Common sexual problem in the male erectile dysfunction & SexualSolution.
No-1Commonsexual problem -
Morning Erection Erections.
Morning erection.Certain drugs may impair libido-beta-blockers, spironolactone, metoclopramide,cimetidine, opiates (addiction), butyrophenone, anticholinergic drugs (impairerection).
Management1. Correction of any organic etiological factor-endocrine, vascular, drugs,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) commencingintercourse 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 increasethe blood circulation in genital area and may enhance quality of erection. Theperson is advised to check his flow of urine when urinating and then startagain 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.Prematureejaculation.1. Anesthetic ointment rubbed into the head of the penis.2. Wearing a condom. Benzocaine condoms can be used.3. Fixing the mind during intercourse on non-sexual activity such as businessmatter or sports.4. Deep breathing and conscious relaxation of genitals may be tried.5. Alcohol in small quantity may like a depressant and prolong Ejaculation.6. Preparing wife by sexual stimulation while keeping genitals away from touchhelps in increasing control and time of sexual activity.7. Ejaculatory control-(i) first phase(a) without a partnerFirststep: the man is advised to masturbate himself by to and fro of the hand. Hemust stop before the stage of ejaculation and allow the erection to decline.This should be repeated a number of times of different occasions before goingon to the next step.Secondstep: (b) ejaculatory control with the partner: the man lies down on his back.The female sits between his legs and masturbates him. When he reaches the stageof ejaculation, he asks her to stop and the erection is allowed to subside.When the sexual excitement has receded sufficiently he asks the partner torepeat the same procedure. This should be done for a total of at least 15 to 20minutes. After this, the man should ejaculation after reaching the stage oforgasm. When he has attained sufficient confidence of ejaculatory control forabout 15 minutes, he goes on to (ii) second phase - this involves intravaginalcontainment using the stop-start technique or removal and squeezing of thepenis.1. Stop-start technique - at first the exercise of step 1 is begun and when erectionis achieved, the female assumes female above position and places the penis inthe vagina. She remains motionless. When the man has the feeling of impendingejaculation, he asks her to dismount. The man may go to toilet or keep lyingtill the excitement subsides. This should be repeated for about 15 minutesbefore going on to the next stage the procedure is the same as above but thistime the female moves to and fro gradually instead of remaining motionless.When the man feels the ejaculatory urge, he asks her to stop. When theexcitation has subsides, the process is repeated. Once the ejaculatory controlis achieved by the above methods, it would be possible to have sexualintercourse in any position.2. Squeeze technique - this is a modification of stop starttechnique in that instead of letting go the penis at the feeling ofejaculation, partner holds the penis between the index and middle fingers. Thethump is placed on the frenulum and the two fingers on the opposite side of thecoronal ridge. The partner squeezes the thump and fingers for 4 seconds. Thepressure makes the man to lose his erection. After doing this 2-3 times thefemale adopts the woman above position, and inserts the penis into the vagina.The no motion technique and later the to and fro motion technique is thanadopted as described above.Note:in men with concomitant ed. The erectile dysfunction should be treated first.Retarded or absent ejaculation - in less common and has several possible organiccauses. However it may be caused entirely by psychological or emotional factorsthat are amenable to behavior therapy or individual psychotherapy.Retrograde ejaculation - is due to bladder neck incompetence. It invariably occurs aftertransurethral resection of the prostate and may occur in diabetic autonomicneuropathy or para-arotic lymphadenectomy.Delayedejaculations or failed emission can occur due to spinal trauma and surgicalprocedures such as radical prostatectomy, proctocolectomy or para-aroticlymphadenopathy.Inhibitedejaculation is the psychological variant of delayed ejaculation. Ejaculationusually occurs rapidly with solitary masturbation but not during intercourse. Avariety of psychological factors may be responsible including fear ofpregnancy, guilt and depressed or repressed hostility towards the partner.Painfulejaculation can be caused by acute genitourinary infection, particularly acuteprostatitis or seminal vasculitis. It may also have a psychogenic basis.Infection can be treated with antibiotic, nsaid's prostatic decongestants eg.Bromhexine and if indicated prostatic massage. ?H��t�r