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Updates found with 'organic etiological'

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Updates found with 'organic etiological'

Male & Female Sexual Problems INTRODUCTION Problems related to sex are common in the life of almost all individuals. Practically everyone has at some time or the other experienced sex related problems. Most of these problems, fortunately, get sorted out by themselves. There are many others about which one may not bother and decide to live with the problem.It has been said that it is easier to treat a sex problem than to admit that you have one. This attitude also results in many problems not coming to light. Most sex problems are painless and are not life threatening. This, compounded by the fact that it requires certain amount of courage to approach a specialist and talk about one’s own sex problem, results in only a fraction of problems coming to the medical practitioners. Even if a person wishes to approach a doctor for help, he is not sure whom to approach. Most clinics have hardly any privacy and most physicians are not well equipped to deal with such problems because hardly any training is imparted on this subject during studies. As a result of all this quack who advertise in all media have a field day. They unfortunately add to the patients ‘misery. CLASSIFICATIONS If we take into consideration only the common sex problems seen in medical practice, they can be classified as follows:1. Those where the individuals are afraid that they will not be able to perform.2. Those where they are able to perform but want something more out of sex. 3. Those where they are actually not able to perform. From the-point of view of management of cases it is better to classify them as follows. 1. Those who need predominantly education. 2. Those who need predominantly counselling. 3. Those who need predominantly therapy. Quite often it is essential to find out whether the cause of the problem is organic or psychological or mixed. It is observed that organic problems tend to get overlaid with an additional functional problem.COMMON SEX PROBLEMS Although its an axiom in sexology that sex problems are couple problems, quite often itis possible to identify one of the partners as needing greater professional attention. It must, the couple, however, be remembered that the couple, or marital unit, as it is called, is treated as a unit. In a number of instances-only one of the partners is willing to come for therapy. There are also single or separated individuals where the question of involving the partner does not arise.COMMON SEX PROBLEMS IN MALES1. Problems arising out of Myths and Misconceptions-regarding loss of semen or ‘Datuk’ or what is popularly known as ‘Dhat syndrome’. The person is usually a young man-who has severed anxiety about his ability to perform sexual intercourse. Some cases of suicide in the young are as a result of this phobia. They need a sympathetic listener and proper sex education with a lot of reassurance that they are normal. It is often dangerous to rush them in to marriage, in the hope that once they get married everything will be all right.2. INHIBITED SEXUAL DESIRE: Absence of libido or diminished libido is one of the problem that is seen more often now. When asked a pointed question about sexual desire many males confess to having a low level of desire. It has recently been seen that patient who watch blue films on video almost daily are not interested in sex. Over-exposure to erotic material seems to kill the desire. Easy available of sex can also kill the desire in those whose main pleasure is in pursuit rather than in actual achievement. There are some others whose lack of desire is due to boredom with routine with the same partner. Some individuals have strong homosexual tendencies which are suppressed due to social and cultural pressures. They have nitration or often definite repulsion sex. This manifests itself as inhibited sexual desire. 3. Erectile Dysfunctions:Failure to get an erection, stiff enough for penetration at the time of sexual intercourse is another common sex problem. In case the person has never had an erection the problem is called primary.This is uncommon. Secondary erectile dysfunction where the person reports satisfactory erections in the past but has lost the ability later on is much more common. Secondary erectile dysfunction may be due to some organic causes such as inadequate filling of the corpora cavernosa, or rapid emptying of blood. this may be as a result of vascular blockage or Venus leek. It may be a part of other neurological or vascular disorders, especially as a complication of diabetes. The cause may be iatrogenic due to administration of certain drugs like antihypertensive or tranquilizers. Surgical operations in the perineal region may also be the cause. 4. Ejaculatory Dysfunctions: Ideally the male partner should ejaculate after the female partner has reached orgasm. Many would even prefer or insist that both partners should reach their orgasm simultaneously. this is not an impossibility since it is now known that females are multi orgasmic and can have several orgasms one after the other during a single sexual intercourse. COMMON SEX PROBLEMS IN FEMALES 1 Inhibited Sexual Desire: Frigidity is a word commonly used to describe a female who has low sex desire Since sex desire drive between two partners is a relative entity a woman who may be called frigid by one partner may be normal for another and over sexed for someone else. Sexual dissonance between the two partners on the matter of frequency of sexual activity is common. 2 Vaginismus: Fear of physical assault on any part of the body leads to a reflex contraction of the muscles of that part like the abdominal wall or the eyes. This is also true of the muscles around the outer third of vagina.3 Anorgasmia: Inability to reach orgasm in a female is not uncommon. Many females report sexual activity as pleasurable but confide that they never climax. It is desirable to exclude all such factors like premature ejaculation in the male, dyspareunia due to any cause and various factors which may turn her off.
