ON DIFFERENT DISORDERS AND SEXUAL LIFE

What are the  most  common sexual  dysfunctions among diabetics?Erectile dysfunctions are common amongst  diabetics.  The causes  could be vascular,  neurological or psychological.  In diabetic  impotence, the history  is suggestive  of the presence of desire  but  decline in erectile ability at all times.  Usually, the  onset is gradual. In some, the presenting symptom could be  premature ejaculation and rarely  retrograde ejaculation.  Diabetic women sometimes  complain of reduction in lubrication and difficulty in reaching orgasm.  Monilial infection  may further reduce lubrication  and associated  itching makes intercourse uncomfortable.  Monilial infection often leads to balanitis (inflammation of the glans  penis).

What limits  should one observe?There is nothing like a limit in sex, either you  indulge or you do not.  A heart attack  could have   occurred even otherwise, like while passing urine or going  to the toilet.  However the best person  the treatment needs  to be tailored according to individual needs.  The following  precautions may be useful:

  • Avoid  clandestine  sexual activity, as it  tends to increase the heart  rate more than   usual.
  • Avoid elaborate meals and alcohol prior to the sex act, as lot of  energy and  blood flow would be utilized  for digestion.
  • It is   advisable  to do  regular physical exercise, so that sexual exercise need not be an unaccustomed exertion.
  • One may keep a nitroglycerine tablet or spray handy, if anticipating chest  pain.

Is the  female  superior  position advantageous  to males with cardiac problems? Scientific  research has proved that alternation in sexual positions such as taking the bottom position  or assuming a passive  role has no  significant  energy saving  advantage.   The blood  pressure  and heart rates  have been directly measured  and have been found  to be almost the same in men in the male superior as well as the female superior positions.  The same  holds true for females  with cardiac problems.

Has high blood pressure anything to do with sex?There is a marked increase  in blood pressure during sexual  intercourse.  Very high blood pressure does pose a danger of cerebral hemorrhage.  However, it is desirable to control  high blood pressure.  Once controlled, the  danger of catastrophic event is  negligible with the short-terms changes that occur during intercourse and other physical activities.  It is equally, if note more, important to inform the patients about the likely side effects of anti-hypertensive drugs on their  sexual response.

Which anti-hypertensive  medicines have  the least  sexual  side effects?No generalization can be made.  However, diuretics, ACE inhibitors and vacillators have the least sexual  side effects.  Yoga and  transcendental meditation with biofeed back could be safe adjunct.

"Whatever anti-hypertensive medications I use, my sex desire  and potency get reduce  considerably what should I do reduce  the dose, stop the  drug or stop sex?"consult a competent physician.  On most occasions, the medication can be changed to a drug , which has the  same effect on the target symptom, without polarizing the sexual  system.

What precautions should  one take  during  coitus if one is suffering  from bronchial asthma?Shortness of breath is a natural response during  the sex  act and more so if one suffers  from bronchial asthma.  It becomes more  intense  if accompanied by anxiety.  Use of a bronchodilator prior to sexual  activity could be helpful.

What sexual  problems  can a man with kidney failure have?  He may have less desire  and inadequate erection due to  anemia, uraemia and testicular  dysfunction.  Like in any other chronic disease, psychological problems like  depression and  anxiety, leading to decline in sexual desire, are common.

What is Peyronie's disease?This is an uncommon condition  usually found in men who are in there fifties and above.  A fibrous plaque develop in the penis, leading to curvature of the penis which become apparent during erection.  It may  cause  discomfort and, at  times, pain during intercourse.  Usually, this is a self-limiting  disease.  Operative  procedures are rarely resorted to.

What are the  causes of blood in semen?Any condition which can  give rise  to  congestion and inflammation of the prostate ad  seminal vesicles can lead to blood  in semen.  Trauma and  urethritis may also lead to blood  in semen.

Can hepatitis (jaundice) lead to sexual  problems?Yes, it kills the appetite for sex.  In addition, the fear of transmitting or acquiring  the disease (Type B) via sexual contact adds anxiety to the existing problem. 

Can one indulge in sex  during  jaundice?This  will depend upon the cause of jaundice.  Of the many causes of jaundice, the  one that should cause maximum concern is viral hepatitis, the reason being the sexual transmission of the disease to the spouse, who then may or may not manifest jaundice but  may yet  harbour  the virus.  Roughly speaking, the changes of transmitting the virus are maximum  in the early  stages of illness, especially in the programme phase which immediately precedes the onset of jaundice.  The  hepatitis 'B' virus and possibly 'C' and 'D' virus being the important culprits, it would be prudent to consult the physician at the earliest  and get both the partners investigated for the  same.
            Vaginal and even oral sex may  transmit  the virus.  Barrier contraception (condom) does  provide an effective method of protection against  the sexual transmission; vaccinated at the earliest as per  the expert's advice.
            Once the  patient with jaundice has developed  immunity (antibodies) to the virus  and the spouse  is already  protected (with vaccination which takes up to weeks), normal sexual intercourse  can be  resumed.
            Hepatitis D (delta) does not  require  any  additional vaccination apart from that for  Hepatitis B.  Hepatitis C is rarely  transmitted due to sexual  contact.    Using barrier contraception  during sexual  activity  is advisable.

