One man out of two, after the age of forty, has experienced at least once a difficulty under the sheets. Yet only a minority talk about it with their doctor. Male sexual dysfunctions remain one of the great taboos in healthcare, despite the fact that they can represent a real warning sign of more serious conditions, such as cardiovascular or metabolic diseases. Today, andrological medicine offers increasingly effective tools, capable of restoring not only a satisfying sex life but also confidence and psychological well-being. We discuss this with Dr. Ninfa Alessandra Giacalone, urologist and andrologist in Palermo.
by Roberta Imbimbo
Dr. Giacalone, what is meant by male sexual dysfunctions?
These are conditions in which the normal functioning of the male reproductive system is altered due to organic, hormonal, vascular, neurological, or psychological causes. The most frequent disorders are erectile dysfunction (that is, the persistent inability to obtain and/or maintain an erection with sufficient rigidity to ensure a satisfactory sexual performance), premature ejaculation (the inability to control ejaculation, which occurs uncontrollably and more quickly than desired), and penile dysmorphisms. These include both actual alterations in the shape or size of the penis (as in micropenis, congenital curvature, or acquired penile curvature typical of Peyronie’s disease) and a distorted, irrational perception of these features (penile dysmorphophobia). Beyond affecting sexual life, these problems deeply impact a man’s self-esteem.
What are the main causes of these dysfunctions?
The causes may be organic—such as anatomical alterations of the genital organs—or functional, including hypertension, diabetes, circulatory, hormonal, or neurological disorders that directly or indirectly affect the functioning of the male genital system. They may also be psychogenic, linked to anxiety, stress, or depression. Often, multiple components coexist. For this reason, a comprehensive andrological evaluation is essential, as a sexual disorder may be the first sign of a more serious systemic disease, particularly cardiovascular or metabolic.
How widespread are these conditions?
Much more than people think. Premature ejaculation affects about one man in three, while erectile dysfunction is even more common, especially with increasing age, affecting approximately 50% of men between 40 and 70 years old, with about 10% experiencing a severe form.
Fortunately, awareness is growing: more and more men are deciding to consult a doctor, overcoming taboos and understanding that asking for help is the first step toward solving the problem. Talking is the first step toward treatment.
How is a correct diagnosis reached?
Diagnosis begins with an in-depth medical interview and a physical examination, followed by targeted tests: penile Doppler ultrasound, hormonal assays, neurological evaluations, and second-level highly specialized tests to analyze nerve conduction. Only a precise diagnostic framework allows the most effective therapy to be established.
What treatments are available today?
The first approach is usually pharmacological, with medications that improve vascular function and erectile response. Personally, I prefer continuous therapy rather than “on-demand” treatment, because it helps restore the physiology of blood vessels, giving the patient the freedom to experience sexuality in a natural and spontaneous way. However, the real goal is not only to treat the symptom but also to identify and correct the underlying causes, which are often related to more complex disorders.
You are also one of the few specialists in Italy who work with penile fillers. What does this involve?
It is a minimally invasive procedure that uses hyaluronic acid—already widely used in aesthetic medicine—to correct functional or morphological alterations of the male genital system. It is performed in an outpatient setting under local anesthesia and is well tolerated. Fillers are now widely used in the treatment of Peyronie’s disease, premature ejaculation, erectile dysfunction, and in cases of asymmetry or reduced dimensions. In addition to functional and physical improvement, patients often experience significant psychological and relational benefits. The results are temporary because the acid is reabsorbable, lasting between 3 and 12 months depending on the filler and individual characteristics. The procedure is extremely effective and safe.
A final message for our readers?
There is no need to be afraid to address these issues with your doctor. Male sexual dysfunctions are not just a couple’s problem but can be a warning sign of other important diseases. Acting promptly means not only improving sexual quality of life but also protecting a man’s overall health.
