Sexual Dysfunction & Male Incontinence

Overview

Sexual Dysfunction

Erectile dysfunction (inability to achieve an erection) is one of the most common male sexual problems. It may result from a variety of causes, including:

• Aging
• Diabetes
• Coronary artery disease
• Hyperlipidemia (high cholesterol)
• Medicines for other conditions
• Perineal trauma (injury to the area between the scrotum and the anus)
• Cancer treatment

Less common sexual dysfunctions include premature ejaculation and lack of libido (desire to have sex). Premature ejaculation may cause embarrassment and interfere with sexual intimacy. Lack of libido may interfere with intimacy as well. Fortunately, highly trained experts at IU Health provide effective treatment for these conditions—all designed for your individual lifestyle and needs.

Male Incontinence

The inability to control urination may interfere with a man’s ability or willingness to go out in public. Men with this condition may feel anxious about wetting themselves in public or smelling like urine.

Two major types of incontinence exist: stress incontinence and urge incontinence.

• Stress incontinence. Release of urine when coughing, lifting and doing other activities that stress the pelvis. This often results from problems with the sphincter (muscle encircling the urethra, or the tube that carries urine out of the body). Pelvic surgery and neurologic conditions commonly cause this difficulty.
• Urge incontinence. The sudden urge to urinate may result in discharge of urine because you cannot reach a bathroom in time. Disease and irritation of the bladder, infection and nervous system disorders commonly cause this problem.

Sometimes physicians need only a history of your urinary problems for diagnosis. In other cases, they may need to perform urodynamic testing. This type of testing uses electrodes that allow your physicians to monitor your bladder, urine flow and volume of leakage during the test. Your physicians can often determine the best treatment options using this information.

How We Can Help

Indiana Health urological specialists have the distinct expertise and extensive experience that allows them to treat sexual dysfunction and male incontinence successfully.

Your physicians recognize that difficulties like these may cause you emotional stress. Their patient-centered approach to your sexual or urinary condition means they take your feelings into account. He/she will involve you in developing your treatment plan and respect your needs and preferences.

IU Health physicians’ ongoing research into new treatments for incontinence demonstrates their commitment to helping men recover from this condition.

IU Health has ongoing clinical studies of incontinence outcomes and research into congenital urinary conditions. Artificial sphincters (muscles encircling the urethra, the tube that carries urine out of the body) include another area of their research. IU Health physicians’ treatment of sexual dysfunction with penile implants (a treatment for erectile dysfunction) has received national recognition.

Treatment

Sexual dysfunction and incontinence have a variety of causes. Their impacts can vary widely. Treatments vary as well to suit the cause and degree of your condition.

Sexual Dysfunction

IU Health physicians use a variety of treatments to overcome erectile dysfunction, including:

• Medicine. A wide variety of medications tend to cause erectile dysfunction. If you take any of these drugs, your physician may substitute a different medicine without this side effect. Several medicines aid erection including, Viagra, Levitra and Cialis. Erectile dysfunction medicines help blood flow to the penis, enabling it to become erect. Changing or adding medicines allows many men to regain erectile function.
• Appliances. A vacuum pump can draw blood into the penis by lowering pressure around the penis. You place a constricting strap around the base to prevent blood from flowing out of the penis when erect. This maintains the erection.
• Penile implants. The penis contains two chambers that swell with blood to create an erection. When neither medicines nor appliances work to gain an erection, inflatable tubes may be placed in these chambers. When the tubes are inflated, the penis becomes erect. Deflating them returns the penis to its flaccid state.

Premature Ejaculation

Premature ejaculation may often resolve with relaxation and other techniques. Sometimes relaxation exercises or thinking about something other than sex may provide the necessary delay. When this does not work, medicines called selective serotonin reuptake inhibitors (SSRIs) may solve the problem. SSRIs (antidepressants) can have the side effect of delayed orgasm.

Low Libido

Sometimes a man may have low libido (desire to have sex). This may happen for a variety of reasons. Various life stressors may reduce libido. Psychotherapy to help deal with these stressors may help regain interest in sex. Some drugs reduce libido. Medicines to lower blood pressure and SSRIs prescribed for depression may have this side effect. Your physician may prescribe different medicines that have less effect on libido.

Male Incontinence

Men with incontinence often use absorbent pads to soak up urine. Choosing an appropriate treatment depends on the number of pads you use each day. If you use a small number of pads, you may decide to simply continue using them. The more pads you use each day, the more you may want to treat your incontinence. Your physicians will help you understand your options so you can make the right decision for you.

Treatments your physicians may suggest include:

• Strengthening exercises. When weakness of your sphincter muscles causes incontinence, and you have undamaged nerves and blood vessels, exercises to strengthen the muscle may control urination. You can do these (Kegel) exercises many times a day and over time, regain urinary control.
• Condom catheter. This slips over the penis and secures at the base of the penis. A tube at the end of the catheter connects to a bag that collects urine. You can strap the bag to one leg, allowing some freedom of movement.
• Penile clamp. This specially designed device compresses the penis, constricting the urethra. When the clamp releases, urine flows freely.
• Male sling. The male sling provides a piece of mesh implanted around the urethra to help hold back urine. It works by compressing the urethra enough to regain urinary continence. You can anchor the sling to muscles or bone in the pelvis. This method works by repositioning the urethra to regain continence.
• Artificial sphincter. A ring placed around the urethra connects to a bulb beneath the skin of the abdomen. Using the bulb, you inflate the ring, which compresses the urethra to stop urine flow. To urinate, you deflate the device.
• Medicines. If uncontrollable urges to urinate causes your incontinence, you can use medicines to reduce these urges. Some of these block nerve impulses and signal the bladder to contract. Drugs to slow the production of urine can also work to reduce urge incontinence. Some medications relax the bladder or shrink the prostate. Both of these actions reduce bladder spasms and relieve urge incontinence.

You may have incontinence because of a combination of bladder and sphincter problems. Your physicians may combine treatments to provide the degree of control you need.