When your sex drive has driven away

Do you find that you're just not as interested in sex anymore? Low libido (reduced sex drive) can strike men at any age, but it becomes more common as a man gets older. It may be caused by:

  • psychological factors, such as child abuse, depression, or relationship issues
  • physical factors, such as low testosterone or medication side effects (such as antidepressants, oral medications used to treat prostate problems or hair loss, and blood pressure medications)

A man with low libido thinks less about sex and is less interested in having sex or masturbating. However, he usually doesn't lose his physical ability to have sex. Low libido can become a problem when it is distressing to the man or his partner, or when it starts to affect the relationship.

The good news is that low libido can be treated. If low libido is caused by a medication side effect, your doctor or pharmacist can suggest a different medication that is less likely to cause low libido.

Low libido that's caused by low testosterone can be treated with testosterone replacement therapy. Your doctor can do a simple blood test to see if your testosterone levels are low. Testosterone is available in a patch, gel, injection, and capsules.

  • Men who are concerned about their ability to maintain an active lifestyle may prefer to use a patch. Applied once daily, these are convenient to use and can be applied to the back, abdomen, upper arms, or thighs. They can be worn during activities such as exercising, showering, or swimming. The patch mimics the normal production rhythm of testosterone in healthy young men. Patches may cause skin irritation, but using a topical corticosteroid cream (which can be purchased at a pharmacy) before applying the patch can usually prevent this.
  • Gels may also be convenient to use, and are applied once daily. Men must wait several minutes to allow the gel to dry before dressing and should not bathe or shower until 5 to 6 hours after application. They should cover the treated area with a shirt to prevent accidental skin-to-skin transfer of the gel to women or children (which can cause them to develop male features such as lower voices or facial hair over time).
  • Injections only need to be given every three to four weeks, and are administered in a doctor's office. Injections may cause mood swings due to sharp "ups and downs" in testosterone levels (they are higher after the injection and lower just before the next injection).
  • Capsules are taken twice daily with meals. People taking testosterone in capsule form need to have their liver function tested regularly.

Testosterone replacement is not appropriate for everyone. All forms of testosterone therapy may have some side effects and risks, including acne, decreased sperm production, fluid retention, and stimulation of prostate growth. Talk to your doctor about risks and benefits before starting treatment.

What about medications like Viagra® (sildenafil)? These medications (which also include tadalafil [Cialis®] and vardenafil [Levitra®]) help men who can't get an erection because of problems with blood flow into the penis. They do not help increase sex drive, so they are not useful for treating low libido.

If the cause is psychological, counseling and a treatment called sensate focus technique may help. This technique helps partners become more aware of the sensations they find pleasurable.

If you suffer from low libido, speak with your doctor to pinpoint the cause and see which treatment option may be right for you.

ED: Rising to the occasion

Erectile dysfunction (ED) occurs when a man has trouble getting or keeping an erection that is sufficient for intercourse. About 2-3 million Canadian men suffer from ED. It can take a toll on the man's self-esteem and put a strain on his relationship.

If you suffer from ED, you may be wondering "why me?" Often, ED is caused by physical factors. Healthy blood vessels and a healthy nervous system are both needed to produce an erection. Heart disease, diabetes, and blood clots can all cause blood vessel damage that may lead to ED. Surgery, diabetes, spinal cord injury, multiple sclerosis, or strokes can lead to nerve damage, which may decrease the ability to get an erection. Low testosterone can also cause erectile dysfunction, probably due to low libido, which may explain why some men don't find success with erectile dysfunction drugs such as sildenafil (Viagra®), tadalafil (Cialis®), and vardenafil (Levitra®). In a study of 75 men aged 18-80 years with low testosterone for whom sildenafil didn't work, testosterone replacement significantly improved their erectile dysfunction. Sometimes, ED can be caused by psychological factors, such as anxiety, depression, performance anxiety, or guilt. Other times, it may be a medication side effect. Antidepressants, lithium, digoxin, cimetidine, and antipsychotics may all cause ED. Smoking has also been linked to increasing the risk of erectile dysfunction.

Most cases of ED can be treated. Treatment options include:

  • Oral medications, including sildenafil (Viagra®), tadalafil (Cialis®), and vardenafil (Levitra®): These are convenient, but not suitable for everyone (such as men with very low blood pressure and men taking nitrates). They may also cause headache, dizziness, flushing, vision problems, and priapism (a prolonged painful erection that lasts for hours despite an absence of stimulation), which can damage the penis.
  • Medications injected into the penis (alprostadil injection [Caverject®]) or inserted into the urethra (alprostadil pellets [MUSE®]): These can be an option for men who can't take oral medications. These medications may also cause priapism.
  • Devices (such as vacuum pumps): These devices create a vacuum that pulls blood into the penis, causing an erection. A constriction device is then placed at the base of the penis to prevent the blood from flowing out of penis. Constriction devices can be used with or without a vacuum pump and should not be left on for more than 30 minutes. These devices offer additional options for men who cannot take any type of medication.
  • Surgery to insert a prosthesis (a rigid rod or inflatable balloon that provides an erection): Because of the risks of surgery (including infection, blood loss, and reactions to anesthetic), this is reserved for cases where other treatments don't work.

