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Erectile Dysfunction

Erection is a complex process which implies a smooth and coordinated equilibrium among the neurological, vascular and the tissue compartments. The process includes arterial dilation, muscle relaxation.

Erectile Dysfunction (ED) is defined as the persistent inability to attain and maintain penile erection that is sufficient to permit satisfactory sexual performance. This may affect physical and psychological health and may have a significant impact on the quality of life of males and their partners.

Erectile Dysfunction shares both unmodifiable and modifiable common risk factors with CVD (e.g., obesity, diabetes mellitus, dyslipidemia, metabolic syndrome, lack of exercise, and smoking).

It is common worldwide. It shares risk factors with cardiovascular disease. It is a symptom, not a disease. In case if patients are not evaluated for underlying disease that can lead to erectile dysfunction.


Causes/Pathophysiology of Erectile Dysfunction
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PREMATURE EJACULATION is a common male sexual dysfunction characterized by ejaculation which always or nearly always occur prior to or within one minute of vaginal penetration, and inability to delay ejaculation on all or nearly all vaginal penetrations and negative personal consequences such as stress, depression, bother, frustration or the avoidance of sexual intimacy. Premature Ejaculation is of two types:

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Smoking has adverse effects on body and is one of the major risk factor for Erectile Dysfunction. Smoking decreases penile and pelvic vascular flow leading to the difficulty in erection process by impairing the smooth muscle relaxation. Heavy smokers, current smokers, former smokers are all effected by the adverse effects and experience sexual dysfunctions especially Erectile Dysfunction.


Men who consume more than 40 units (400 ml of pure alcohol / week) have double the rate of Erectile Dysfunction in comparison to moderate drinkers, and control (those who don’t take this volume of alcohol).

During an erection, the penis fills with blood then the vessels close, preventing backflow, so that the penis remains erect. Overconsumption of alcohol causes the blood vessels in the penis to expand, allowing for more blood flow, but prevents those vessels from closing. As a result, the penis may become erect but not remain so, as there is nothing to prevent backflow. Overconsumption of alcohol actually damages the blood vessels and contributes to hypertension and even heart disease, both contributing factors to erectile dysfunction.


Male hypoactive sexual desire disorder is defined as the persistent and recurrent absence of sexual thoughts and desires for sexual activity. This can be result of common medical complications, depression, substance abuse, chronic alcoholic, chronic smokers, or use of any pharmacological agents.

In such cases, patients are evaluated for sexual behavior, social dealing, presence of any systemic condition like thyroid disease and use of any specific drug, psychological status and general medical history.


Males are often troubled by concerns that their penis is not large enough to satisfy their partner or themselves. It has become an ego issue and such cases are ashamed to have others view on this topic. Concern over the size of the penis, when such concern becomes excessive, might present as the 'small penis syndrome' or as a part of psychosis. Various potential factors are considered. Thorough assessment, normalizing the anxiety and exploring the treatment options in detail, is essential to consolidate the male ego to satisfaction.




It is the involuntary contraction of the vaginal musculature, resulting in the failure of penetration. It affects a woman’s ability to allow proper sexual intercourse, use of tampons, internal contraceptive devices and gynecological examination. It is the part of female dysfunction.

The causes can be:

Management of such patients comprises, involvement of the partner in the treatment, and education, counselling and behavioral exercises.


Dyspareunia is defined as recurrent or persistent genital pain before, during or after sexual activity. It can be divided into superficial, vaginal and deep. Superficial dyspareunia occurs with attempted penetration, usually secondary to anatomic or inflammatory conditions. Vaginal dyspareunia is pain related to friction. Deep dyspareunia is pain related to thrusting, often associated with the pelvic disease


Success in treatment depends on accurate diagnosis which in turn depends on an elaborate sexual history and appropriate examination. Serum levels of prolactin, estrogen, progesterone, follicle‑stimulating hormone and luteinizing hormone are most commonly implicated.


Orgasm is a transient peak sensation of intense pleasure that is accompanied by a number of physiological body changes. Contractions of the vagina, uterus, and anal sphincter have been proposed as current indicators of orgasm.