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Common sexual problem in the male 1 Erectile dysfunctionErections. Morning erection.Certain drugs may impair libido-b-blockers, spironolactone, metoclopramide, cimetidine, opiates (addiction), butyrophenone, anticholinergic drugs (impair erection).Management1. Correction of any organic etiological factor-endocrine, vascular, , metabolic, neurological disease, local lesion or alcoholism.2. Psychotherapy and counselling: emphasis must be on communication between the partners and not on achieving an erection.3. Approach recommended (masters and Johnson) in stages:(a) the stimulation of each partners body by the other to learn how best to arouse the other genitals must not be touched at this stage. (b) when both partners are non-anxious in the first situation, genital stimulation is introduced. (c) commencing intercourse with the husband lying supine.4. Androgen therapy if evidence (clinical or biochemical) of hypogonadism:Note: testosterone treatment is contraindicated in men who want to have children because it tends to suppress sperm production. Also it tends to precipitate cancer of the prostate in the elderly. Androgen replacement may enhance libido without improving potency. Sex tonics or aphrodisiacs have little or no effect on sexual function except perhaps by way of suggestion.5. Other hormones: if increase male sexuality: certain exercises can strengthen muscles of the pelvis, in particular those surrounding the penis. They increase the blood circulation in genital area and may enhance quality of erection. The person is advised to check his flow of urine when urinating and then start again repeating this about 5 times. This can be done at least 3 times a day. Once this is learnt, it can be carried out even without urinating.
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MALE ERECTILE DISORDER (IMPOTENCE)DefinitionPersistent or recurrent inability to attain, or to maintain until completion of sexual activity, an adequate erection.This is also known as ‘Erectile Dysfunction’. The disorder may cause marked distress or interpersonal difficulty. There are different patterns. Some individuals report inability to obtain erection from the beginning of sexual experience, while others reports being able to experience erection only during masturbation or on awakening, but not during the coitus. Some experience adequate erection, but lose it when attempting penetration. Still others report that they have an erection that is sufficiently firm for penetration, but they lose erection before or during thrusting.Male Erectile disorder is frequently associated with anxiety, fear of failure, pressure of sexual performance, and decreased sexual excitement and pleasure. This can disrupt marital relationship and may be the cause of unconsummated marriage and infertility.EtiologyAging: With advancing age, The orgasm is less intensive, The ejaculate is reducedThe interval between the two-successive act is increased.Psychological factors:FatigueDepression, Stress, Mental disorders, Guilt, Fear of failure, Low self esteemReligious restrictionsHomosexualityLong/ serious illnessTraumatic initial experienceNegative feeling towards the partnerResentment Hostility Lack of interestVascular causes:Use of tobacco/alcoholAtherosclerosisPeyronie’s diseaseDiabetesHypertensionVenous leak or occlusionTraumaSurgeryRadiationHormonal causes:HypogonadismHyperprolactinemia DiabetesThyroid diseaseAndrogen deficiencyEstrogen excessAdrenal, pituitary or hypothalamic diseaseNeurogenic causes:Peripheral neuritisAutomatic neuropathy (in diabetes)Multiple sclerosisSpinal cord diseaseDrug related causes:Antiandrogens (cyproterone acetate, flutamide, estrogen)H2 receptor antagonists (cimetidince, famotidine)Diuretics (spironolactone, thiazides)Antihypertensive (beta blockers, ace inhibitors, ganglion blockers)Anticholinergics (atropine, probanthine, dicyclomine)Antidepressants (M. A. O., Tricyclic)Antipsychotics (tranquilizers)CNS Depressants(barbiturates)Substance abuse (heroin, marijuana, alcohol, tobacco)MiscellaneousRenal failureProstatectomyPitfallsA detailed history is essential before arriving at the diagnosis of impotence. Many times, sexual stimulation is not adequate in duration and intensity. Morning erection while awakening is suggestive of psychological origin of impotence. Psychological aspects of erectile problem should always be evaluated in all the cases of erectile difficulty even when the cause is organic. Performance anxiety, fear of failure, over concern with pleasing the partner, ignorance about sexual