, at times, between you and your partner are normal and inevitable in long-term relationships. It is how you handle these challenges that makes the difference.
The good news is that there are ways you can overcome both impotence and loss of libido with new drugs and therapies, or with counseling. If you have a problem with either of these, talk with your doctor about treatments that could help you. Don't be embarrassed. Being honest and getting help now can help you relax and enjoy an even better relationship with your partner.
Infertility
It is not uncommon for couples to have trouble becoming pregnant or experience infertility. Infertility is defined as not being able to become pregnant despite trying for one year, in women under age 35, or despite trying for six months in women 35 and over. Pregnancy is the result of a chain of events. As described in our Fertility Awareness section, a woman must release an egg from one of her ovaries (ovulation). The egg must travel through a fallopian tube toward her uterus. Your sperm must join with (fertilize) the egg along the way. The fertilized egg must then become attached to the inside of the uterus. While this may seem simple, in fact there are many things can prevent pregnancy. Reasons for infertility in men include:
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Age. Although your body decreases some sperm production after age 25, unlike women, you might remain fertile into your 60s and 70s. But as you age, you might begin to have problems with your sperm that make it harder for them to fertilize an egg. These can include problems with the shape and movement of your sperm, sperm gene defects, or producing no sperm, or too few sperm.
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Lifestyle. Behaviors such as smoking cigarettes or marijuana, heavy alcohol use, and taking illegal drugs can temporarily reduce sperm quality.
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Environmental exposures. Researchers are looking at whether exposure to environmental toxins, such as pesticides and lead, also may be to blame for some cases of infertility.
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Health problems. For men, having a health problem, such as a sexually transmitted disease (STD), diabetes, genetic disease (such as cystic fibrosis), the mumps virus after puberty, surgery on or infection in the prostate gland, or a severe testicle injury or problem, can cause infertility. Some men who are infertile have suffered from a condition called a varicocele — a network of veins in the scrotum that are bluish, long, "worm-like" and enlarged. They can cause pain and discomfort, but seem to become smaller or disappear when the man lies down. Although these can be treated, they might damage the testes.
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Medications. Some medicines that men take for ulcers or psoriasis can cause infertility. Some blood pressure lowering drugs (such as diuretics, beta blockers, and central agonists) also can cause impotence.
