the male clinicSydney Men’s Health now located at The Male Clinic

Dr Michael Lowy


Welcome to The Male Clinic

Dr Michael Lowy is a sexual health physician specialising in men's health conditions, sexual medicine and counselling. He is specifically trained in the treatment of male sexual dysfunction (libido, erection, ejaculation disorders), relationship and sexual problems affecting individuals and couples.

Areas of Specialty

  • Erectile Dysfunction
  • Ejaculation Problems
  • Libido disorders
  • Androgen deficiency
  • Peyronie's Disease
  • Sexual Rehabilitation
  • Prostate Disease
  • The Ageing Male
  • Relationship Issues
  • Mindfulness approach to sexual dysfunction treatments
  • Female Sexual Dysfunction
    Dr Margaret Redelman

Dr Michael Lowy

Dr Michael Lowy is a sexual health physician specialising in men's health conditions, sexual medicine and counselling. He is specifically trained in the treatment of male sexual dysfunction (libido, erection, ejaculation disorders), relationship and sexual problems affecting individuals and couples. Dr Lowy works in close association with many urologists for the treatment of sexual dysfunction arising from conditions such as prostate disease (sexual rehabilitation).


Dr Michael Lowy MBBS, MPM, FAChSHM, FECSM obtained his original medical degree from the University of NSW. He is a Fellow of the Australasian Chapter of Sexual Health Medicine and obtained a Master of Psychological Medicine from the University of NSW. Dr Lowy is also a Fellow of the European Committee in Sexual Medicine.

Professional Experience

Dr Lowy has worked in the specialty of sexual medicine since 1992, with an interest in the physical and psychological causes and treatments.

In addition to his clinical work, Dr Lowy has been an investigator in numerous clinical drug trials of medical treatments for male sexual dysfunction. He has been a member of a number of pharmaceutical industry clinical advisory boards.

Dr Lowy is a lecturer in Men's Health at the University of NSW, Notre Dame University, Sydney University and Family Planning NSW. He is a founding member of the Society of Australian Sexologists (SAS) and has been awarded a life membership of ASSERT NSW.

The Male Clinic

Dr Michael Lowy's services at The Male Clinic include:

  • Sexual & relationship counselling
  • Assessment and treatment of male sexual dysfunction, hormone and prostate disorders
  • Medico-legal assessment of sexual dysfunction
  • Clinical research of sexual dysfunction
  • Women's sexual health

The Male Clinic can organise the following investigations:

  • Penile arterial blood flow studies (Duplex Doppler ultra-sound)
  • Cavernosography to assess veno-occlusive dysfunction
  • Close liaison with associated specialists in urology

Too Fast

Too Fast Dr Lowy has co-authored a book on the latest theory and treatment of premature ejaculation. Too Fast can be purchased as an e-book download from Amazon.


Professional Services

Dr Lowy specialises in diagnosing and treating the following:

Erectile Dysfunction

ED is a condition that affects both younger men (mostly psychological in origin) and older men (usually physical causes) but often arises from a combination of a number of factors. There are various investigations and treatments available.
▶ Play Video "Causes" | ▶ Play Video "Treatment Options" | ▶ Play Video "ED" | Read more...

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Ejaculation Problems

Premature ejaculation (PE) is a common male sexual dysfunction that is now defined as ejaculation occurring within 1 to 2 minutes of penetration and associated with significant distress to the man and his partner.

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Libido disorders

Libido, also known as sexual desire, is a reflection of a person's sexual behaviour and desire to engage in sexual activity. Libido arises from the effect of the hormone testosterone which is generally known as “the male hormone" but is responsible for sexual desire in both men and women.

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Androgen deficiency

The most important androgen in men is testosterone. Androgens are the sex steroids or hormones that produce changes in body shape and sexual characteristics typical of men after puberty. Androgens play a major role in the reproductive and sexual function of the adult male. The equivalent sex steroid produced by women is oestrogen.

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Peyronie's Disease

Peyronie's disease is a localised area of abnormal scar tissue or fibrosis that appears as a plaque or nodule in the penis. It may present with a developing curvature or a painful nodule or plaque.

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Sexual Rehabilitation

Any treatment of prostate cancer has the tendency to result in sexual dysfunction at least temporarily initially, but sometimes this continues in the long term. Many treatment strategies have been developed for this situation.