anatomy and physiology are major causes of erectile problem. The degree of penile erection required for successful vaginal penetration should be enquired. There are individuals who feel that they need a steel hard erection for penetration. This is not necessary. Nature has designed vagina in such a way that the male gets maximum erection followed by ejaculation in the vagina. The male needs to be convinced that if the alignment of vagina and penis is perfect, and the women is stimulated enough, the male will be successful in penetration even if he gets partial erection. Fur there he gets the rigidity during penile thrusting.Sometimes premature ejaculation is associated with impotence. At times, anejaculation is misinterpreted as impotence. Many times, vaginismus in female is the root cause of impotence in the male. He tries at the right site and in the right direction, but since the vaginal opening does not relax, the penis gets tried and he loses the erection. In unconsummated marriage, he may try at a wrong site and lose the erection. Some individuals try penetration at the right site and in the right direction, but since the vaginal opening does not relax, the penis gets tried and he loses the erection.In unconsummated marriage, he may try at a wrong site and lose the erection. Some individuals try penetration at the right site but in a wrong direction, and so they may lose the erection. Some are not aware that they have to make to-and-fro pelvic movements. Such individuals remain quiet after penetration, and ultimately lose the erection. Man is the only animal doing coitus in a face to face position. Coitus is the only act that is performed in the dark and the individual has no opportunity to learn from others. InvestigationsBlood Sugar estimation: Fasting and P.P.Lipid ProfileF.S.H., L.H., Prolactin & TestosteroneT3, T4, T.S.H.Diagnostic testsStamp Test: A long strip of postal stamps is wound around the base of the penis at night before going to bed. Next morning if the perforations of the strip are found to be torn off, impotence is supposed to be of psychological in origin.Peno- brachial index: The ratio of penile systolic blood pressure to that of brachial systolic blood pressure is normally 0.6. If found to be low impotence is vascular in origin.Papaverine Injection Test: Papaverine is a vasoactive drug. Using a 26 gauge needle, 30 mg Papaverine is injected at the mid-shaft of Corpus cavernosum of penis. He is isolated, asked to stoke the penis and exposed to erotic literature (or erotic fantasy). Erection will occur in 10 to 15 minutes. If the erection is short-lived or partial, then impotence is considered as vasculogenic. If the erection is full, then impotence is considered to be neurogenic or psychogenic in origin. Caution: This test should be performed in a hospital setting or where the facilities for detumescence are available. The patient should be observed for next few hours till the erection subsides.Rigiscan Test:This is a gold standard for evaluation of Nocturnal Penile Tumescence and rigidity(NPTR). This test is based on the physiological principle that a male gets erections 3 to 5 times during REM sleep. At night before going to sleep one ring of Rigiscan is slid over the base of the penis and the other over the tip. Next morning, the tracing obtained are studied. This test can quantify erectile tumescence and rigidity. Rigiscan tracing indicates whether the impotence is organic or psychological in origin.Arterial insufficiency and venous leaks can also be suspected on the basis of Rigiscan graphs. Patients with purely artery disease have low levels of rigidity but of adequate duration (20 minutes or more). Patients with venous leak will have varying rigidity levels with shortened duration.Penile Ultrasound: This test is for evaluation of the functioning of the penile arteries. A simple acoustic Doppler emits auditory signals or a color Doppler can help visualization of arteries. Cavernosometry & Canvernosography: This hemodynamic test is useful for diagnosing Veno-occlusive Dysfunction of the corpora. Biothesiometry, electromyography (EMG), nerve conduction studies: these tests are for evaluation of impotence. TreatmentCounselingSexual dysfunction is a marital unit problem and therefore both, husband and wife, should attend. Counseling is towards strengthening marital relationship. Wife is requested to co-operate. Client is requested to quit smoking and alcohol. He is advised relaxation exercises, yoga. The couple is educated about anatomy, physiology of sexual organs and about sexual response. Their myths and