In short
Sexual problems are common, mostly treatable, and rarely asked about. This part of the clinic exists because the last part is the reason for the other two.
- Up to a third of men have erectile dysfunction, and around 40 per cent of women report a sexual concern.
- The cause is identified first. In men, erections, desire and ejaculation are three different problems. In women, desire, arousal, orgasm and pain are four.
- Erectile dysfunction is assessed as a cardiovascular problem too, because it usually arrives before the heart diagnosis.
Who This Service Is For
Who is this for?
- Men with erectile difficulties, whether sudden or gradual, and whether or not tablets have been tried
- Men with low desire, which is a separate problem from erections and is treated differently
- Men with ejaculation problems, too soon, too late or absent
- Women with low desire, arousal or orgasm difficulties, or with pain during sex
- Couples, where one partner’s difficulty is affecting the other, which the evidence shows it does
- Anyone already on treatment that has not worked or was prescribed without an assessment
Why so many people never ask
Sexual problems in women in particular remain largely unrecognised and untreated, often because clinicians feel they do not have the time or the knowledge. Patients are usually grateful to be asked.
Interpersonal conflict is one of the more common and least acknowledged causes of male sexual dysfunction, and it will never appear on a blood test.
What this clinic does not do
Prescriptions without assessment. Treatment before the cardiac question is settled in men with erectile dysfunction. Testosterone on a single borderline result. Compounded hormone mixtures or saliva hormone testing. Shockwave and platelet based therapies marketed as regenerative.
Treatment Programs Under This Pillar
Why Physician-Led Care Matters
Why the assessment comes first
Because these problems are frequently mislabelled, and treating the wrong one wastes months.
In men
Most men presenting with erectile dysfunction do not report low desire. When both are present, the one that came first is usually the one to treat. Sudden onset in a previously unaffected man is almost always psychological, apart from after pelvic surgery or trauma.
In women
Pain is the problem most often relabelled as low desire. Treating sexual pain often improves interest, arousal and orgasm at the same time, so it is treated first and the desire reassessed afterwards.
The cardiovascular point
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 cardiac risk is graded before treatment. Intermediate risk means an exercise test first, and high risk means cardiology review first. Nitrates in any form are an absolute contraindication to the standard tablets.
The honest position on hormones
- Testosterone is measured in all men with erectile dysfunction, and low levels are confirmed on a repeat sample before treatment
- It improves desire more reliably than erections, and is usually given alongside a tablet rather than instead of one
- In women, androgen levels do not correlate with sexual function in most studies, and routine testosterone is not recommended
- Oral oestrogen lowers free testosterone. Transdermal does not, and improved sexual function where oral did not
What is offered before medication
Sex therapy and couples counselling are effective and safe, and a 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 sex therapy as successful.
How the Consultation Works
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1
The history, in private and without rush
In men: how it started, whether morning erections persist, whether desire changed, and ejaculation. In women: which of desire, arousal, orgasm or pain, when it changed and what changed with it. Medication, mood, alcohol and the relationship are asked about directly.
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2
Examination and targeted tests
In men: pulses, penile examination, testicular size, plus glucose, blood count, liver and kidney function, thyroid, lipids and testosterone. In women: examination where pain is involved, since pain is a tissue problem until proven otherwise.
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3
Cardiac risk graded before treatment in men
Low, intermediate or high. Sexual activity is exertion and the standard tablets are absolutely contraindicated with nitrates, so this is settled before anything is prescribed rather than after.
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4
A plan in the right order, with a baseline
Pain first in women. The primary problem first in men. Non drug options before drug ones. A validated baseline score so improvement is a defined change, and referral where a therapist or physiotherapist is the right treatment.
Frequently Asked Questions
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 associated with personal distress, which is what defines a dysfunction.
Not before the cardiac question is settled. Sexual activity is exertion, and these drugs are absolutely contraindicated with nitrates in any form. Intermediate cardiac risk needs an exercise test first.
Well. Successful intercourse in 68 to 69 per cent of men against 33 to 35 per cent on placebo. And retrying with proper instruction rescues about 25 to 30 per cent of men previously labelled as non responders.
Less often than expected. In one series of 1022 men with erectile dysfunction, persistently low testosterone was found in 4 per cent under 50 and 9 per cent over 50. It is measured in everyone and treated in few.
It is treated first. Pain is a tissue problem until proven otherwise, and treating it often improves interest, arousal and orgasm at the same time. It is the problem most often mislabelled as low desire.
It usually helps and it is entirely your choice. A partner's own sexual difficulty measurably affects yours, and men whose partners have no difficulty recover erectile function more often.
Because it works. 65 per cent of 365 couples in one study described sex therapy as successful, and it is generally considered a prerequisite before trying drug treatment for sexual dysfunction.
Dubai Healthcare City, in English and German. Entirely confidential, with nothing shared with an employer, insurer or anyone else without your explicit instruction.
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.