Why does low sexual desire occur in men?

Question

Hello doctor,

I am a 42-year-old married individual. Before marriage, I had a girlfriend with whom I was physically intimate on multiple occasions. After getting married, I initially had sexual relations with my wife, but I noticed that I did not achieve an erection as quickly as expected. Although my sexual desire was strong during that time, things have changed.

Over the past three years, I have been involved in an extramarital affair. Since then, I have observed that my erections occur more quickly, but my overall sexual desire has significantly diminished. At times, I also experience anxiety or fear before sexual activity, concerned about whether I will be able to perform adequately.

Additionally, I have some lifestyle habits that may be relevant. I chew tobacco on a daily basis and consume alcohol approximately once a month. Please help.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I read your query and can understand your concern.

Low libido can have several underlying causes, which may include the following:

1. Infections:

Urinary tract infections or infections in the pelvic region can contribute to low libido.

Recommended tests: Urine routine and microscopy (complete urine examination) and an ultrasound of the pelvis to help identify any infection or structural issues.

2. Chronic Medical Conditions:

Conditions such as diabetes mellitus (high blood sugar levels) and hypertension (high blood pressure) can affect libido and erectile function.

It is important to ensure that both blood glucose levels and blood pressure are well-controlled.

If you are currently taking any medications for these conditions, please share the names and dosages.

3. Hormonal Imbalances:

Low levels of testosterone, low thyroid hormone levels, and elevated prolactin can all lead to decreased sexual desire.

Recommended Tests:

Thyroid function tests (free T3 (triiodothyronine), free T4 (thyroxine), thyroid-stimulating hormone or TSH).
Serum prolactin.
Serum total testosterone.

4. Obesity:

Being overweight or obese can negatively impact hormone levels and sexual function. A structured plan including regular physical activity and yoga is recommended.

5. High Cholesterol:

Elevated cholesterol levels may contribute to vascular problems, which in turn can affect erectile function.

Recommended Test: Lipid profile

Regular exercise and a heart-healthy diet are advised.

6. Chronic Diseases or Long-Term Medications:

Certain chronic illnesses and long-term use of specific medications can reduce libido.

Please provide details of any chronic health conditions or medications you are currently taking.

7. Psychological Factors:

Anxiety, performance pressure, stress, and emotional concerns can significantly affect sexual desire and function.

Psychological counseling or therapy may be helpful in addressing these issues.

Next steps and suggested investigations:

Ultrasound of the pelvis (USG pelvis) to rule out infections or abnormalities.
Thyroid function test: free T3, free T4, TSH.
Lipid profile to assess cholesterol levels.
Blood pressure monitoring.
Random blood sugar (RBS) test to assess glucose control.

Temporary Symptomatic Relief:

Tablet Mildfil 5 mg may be taken twice daily to help with erectile function as a temporary measure, under medical supervision.

Kindly share additional details regarding the above-mentioned areas so that the root cause of the issue can be identified and an appropriate treatment plan can be initiated.

I hope this helps.

Kindly revert so I can assist you further.

Thank you.