Sexual issues in men are often complex and varied in nature, from erectile dysfunction to infertility. Sometimes they can be linked to each other, or one might be causing another.

On this page we’ll explore the potential links between:

  • erectile dysfunction and premature ejaculation;
  • ED and infertility;
  • erectile dysfunction and vasectomy;
  • and ED and prostate cancer. 

Erectile dysfunction and premature ejaculation

Premature ejaculation is a common sexual condition among men. It happens when men climax too quickly. Clearly, sex can be subjective and complete sexual fulfilment will depend on those involved. It’s up to both parties involved to decide whether they’re happy or not. 

Studies show that the typical male ejaculates between four and seven minutes after starting penetration, though it will differ depending on the individual. One study by Australian scientists defines it as being probable if ejaculation occurs within 1.5 minutes. But the subject of how ‘premature’ ejaculation has to be to qualify as premature ejaculation is a widely debated one, as evidenced by a joint metastudy by London and Istanbul researchers.

Sometimes the condition can be present from an early age, known as primary PE. This can be because of certain environmental factors experienced when growing up, like trauma, conditioning or strict education surrounding sexual beliefs. Some men may also find their penis is extra sensitive. 

In other cases, it can develop later in life, or be the symptom of a developing health condition (like prostate problems, thyroid dysfunction, recreational drug use, depression, anxiety or pressure because of a new sexual relationship). This is known as secondary PE.

But can premature ejaculation be linked with erectile dysfunction? The answer is complicated. Sometimes, the two conditions are unrelated. 

For example, erectile dysfunction can be a condition in itself. It may be the symptom of a more severe health condition, like diabetes or high blood pressure, but it can also be the symptom of a psychological health condition like depression. 

But, sometimes, sexual problems can feed into each other. If erectile dysfunction is something a person struggles with, the pressure of performing might be so severe that it leads to premature ejaculation, and vice versa: the anxiety surrounding ejaculating too soon could be so severe that it makes an erection an impossible feat to begin with. 

Infertility 

Infertility doesn’t always present itself in a recognisable way. Often, sexual couples who are trying for a baby may only begin to consider infertility if they’ve been trying without success for a number of months or years. 

The largest cause of male infertility surrounds the ‘quality’ of sperm. Sometimes, the body doesn’t produce sperm in great enough quantities to make fertilisation possible, the sperm does not swim sufficiently enough to reach the egg, or the sperm is misshapen or abnormal. 

There is thought to be a link between infertility and the temperature of the scrotal sack. Furthermore, damage or trauma to the scrotum can also cause infertility as it may hinder the ability to produce adequate sperm. 

However, in the majority of instances infertility should not interfere with the ability to get an erection, nor does erectile dysfunction make you infertile. (Medically, erections are not required for male ejaculation to occur). 

However, this is not to say the two cannot affect one another. Some men might not feel comfortable engaging in sexual activity knowing they suffer with erectile dysfunction, and clearly conception cannot occur in these cases. 

But infertility might interfere psychologically. Some men want children, and some may even feel like it is a biological obligation. Coming to terms with infertility with these things in mind can be difficult for some men, and can lead to mental decline. It can affect their ideas of ‘manhood’ and ‘masculinity’, and cause them to feel less ‘manly’ overall. 

This, in turn, can bring about psychological conditions like depression or anxiety. Of psychological erectile dysfunction, depression and anxiety are among the most significant causes. 

Vasectomy 

A vasectomy is a minor procedure whereby a man’s tubes which carry sperm are either sealed or cut, inducing a state of sterilisation. 

It is something which should take a lot of consideration, as it can be difficult to reverse. Men should only undergo the procedure if they’re sure they do not want children, or any more children, later on in life. 

NHS doctors will typically be more reluctant to offer vasectomies to men aged 30 or below, as their personal circumstances could change in several years time. 

Vasectomies are not linked with erectile dysfunction in a physical sense. The small operation does not interfere at all with any of the anatomy responsible for erections. There is a slight misconception among some that vasectomies can cause erectile dysfunction, but in the vast majority of successful vasectomies this is not true. 