misconceptions about sexuality are countered. They are also explained that he does not have to do anything to have an erection. Erection is a physiological response to effective stimuli.Sex therapyNo sexual activity is permitted till specific instruction are given. To remove his performance fears he must stop mentally watching himself during the sexual activity. The couple is advised sensate focus exercise (mutual pleasuring) without any goal. Basic to the sensate focus is the recognition that touch is a vital part human communication that gives meaning to sexual responsiveness for both men and women. They are advised to touch each other in a communicative way. Tenderness, affection, solace, understanding desire, warmth, comfort- almost any feeling can be conveyed to the partner by touching. Though the problem is of one partner, both are involved. There is nothing like uninvolved partner. One partner is advised to trace, massage or fondle the other, using the information from verbal and nonverbal directions from the other getting partners about preferences for locations and intensity of touching. Partners are forbidden to touch breasts, genital organs or to have intercourse.After three or four days the partners are asked again to pleasure each other, but this time, caressing other part of the body, they are specifically instructed to touch the genitals and breasts but not to have intercourse. If erection occurs, as it does during the pleasuring sessions, the couple is not permitted to rush to complete the performance. They are encouraged to develop the ability to communicate with each other during the pleasuring sessions until erection regularly, but not proceeding to intercourse. After next three to four days the wife is instructed to tease the man’s genitals. When the erection is firm she stops teasing and they lie in each other’s arms until the erection goes away. She then repeats the process several times during the next half an hour. By use of teasing technique for the next three to four days, the man gradually overcomes the fear of losing his erection and getting it back.During the next step, after the preliminary sex play, the wife is instructed to straddle her husband and sit on his thighs. She Is asked to stimulate his penis to full erection and to insert it in her vagina. The therapist asks the wife to insert the penis because she knows exactly where the entrance is.After the entry has been accomplished, the wife moves forward and backward slowly on the penis (female superior coital position). If the erection is lost, the wife needs to withdraw and manipulate the penis to erection again. The couple has been told not to move demandingly. There is no pressure to perform. The therapist never instructs the couple to proceed to climax.If orgasm does occur, it should not be by plan, but allowed to be a natural involuntary happening.Once this is accomplished, the couple is instructed to resume intercourse in the man superior coital positionPharmacotherapyPharmacotherapy alone may not be effective unless it is associated with education, counselling, reassurance, countering myths & misconceptions, behavior modification, relaxation and supportive psychotherapy. 1. PDE5 inhibitors are found to be most effective for impotence of no known cause. These drugs maintain the erection and do not initiate the erection or increase the libido. Therefore, sexual stimulation is must. The side effects are headache, facial flushing, nasal congestion, visual disturbance and dyspepsia. Visual disturbances can occur with Sildenafil.Backache or muscle pain has been reported with Tadalafil. Special precaution is to be taken in persons having cardiovascular disease or renal impairment. PDE5 inhibitor must never be given to patients taking nitrates(e.g. Sorbitrate, Angised). Erythromycin, Cimetidine, ketaconizole, grapefruit juice or alcohol should not be taken concurrently. Generally priapism is not observed. PDE5 inhibitors should be prescribed along with alpha blockers (e.g.Prazopress), since this may cause hypotension.Sildenafil (Viagra, Caverta): Dose 25 mg to 100 mg given ½ hour after food and 1 hour before the sexual activity. Not more than once a day. Duration of action is 12 hours.Tadalafil ( Forzest, Zydalis) : Dose 10mg to 20mg. No relation to food. Given ½ hour before sexual activity. Duration of action is 12 hours.Vardenafil (Levitra) : Dose 5 mg to 20 mg. given ½ hour after food and 1 hour before sexual activity. Only once a day. Duration of action is 12 hours.The action of these drugs is dose related. To start with, minimum dose is prescribed.
