Overview

Sexual dysfunction in men — including erectile dysfunction (ED) and ejaculatory disorders — is a significant but under-reported cause of fertility difficulties. These conditions are very common, highly treatable, and nothing to be ashamed of.

Types

• Erectile dysfunction (ED) — persistent inability to achieve or maintain an erection
• Retrograde ejaculation — semen enters the bladder instead of exiting; cloudy urine after orgasm
• Anejaculation — complete inability to ejaculate
• Delayed ejaculation — difficulty ejaculating despite adequate stimulation

Causes

Physical: Diabetes, cardiovascular disease, neurological conditions, low testosterone, pelvic surgery, medications (SSRIs, beta-blockers, antipsychotics), obesity.
Psychological: Performance anxiety, stress, depression, relationship difficulties, past trauma.

Diagnosis

• Detailed medical and sexual history
• Post-ejaculate urinalysis (for retrograde ejaculation)
• Hormone profile — testosterone, prolactin, TSH
• Cardiovascular assessment

Treatment

• PDE5 inhibitors (sildenafil, tadalafil) — first-line for ED; highly effective
• Lifestyle changes — weight loss, exercise, smoking cessation
• Testosterone replacement — for documented deficiency
• Sympathomimetic drugs — to convert retrograde to antegrade ejaculation
• Sperm from post-ejaculate urine — for retrograde ejaculation; used for IUI or IVF/ICSI
• Surgical sperm retrieval + ICSI — when ejaculation cannot be achieved
• Psychological therapy and couples counselling

Sexual health issues are common and treatable. Book a confidential consultation today