It is not uncommon to find young men worried about their penile size, emission of seminal fluid during sleep and about their concern on masturbation and loss of semen over the years. None of the above factors are cause for concern. Unfortunately the ‘Quack Professionals’ create suspicion in the minds of the gullible young men and exploit huge amount of money in instalments – in other words Male Sexual dysfunction – Erectile and Ejaculatory disturbances have been the concern of most of the married men and also for those intending to get married.
When counselled these men come out with a variety of medical problems from head to toe which does not form any symptom complex of known organic disease. It is to be understood that Erectile dysfunction is more often functional (Psychogenic) and largely curable.
Current Andrological research has established that there could be problems in erection related to arterial, venogenic or nervous problems.
- ARTERIOGENIC: where the arteries supplying blood to the penis do not bring enough blood to cause an erection. This occurs in elderly, diabetics or those with injury to genitalia like pelvic fracture or vehicular accident.
- VENOGENIC: In normal men during full erection the veins close down almost completely preventing to outflow from penis. This allows blood to accumulate in the sinusoids of penis, raising pressure and develop rigidity and hardness.
- NEUROGENIC: Intact nerve supply and proper conduction of impulses is necessary for initiation and maintenance of penile erection. Injuries on spinal cord, operations on rectum or urinary bladder could affect the nerve supply. The most common cause is Diabetes Mellitus.
- ENDOCRINE (Hormonal): Generally hormonal changes affect the sex drive. During recent years ‘ANDROPAUSE’ in men has been recognized analogous to ‘Menopause’ in women. ‘Andropause’ may occur at different ages in the elderly.
Current Treatment options for Erectile Dysfunction
Invariably erectile dysfunction remains concealed by the husband, who in the pretext of saving his Masculine ego tend to offer excuses viz work exhaustion – stress and many others. Male sexual dysfunction by itself has been the sole cause for barren marriages. It is not uncommon to find ‘Unconsummated marriages’ even after several years of their marital life.
Indian women in general have learnt to suffer in silence and when confronted with the problem of erection and ejaculation as the factor, serious consequences follow which may even lead to legal suits and divorce. Gone are the days when counseling alone was the option for the treating physicians.
Oral medications like SILDENAFIL (VIAGRA) are adjuncts widely used along with counseling – for these oral drugs to be effective there is need for perfect harmony and understanding among the couple. Sexual counseling is a time taking exercise but worth a fortune if they could succeed in preserving the matrimonial intent and effect to produce children.Various other forms of treatment like ‘External Vacuum Devices’ Penile Injections with Papaverine , Phentolamine, Prostaglandin etc., ‘Self injections’ are successful in selected cases. “Priapism’ is a painful, purposeless, prolonged erection which has been reported following use of ‘Self Injections’ – if and when it occurs urgent medical intervention is mandatory. Penile prosthesis – Rigid and Inflatable are used only in cases refractory to any of the above methods of treatment.
In the modern era with better understanding of Erectile function and Dysfunction, Male Impotence is largely curable.
Time immemorial men have been obsessed about semen – its colour, quantity and loss or force of ejaculation. ‘Quacks’ and self proclaimed ‘Sexologists‘ capitalise on the guilt and fear of such men and exploit them. Modern men with use of pornographic exotic films on Internet desire to match such events in real life and mistakenly set a standard for themselves based on such visuals. Erection and Ejaculation are complex phenomenon that is regulated by different systems. The following are some of the common problems with ejaculation.
1. Premature Ejaculation
This is extremely common condition, often related to female sexual gratification. The Spectrum of premature ejaculation is so vast – some men ejaculate at mere thought of sexual act, others even prior to vaginal penetration. Instantaneous intravaginal insemination of semen is adequate for effecting a pregnancy. Premature ejaculation by itself is difficult to treat. The squeeze technique described by MASTERS and JOHNSON are tedious to employ. In todays context with better understanding of central and peripheral neurological control of ejaculatory process, pharmacological therapy with Dopamine antagonists, Anxiolytics are prescribed.
2. Delayed (Retarded Ejaculation)
This is the opposite of premature ejaculation. It is defined as persistent difficulty in achieving ejaculation despite the presence of adequate sexual desire, erection and stimulation. Often it is a more cause for worry than rejoicing. With the female partner reaching the orgasm the reminder of the sex act is a painful formality. There are men who could masturbate but never able to ejaculate inside the vagina. Some adults expect the pressure generated with hands during masturbation to be same at vaginal intercourse. These couple need proper counseling and understanding.
3. Retrograde Ejaculation
This is the condition where ejaculation does not take place at coitus or masturbation and instead the seminal fluid ejaculated backwards into the urinary bladder. This is a rare situation where there is physical damage to bladder neck. These men require retrieval of sperm from urinary bladder and Assisted reproduction.
Absence of Ejaculation- psychological anorgasmic anejaculation – some men may not ejaculate at coitus and yet collect sample at laboratory by masturbation. Trans Rectal Ultrasound done for the presence of obstruction to ejaculatory duct. In the absence of obstruction Vibrator therapy or Electro Ejaculation may help to retrieve sperms. Occasionally Transurethral Resection at the orifice of ejaculatory duct may help to restore ejaculation.