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Prostate Disease

Common prostate conditions experienced by men are prostatitis, benign enlargement and prostate cancer.

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The Ageing Male

Reproductive and sexual health changes occur as a man gets older. These changes involve fertility, hormone levels, prostate health and erectile function.

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Female Sexual Dysfunction

Roughly half the world's population is female so it is worthwhile to understand the factors that will determine good female sexuality and what some of the difficulties are due to.

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Relationship Issues

A relationship may involve the interaction between two people, or may involve the way a person relates to a group of people. A good relationship is often the foundation stone for a mutually satisfying sexual relationship.

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Women's Sexual Health


Dr Margaret Redelman
OAM, MBBS (Uni NSW), M Psychotherapy (Uni NSW)

Read more about Dr Redelman here.

young couple


Here you can find more information about some of the conditions treated by Doctor Lowy.

If you would like to discuss any of these conditions further or if you would like to know more about treatment options, please contact Doctor Lowy here.

Erectile Dysfunction ( Impotence )

Erectile dysfunction (ED) is defined as the inability to achieve and/or maintain an erection that is suitable for penetration. Erectile dysfunction is often referred to as “impotence".  However this term is no longer used. It is important to distinguish erectile dysfunction from other forms of sexual problems such as low libido or premature ejaculation.

ED is an increasing issue in older men. About one third of men over the age of 50 complain of erectile difficulties. It is important to stress that the change in erections with age is not necessarily a physical disorder requiring treatment, often an understanding of the nature of these changes is sufficient treatment alone. The firmness of the erection changes with age and the ability to re-engage in sexual activity increases increases in time with age (refractory period). An erection is obtained by a process of the spongy tissues in the penis becoming engorged with blood. This vascular process is initiated by a signal from the brain that travels down the spinal cord through the pelvis directing blood vessels in the penis to dilate. There are chemical factors involved in this vascular process and the mechanism that traps the blood in the penis is known as the veno-occlusive mechanism. When this does not work effectively the leakage of blood is known as “venous leakage". This commonly occurs when anxiety is present during sexual activity or as a consequence of age and the effects of other medical conditions such as diabetes and coronary artery disease.

The presence of ED in a younger man is often due to psychological causes or in some cases due to a congenital anomaly in the penile erection tissues or blood vessels.

The causes of ED may involve problems with the brain and nervous system, the arteries and veins in the penis and the penile spongy tissues (cavernosal tissues). Some medications used to treat medical conditions may affect the erection process and these include blood pressure and cholesterol lowering tablets. Conditions such as high cholesterol, high blood pressure, diabetes and obstructive sleep apnoea may be associated with erectile dysfunction. Peyronie's disease may affect erections. Excessive alcohol intake and substance abuse are other known factors. Treatment of erectile dysfunction may simply involve counselling and explanation of the normal anatomy and physiology of erections. Counselling can benefit relationship issues that may be contributing to the erection problems.

ED may be associated with other vascular conditions particularly in the older man. It is thus important to carry out a full general health check including the heart. Overnight erection testing may assist in establishing in a younger man whether the cause is physical or psychological. It is usual for a man to experience during rapid eye movement sleep between 3 to 5 erections each night.

A common and popular treatment these days is the use of oral medications known as PDE5 inhibitors. The products available on the Australian market include Viagra™, Cialis™ or Levitra™ tablets. These medications are effective in most situations but cannot be used if the patient is not fit enough to engage in sexual intercourse or is on nitrate medication.

When oral medication is not effective, penile injection therapy may work. The injection is self administered into the shaft of the penis, the dose needs to be carefully regulated so that a prolonged erection (priapism) does not occur. The injection medication may consist of a single chemical called prostaglandin (PGE1) or alprostadil known as Caverject Impulse™ available by a doctor's prescription through a regular pharmacy. If the single medication injection is not adequate, then a compounded triple mixture that contains PGE1, phentolamine and papaverine is obtained through an approved compounding chemist.

A less invasive treatment is the use of a vacuum erection device that allows an erection to occur by creating a vacuum with a plastic cylinder placed over the flaccid penis. The induced erection is then held in place by a constricting band placed around the base of the penis for a maximum time of 30 minutes.

In some cases regular treatments are not effective and a final treatment option is to insert a penile prosthesis or implant which usually comes in the form of a hydraulic device that is internal with no obvious external change in appearance of the genitals. This operation is performed by a urologist.