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Evaluation of Male Erectile Dysfunction INTRODUCTION In recent years, the importance of physical factors in the enteropathogenesis of male erectile dysfunction has become incontrovertibly established. It is now know that erectile dysfunction can occur as a result of psychological factors, physical factors or both. HISTORY- TAKING Too often, history taking is performed very cursorily; this can lead to great blunders. Because of the intimate admixture of psychological and physical issues in erectile function, a detailed psychosexual, marital and social history is mandatory. Such a history not only improves the diagnostic yield but also goes a long way in planning proper treatment. Importantly, it can help avert many a post- operative disaster should the candidate require surgery. A detailed sexual history is invaluable. Direct questions should be asked about the rigidity and duration of erection during sleep, masturbation and sexual intercourse. History- Taking should also include a systematic check list for contributory organic factors (Table 1) often; a good history alone can lead the clinician to a working diagnosis of the relative preponderance of psychological or physical factors in any given patient. PHYSICAL EXAMINATION Although physical examination often contributes very little to the eventual diagnosis and treatment plan, the importance of its thoroughness cannot be over- emphasized. A thorough general and local examination must be performed. A complete neurogenic impotence is still made mainly by elimination of other causes coupled with a high index of clinical suspicion. INVESTIGATIONSa) General Systemic investigations contribute little to the diagnosis and management of impotence per se. However, these must be performed in the interest of the general health of the patient and to identify contributory underlying causes. Monitoring of diabetes, for example, does little to alter the continuing impact of the diabetic process on the erectile apparatus. The same is perhaps true for other systemic diseases associated with erectile dysfunction. It must be noted that even endocrine disorders usually affect the libido rather than the erection itself. Hormonal measurements, therefore, do not obviate the need for more specific tests. b) Specific The armamentarium of diagnostic gizmos and devices flooding the impotence market is quite confusing to the newcomer dabbling in impotence. While some of these are indubitably useful, many are mere research tools that contribute little to an objective diagnosis. Besides, the international literature on the subject is very contradictory and clear standards have not been enunciated for many of these tests.It is still possible, however, with the modalities available today to make a fairly accurate diagnosis of the predominant causal factor/s in any patient. It is not necessary to perform all tests on all patients. The work-up should be tailored according to the individual needs of the patient. Apart from the patient’s economic capacities, time is an important consideration especially in case of the patients coming from faraway places. The psychological make-up and the attitude of the patient are also important. An invasive test should be eschewed in favor of non-invasive ones in especially anxious. The ultimate goal of the investigative work-up is to determine whether the cause of the impotence is psychological, arterial, venous, neurological or endocrinological. It is important to remember that often many factors may co-exist in the same patient. 1) The Injection TestIf performed correctly, this test alone can enable a working diagnosis within one day. Drug used are prostaglandin or papaverine hydrochloride. Prostaglandin is preferable when the patient has to travel within a few hours because of the much lesser risk of priapism. Many other vaso-active substances and their combinations (most notably papaverine – phentolamine have been described. However, these are not indispensable and their non –availability should not be a deterrent to an accurate diagnosis. Papaverine hydrochloride alone is adequate for most purposes. It is cheap and freely available throughout India. Prolonged erections and priapism, should they occur, are very easy to treat. The biggest enemy of papaverine is the anxious patient. For these reasons, it is very important that the patient’s anxiety should be allayed. If necessary, the test should be repeated on more than on occasion. If there is no suspicion of neurological disease, it is safe to start with a dose of 45-60mg. A 26-30 gauge needle is used to inject the drug directly into the corpora cavernosa at the mid-shaft level. The patient should always be given the privacy of a quiet, relaxed room. This test should never be performed in a busy out- patient setting with people walking in and out. This is certain to affect the outcome of the test. The