If ED is caused by low testosterone, testosterone replacement therapy can help. Testosterone is available in patches, gels, injections, and pills. For more information, see "When your sex drive has driven away." If a medication side effect is involved in causing ED, your doctor or pharmacist may suggest switching to a medication that is less likely to cause this side effect.

Lasting longer: Controlling premature ejaculation

Premature ejaculation (PE) occurs when a man ejaculates ("comes") too soon during sexual intercourse. Often, men with PE have trouble lasting long enough to help their partners have an orgasm. This can lead to dissatisfaction with sex, stress in the relationship, and feelings of shame or anxiety. But if you or your partner suffer from premature ejaculation (PE), you're not alone. Between 30% and 70% of men have PE - it's one of the most common sexual problems in men.

Why does PE happen? The exact cause is unknown. In most cases, it's believed to be psychological, but new information suggests that there may be a physical side as well. PE is more common in younger men.

Only 1-12% of men with PE seek treatment. But PE can be treated - here's how.

Techniques you can try at home (can be used alone or in combination):

  • Squeeze technique: When the man feels a state of excitement where he may ejaculate, his partner gives the head of his penis a short sharp squeeze to prevent ejaculation from occurring. Do not attempt this once the ejaculation has started.
  • Stop-and-start technique: Just before the man is about to ejaculate, he and his partner stop moving and the man tries to relax and control his ejaculation. Pausing at this time gives the man a better sense of how he feels just before ejaculation. Eventually, this helps him condition his response to sexual stimulation so that he can last longer.

Don't worry if these techniques don't work right away - it may take weeks of practice to master them. You may wish to speak to a sex therapist or your doctor to help you learn the techniques. A sex therapist or counselor may also be able to help you iron out personal and relationship issues.

If you've tried these techniques and they just don't seem to work, it may be time to visit your doctor, who can refer you to other treatments that may help, such as counseling or medications. Although there are no medications currently approved for treating PE in Canada, some are being studied: topical anesthetics (to numb the penis and hopefully delay ejaculation), SSRIs (a type of depression medication believed to block chemicals in the brain involved in ejaculation), some tricyclic antidepressants and pain medications, and PDE-5-inhibitors (better known as sildenafil [Viagra®], vardenafil [Levitra®], and tadalafil [Cialis®]).

3 secrets of better sex

These better sex secrets don't require special techniques or mail-order potions - most of them are simple things you can try at home.

1. Take care of yourself
Keeping your body in top-notch condition can help you enjoy a better sex life. Here are some easy steps to help you get there:

  • Exercise. It improves stamina and helps with blood circulation (needed for a healthy erection). And you'll look fitter and more toned too!
  • Eat a healthy diet. Healthy foods will help you maintain your weight, and also give you the fuel you need for all of your daily activities, including sex.
  • Quit smoking. This will improve your health (and give you fresher breath).
  • Get help with health problems. If you have sexual health problems such as low desire, erectile dysfunction, or premature ejaculation, see your doctor. These conditions can be treated. Finding and treating other health problems, such as sexually transmitted infections (also known as sexually transmitted diseases), and problems with the nervous system or blood vessels, can also help improve your sex life.
  • Take your medications as directed.

2. Communicate with your partner
Communication is the key to great sex:

  • Talk. Even though talking about sex may feel awkward at first, it's worth it.
  • Be honest. If you don't like something your partner is doing, or if you're uncomfortable with what's going on, let your partner know.
  • Focus on the positive. If your partner does something you like, tell them.
  • If you're feeling shy, use non-verbal clues. By moving and making noises, you can let your partner know how you feel without having to say a word.
  • Let your partner know what you enjoy in bed, and find out what they like.
  • Don't hide STDs. If you have a sexually transmitted infection (also known as a sexually transmitted disease [STD]), tell your partners so they can protect themselves.
  • Don't hide sexual problems. If you're struggling with a sexual problem such as low desire, erectile dysfunction, or premature ejaculation, talk to your partner about it. This will help them understand it's not their fault, and help them help you.

Good communication can help take your sex life, and your relationship, to new heights. Try it tonight!

3. Shake it up, baby
Sex is supposed to be fun! Strangely enough, it's easy to forget that. Put the fun back into your sex life with a little experimentation:

  • Trade fantasies. Find out what your partner would like to try in bed, and share your own desires.
  • Add to the wardrobe. Buy your partner some new lingerie or other sexy bedroom clothes.
  • Vary the scenery. Try having sex in a new, unusual place.
  • Pencil it in. Too busy for sex? Put it in your schedule. Make a date for sex, or plan a sexy getaway. Sex doesn't have to be spontaneous to be good.
  • Daydream. Take a few moments throughout the day to think about sex - it keeps the engines stoked.