Vascular surgery is mainly performed in younger men when trauma has damaged the blood vessels leading to the genitals. Some men with “venous leakage" may benefit from vein stripping surgery.

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Ejaculation Problems

Premature Ejaculation

— Introduction

Premature ejaculation (PE) is the commonest male sexual dysfunction and is defined as ejaculation before the person wishes it, often within 1 to 2 minutes after penetration though it can occur before or on penetration.

PE present since commencing sexual activity is called a primary lifelong disorder and is associated with a hypersensitive ejaculatory reflex now believed to arise from serotonin receptor sites in the brain. PE may also arise as a secondary acquired disorder at any stage and can be associated with performance anxiety or psychological trauma. PE resulting from anxiety often has a situational component, such as when starting a new relationship. Men with PE will usually have better control over their ejaculation time with masturbation. Older men who develop erection problems may develop PE as a compensatory mechanism.

— Treatment

Treatment to slow down ejaculation time is not always appropriate due to the man's expectation of how long ejaculation time should be. Ejaculation time averages between 5 to 10 minutes. Consideration should be given to these expectations and other factors such as the state of the relationship. Sometimes communication and simple adjustment of the couple's sexual technique is adequate therapy.

An established exercise treatment is Seman's stop-start technique. This involves 3 stages of stimulation of the erection to the point before ejaculatory inevitability and then temporarily withdrawing to allow arousal to subside, when the stimulation is recommenced. The stages involve use of a dry hand, lubricated hand and finally vaginal penetration.

Seman's manoeuvre was modified by Masters and Johnson who devised the squeeze technique. The partner firmly squeezes the frenulum and ridge of the penis for 10 seconds to reduce the ejaculatory sensation. This occurs just before penetration.

— Pharmacological Therapy

SSRI anti-depressants have been successfully used to delay ejaculation. Dapoxetine (Priligy™) is the only SSRI approved for use in PE. It is taken on an as required basis.

Daily use of SSRI medication is an off label use where the medication is taken daily for 1 to 2 years. The PE may return when the medication is stopped. Whilst delayed ejaculation is a side effect of SSRI anti-depressant medication, other side effects such as insomnia and anorexia may occur.

Local topical anaesthetic sprays have limited success.

Delayed Ejaculation

Delayed or inhibited ejaculation can be a natural consequence of ageing in men. The presence of conditions such as diabetes or the use of anti-depressant medication may exacerbate the problem. There may be emotional causes in younger men who may have always experienced difficulty ejaculating.

Treatment involves techniques to enhance sexual stimulation as well as counselling.

Retrograde Ejaculation

Retrograde ejaculation involves the passage the semen during ejaculation into the bladder rather than through the penis. This arises from incompetence of the bladder neck that most commonly occurs after surgery for benign enlargement of the prostate. It may also occur from autonomic nerve damage associated with diabetes.

Treatment is difficult for this condition and often involves counselling to accept the changed ejaculation pattern. There are some medications that tighten the bladder neck but their use is not always suitable.

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Libido Disorders

Libido, also known as sexual desire, is a reflection of a person's sexual behaviour and desire to engage in sexual activity. Libido arises from the effect of the hormone testosterone which is generally known as “the male hormone" but is responsible for sexual desire in both men and women. Testosterone is responsible for the peak in sexual interest in men around the age of 20 and women in their mid-thirties. The ageing process in men and women reduces the bio-availability of testosterone resulting in a natural decline in libido in the older years. However a man's libido may not necessarily be related to his level of testosterone as there are other factors that can influence sexual desire.

Libido problems usually present as low desire but sometimes excessive desire can be the issue. These problems may present as a lifelong issue that has always been present or occur only in some situations. Another common desire issue is desire discrepancy where the difference of desire within a relationship creates problems within that relationship.

A common cause of low libido is not related to lack of production of testosterone but rather due to relationship problems, such as when a decision is required for a long term commitment in a new relationship. Any medical condition as well as excessive alcohol intake may contribute to reduced libido. Lack of sexual activity and stimulation may have a negative effect on testosterone production. Any damage to the testes in the male or ovaries in the female will affect testosterone production. This can be seen in removal of such organs or damage from chemotherapy for treatment of cancer.