patient should be seated upright during the injection. Pressure on the puncture site should be very gentle or it can have a retrograde milking effect on the penis. This can lead to false-negative results even after appropriate dosage and can cause drug-related systemic side effects as well. After injection, the penis should be gently stroked in order to distribute the drug and facilitate the lubricating jelly help. Visual Sexual Stimulation (VSS) using erotic literature, computer software or video films may be used but doesn’t always help. Unlike in the west, erotica does not have the same effect on the Indian male. This is probably because of socio-cultural and attitudinal differences. Lastly, it must be remembered that erotic literature and films are prohibited by law in India. For these reasons, VSS can be safely omitted without notable compromise in diagnostic yield.Likewise, it may or may not be very helpful to keep the patient in his sexual partner’s company during the conduct of this test. Many men are embarrassed in their partner’s presence and this might affect the outcome of the test. The patient remains seated throughout the test, it is best to seat the patient on a large bed with his back propped against a back- rest or a wall. The legs should be stretched out on the bed. These simple precautions will prevent accidental injuries which could arise from the systemic effects of papaverine hydrochloride. If the patient is relaxed and a suitable does has been injected, a good erection will occur within 10 minutes. Erectile dysfunction secondary to arterial disease may take several minutes longer to produce an erection. Patients with neurogenic importance may develop priapism with very low doses of papaverine but this should not be a deterrent to using adequate dosages. If the erection is unequivocally rigid and the penis cannot be buckled, vasculo genic importance can be virtually eliminated and no further investigations are necessary. If the erection is not rigid enough, a second does may be employed at the same setting. This is quite safe and systemic side effects are uncommon. However, it must be emphasized that this should be performed in a hospital setting with full infrastructural back-up rather than in an office environment. Any curvature of the penis can be studied at the same time. If the erection is still not rigid enough, vascular disease must be eliminated using more sophisticated tests. A Doppler study can be easily combined with the injection test. If an objective measurement of the erection is desired either for academic, medico-legal or psychotherapeutic purpose, a real- time Rigiscan monitoring may be performed at the same session. 2) The Rigiscan Test The Rigiscan is the gold standard for NPTR (Nocturnal Penile Tumescence and Rigidity) measurement. It is the test of choice for non-invasive diagnosis.It is especially suitable for anxious patients since it can be performed in the privacy of their own bedrooms. Its ability to objectively quantify erectile rigidity and establish physical normalcy makes it an important, reassurance providing device to the patient with purely functional problems. It is also useful in medico-legal cases. Time and cost are two relative deterrents.A Rigiscan tracing showing a good number of erectile episodes with rigidity levels of 80% or more and a duration of 20 minutes or more in a single episode almost effectively rules out serious vascular disease. Arterial insufficiency and venous leaks can also be suspected on the basis of the Rigiscan graphs. Patients with purely arterial disease generally have low levels of maximum rigidity but of adequate duration. Patients with predominant venous leakage will have varying rigidity levels depending on the severity of the leakage but the duration is almost always shortened. These patients must be evaluated using other means. The erectile response to vaso-active injection can be objectively studied by the concomitant application of the Rigiscan monitor. This is called a Real time study.1 Abnormal NPTRShowing few ill sustained episodes with inadequate rigidity. All in all, the Rigiscan is an extremely useful device. In an era where many doctors as well as patients continue to believe that most impotence is predominantly due to psychological factors, it is important to eliminate psychological causes first even though such a policy grossly violates conventional medical teaching according to which organic disease must always be eliminated first. 