Andrology

Male Sexual Dysfunction

Sexual dysfunction is a common problem. It is more prevalent in women (43%) than men (31%). Inspite of the high prevalence, physicians as well as patient are hesitant to discuss sex related issues. Sexual dysfunction can lead to distress to both partners and may have a negative impact of their relationship. It can be a result of a physical or a psychological problem.

The common sexual problems affecting men are premature ejaculation and erectile dysfunction. Evaluation for sexual dysfunction involves a thorough history of symptoms and a physical exam. Investigations may be required to rule out any medical problems that may be contributing as a cause of sexual dysfunction.

.

• Education about sex, sexual behaviors and responses helps to clear misconceptions.

• Communication with your partner about your needs and concerns helps to overcome many barriers to a healthy sex life.

• Psychological therapy can address feelings of anxiety, depression, stress, fear or guilt that may have an impact on sexual function

• Treatment options for erectile dysfunction are

  • Medical treatment: eg Tadalafil, Testosterone replacement therapy if testosterone levels are low

  • Intra Cavernosal Injection Therapy

  • Vacuum Erection Devices

  • Penile Implants
    

• Treatment options for premature ejaculation:

  • Dapoxetine.

  • Topical lignocaine spray may  help to control ejaculation by reducing sensitivity.
    .

Some common causes for male infertility are

• Varicocle

• Idiopathic

• Obstruction in genital tract

• Cryptorchidism

• Testicular failure

• Endocrinopathy
  .

.
Treatment:

Whenever possible the treatment is directed to correction  of a specific problem and the costly ART is kept as a last option.

• Varicocele is the commonest cause for male infertility and requires a surgery namely varicocelectomy.

• Medical treatment may be given for idiopathic cases but the overall success rates are not very encouraging.

• Obstruction in genital tract may require a micro surgery eg Vaso-Vasal Anastomosis or ART.

• ART is the option for those in whom no therapy is available or if previous treatments have been unsuccessful. ART may include artificial insemination or In-Vito fertilization (Test Tube Baby). The clinical success rate of these techniques is upto 45 %. If ART is not successful then the remaining options are use of donor sperm or adoption.