An assessment of libido problems requires investigation of medical and psychological aspects. It is important to involve the couple in the assessment. Medical treatment if required may involve use of testosterone supplementation, usually in the form of daily applications or long acting depot injection. There a pharmaceutical guidelines that provide the level of testosterone in men that qualifies for a subsidised authority prescription. There are no approved guidelines for testosterone treatment in women.

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Androgen Deficiency

The most important androgen in men is testosterone. Androgens are the sex steroids or hormones that produce changes in body shape and sexual characteristics typical of men after puberty. Androgens play a major role in the reproductive and sexual function of the adult male. The equivalent sex steroid produced by women is oestrogen.

Androgen deficiency occurs when reduced levels of testosterone arise from a lack of hormonal drive from the brain or problems with the testes. Replacement of testosterone may be given to such men and this is usually continued for life. About 1 in 200 men under 60 years of age suffer from androgen deficiency. However as men age, testosterone levels begin to fall from the age of 40 years. It is believed that by the age of 65 years, 10% of men will have androgen deficiency and by the age of 70 this figure will have risen to over 20%. Men's testosterone levels fall much more gradually and over a longer period of time, unlike women, whose oestrogen levels fall rapidly when they go through the menopause.

Men with low testosterone complain of a number of symptoms including easy fatigue, low energy levels, low mood, irritability, poor concentration and reduced libido. Low testosterone may also contribute to erectile problems though androgen deficiency is an uncommon cause of this. As men age, the amount of body fat increases and muscle mass and strength decreases. A fall in testosterone levels is likely to contribute to these conditions. Low testosterone levels are also a risk factor for the development of osteoporosis.

It is difficult to diagnose androgen deficiency in older men purely on the basis of symptoms. Medical research is still needed to develop ways to identify older men who may be at risk of having androgen deficiency. As men age any significant medical illness can cause a fall in the level of testosterone but these levels usually recover when the illness has been treated.

Replacing testosterone in older men who have a very low testosterone has been shown to have a number of benefits on body fat, muscle, cholesterol and bone density as well as an improvement in quality of life.

— Acknowledgement: Andrology Australia.

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Peyronie's Disease

Peyronie's disease is a localised area of abnormal scar tissue or fibrosis that appears as a plaque or nodule in the penis. These plaques occur in about 1% of men over 50 years of age. A plaque when mature is painless and often associated with curvature of the erection. Most plaques occur on the top of the penis. Patients present with pain, a lump in the penis, a curvature of the erection or erectile dysfunction.

Peyronie's disease has two distinct phases. The acute phase lasts 12-18 months and may be associated with pain during erection. Nodules form and a curvature may slowly develop. The chronic phase involves thickening of the scar tissue and the absence of pain. The curvature may improve, stay the same or deteriorate. The presence of calcification indicates a poorer outcome.

These plaques may arise without any known cause or may arise from mild trauma associated with mechanical strain of the erect penis during intercourse. This effect is commonly seen with the partner in the superior position. The exaggerated localised scarring response may be genetic (HLAB27) and associated with scarring in the hands, a condition known as Dupytren's contracture. Penile injection therapy may also predispose to this scarring.

Erection problems may occur in 20% of men with Peyronie's disease. This may arise from a performance anxiety due to the pain and visible bend or due a physical cause when penile blood vessels are affected by the plaque.

No treatment is required with minimal deformity, no pain and no discomfort. There is no consensus on the best treatments for Peyronie's disease. Many treatments are anecdotal and not evidence based.

However, when the plaque presents as a painful lump, the pain may be improved by oral medication using colchicine tablets (an anti-inflammatory used for the treatment of gout). Vitamin E can be taken orally and also applied to the skin of the penis. Oral l-carnitine and l-arginine are also used. An oral prescription medication oxypentifylline (Trental™) has been trialled overseas with some apparent benefit.

Various chemicals havebeen injected into the plaque such as cortisone, verapamil and interferon. A new injectable collagenase injection will soon be available in Australia. Penile traction devices may assist to improve the shortening and curvature that Peyronie's disease may cause.

Three surgical procedures are available to straighten the penis if the bend in the erection interferes with penetrative intercourse. However, surgery will not improve the rigidity of the erection if there is already a pre-existing problem with the rigidity. Surgery is only considered if the Peyronie's has been present for 12 months and stable for 3 months.