Absent of orgasm is Persistent or recurrent delay in, or absence of, orgasm following a normal sexual excitement phase. The disturbance causes marked distress or interpersonal difficulty. Treatment includes psychoanalytic, cognitive behavioral, pharmacological, and systems theory perspectives.


The term “female hypoactive sexual desire disorder” means lack of sexual desire, as opposed to lack of interest or motivation, to be sexual. When that arousal is insufficient or not enjoyed, motivation to be sexual typically fades.

Hypoactive sexual desire disorder is problematic because its only focus is on initial desire, does not acknowledge the many reasons that motivate the woman towards sexual activity, and ignores the broad range of frequency of fantasies among sexually healthy women. There are absent or diminished feelings of sexual interest or desire, absent sexual thoughts or fantasies and a lack of responsive desire.


“Infertility is the inability of a sexually active, non-contracepting couple to achieve spontaneous pregnancy in one year”.

For some couples it is very difficult to conceive. Male infertility is diagnosed when, after testing both partners, reproductive problems have been found in the male.

Infertility is a widespread problem. For about one in five infertile couples the problem lies solely in the male partner and in another quarter, both partners have problems. In most cases, there are no obvious symptoms or signs of infertility. Intercourse, erections and ejaculation will usually happen without difficulty. The quantity and appearance of the ejaculated semen generally appears normal to the naked eye. Medical tests are needed to find out if a man is infertile. Male infertility is usually caused by problems that affect either sperm production or sperm transport (blockage). Through medical testing, the doctor may be able to find the cause of the problem.


Male fertility can be reduced as a result of / causes of Male Infertility:

Sperm production problems-
Blockage of sperm transport (obstruction)
Sexual problems (erection and ejaculatory problems)
Hormonal problems
Sperm antibodies

The term Infertility means inability to become pregnant. This term is used when a couple has not conceived after 12 months of regular unprotected intercourse. It doesn’t mean that you cannot have children, but you may require treatment or assistance to achieve a pregnancy.

Two types of infertility are seen in women:


Diabetes Mellitus is one of the most common diseases found in every age group. It has been seen that Diabetes Mellitus is a risk factor for sexual dysfunction in both men and women with predominance of men. Hyperglycemia which is a major symptom and determinant of Diabetes participate in the pathogenesis of Sexual Dysfunction in such cases.

Male sexual dysfunction among diabetic patients can include disorders of libido, ejaculatory problems, and erectile dysfunction (ED). All three forms of male dysfunction can cause significant bother for diabetic patients and can affect their quality of life.

Women with diabetes experience a higher rate of sexual problems than women without diabetes because the tissue and nerve supply of a woman’s sexual organs may be affected by high blood glucose levels in the same way a man’s sexual organs are affected. Women with diabetes may experience decreased sexual desire, inability to have orgasms, and decreased sexual satisfaction. As a result, sexual activity may be reduced, which may impact a woman’s relationship with her partner.

Sexually Transmitted Disease

Sexually Transmitted Diseases are caused by the germs that live on the human skin or in the body fluids such as semen, vaginal fluid and blood. These germs are passed from an infected person to another through sexual contact via skin, blood, body fluids. The openings in our body (mouth, vagina, anal, open sores/ wounds or cuts) are the entries through which these germs attack our body.


Common signs of STDs include genital ulcers, skin rash, burning sensation during urination, discharge from penis or vagina and abdominal pain in women.


The most common types of STDs are:
Chlamydia, Syphilis, Gonorrhea, Hepatitis and Human Immunodeficiency Virus (HIV), Human Papilloma virus, chancroid, Trichomoniasis, Herpes, Scabies, Bacterial Vaginosis, Pelvic Inflammatory Disease.


The approach to Sexually Transmitted Infection diagnosis and management is to treat the signs and symptoms of a group of diseases that have attacked the body. These diseases are preventable and curable if treated on time. Patient education, counselling, laboratory tests are the points that are taken into consideration in such cases.