However, this is some evidence, some of which is clinical and other is testimonial, that vasectomies can impact men psychologically, in a way that can interfere with the ability to get or maintain an erection. 

The full reasons behind this are not yet understood, but it is thought to relate similarly to the psychological difficulties some men experience following on from the news that they may be infertile. 

Vasectomies may interfere with men’s feelings of ‘masculinity’, and cause them to feel inadequate. Furthermore, because of the nature of the procedure, some men may fall victim to the illusion that there was a complication during the procedure, leaving them impotent because they believe it so. 

It’s important to speak with a doctor or sexual health expert if you’ve recently undergone a vasectomy and are experiencing symptoms of erectile dysfunction. More often than not, there are options that may be beneficial to you. 

Loss of libido 

It’s easy to assume that a lack of sex drive and erectile dysfunction are the same thing - but they’re not and can be exclusive. 

For example, you may not feel adequately aroused nor derive pleasure from sex, which can make erections harder to maintain - but many men will experience erections during the night while they’re asleep and in the morning. You can lose your libido, but this can still happen. This shows the two can be different. 

However, erectile dysfunction and a lack of libido can, at times, go hand-in-hand. 

Sex drives will differ depending on the person. The term ‘loss of libido’ can imply that a sex drive is something people should definitely have. But it’s important to remember that people experience arousal in different ways, and what is normal for one person may not be for another. 

Some people don’t experience arousal at all. While this is more uncommon, it’s only something you should worry about if you feel it interferes with your overall ability to live a normal life. 

However, there can be some reasons for a loss of your ‘normal’ sexual drive. That is, not feeling like you want sex at times you normally would. Some reasons can be temporary and range from moderate in nature to severe. 

One reason often put forward by those experiencing a lack of sex drive is the sexual relationship itself. People in long-term relationships can become over-familiar with their partner, and lose sexual attraction that was initially present. Frequent arguments and communication problems can also contribute. Your GP may be able to refer you to a relationship therapist if the problems become so severe that they interfere with your ability to live normally.

Other sexual issues can also bring about a loss in libido. In men, having erectile dysfunction may, in itself, bring about anxiety or stress surrounding sex. It might make them want to avoid it altogether. 

Though there are other sexual issues too, not all are related to men, that can affect libido. These can include premature ejaculation, vaginal dryness, painful sex, an inability to orgasm or an involtunary tightening of the vagina (called vaginisms). 

Mental stability can also contribute toward a reduced sex drive - this can include more moderate factors like workplace stress or tiredness, but can be more severe and take the form of mental illnesses such as depression or anxiety. 

Lastly, some underlying health conditions might be the cause of a reduced sex drive. That’s why it’s important not to ignore it if you experience a lack of sexual desire which isn’t normal for you. It could be indicative of something more severe. This might include things like diabetes or cardiovascular disease. 

Prostate cancer 

Prostate cancer may not seem initially like a sexual issue, but it can be. The prostate is a small, walnut-sized, gland found in the pelvis. Doctors are able to feel the gland if they perform a rectal examination. 

The prostate helps to produce ejaculate (the fluid that carries semen), without which pregnancy cannot happen. However, complications can arise in the prostate, including cancer. Like ED, the chances of developing prostate cancer can increase with age. 

Prostate cancer can be very psychologically distressing for some men, and sex may often not be something on their minds during and after their diagnosis. Anxiety, fear and depression can all follow on from a prostate cancer diagnosis. These things can feed into a reduced sex drive which, in turn, can feed into erectile dysfunction. 

However, treatment for prostate cancer can also damage the nerve vessels and arteries. This might interfere with blood flow, making erections difficult to fulfil. 

What next? 

Sexual issues and erectile dysfunction do not always coincide with each other, they can be independent of each other. Sometimes, erections will not be affected by sexual issues like those described here. Other times, sexual issues and erectile dysfunction can be interwoven and be mutually causative. 

Either way - sexual issues can be difficult and psychologically taxing. It’s important never to suffer in silence. If your quality of life is affected, regardless of the condition, have an open and honest conversation with a partner or friend. Visit your GP, who will be able to offer guidance and advice, and, where necessary, discuss treatment. 

Page last reviewed:  28/07/2020