The first operation is a plication operation (Nesbitt procedure). It may cause slight shortening of the erection. The second operation involves incision and graft and is more complex and has slower recovery but has less effect on penile length. The third operation is the insertion of a penile implant when other options fail.

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Sexual Rehabilitation following treatment for prostate cancer

Prostate cancer can be treated surgically with an open or robotic radical prostatectomy or with radiation therapy, brachytherapy or androgen deprivation therapy (ADT).

The sexual dysfunctions that may occur after these treatments include erectile dysfunction, loss of ejaculation, shortened penis and climacturia (passing of urine during orgasm). Loss of libido occurs particularly with ADT.

The outcome of sexual function after treatment depends on the age of the patient, the level of sexual function present before treatment and in the case of surgery, the sparing of the nerve bundles (better outcome if both sides are spared).

Surgery tends to result in immediate loss of erections, whereas the other treatments may result in a delayed loss of erections, up to 6 months after treatment.

Sexual rehabilitation addresses these sexual dysfunctions, especially erectile dysfunction, that men may experience as a result of treatment for prostate cancer. It is an important part of the holistic care of men undergoing treatment.

There is evidence that the earlier the erectile dysfunction is treated, the better the chance of a return of erections. If natural erectile function returns after treatment, the quality of the erections may not be as good as in the past. Erections may take up to 3 years to recover, but usually an indication of the outcome is seen at 18 to 24 months.

Erections can be induced within 2 to 3 weeks of surgery with penile injection therapy using prostaglandin E1 (PGE1). The penis is injected with a low dose of PGE1, about 2.5 to 5 mcg once or twice a week, whether sexual activity occurs or not. The early and regular "exercising" of the penis to erection has been shown to expedite the return of erections (but only when the erection nerves have been saved).

PGE1 injection treatment has been safely used for many years but sometimes its use is painful due to a "chemical post-injection pain". Care must be taken with the amount injected to avoid a prolonged erection and there is a risk of scarring occurring in the penile tissues.

This "exercising" regime allows oxygenation of the erection tissues thus minimising the risk of deterioration of these tissues due to lack of use and low oxygen (hypoxia) levels. If there appears to be an improvement in natural erections whilst on PGE1 therapy, oral treatment can be tried about every 3 months.

The oral treatments are known as PDE5 inhibitors, there are 3 available (Viagra™, Levitra™ and Cialis™). The tablets are swallowed about 1 hour before planned sexual activity when used on an as required basis. But initially they are usually taken daily and later that may be changed to an as required basis. However during the first few months after surgery, these oral tablets may not have the same erection inducing effect that injections have, but some men may prefer tablets to injections at the early stage of recovery, either due to personal preference or not being ready to engage in sexual activity. The tablets may result in a softer erection not firm enough for penetration, but sexual play is encouraged as part of the "exercise" concept. An orgasm is entirely possible with a soft erection or indeed with no erection when adequate stimulation to the penis occurs. But there is some evidence that just by taking PDE5 inhibitors even without an erection occurring, there may be benefit in prevention of deterioration of the erection tissues.

The common side effects include flushing of the face, headache and blocked nose. PDE5 inhibitors cannot be taken by men who are on cardiac medication known as nitrates.

Other treatment choices are the use of a vacuum erection device which is a non invasive method involving placement of a cylinder over the penis. Air is extracted by a pump which results in the formation of an erection that is held in place by a rubber constriction ring.

The surgical insertion of a penile prothesis is considered when all other treatments have proven ineffective. This hydraulic device allows an erection suitable for penetrative intercourse to occur with the simple activation of a pump discreetly placed in the scrotum.

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Prostate Disease

The prostate is a variable sized gland located in the male pelvis, usually the size of a walnut measuring 3-4cm long and 3-5cm wide. On average the gland weighs about 20gm. The prostate surrounds the urethra which carries urine from the bladder to the penis. The seminal vesicles attach to the prostate and produce material that mixes with the prostatic fluid to form semen. The tubes from the testicles carry sperm to the prostate where the sperm are mixed with the prostate and the seminal vesicle fluid. The fluid is then ejaculated during orgasm by a connection to the urethra called the ejaculatory ducts.

Prostate disease is a term used to describe any medical problems involving the prostate gland. Common prostate problems experienced by men include:

  • Prostatitis which is inflammation and swelling of the prostate gland.
  • Benign prostatic hyerplasia (BPH) which is a benign enlargement of the prostate gland.
  • Prostate cancer.