How does  arthritis affect  sexual  relationships?In arthritis, pain and  deformity usually lead to difficulty in the sex act, especially when the  hip, knees  or the back are involved.  Factors   like frustration, anger, dependency and low self-image due to deformity lead to depression.  Steroid  side effect, e.g.  obesity  and moon -face  complement  this depression.  Thus, arthritis debilitates sexual relationships both  physically as well mentally.

What are the  treatment options  available?Discussion with the partner about  alternatives and more comfortable positions is the best option.  Speak   to your  partner about the  best  options.  Speak to your partner about the areas which arouse you the most and inform  him/ her about the painful areas.  Plan  your drug  schedule in such a way that you take pain relievers prior to the sex act.  Select  the best  time for   coitus, i.e.,  osteoarthritis is at its worst in the evening  and better in the morning and the reverse   is true for rheumatoid arthritis.  This precaution will  make the sexual  encounter more comfortable.  A shower or a tub  bath together with warm water will act  as a good foreplay activity, in additional to diminishing stiffness and pain.  Use of   lubricants   can enhance the pleasure.  It is particularly useful in Sjogren's  syndrome, where along with a reduction of other  secretion  of the body, there is a reduction  in vaginal lubrication.  Advice  will vary  with individual  cases.

Can  a man have sexual intercourse after a prostate  operation?Yes, he can.  Currently, the greatest number of prostatectomies is done via the transurethra route.  After surgery, the  quality of erection remains the same at the time of   climax and men experience the same pleasure.   the ejaculation  usually remains unaffected though, in some  individual,  the quantity of ejaculate  outside   may be less or absent  because of  retrograde ejaculation.

What is the effect of mastectomy on a woman's sexuality?Though  anatomically mutilating, theoretically a mastectomy should have  no effect  on woman's sexuality as her physiology remain unchanged.  However, the    physical mutilation may wreak a psychological trauma  which can  affect a woman's self-image and  self-esteem to a great  extent.  She may begin to harbour the feeling that she has become less feminine and hence  less attractive.  This  feeling may depress her and make her withdrawn fro social and sexual contacts.   The surgeon must explain to the  patient the operative procedure, the  interpretive  risks, the  possible  outcome and that it is  being performed as a potentially life-saving curative / palliative procedure.  To patients who are  very apprehensive about the disfigurement, the surgeon may explain that reconstructive  mammoplasty can be performed  if so  desired.

Can a woman lead a normal  sex life  after hysterectomy?Yes.  Women who are sexually active before  hysterectomy continue to  remain so even after the surgery.  Sexual  life remains  unchanged, as the  coital function is preserved.  Hysterectomy usually  involves  the removal  of the uterus, but  if it necessitates the removal of the uterus, but  if it necessitates the    removal of the  ovaries as well,  then the  patient may require hormone supplementation.

Is there any relation between sex and  obesity?On the face of it, sex and obesity may have no connection at all.  Often sexual  inadequacy  may lead to anxiety and/or  depression which may result in increased  food intake in some individual.  Hormonal disturbances  may also lead to obesity.  This factor may produce  interference with normal  sexual functioning and lead to overall sluggish   behaves.  Seen try habits and lack  of exercise  are common in obese individuals.  This life style  may result in flabby muscles and sexual pleasure may decrease when the specific muscles that play a part in love making get easily fatigued.

Can smoking hinder sexually response?Smoking results in contraction of the blood vessels, leading to an inadequate supply of blood  to the  genital organs  which may, in turn, lead to  sexual inadequacy.  Discontinuation of smoking by a heavy  smoker leads to an increase in the desire and many have reported better erectile ability.

Do routine X-rays induce  impotence?No.

Are there  any  diseases  associated  with increased sexual desire?increase in sexual desire can be seen during  mania where there is  acceleration of activity  in all  spheres.  Sometimes, there is increased sexual desire in schizophrenic patients, perhaps  because of loss of inhibitors.  Organic diseases, like a tumor in the frontal lobe of the brain or  disturbances  following  an epileptic attack, may be associated  with increased sexual desire.

Is masturbation after marriage normal?Yes.  Masturbation  is normal even in married individual.  It may be encouraged during  period  of separation, illness and in conditions where  one partner's sexual  needs are beyond the sexual capacity of the other.

