Ask the expert: Causes of low libido
Not feeling sexual lately? Learn about the causes of low libido from an expert. Dr P Ganesan Adaikan tells all about erectile dysfunction
My husband’s libido and ability to maintain an erection has declined in the last couple of years. When we have sex, he cannot sustain his erection for more than 3-4 minutes without going limp. Also, when he ejaculates, he releases very little sperm.
He blames it on stress, but I think it’s because he has been taking a medication called Proscar daily for about for years now. Am I right?
Answer from the doctor:
For a man with normal erectile capacity and libido, the erectile tissue in the penis relaxes with ease and blood enters the penis via the artery when there is desire, fantasy, feeling of intimacy, fore play and or tactile stimulation of the penis.
Towards the completion of the filling of the penis, return of the blood back to the body through the vein will get restricted; this allows further erection and rigidity sufficient for vaginal penetration.
During sexual intercourse, focused desire and sensation-induced stimulation will help to continue releasing the erectile chemicals from the nerves and erectile tissue of the penis for maintaining the erection until the episode of ejaculation; this is when the release of anti-erectile chemicals reverses the penis to non-erect state.
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The role of testosterone
Normal level of testosterone in man plays an important role in providing libido, desire, frequency of sexual interest and in keeping the spontaneous night/morning erection intact.
Reasons of inability to maintain an erection
There are several reasons for the inability of the penis to maintain an erection during sexual intercourse. Psychogenic causes contributing to prevention or maintenance of erection are:
- performance anxiety
- stress and bringing work related and other worries/issues to the bed
- fear of pregnancy etc; in such a situation, adrenaline / noradrenaline released in the penile tissue can reduce the erectile capacity by contracting the tissue and allowing the blood to easily flow back to the body
- Partner’s lack of interest, negative comments or unreasonable expectation can also contribute to maintenance problem
This phenomenon of psychogenic ED is simply called “it is all in the head”.
Physical problems, on the other hand, are contributed by: smoking, high cholesterol, hypertension, diabetes, age-related changes etc. These conditions can easily cause maintenance problem because of the damage they can cause to the erectile tissue such as fibrosis and nerve damage and prevent or reduce the release of erectile chemical in the penile tissue and thereby reduce the inflow of blood into the penis for erection. If a man’s level of testosterone is abnormally low, it can contribute to loss of libido and reduce the erectile and ejaculatory capacity.
You and your husband may be right. Both Proscar and/or stress can cause sexual difficulties. Proscar (finasteride) is used in the treatment of enlarged prostate. In low doses, it is also used for male pattern baldness. Finasteride inhibits the enzyme that converts testosterone to dihydrotestosterone. It is known that Proscar can cause decreased libido (10%), lower intensity of ejaculation/volume (7.2%) and ED (18.5%) in a small number of man taking this medication. It was reported that up to 3.7% of men stopped taking Proscar because of sexual side effects. However, your husband should consult a specialist for a detailed examination and consultation.
Prof P Ganesan Adaikan
Department of Obstetrics & Gynaecology,
National University Hospital