Prostatitis tends to be a condition in younger men. BPH commonly occurs as men age. Prostate cancer is now the most common form of cancer in men in Australia.

BPH is one of the most common diseases affecting the prostate and is the most common benign tumour in men as they get older. This condition is present in 50% of men over 50 years. The symptoms involve noticeable changes in urination due to the effects of enlargement of the prostate around the urethra. The urinary symptoms may be obstructive (weak stream, dribbling, inadequate emptying) or irritative (urgency, frequency urination through the night). The prostate can be assessed by a digital rectal examination where a gloved and lubricated finger is inserted into the anus. The back of the prostate can thus be felt and an assessment of its size may be possible. This digital examination may also feel a cancerous lump though not all prostate cancers are palpable in this manner.

The PSA blood test (prostate specific antigen) is an important marker of prostate cancer though it is not cancer specific. It may also be raised in benign enlargement or prostatitis. Normal values for PSA blood test results are available for different age groups.

Treatments for benign enlargement of the prostate range from watchful waiting to medication to surgery. Medications derived from plants have shown some benefit, for example, Saw Palmetto. Prescription medications may reduce the prostate size thus improving symptoms, yet often this is only a temporary relief. Transurethral surgery may involve resection with a blade or the newer modalities of laser or heat treatment.

Treatment of prostate cancer is complex and the decision on the most appropriate treatment involves many factors. The choices are watchful waiting, brachytherapy, radical prostatectomy, radiotherapy and chemotherapy.

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The ageing male

There are normal physiological changes that occur with aging that can impact on sexual function and the sexuality in the relationship. Other medical conditions increase with age or can become more severe and these can further impact on the sexual health. Medications and surgical procedures also impact on sexual function. Because most people do not get a good sex education and don't know what to expect or how to compensate for the changes and often other medical practitioners are focused primarily on their area of specialty, there is attention paid to the sexual needs of older men.

Meanwhile we are living longer, generally in better health and expect to maintain good enjoyable sexual function. So if changes have occurred in your sexual life that are causing distress to yourself or your partner it is best to seek expert advice.


Sperm counts decline with age and the ability of an older man to father a child declines.


Testosterone levels begin to slowly fall from the age of 40 years onwards. The fall is not as dramatic as the drop in oestrogen that occurs in women at the menopause. Whilst low testosterone may result in a decreased libido, ageing men are at risk of osteoporosis and decreased muscle mass. Tiredness and irritability may also be a feature of low testosterone. Ongoing research is aimed at establishing at what level men should be treated with testosterone and at what dose. There is still no general consensus on this issue at this moment in time.


The commonest change with the prostate gland in the ageing man is benign enlargement. This may affect urine flow. A less common change is prostate cancer which may present with the same symptoms as benign prostate disease or no symptoms at all. A regular prostate check over the age of 50 years is recommended.

Erectile Dysfunction

Erectile dysfunction increases with age. This may be exacerbated by the presence of medical conditions such as high blood pressure, high cholesterol and diabetes. Many new treatments have been developed for erectile dysfunction.

The fact sheets present on this website provide further detailed information on the above conditions.

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Female sexual dysfunction

Roughly half the world's population is female so it is worthwhile to understand the factors that will determine good female sexuality and what some of the difficulties are due to.

In general because females only have a small amount of the libido hormone testosterone, sexual interest and behaviour is more influenced by personal wellbeing, relationship dynamics, context of the sexual activity, appropriateness of the sexual behaviour, sexual beliefs and sexual education. Women may be more affected by negative factors such as lack of time, fatigue, anger and resentment and lack of intimacy.

Among younger women lack of sex education and experience, shyness and insecurity about their bodies and lack of assertiveness may be major contributors to difficulties. Later, tiredness, poor relationships and anger become more relevant and then with menopause hormonal factors, health issues, longevity of the relationship and partner health and sexual function issues become significant.

The main female sexual difficulties are:

  • Inhibited sexual desire and desire discrepancy.
  • Orgasmic difficulties.
  • Dyspareunia.
  • Vaginismus and pain disorders.