What physical changes  occur in the sexual apparatus when one  grows   older?As a man grows older, erection takes a longer time to occur.  Similarly, in women, lubrications takes a longer time to occur.  A man  may often require direct physical  stimulation to achieve  erection and the same is also true for  a woman's lubrication.  With the  passage of time, the  colour  of the semen changes  from white to light yellow,  the consistency gets thinner and the  quantity decreases.  When people  are not informed about these facts, anxiety  can be  generated, as there is a vast discrepancy between the unrealistic expectation and the real experience.  This factor  hampers the sexual response, leading   to avoidance  of sexual overtures. Older persons tend to  become obese because of sedentary lives,  lack of exercise  and changes in hormonal levels.   Exercises to tone up the muscles  and good  functioning to beautify are essential.  Such exercise help in improving  the self-image and promotion a better sex life.

What are the most common conditions which could  decrease one's sex drive in the later years?The common reasons  for a reduced  sex drive in later years are:

  • Monotony  and lack of interest.
  • Changes in physical appearance.
  • Misconception about one's waining sexuality.
  • Lack of  communication.
  • Depression.

Does the  female  sexual desire  increase  or decrease  at menopause?Some women report an increase, while others report  a decreases, in sexual desire at menopause .  Increase  in sexual  desire  may be because  of  relative freedom from pregnancy and,  hence, one may reopen and perform  with greater enthusiasm.  Some women harbour the misconception that menopause marks the end of their   sexual career and this fear increases their sexual drives as an affirmation of their femininity.  During  menopause (or  even a few  years  earlier), a reduction in the secretion of the ovarian hormones may cause atrophy of the  vaginal epithelium which  leads to reduction in lubrication and hence  pain at the time of sexual intercourse.  This development causes a decline in sexual  desire and a woman tends to avoid sexual  overtures.

Is  estrogen therapy at menopause safe?It is  advisable to consult  a gynecologist  for the use of hormonal preposition during menopause.  Sturgeon  replacement  can avoid atrophic vaginites which leads to painful  intercourse and can also help in preventing osteoporosis  which usually leads to frequent  fractures.  It would be best  to take estrogen with progesterone in monthly cycles.

Does benign prosthetic hyperbolas (BPH) increase  libido?No, it does not  increase  libido.

Which   sexual  position is useful to individual  with localized low back pain?The affected  partner should  lie on his/ her  back with the hips flexed.  In this  posture, to  muscles are relaxed  and the vertebral column remains flat on the bed; hence this position is  comfortable.

Can obese individuals  be helped in matters of sexual activity?  Extreme obesity primarily inhibits  sexual pleasure on account of mechanical interference.  Side-by-side positions where neither   partner bears the other's weight and, at  the same time, has all limbs free from embrace can be advantageously.

Which positions are comfortable for the  woman during  late pregnancy?The lateral positions are generally found to be more comfortable.

Is there any  sexual position which allows  better grip?Yes, the rear entry (doggie) position and the woman's legs crossed position allow better  grip as compared to other positions.  In the woman's  legs crossed  positions, the  intercourse is performed  in the missionary position, where later, the woman crosses and keeps her legs inside  her male partner's  legs.  This enhances arousal and both these positions are helpful in those males who face difficulty in reaching orgasm.

What is meant by retarded ejaculation?  Does diabetes have a part to play in cases of  retarded  ejaculation?Retarded ejaculation is the opposite of  premature ejaculation.  Western  researchers observed that undetected diabetes  is the most  common cause  of impotence.  Diabetes may also cause ejaculatory disturbance,  but it seems to impair the erectile mechanism more   poundal, or at least equal.
            This history is absolutely essential and, in a large number of individuals suffering from sexual   inadequacy, ignorance about the sex act  may be a major  factor.  Adequate  explanation about the  act of  coitus and methods to enhance orgasmic pleasure   may improve  the majority cases.

What could be the reason for buckling of penis  during penetration?Such bucking usually takes places because  of reduced axial pressure following  trauma or fracture of penis.  In this  condition all tests, including  NPTR and Doppler will be normal  but  the patient will give  a history  of bending  or buckling of penis at any attempt.

Are people with a single testicle impotent?No.  a single 'normal' testicle secretes enough  hormones to maintain an individual's  vitality.

What  is the most common cause  of erectile  dysfunction?An occasional episode  of an erectile failure, due to functional or situations like fatigue, tension or pressure to respond bad perform, is  one of the common  causes of erectile disjunction.   This anxiety,  fire-lived during  subsequent,  similar encounter, would result in related failures.

How can one  distinguish a psychological erectile problem  from an  organic one?If a man reports  an erection of adequate quality without any situation one can conclude that the problem  is largely psychological

Can  alcohol lead to  impotency?Yes.

