Sex is great until, well, it's not so great. When something goes awry, it's easy to blame being in a bad patch or a bad relationship. Or . . . could your body be trying to tell you something?
"There's an increasing awareness that sex isn't just about quality of life -- sex can be a harbinger of underlying medical conditions," says urologist John Mulhall, director of the Sexual Medicine Program and the Sexual Medicine Research Laboratory at Weill Medical College of Cornell University in New York City.
The following ten sex scenes are no fun, but they're worth mentioning to your favorite primary doctor or urologist (the specialist who handles many men's plumbing issues).
Sex scene #1: You're just not interested any more.
It might be: Low testosterone
Lots of things can cause your sex drive to shift into neutral: work stress, falling out of love, lack of sleep. (See also: Sexless After 40? Don't Be!) But what if those things don't apply and you'd still rather count sheep than make love? Or if the sights and touches that once turned you on leave you literally unmoved? You might have a hormone out of whack.
"Testosterone is the most important metabolic hormone for men," Mulhall says. "If it's low, you're at increased risk for osteoporosis, type 2 diabetes, coronary artery disease, metabolic syndrome, and premature death -- and your only symptom may be low libido."
What to do: Get your testosterone level checked with a simple blood test. Make the appointment for before 10 a.m., Mulhall says, when levels are highest. If yours is low, you'll be referred to a urologist or endocrinologist who can help you evaluate treatment options, which include testosterone supplements.
Sex scene #2: You're just not interested -- and you're feeling down, too.
It might be: Depression -- or depression meds
Loss of interest in sex is a classic sign of clinical depression. Yet the treatment for depression can have the same side effect. Talk about a catch-22. Drugs in the SSRI family of antidepressants (including Prozac, Paxil, and Zoloft) have been found in many studies to zap desire in both men and women. (They can also cause anorgasmia -- the inability to climax.)
What to do: If you haven't been diagnosed with depression and you're feeling low (along with experiencing low libido and other common symptoms of depression, mention all this to a doctor. Clinical depression is highly treatable with talk therapy and medication. If you're currently being treated with an antidepressant, ask your prescribing doctor about switching to a class of drugs less associated with sexual side effects, such as bupropion (Wellbutrin). Ask, too, about taking a "drug holiday" from an SSRI if you're on one; some doctors endorse quitting these meds for a day or two at a time in order to allow libido to bloom.
Men: What Your Sex Life Says About Your Health
Sex scene #3: More and more often, you can't hold an erection.
It might be: A heart problem (the cardiovascular kind, not the romantic kind)
Say you're a relatively healthy midlife guy, a little overweight, and you start having erectile trouble. Count yourself lucky. It might be your tip-off that you're three to five years away from coronary artery disease, says Mulhall. "Two-thirds of men who have had heart attacks had erectile dysfunction (ED) that predated angina by at least three years," he says. "Men are increasingly being diagnosed with ED due to low blood flow, which increases their chance of heart disease."
What to do: Get your cholesterol checked. It's abnormal in 75 percent of men with ED, Mulhall says. "ED isn't just about having bad sex; it's a window to your vascular health," he says. And before things worsen, start exercising and lose weight.
Sex scene #4: You suddenly can't get it up -- but you were fine last month.
It might be: A blocked artery, especially if your leg mysteriously hurts too
The occasional limp penis is a casualty of naturally decreasing hormone levels as men age and experience changes in relationships, says Adam Tierney, a urologist with Dean Health Systems in Madison, Wisconsin. But what happens when ED comes on suddenly? An unusual but worrisome cause is aortoiliac occlusive disease, or Leriche's syndrome, a narrowing of a heart artery due to blockage.
Hallmarks of Leriche's syndrome: erectile problems that come on suddenly (one week you're fine, and the next you have persistent issues) and are accompanied by pain in the leg (especially the calf) or the buttock, especially when you walk or exercise. People with problems of the nervous system (Parkinson's disease, multiple sclerosis, diabetes) are at higher risk, as are smokers and those with high blood pressure.
What to do: Report this unusual combination of symptoms to your doctor. "It's another kind of blood flow issue," Tierney says.
Men: What Your Sex Life Says About Your Health
Sex scene #5: Your penis aches while you're having intercourse.
It might be: Peyronie's disease
Peyronie's disease, an uncommon condition that can develop at any age, is the formation of abnormal scar tissue under the penile skin, which can cause a hardened spot in the middle or make the penis bend slightly when erect. It's often simply noticed as a constant discomfort during intercourse. "Some guys come in and say, 'My penis just aches when I have sex,'" Mulhall says.
