 There are no research studies on the topic of sexual problems in males with eating disorders, although some researchers have observed reduced libido (sexual desire) and low testosterone levels in males with eating disorders.
The lack of research on this topic demonstrates an essential missing link to our understanding of eating disorders in males.
This page presents the limited information we have on the issue and draws the conclusion that sexual problems in anorexics, bingers, and compulsive overeats is perhaps a significant problem, but one that no man wants to admit to.
SEXUAL PROBLEMS
MedlinePlus, a website created and maintained by the U.S. National Library of Medicine, provides information about health-related topics. MedlinePlus defines sexual problems as “difficulty during any stage (desire, arousal, orgasm, and resolution) of the sexual act, which prevents the individual or couple from enjoying sexual activity.”
“Sexual dysfunction disorders are generally classified into four categories: sexual desire disorders, sexual arousal disorders, orgasm disorders, and sexual pain disorders.”
The sexual problem in men that gets the most attention is erectile dysfunction, the inability of a man to get an erection hard enough or long enough to engage in sexual intercourse. Erectile dysfunction is just one type of sexual problem among others.
It is difficult enough to admit to an eating disorder (ED), but it is even more difficult to admit to the “other ED” (erectile dysfunction) or other sexual problems. Many men have difficulty talking about sexual problems and diseases.
Culture has taught us that “real men” are virile and only “sissies” have sexual performance issues. Such a myth is emotionally damaging to the self-esteem of affected men. Sexual problems, including erectile dysfunction become another secret to keep, another blow to self-esteem, another thing to make a male with an eating disorder feel alone and different from others.
There should be no embarrassment or shame in admitting to erectile dysfunction or any sexual problem. It is just one of those things that men cannot control. A lot more goes into making the “man” than the way he performs in the bedroom.
If you experience sexual problems, know you are not alone. About 30 percent of men experience sexual dysfunction, a rate much higher than previously believed, according to a study by researchers at the University of Chicago and the Robert Wood Johnson Medical School. This was the first study to be done on the prevalence of sexual dysfunction in general in the U.S. population. A few studies had been previously conducted, but they researched specific problems.
With regard to erectile dysfunction, the Minnesota Men’s Health Center, P.A. (MMHC) claimed that erectile dysfunction is the most common sexual dysfunction among men and estimated one in ten men in the world have erectile dysfunction and 30 million men in the United States have this condition. Men of any age can have erectile dysfunction, although the percentage of men with erectile dysfunction increases with age.
Sexual problems can be caused by both physiological and psychological factors. Here is a list of potential causes for erectile dysfunction:
Always consult your doctor for his or her recommendations on the best form of treatment for your sexual problems. Your doctor will want to determine the cause(s) of the problem for two reasons:
- To treat the underlying cause(s), such as high blood pressure
- To know how to best treat the sexual problem itself
In the case of erectile dysfunction, forms of treatment include:
- Prescribed oral medications, such as Viagra, Cialis and Levitra
- Herbal sexual enhancement supplements
- Alprostadil self-injections or penis suppository
- Testosterone replacement therapy
- Penis pumps, surgeries or implants
-
Psychological counseling
BINGE EATERS & COMPULSIVE OVEREATERS
Scientific studies have shown strong evidence for a link between obesity in men and erectile dysfunction.4
First, binge eaters and compulsive overeaters typically are obese and those who are excessively overweight are at high risk for cardiovascular problems and diabetes, which are physical problems contributing to erectile dysfunction.
Second, low testosterone is another potential culprit for erectile dysfunction in excessively overweight men. Adequate levels of testosterone, a male sex hormone, is necessary for getting an erection and elevating one’s desire for sex.
One study showing a connection between obesity and low testosterone was published in The Journal of Sexual Medicine, the official journal of the International Society for Sexual Medicine. Researchers observed that obese men with erectile dysfunction had low hormone levels, including that of testosterone. In this study, it was observed that as the severity level of obesity increased, levels of testosterone decreased with 2 out of 3 morbidly obese participants in the study having low testosterone. Additionally, scientists observed that certain conditions associated with obesity, primarily high blood pressure, are the primary determinants of obesity-related erectile dysfunction.
In another study by endocrinologists at the University of Buffalo called the “Hypogonadism in Males” study, researchers found that 40% of obese participants had lower-than-normal testosterone readings. This study was conducted from November 2003 to February 2004 with 2,165 men 45 years and older.
It seems unclear exactly what causes low testosterone, but studies have correlated it with certain congenital conditions, injuries, diseases, infections, and aging.
It can be concluded that obese men who typically have lower-than-normal testosterone levels and are at high risk for cardiovascular disease are a high risk population for erectile dysfunction. Therefore, bingers and compulsive overeaters who typically are excessively overweight are at increased risk for erectile dysfunction.
