According to the World Health Organisation, “sexual health is a state of physical, mental and social well-being in relation to sexuality. It requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence”.

Optimal male sexual health includes sexual desire (libido) and the ability to get and sustain an erection (erectile function). Although physiology can affect both the desire for sex and the ability to have sex, mental health and emotional factors also play important roles. Male sexual health also covers the prevention and treatment of sexually transmitted diseases, some forms of cancer and male infertility.

Early detection of testicular cancer is an important factor in its treatment. It is therefore important to carry out regular testicular exams by feeling the entire surface of testicles for small painless or uncomfortable lumps, and should be carried out monthly. The best time to do it is after a warm shower when the scrotal sac is relaxed. If you are not sure what’s right and what’s wrong or just need some reassurance, then speak to your family doctor.

Discovering the symptoms of testicular cancer at an early stage can be vital for effective treatment. These include testicular swelling; a sudden collection of fluid in the scrotum; a feeling of heaviness in the scrotum; a pea-sized hard lump on the testicle; a dull ache in the abdomen or groin harp or pain around the testicle or in the scrotum.

Prostate cancer unfortunately is common. The prostate is located at the base of the bladder. Its main function is to produce a secretion, which serves as a transport medium for sperm. Early prostate cancer does not give any symptoms. Later stages symptoms may include needing to urinate more frequently often during the night; needing to rush to the toilet ; difficulty in starting to urinate; taking a long time to urinate; weak flow and feeling that you have not urinated completely. It is best to speak to your doctor who will carry out a prostate exam and blood tests if you have such symptoms.

Arousal difficulties (i.e. getting an erection) are different to decreased libido, because in the latter the person does want to engage in sex. Erectile difficulties can affect a man’s ability to attain and maintain an erection. It is common that a man will experience such difficulties at some point and this is not necessarily an indicator of an underlying problem.

However, if it persists, advice needs to be sought. Some men may get morning erections but not get erections on masturbation or before intercourse. This could be indicative of psychological factors being involved, such as anxiety. Anxiety and doubts about getting an erection may exacerbate the symptoms.

It is typical that at some stage in life, a person will experience decreased desire. This is marked by a decreased interest in sex, less engagement in sexual activity and fewer sexual fantasies

Erectile dysfunction can result from a number of conditions, namely diabetes, cardiovascular disease, high blood pressure, high cholesterol, multiple sclerosis, Parkinson’s, stroke and hormonal imbalance. It can also be a side-effect of a number of medications and treatments, including anti-hypertensives (i.e. for high blood pressure), diuretics (for high blood pressure heart failure and kidney disease), fibrates (for cholesterol), chemotherapy and antihistamines (for allergies). In such cases, the need for medication should be reviewed regularly, and other methods of controlling the condition could be considered. When this is not possible, the couple may consider alternative methods of sexual activities.

It is typical that at some stage in life, a person will experience decreased desire. This is marked by a decreased interest in sex, less engagement in sexual activity and fewer sexual fantasies. It can be chronic (long-term) or episodic. It can be caused by a change in hormone levels, but could be part of an underlying condition, such as depression, or arise because of another sexual problem, such as erectile dysfunction.

In this case, the man loses interest in sex because of shame or anxiety due to erectile dysfunction. Although it is quite common, a decrease in desire could be indicative of relationship problems in some cases, difficulties with body image, poor self-esteem, excessive alcohol consumption and anxiety. In such cases psychological therapy or medication should be considered.

Inhibited ejaculation can have an effect on men and their partners. Premature ejaculation is when a man reaches orgasm too early and can lead to significant distress and avoidance of sexual intimacy in some instances. It can occur at any age across the lifespan. To date, the efficacy of both medical (eg. local anaesthetic gels, antidepressants) and psychosexual therapy are still being investigated, yet preliminary results show that premature ejaculation can be treated with some success.

Sexually transmitted infections are caused by viruses, bacteria and parasites. Several infections have been identified as transmitted through sexual contact i.e. vaginal, anal and oral sex. In the past couple of decades, there have been changes in sexual attitudes and behaviour, thus contributing in an increase in cases of both HIV and STDs in the world, including Malta.

It is advised to consult health professionals if a person wants to discuss sexual health matters or suspects an infection. Services available are the GU clinic on 2122 7981, the Health Promotion and Disease Prevention Directorate on 2326 6000 or your family doctor.

Dr Charmaine Gauci is Superintendent of Public Health.