What to do: Always take pain as a sign something's amiss -- and tell your doctor. Peyronie's cause is unknown, but it's not an STD or a cancer. (It sometimes runs in families.) There's no surefire treatment, although surgery is often successful.
Sex scene #6: Your partner, touching you, asks, "Hey, what's that?"
It might be: Testicular cancer
Testicular cancer is asymptomatic -- it doesn't hurt. But it often presents as a painless bump or swelling on the testicle, which can be detected through self-exam (a good monthly habit) or by a partner's roaming hands during sex.
What to do: Testicular cancer has a near-100-percent cure rate in early stages, so don't ignore a lump; get yourself to a doctor. The best time for self-exams: standing up in a hot shower, when your muscles are relaxed.
Sex scene #7: You ejaculate way too quickly.
It might be: Hyperthyroidism
Premature ejaculation (PE) -- climaxing either before intercourse or very soon after it begins -- is the bane of younger men but can strike at any age. How soon is too soon is a relative issue, but a general rule of thumb is that PE is a problem when it routinely strikes without any control within a couple of minutes of insertion and sooner than either partner would like. As many as one in three men experience it at some point in their lives. Psychological issues (too excited, too immature, guilt) were once blamed for all cases, but doctors now know there can be physical causes, especially a malfunctioning thyroid (the gland responsible for making and storing key regulatory hormones).
"For some men, the only symptom of hyperthyroidism is premature ejaculation," Mulhall says. One 2005 study found that fully half of men with a malfunctioning (hyper) thyroid complained of PE.
What to do: Though premature ejaculation is hard for many men to talk about, it's highly treatable. If blood tests and an exam point to hyperthyroidism, medication can return your sex life to normal. And if your thyroid checks out OK? Therapies that thwart PE include breathing exercises, distraction, using a condom to diminish sensation, and behavioral therapies. SSRI-class antidepressants are also prescribed because, Tierney says, in healthy people without PE, they cause delayed orgasm.
Men: What Your Sex Life Says About Your Health
Sex scene #8: When you ejaculate, it hurts.
It might be: A muscle spasm disorder, or prostatitis
In women, there's a condition known as vulvodynia, mysteriously chronic pain of the vulva (around the vaginal opening). Penile pain at orgasm is thought to be the male counterpart, Mulhall says. The latest thinking on both conditions is that they're some kind of nerve disorder, although it's not clear whether this is in response to an infection or some kind of trauma, or what. It's more often seen in young men in high-stress phases of life.
Another possible cause for painful ejaculation is prostatitis, an inflammation of the prostate, which is a gland located up under the rectum. "It's a benign condition but an annoying one," Tierney says. And the cause is a mystery in this case, too.
What to do: Dysorgasmia (orgasmic pain) is tough to treat. Some men choose to endure discomfort, while others work with a qualified doctor (usually a urologist) to try various treatments.
Sex scene #9: When you ejaculate, nothing comes out!
It might be: Your prostate meds
Retrograde ejaculation is a condition where you experience orgasm -- but little to no semen comes out. (It exits through the bladder.) Alpha-blockers such as tamsulosin (Flomax), used to improve urination in men with enlarged prostate, are a common culprit. Sometimes diabetics also experience this due to nerve damage.
What to do: Nothing, unless it bothers you. "Most men don't care, but some do," Tierney says. A couple struggling with infertility would want to explore drug treatments or assistive reproduction techniques to remedy the condition.
Sex scene #10: It takes forever to ejaculate -- if it happens at all.
It might be: Diabetes, or prediabetes in the form of a weight problem
In 9 out of 10 men with anorgasmia -- the inability to reach orgasm -- the root cause is psychological (anything from performance anxiety to work stress to a history of childhood sexual abuse). But in the remaining 10 percent of cases, there's a penile sensory problem, most often caused by nerve damage due to diabetes, Tierney says.
Diabetics typically have other clues to the disease, including numbness in the feet, thirst, itchy skin, excessive urination, and fatigue -- but they don't always link the condition to sexual performance problems, which can include the inability to climax.
Overweight but not diabetic? "There's increasing evidence that obesity itself is a medical cause of erectile dysfunctions and loss of libido," Tierney says. "And obviously it can be a psychological barrier in the form of self-esteem issues."
What to do: Ask your doctor about medications to treat ED, such as Viagra or Cialis, but be aware that because diabetics often have heart problems, these drugs aren't always recommended. Instead: Don't discount the healing power of lifestyle changes.
"People want to take a pill to make sexual problems better, but a pill won't fix problems that are further back," Tierney says. "Sometimes the best fix is to do the hard work of taking better care of yourself: stress management, losing weight, working on the underlying medical conditions."