More than two-thirds of men who contacted an email advice service run by a leading sexual advice charity had erection problems, which were frequently linked to loss of sex drive, according to research in the October issue of IJCP, the International Journal of Clinical Practice.

The study by UK researchers also found that a large number of men from the Middle East and Indian subcontinent sought email advice on problems with premature ejaculation and masturbation. Previous research has suggested that these issues are often related to arranged marriages.

People can contact the UK-based Sexual Advice Association by telephone or email and talk to a chartered psychologist. More detailed advice is available from a multi-disciplinary medical team that includes a family doctor with a special interest in men's health, a cardiologist, urologist, psychiatrist, gynaecologist and sexual health clinical nurse practitioner.

The IJCP study looked at the 5,531 telephone calls and 2,160 emails received during 2009 and 2010, with specific reference to the 673 emails that required a more in-depth reply from a doctor specialising in male sexual dysfunction.

Most people found out about the service through the charity's website, which attracted more than 200,000 visitors from 20 different countries during the study period, from as far afield as Afghanistan and Zimbabwe. More than two-thirds were from the UK, with a significant number of visitors from the USA, India, Canada and Singapore.

"A lot of men do not seek medical advice for sexual problems and it is estimated that only half of them will seek help within a year" says lead author and family doctor Dr John Tomlinson, who ran a hospital-based men's health clinic for nine years and now works with the Sexual Advice Association.

"Although there have been a number of reports in the literature about the value of telephone helplines, little is known about the role of email advice in supporting patients with sexual problems."

Analysis of the 673 emails that required an in-depth reply showed that:

    71% were from the UK, 23% were from outside the UK and the rest were unknown. Men aged 21 to 30 were most likely to make contact by email, accounting for a quarter of those received.

    The most common problems were erection problems (69%), loss of sex drive (17%), premature ejaculation (12%), masturbation problems (10%) and genital problems (12%).

    Erection problems increased with age and the age groups most concerned with premature ejaculation and lack of sex drive were 31 to 40 years and 41 to 50 years respectively.

    Men in the UK were more likely to express concerns about erection problems and lack of sex drive than men outside the UK. UK men with erection problems tended to be older than those outside the UK -- averaging 47 years of age compared with 37 years.

    Premature ejaculation and masturbation worries were more commonly reported by men from outside the UK, particularly from the Indian subcontinent. These included concerns that excessive masturbation in adolescence had caused their current sexual problems.

    70% of the men who expressed concerns about the size of their penis or a bend in their erection were under 40.

    Advice included contacting their family doctor, getting their testosterone checked -- particularly if they were over 40 or had diabetes or heart disease -- and referral to a specialist charity for sexual and relationship therapy.

"Telephone advice lines are an established source of support for patients with sexual problems" says co-author Professor Kevan Wylie, who specialises in sexual medicine at Sheffield Care NHS Trust. "Our study shows that e-mail advice and counselling are also an increasingly important and effective resource for men who find it difficult to discuss intimate issues with their family doctor.

"Sexual problems can have a serious impact on people's quality of life and relationships and can often point to underlying medical problems that need attention. We believe that the advice provided by organisations like the Sexual Advice Association is invaluable in helping men to get the treatment and advice they need."