How does one  treat  alcohol-induced  impotency?The  treatment  programme needs to be  tailored according to individual needs and circumstances.  The  physician  must  determine whether  the sexual   dysfunction is connected with  an isolated episode   of drinking  or is  related to the  long-term consumption of alcohol.  He must confirm  the status of the erectile and ejaculator  components  after  history  tacking and a careful physical  examination.  If the impo9tency is secondary to an isolated episode  of alcohol intake, then  the  physician   may reassure the patient that the sexual   function  may  revert to normal   if he completely abstains from alcohol.  He should also then be  made aware that his  preoccupation  with fear of  failure   can hamper his sexual  responses.  Necessary sexual techniques, with adequate blending of supportive  psychotherapy and behavior modification, may prove extremely beneficially.  It is advisable to counsel the partner  as well.  She could be of great  help  in the treatment programme if she can  understand the  situation and is prepared to provide  the supportive atmosphere.

What are the most  common causes of organic  impotence?Diabetes, vascular disorders and radical cancer surgeries of the abdomen and pelvis  are amongst the most  common  causes  of organic  impotence.

Is semen  analysis  necessary  in a  patient  affected by impotence?  Absolutely not.  The absence or deficiency  of sperms neither   indicates  nor results in impotence.  Sterility and fertility   are two entirely different  concepts and depend  upon  different types of cells present in the tests.

Which investigations are helpful in the diagnosis of  sexual dysfunctions?Along with metabolic, hormonal and routine  physical examination, one should also  check the  tone of the anal sphincter.  Evaluation of the autonomic nervous system is a must in cases  of impotence.
            The following procedures  are important:
            NPT monitoring nocturnal penile tumescence  monitoring can help in determining whether  one is getting  erections  or not.  This procedure,  however, does not give any idea about  the rigidity of the  penis.

NPTR monitoring:This procedures  along with the  preceding one  gives an idea also  about rigidity and sustenance of the erection.  

EMG:Electromyography studies could help   diagnose  neurological lesions causing  impotence and reduction  in pleasure and squirting of semen  at the time of  orgasm.

Intrapenile injection:This  procedure  involves an injection of vasoactive drugs  (Papaverine mixed with Chlorpromazine or Phenotolamin, Prostate  gland   in E1) directly  into the   lateral aspect of the penis.   Depending upon the   erectile response which the paten has and the amount of drugs   which is  injected gives  a conceal a clue  to diagnose inorganic, psychogenetic or vasculogenic erectile dysfunction.

Doppler examination:  This is a non-invasive technique  which helps in determining the potency of the superficial and deep blood vessels of the penis.  Its graphic representation are useful in judging the blood flow.  On colour Doppler,  blood flow can be clearly visualized.

Penile blood pressure:  Penile  systole blood  pressure (by using a Doppler probe and a special cuff tied round the penis) divided   by the systolic   blood pressure  of the  arm, gives  the penile bronchial index (PBI).  If the reading is abnormal, it is probably indicative  of vascular insufficiency.

Infusion cavernosometry and cavernosography:  infusion studies with normal saline are helpful in diagnosing venous leaks responsible  for   inadequate  erection.  Cavernosography with a contrast medium helps in detecting the presence of abnormal drainage channels  responsible for  erectile inadequacy.

Sexually Transmitted Diseases: Infectious  disease that are  mostly  transmitted  by contact with genital organs or their secretions.  They are widely referred to as STDs.  There are  several other possible modes of transmission:

  • Via blood, mainly through use of  contaminated  syringes  and needless  by drug  abusers.
  • Mother-to-child contact  during   pregnancy or birth.
  • Close non-sexual  body  contact
  • Accidental, from a needle  prick  sustained   by medical, staff.
  • From sharing intimate objects (for example  underwear, diodes) in the case  of some STDs.

Many  of the once-serious   chronic  bacterial STDs (for example Gonorrhea, Syphilis and infection caused by Calamity) and  now  be cured by antibiotics and active  ayurvedic  herbs.  There is so far no cure for  STDs  caused  by viruses (for  example, Genital Herpes, simple  Hepatitis B and AIDS), but  treatments are available to relive  symptoms and reduce their   duration.  Early diagnosis  is important for treatment of infected people   and their partner or  partners, to prevent  diseases spreading to others. Some STDs must be notified  to healthy authorities.  Sexual   health centers (public and private )  provide   diagnostic  services  and screening, treatment, information, assistance in tracing  contacts, and counseling  about STD prevention.

           
Safer sex will prevent most STDs.  Sex  can only be quite  safe in monogamous relationships where both partners are free of these  diseases.  Using condoms prevents transmission of most  of the serious STDs.