Management of each of these difficulties requires specific strategies based on understanding the individual's sexual, psychological and relationship history. Inhibited sexual desire has to be evaluated understanding the broad range of normal female sexual desire which at one end may be that the female is responsive to a male on a few occasions early in the relationship adequate for impregnation. Nature is not particularly interested in recreational sexual activity. In a desire discrepancy situation both partners may be sexually, medically and psychologically normal.

Orgasmic difficulties mainly require behavioural sexual techniques and encouragement to overcome inhibitory behaviours. Dyspareunia needs to be properly medically evaluated and relevant causes treated, before corrective behavioural and psychological therapies are instituted. This is the same for pain disorders. Vaginismus needs a very empathic history and then supportive behavioural sex therapy.

With menopause and age related changes there needs to be a proper medical evaluation of the hormonal and anatomical situation before corrective advice is given. It is unusual for medical difficulties to be present in isolation from psychological and relationship issues.

If you are unhappy or worried about any aspect of your sexuality or relationship seek help early so that you can get the best possible out of your life.

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Relationship Issues

An intimate relationship involves the interaction between two (or more people) engaged with each other in more than just the social sense. There are many aspects to how a couple relate with each other in the context of their relationship. Examples may be whether the couple are involved in an intimate non-sexual relationship or a sexual relationship or on whether the couple are same sex or opposite sex. A good relationship is often the foundation stone for a mutually satisfying sexual relationship.

Relationships are not always easy and often require compromise by both members of the partnership. Desire discrepancy is an example of differing sexual needs within a relationship which usually requires a negotiated compromise solution for the long term contentment of the two individuals. There are many factors, both positive and negative, involved in the attraction between two people so forming a relationship may not be easy or without stress.

All relationships benefit from good effective communication and commitment to making the relationship succeed. All relationships require ongoing maintenance and attention to succeed happily for 50 years. Couples also benefit from time alone. Children may pose extra stress on intimate relationships as time becomes limited, energy is depleted and differences of opinion on parenting techniques arise. It is also important for each member to have time out to pursue their own interests, but not to the detriment of the relationship.

Over time sexual needs may change in relationships so the importance of ongoing respect, affection and attention to each partner must always be emphasised. There are many self help books available which address the many issues that most couples may face at one time or another. Sometimes the problems prove too difficult to manage without outside help. Relationship or couples counselling may then be an appropriate

To find out more about relationships please visit the Australian Relationship support website on

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Chronic Ill Health and Sexual Function

Men and women often lose interest in sex when they feel their lives are being threatened by illness. Loss of sexual function in the presence of a chronic medical condition may arise more from the treatment of the condition than the actual illness itself. In addition the level of sexual functioning present before the onset of the illness determines the eventual level of return of sexual function.

At first concern for survival is so great that sex is far down the list. Loss of desire may be a result of worry, fear, depression or anxiety. It may also be caused by physical problems such as nausea, pain, fatigue or hormone imbalance.

Sex and sexuality are important parts of everyday life. There is a difference between the two. Sex is thought of as an activity—something you do with a partner. Sexuality is more about the way people feel and is linked to your need for caring and closeness, playfulness and pleasure.

Feelings about sexuality affect our zest for living, our self-image, and our relationships with others. Yet patients rarely talk to their doctors about how they may feel as a sexual being or how the medical treatment may affect their sex lives. Many of us feel awkward talking about these matters even to a close sex partner. Many people with a chronic illness, including cancer, worry that their partner may be turned off by changes in their bodies. Or the partners worry that they may hurt the ill person during sex.

Good quality sex is possible in the face of medical conditions including diabetes, heart disease and cancer. This is true notwithstanding that many medications have a variety of side effects. Many people with chronic illnesses continue to have sex, and some have exceptionally good sex. Loving expression is possible almost regardless of what kind of physical condition you are in.

Serious illness, potent medication often known to inhibit sexual desire and exhaustion may be enough justification to stop having sex altogether. Yet, if you want to have sex you can deal with these situations and enjoy great lovemaking. You may have to change how and when you have sex, but all in all it can be worked out.

Many sexual problems that people have after cancer treatment will not last long. Pain with erection or ejaculation after pelvic surgery or radiation is likely to go away. The stress of treatment can also reduce hormone levels temporarily which may reduce desire or cause erection difficulties until hormone levels return to normal. As one feels more in control of one's body, self-confidence returns and one's sex life often improves.