2) Penile UltrasoundA Doppler evaluation of the penile arteries is indicated if the erectile response to the injection test is inadequate or if the patient’s Rigiscan study is suggestive of arterial insufficiency. Pure arterial disease or trauma.Ultrasonograpic evaluation of the cavernosal arteries can be performed with varying degrees of sophistication once cavernosal smooth muscle has been effectively relaxed by vaso-active injection. A simple acoustic Doppler probe, which is inexpensive and portable, emits auditory signals which can effectively eliminate gross cavernosal arterial disease. Duplex Doppler and Colour Doppler studies can help visualization of the cavernosal arteries and measurement of flow.They can also hint at the presence of venous disease. But while these are useful for quantifying penile arterial flow and help diagnose abnormalities in the main cavernosal arteries, they cannot altogether eliminate arterial insufficiency because of their inability to image the microvasculature. Thus, a normal arterial study does not eliminate arterial disease. This is important to bear in mind. 3) DICC (Dynamic Infusion Cavernosometry & Canvernosography) The DICC is an useful hemodynamic test for the diagnosis of CVOD (Corporal Veno-Occlusive Dysfunction). In its simplest form, two cannula are inserted into the corpora cavernosa after smooth muscle relaxation has been achieved with a vaso-active injection. One cannula is connected to a pressure transducer; the other conducts saline or radio-opaque contrast solution at controlled flow rates through an adjustable flow pump. Pressures are measured after injection and 30 seconds after a pressure of 150 mm Hg has been induced. Flow rates are measured in order to induce erection and attain 150 mm Hg, to maintain erection at150 mm Hg; the study is then repeated at a pressure setting of 90 mm Hg. The Convernosal Artery Systolic Occlusion Pressure (CASOP) is also measured at the same time using a Doppler device. These are also the only universally accepted standards for DICC evaluation. There are some centers that perform an 8 or 9 track multi- phasic DICC. Radiologic visualization of leaking penile veins (cavernosography) is performed at the same sitting in many centres. Such radiologic studies are useful only if site-specific, selective ligation is planned as a surgical option. 4) Neurologic Evaluation Many tests have been used for the evacuation of neurogenic impotence. These include nerve conduction studies, biothesiometry and corpus cavernous electromyography (CCEMG), among others. None of these is 100% reliable. The diagnosis of neurogenic impotence continues to be based on elimination of vasculogenic causes, a high index of clinical suspicion and a thorough neurological examination. In any case, tests for neurogenic impotence, whatever their results, will not alter treatment options.
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First Night FailureFirst night failureIntroductionThe first night or honeymoon night of marriage traditionally means the first sexual encounter for an Indian couple. It is the moment when society legally permits the consummation of the union of man with women. The first night is the most awaited night in one's life.Unfortunately, as sexologists, we come across a large number of clients failing on their night. The first-night failure' often results in sexual dysfunctions, social maladjustments, marital disharmony and even divorce.Why failure?The first night has been given special importance from ancient days. Our Sanskrit literature gives detailed descriptions and exotic fantasies woven around the first night. In the kumar saum bhava, Kalidasa takes liberty in describing the love dalliance of the newly wedded shiv and uma.Our cinema has glorified the first night. The entry of the bridegroom in the decorated bedroom, flower bedecked beds, the bride, veil, glass of milk, sweets and the magic moment begins! today, a large number of novels in vernacular languages are available under erotic titles glamourising the sexual raptures of the first night. So the first night become the most special night of a young couple's life i. E the golden night'. In our culture, till today in many parts of india, adolescent boys and girls are not allowed to interact with each other socially (except in some tribal societies) once the girls attains puberty. Marriages are fixing by elders. There is hardly any change of courting. The first night in reality becomes the first encounter' to know each other. Some young individuals are scared to death about their performance on the first night. Their fear is doubled by misguiding friends, yellow books, white self-advertised pamphlets by quacks and blue films. They have a feeling of sexual inadequacy, 'kamjori' or believe that they have become impotent and life has come to an end.One of the most worrying question on a man's mind whether on the first night' he will succeed in breaking the virginal seal' with bang, as this is supposed to make a successful marriage. Because of this fear, many eligible bachelors avoid marriage. Sometime they end up buying so called sex tonic advertised in lay press or even rejuvenators even prescribed by consultants. To avoid first night' failures some of them even visit prostitutes to test their potency! a women enter into the first night with anxiety, tension, fear