In short
Overview
Most sexual problems are common, treatable, and never mentioned to a doctor. The last part is the reason for the other two.
Direct Answer
Erectile dysfunction affects up to a third of adult men. Around 40 per cent of women report a sexual concern, and about 12 per cent have one causing personal distress.
Sexual problems in women in particular remain largely unrecognised and untreated, often because clinicians feel they lack the time or knowledge to address them.
Patients are usually grateful to be asked. Being told that these problems are common and that effective treatments exist is itself part of the treatment.
Who This Applies To
- Erections have become unreliable over months
- Desire has dropped and you are not sure why
- Ejaculation timing has changed, in either direction
- Sex has become painful or dry
- Arousal or orgasm has changed
- Something changed after a medication, a birth, an illness or the menopause
- One partner’s difficulty is affecting the other, which the evidence shows it does
- Chest discomfort or breathlessness on exertion
- Bleeding after sex, or any bleeding after the menopause
- A new lump, ulcer or skin change
- A bend or hard plaque in the penis
- Any sexual activity you feel pressured into
Option Comparison / Decision Criteria
What gets assessed
In men, three separate categories: erections, desire, and ejaculation. Most men with erectile dysfunction do not report low desire, so when both are present the order they appeared in identifies the primary problem.
In women, four: desire, arousal, orgasm and pain. Pain is the one most often relabelled as low desire, and treating it usually improves the rest.
The cardiovascular thread
Erectile dysfunction shares its mechanism with cardiovascular disease and usually arrives first. Men reporting it had twice the rate of undiagnosed diabetes in one national survey.
So the assessment includes blood pressure, lipids, glucose and thyroid function, and cardiac risk is graded before treatment. That is often the most valuable part of the appointment even though it is not what brought you in.
What is offered before medication
Sex therapy and couples counselling are effective and safe, and consultation with a sex therapist is generally considered a prerequisite before drug treatment for sexual dysfunction. 65 per cent of 365 couples in one study described their treatment as successful.
Why an In-Person Physician Review Matters
The examination carries information In men: pulses, penile plaques, testicular size, breast tissue, body hair and visual fields, since a pituitary tumour can present as low testosterone.
In women, where there is pain: examination identifies vulvovaginal atrophy and pelvic floor hypertonus, which have specific and effective treatments and will not respond to anything aimed at desire. What is checked that people do not expect Medication. SSRIs, antipsychotics, benzodiazepines, opioids, antiandrogens and prostate drugs all contribute Alcohol and sleep Mood, since depression is a leading cause and is often not volunteered The relationship, which is the strongest predictor of sexual satisfaction in midlife and is rarely raised What is not offered Prescriptions without assessment, treatment before the cardiac question is settled in men, testosterone on a single borderline result, compounded hormone mixtures, saliva hormone testing, and shockwave or platelet based therapies marketed as regenerative.
Frequently Asked Questions
Less than people expect. These problems are common, most clinicians simply do not ask, and patients are usually grateful when someone does. Being told that effective treatments exist is part of the treatment.
Only if you want to. It often helps, since a partner's own difficulty measurably affects yours, but you can attend alone and nothing is shared without your agreement.
Not before assessing what is actually wrong and grading your cardiac risk. And for many problems, particularly in women, non drug treatment comes first because it works better and is safer.
Entirely. Nothing reaches an employer, insurer or anyone else without your explicit instruction, and referral letters carry only what the receiving clinician needs.
Evidence
Where this information comes from
Every figure on this page is taken from the sources below. All of them are free to read, so you can check them yourself.
This page is general medical information and does not replace a personal consultation. Trial results are averages across large groups, not a prediction for any one person.