It is very difficult to find studies assessing the effects of sexual problems on people who are underweight and malnourished despite millions of poverty stricken people around the world who are unable to meet their caloric and nutritional needs.
A well known 13 month clinical study done by Ancel Keys and colleagues at the University of Minnesota from November 1944 to December 1945 researched the physiological and psychological effects of severe and prolonged food restriction and the effectiveness of dietary rehabilitation strategies following starvation on 36 men. The study is known as the “Minnesota Starvation Experiment”. The results of this study were published in 1950 by Ancel Keys & colleagues in a 1,385 page, two-volume book.
Key’s research offers insight into the physiological and psychological components experienced by individuals with anorexia nervosa. Among other results observed, subjects in the study experienced severe emotional distress and depression; became socially withdrawn and isolated themselves; were preoccupied with food; and reported a diminished ability to concentrate, comprehend, and make judgments (although standardized testing showed no diminished capacities). The male participants’ sexual interest drastically declined with a severely restricted diet. These findings reflect the features observed in anorexic males.
Similar to those severely overweight, those who are severely underweight tend to have low testosterone. Low testosterone contributes to decreased libido and erectile dysfunction.
A study by Andersen and Mickalide (1983) suggested a disproportionate number of male anorexics have persisting or preexisting problems in testosterone production.
Fichter and colleagues (1985) observed in their study noticeable sexual disinterest in their sample of anorexic males, which they attributed to reduced levels of testosterone.
It appears that low testosterone has a correlation with extremes in weight, whether it is overweight or underweight. It is unclear why this correlation exists. Perhaps, hormone imbalances occur when the body is physically stressed at either weight extreme.
Besides low testosterone being a potential culprit for sexual problems, the male who is anorexic may be at additional risk for sexual problems for the following reasons:
1. Psychological reasons, including depression, anxiety, guilt, and stress
2. Physical reasons that are not well understood, including damaged organs and
biochemical imbalances
3. Social reasons, such as difficulty with intimacy and relationship problems
4. Medication reasons, including sexual side effects from some antidepressants
5. If they abuse alcohol or drugs or smoke
When the body’s organs are damaged by deterioration for lack of food, the body’s health and ability to function at its best is seriously compromised. Physiologically, the body needs to be healthy and take in nutrients and calories and to be hydrated to maintain its bodily functions, including the ability to produce semen, sustain libido, and perform sexually.
Sexual performance and satisfaction is enhanced by:
1. Physical and mental health
2. Healthy, effective stress management coping skills
3. Relationship intimacy
Given this information, it seems reasonable to hypothesize that a significant percentage of males with anorexia nervosa are likely to experience sexual difficulties, including erectile dysfunction.
What to do, if you experience sexual problems? If you experience erectile dysfunction, unsatisfying climaxes or any other sexual problems, tell your doctor. Your doctor can assess why you are having problems and treat both the underlying conditions of the problem and the sexual problem itself. If you feel embarrassed about discussing this topic with your doctor, ask yourself, “What is worse, continuing with the sexual problem or the embarrassment of approaching my doctor about it?”
It is reasonable to assume that sexual problems are probably common in males with anorexia, binge eating disorder, and those who compulsively overeat. Males with bulimia who tend to be more impulsive, less inhibited sexually, more sexually active, and whose body weight fluctuates closer to their ideal body weight may tend to be at less risk for sexual problems than those with anorexia and binge eating disorder.
Physical and psychological factors along with intimacy issues and relationship problems can contribute to sexual problems.
There have been no research studies to substantiate what percentage of males in the various eating disorder sub-groups experience sexual problems (including erectile dysfunction) or even if it is a common occurrence. This subject needs further investigation.
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2. William Harms, “Research Publishes New Study On Sexual Dysfunction,” The
3. www.mmhc-online.com/articles/impotency.html
4. www.healthexpress.co.uk/news/scientists-prove-link-between-obesity-and-ed.html
5. www.buffalo.edu/news/11311
7. A. Keys, J. Brozek, A. Henschel, O. Mickelsen & H. L. Taylor (1950). The
Biology of Human Starvation (2 volumes). St. Paul, MN: University of
Minnesota Press, MINNE edition. ISBN 978-0816672349
8. A. E. Andersen & A. D. Mickalide (1983). "Anorexia Nervosa in the Male:
An Underdiagnosed Disorder," Psychosomatics, 24, 1067-1075 as reported in
A. E. Andersen, ed., Males with Eating Disorders (NY: Brunner/Mazel, 1990)
37.
9. M. M. Fichter, C. Daser & F. Postpischl (1985). "Anorexic Syndromes in
the Male," Journal of Psychiatric Resources, 19,305 - 19,313 as reported in
A. E. Andersen, ed., Males with Eating Disorders (NY: Brunner/Mazel,
1990) 102.
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