Sexual function includes erection, desire, arousal, ejaculation, orgasm, pain and the relational context in which sex occurs. A symptom described as a “performance problem” may therefore have vascular, metabolic, hormonal, neurological, psychological or relationship-related contributors.
Erectile dysfunction
Erectile dysfunction is the persistent or recurrent inability to achieve or maintain an erection sufficient for satisfactory sexual activity. Assessment includes cardiovascular and metabolic risk factors as well as sexual history. PDE5 inhibitors are established first-line pharmacological therapy for many men. [S05]
Premature ejaculation
Premature ejaculation is not defined by time alone. Perceived control, persistence of the problem and clinically significant distress are also important. Lifelong and acquired premature ejaculation may require different evaluation. [S14]
Low sexual desire
Low desire is not automatically a disorder. It becomes clinically relevant when persistent or recurrent loss of desire causes distress and is interpreted in the context of health, medication, hormones, mood and relationships. [S13,S15]
Penile curvature and Peyronie’s disease
A new penile curvature, plaque, shortening or painful erections may represent Peyronie’s disease and should not be treated as a simple cosmetic issue.
When testing is useful
Not every sexual complaint requires hormone panels, penile Doppler ultrasound or extensive imaging. Testing should answer a specific clinical question.
Urgent situations
A painful erection lasting more than four hours, major penile trauma, sudden severe testicular pain or acute urinary retention can require urgent medical assessment.
UrologNet approach
Treatments are not ranked as “best” by marketing language. Each option is described according to:
- who was studied,
- what outcome improved,
- known risks,
- strength and limitations of the evidence.
Medical editor: Op. Dr. Cem Özlük — Urologist