and a variety of other emotions. The greatest worry on the mind of the bride is how she will fare in the virginity test'.Virginity is considered a virtue. It is a sign of purity. In some societies, the couple is expected to show the bed cover stained with blood after first night as proof of virginity!Thus, the bedroom, instead of being the foundation for developing tenderness, care, warmth, affection, life long love, pleasure bond, trust, intimacy and relationship, turns into a laboratory for testing potency and virginity.The west got the honeymoon problem i. E. First night failures. One dose not even find a mention of first night failure in any standard text book of sexual medicine or in diagnostic and statistical manual (dsm-iv)Western viewsDr wadell b pomeroy, co-author of the kinsey's report, describes premarital intercourse as a training ground for marriage. Lessons learnt without feeling of guilt and fear and the knowledge of good techniques, go a long way in developing relationship. Urge to have intercourse is like any other urges, e. G. Playing tennis, swimming or dancing, riding a horse or doing anything which gives pleasure. Premarital intercourse, unlike masturbation, is a means of interaction with another human being and consequently is a means of learning how to live with people. Sometime, it is learnt too late after marriage that they are not suited to each other sexually.PrevalenceThe first night' performance as still an important event in one's life. Failure can lead to disaster!It is difficult to statistically because of want of actual reporting and documentation. One can say 20% to 30% of couples who seek sex therapy have failure on their first night or at the time of first sexual contact.AetiologyThe sexual behavior in a human being is the outcome of learning and conditioning sex being considered a taboo, there is hardly any opportunity for learning. Therefore, ignorance, myths, and misconceptions about sex prevail. The most common etiology factor for first night failure in marriage is ignorance about male and female anatomy and facts of sex act. Some couples have unrealistic expectations of sex act.Other cause of first night failure is tight foreskin in male, tough hymen in female and dyspareunia, etcFirst-night blues1 psychologicalInadequate sexual informationRestrictive upbringingA. Sex is dirtyB. Women who enjoy sex are disreputableGuiltSexual mythsFear of pain, failure, not satisfying partnerFear of std/HIV/aids2 organicDysfunction in the partner e. G. VaginismusTight foreskinIf failure occurs on the first attempt, the first thing comes in mind am I impotent?' the more he tries. The more he fails. He feels something is terribly wrong with him. He feels that due to his past habit of masturbation, he has lost his vitality, vigour, and potency. He stops further sexual advances. It starts a vicious cycle of performance anxiety and spectatoring' and failure.Consequences They may avoid sexual activity. They may continue to have only foreplay. They may have good relationship in other aspects of life. Some may suffer from anxiety/depression. Impotency They may make allegations at each other leading to marital conflicts, separation or divorce
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WNHO Package for Low Libido Men90 Days validity • Medicines includedPrice: ₹6000 ₹3000Buy Now Send EnquiryWhat is this package about?Loss of libido (Sex drive) is a common problem affecting up to one in five men at some point in their life.It?s often Linked to professional and personal stress. However, an unexpected loss of libido especially when it lasts for a long time or keeps returning and indicate an underlying personal, medical or Lifestyle problem, which can be upsetting to both partners in a relationship.If you?re concerned about your libido, especially if your diminished sex drive distresses you or affects your relationship? it time to make a bold move by accepting it and searching for best options available. Specific tips can offer significant help for this condition and overall sexual well ? being.What problems does this package intend to treat?- Loss of libido- Premature/early Ejaculation- Erectile dysfunction- Thinning / shrinkage in penis size - Low sperm countFeatures of this package include:- Zero side effects. Medicines are absolutely safe- Diet will suggest- Plan of treatment - Symptom are analyzed- Detailed medical history of patient is acquired- The root causes of the problems are highlighted to the patient- Necessary lifestyle changes are suggested- Appropriate medicine is provided- Medicine is delivered at your HomeExpected outcome:- Restoration of healthy libido- Healthy and Delayed Ejaculation time- Hard and long lasting erection- Improvement in sexual performance and organic pleasureConsultations offeredText Chat (90 days validity)6 Nos.Audio Call (10 mins validity)3 Nos.
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