Masturbation is an aberrant sexual behaviour which is more common than other socially unacceptable behaviours.

Masturbation does not cause any disease. Masturbation is very healthy for both males and females. According to studies, regular masturbation lowers the risk of developing prostate cancer. It also boosts the immune system, improves mood, sleep and has many other benefits.

How much MASTURBATION is enough

As long as Masturbation is a part of your life and has not overruled your life, you are fine. When Masturbation becomes an escape from problems in your relationship, or affects your health and wellbeing, then you should consider slowing down on your number of attempts.

How much MASTURBATION is enough

Masturbation is a part of normal people’s sex. Many people who are married continue to masturbate, enjoying both their partner’s sexuality while continuing to enjoy their own as well. One should not feel guilty for continuing the process of masturbation even after marriage or when in a relationship. There is nothing wrong in this if a person masturbate even after having a partner in crime. In fact, according to researches, people who actively masturbate in life have better sex life (sexual satisfaction) than the ones who don’t masturbate or regularly are in touch with this process.

Does Masturbation causes any systemic disease/ systemic side effects

Masturbating is a universal practice with the predominance of men. Women also practice masturbation since the women’s liberation began to enable women to know and appreciate their bodies. According to researches, this practice of Masturbation causes no ill effects on body, body organs, mental and physical wellbeing, misshapen penises and infertility. Many people masturbate even after marriage, not because they don’t have satisfactory sex with their partners, but because they occasionally like the alternative of giving themselves pleasure. There is no side effect, harm, down side of Masturbation.

Infections caused by Masturbation

Masturbation never cause any known infections, unless you are using some objects during the process or inserting things into your vagina that are not properly clean. If you are putting fingers inside and they are not clean it can become the reason for infection to develop.

Should I tell my partner I Masturbate

Masturbation is a normal sexual activity that most people do and enjoy and gives one the sexual relaxation. Not all people masturbate, but those who do, there is nothing to be ashamed of or anything to hide. Discussion about your masturbation n related activities with your partner is something one should decide to do or not. Depending upon the nature, attitude, compatibility and attitude of both the partners toward sex and masturbation, one should decide at his/her own about the discussion of the topic.


Paraphilias are defined as psychosexual disorders in which significant distress or impairment in an important domain of functioning results from recurrent, intense sexual urges, fantasies, or behaviors generally involving an unusual object, activity, or situation. Three subtypes of paraphilias are there:

Those involving nonhuman objects,
Those involving the suffering or humiliation of oneself or one’s partner,
Those involving children or other nonconsenting persons.
The paraphilic fantasy or behavior may be obligatory, or required for arousal, or nonobligatory, where an individual experiences arousal in response to other erotic stimuli as well. It may be nonobligatory in early life but become increasingly obligatory over time or with increased engagement with the pattern.


HIV infection is a life threatening issue. Entry of HIV virus in human body attacks the immune system and the defense cells of our body’s defense mechanism that leads to the collapse of our immune system and the body becomes easily prone to around 30 opportunistic infections that results in short life span and a complicated lifestyle.


HIV can caused by many reasons like, sexual intercourse with anoymous, homosexuals, bisexuals,any instumentation injury like needle prick or any surgical instrument, expsoue of infected blood in the area of skin wound or scratch, blood transfusion,intimacy with anonymous during sexual activity, massage etc.

Treatment (within 72 hours-PEP THERAPY and after 72 hours )

Treatment of HIV by PEP (post exposure prophylaxis) within 72 hours of possible exposure can prevent one from becoming HIV positive and the life can be saved. PEP treatment includes set of drugs prescribed according to the case and it is continued for a period of 28-30 days continuously. In such cases when treatment is started within 72 hours of possible exposure, a person can be save from becoming HIV positive and a slave of AIDS.

Treatment after 72 hours

If treatment is delayed or one get to know about being HIV positive is late, then the treatment protocol is different from PEP treatment. In such cases the treatment is continued for life and the person remains HIV positive for life. The body is always under the influence of various infections.

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