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Male Sexual Dysfunction

Our bodies function in many ways. Often, we are not sure how sexual functioning takes place. Below are stages that outline general physiological responses to sexual stimulation. Keep in mind, these stages are variable, and very individual. Although men will progress through the stages in order, the amount of time spent in each stage can vary dramatically.

FUNCTION

Stage One - Excitement

  • Vasocongestion, or the accumulation of blood in the pelvic area during early sexual arousal contributes to erection of the penis. The degree of erection during this phase depends on the intensity of sexual stimuli.

  • The inner diameter of the urethra doubles. The scrotum pulls toward the body.

  • Muscular tension increases in the body. Heart rate and blood pressure both increase.

Stage Two - Plateau Phase

  • The penis does not change markedly during the second stage of sexual response, although it is less likely for a man to lose his erection if distracted during plateau phase than during excitement.

  • The testes increase in size by 50 percent or more and become elevated toward the body.

  • Muscular tension heightens considerably and involuntary body movements such as contractions in the legs, arms, stomach or back may increase as orgasm approaches. Heart rate increases to between 100-175 beats per minute.

Stage Three - Orgasm

    • Actual climax and ejaculation are preceded by a distinct inner sensation that orgasm is imminent. This is called ejaculatory inevitability. Almost immediately after that feeling is reached, the male senses that ejaculation cannot be stopped.

    • The most noticeable change in the penis during orgasm is the ejaculation of semen, although orgasm and ejaculation are two separate functions and may not occur at the exact same time. The muscles at the base of the penis and around the anus contract rhythmically.


 


  • Males often have strong involuntary muscle contractions through the body during orgasm and can exhibit involuntary pelvic thrusting. The hands and feet show spastic contractions and the entire body may arch backward or contract in a clutching manner.

Stage Four - Resolution

  • Immediately following ejaculation, the male body begins to return to its unexcited state. About 50% of the penile erection is lost right away, and the remainder of the erection is lost over a longer period of time.

  • Muscular tension usually is fully dissipated within five minutes after orgasm, and the male feels relaxed and drowsy.

  • Resolution is a gradual process that may take as long as two hours.

Refractory Period

  • During resolution, most males experience a period of time in which they cannot be re-stimulated to ejaculation.

  • On average, men in their late thirties cannot be re-stimulated for 30 minutes or more.

  • Very few men beyond their teenage years are capable of more than one orgasm during sexual encounters.

  • Most men feel sexually satiated with one orgasm.

Sexual dysfunction may have physiological or psychological causes or a combination of both. Between 10-52% of men at some point in their lives will experience some type of sexual dysfunction. One study in the Journal of American Medical Association (1999) found sexual dysfunction common in 31% of men age 18 to 59.

Primary Sexual Dysfunction: Never having been able to achieve a particular function.
Secondary Sexual Dysfunction: Having been able to achieve a particular function previously but cannot now.
Erectile Dysfunction: Inability to maintain or have an erection that is firm enough for intercourse. 20-30 million men in the U.S. or about 10.4%, at any one time may experience erectile dysfunction.
Primary Erectile Dysfunction: Never before had an erection.
Secondary Erectile Dysfunction: Ability to have an erection and intercourse in the past but cannot now.
Premature Ejaculation: Ejaculation that occurs immediately upon entry or when becoming sexually aroused.
Ejaculatory Incompetence: Inability to ejaculate even when the penis is erect and sufficiently stimulated.
Primary Ejaculatory Incompetence: Never being able to ejaculate.
Secondary Ejaculatory Incompetence: Formerly able to ejaculate but cannot now.
Retarded Ejaculation: Ejaculation occurs but takes a long period of time.
Retrograde Ejaculation: The bladder neck does not close off during orgasm, and semen is pushed backwards into the bladder where it mixes with urine.
Dyspareunia: Painful intercourse occurring anytime during intercourse or even after intercourse.
Hypoactive Sexual Desire: Loss of interest and pleasure in what were formerly arousing sexual stimuli.
Sexual Aversion: Avoidance of or exaggerated fears toward sexual expression.

Sources: Kelly, G.F. (1994). Sexuality Today. Guilford, CN: Dushkin Publishing Group. Masters, W.H., Johnson, V.E., & Kolodny, R.C. (1997). Human sexuality. New York: Addison-Wesley.

next: Diagnosing and Treating Male Sexual Dysfunction

Last Updated: April 6, 2016

Reviewed by Harry Croft, MD

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