Erectile dysfunction
Certain drugs may impair libido-b-blockers, spironolactone, metoclopramide, cimetidine, opiates (addiction), butyrophenone, anticholinergic drugs (impair erection).
Management:
1. 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. The approach recommended (masters and Johnson) in stages:
- 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.
- When both partners are non-anxious in the first situation, genital stimulation is introduced.
- 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 there is an increase in male sexuality than 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.