Sexuality for the man with cancer

Some cancer treatments can cause lifelong change in a man's sexual function. This may depend of the type of treatment that was required as well as the individual response and recovery. For example after a radical prostatectomy for prostate cancer where nerve sparing was possible, a reasonable sexual recovery may be possible.

Dealing with short-term problems: As men age or go through health problems, feelings of sexual excitement no longer lead to an instant erection. There are simple strategies that may help; perhaps you may just need more time or more stroking to get aroused. Perhaps you have not found the right kind of caressing. A hand held vibrator can provide intense stimulation. Sexual fantasy, looking at erotic stories or pictures may help. The more excited you are, the easier it is to reach orgasm. The first orgasm after cancer treatment may occur while asleep during a sexual dream. Sleep erections are not affected by mood or state of mind and may give an indication of the best erection your body can produce.

Sexuality for the woman with cancer

No matter what kind of cancer treatment you have you will still be able to feel pleasure from touching. Few treatments (other than those affecting the brain or spinal cord) damage the nerves and muscles involved in feeling pleasure from touch and reaching orgasm. For example women who have pain in their vagina due to pelvic surgery or radiotherapy or dryness due to menopausal symptoms or lack of oestrogen can often reach orgasm through stroking of their breasts and outer genitals. Sexual touching is often satisfying even if some aspects of sexuality have changed.

Many couples have a somewhat narrow view of what is normal in sex. If both partners cannot reach orgasm with penetrative sex they feel cheated. This may be a chance to learn new ways to give and receive sexual pleasure. Touching, stroking and cuddling can be pleasurable. Try touching yourself. You may need to practice having orgasms alone before going back to sex with a partner.

In some cases a woman may need to try different positions or types of genital touching.

Remember if you are in a sexual relationship and one of you has a problem it affects both of you. Dealing with the problem works best when your partner can be part of the solution. If sex becomes difficult, the physical expression of caring remains an important way of sharing closeness and can bring much pleasure.

Mandy Goldman
Cancer Counselling Professionals

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The Male Clinic
Suite 2, Level 6
75 Crown St
Woolloomooloo NSW 2011

Phone: 1300 002 111
Fax: 02 9012 0385

To contact Dr Lowy and The Male Clinic please first call 1300 002 111, however if there is difficulty making contact, please leave a message on 0414 242 426 and your call will be returned as soon as possible.

The Male Clinic is located within the East Sydney Private Hospital (formerly known as the City Ford building). The building is situated between Crown and Riley Streets close to William Street.

The Male Clinic is located a 10 minute walk from either Kings Cross or Museum train stations. There are regular bus routes along William Street.

There is a Wilson car park within the building and the Domain Car Park is a short walk down Riley Street. There is limited street parking.

Shock wave therapy

How does it work?

  • Electrical energy is converted into acoustic shockwaves
  • When shockwaves come into contact with the endothelial wall there is the creation of cavitation forced, sheer stress and tissue radical formation — enhances endothelial function and new blood vessel formation (angiogenesis)
  • Assumed that shockwave therapy may provide a rehabilitative or curative effect for ED
  • May have a role in men with vascular aetiology who are poor responders to PDE5 inhibitors

Dr Margaret Redelman

Women's sexual health and couples counselling are performed by Dr Redelman at Sydney Men's Health.

Dr Redelman trained in sexuality in the USA and worked in Sexually Transmitted Diseases Clinics, Family Planning Clinics and General Practice for many years. She has a Master's Degree in Psychotherapy.

She works in private practice in Bondi Junction and Woolloomooloo, Sydney, as a Sex Therapist and a Relationship Therapist. Her work covers positive male and female sexuality and sexual dysfunctions, and the interpersonal relationships of both heterosexual and homosexual couples.

Dr Redelman is a guest lecturer and public speaker on topics of sexuality. She has published articles on sexuality in accredited medical journals and participated in research for the treatment of male and female sexual function.

She is on the executive committee of SAS (Society for Australian Sexologists) and has full clinical accreditation from SAS as a Psychosexual Therapist. She is President of SAS NSW. She was national President of ASSERT (Australian Society Sexuality Educators Researchers and Therapists) from 2004 to 2009 and President of the 18th World Association for Sexual Health (WAS) Congress held in Sydney in 2007. She is the current president of the Asia-Oceania Federation for Sexology (AOFS) and was President of the 13th AOFS Conference held in Brisbane in 2014.