When Performance Deceives Desire
Male Sexual DysfunctionTalk at HELPTalk to HELP
“IS IT NOT STRANGE THAT
DESIRE SO MANY TIMES
OUTLIVES PERFORMANCE ?
W. Shakespeare
Dr. Vijay Kulkarni
Consultant Andrologist&
Microsurgeon
LTM Med College & HospitalBhatia HospitalRaheja Hospital
Nat. Inst. for Research in Reproductive Health
MALE SEXUAL DYSFUNCTION (MSD)
•Libido + Arousal - Psychogenic
•Erection + Rigidity + Sustainance - Physical •Penetration - Physical +Techn
•Ejaculation +Orgasm - Reflex act
MSDThree componants
•PhysicalPhysical
•PsychologicalPsychological
•MixedMixed
Erectile Dysfunction(ED)
Is defined as a persistent inability to achieve or to maintain erection adequate for mutually satisfyingsexual intercourse
It is surprisingly common
20 mil. men in U.S.A. suffer from some degree of E.D.
52% men in age 40-70 suffer from some degree of E.D.
5% at age 40 & have total impairment25% at age 70
ONLY 15% GET TREATED
• Prevalence of ED much higher in younger age group in our setup
• Because of cultural, social and religious belief elderly people seeking help for ED is uncommon
• E.D. is a man’s problem but couple's concern
Facts about ED in S.E.Asia
Risk Factors for ED
• Obesity, Smoking, Alcohol abuse • Diabetes• Hypertension• Depression• Drugs : Antihypertensives, Antidepressants• Endocrine disorders : Hypothyroidism• Trauma or Surgery to pelvis/ spine
Are identical to those for Heart Disease
Diabetes &
Erectile Dysfunction • Men with diabetes have more than a
3-fold increase in the incidence of ED
• Over 65% develop ED after 10 years of being diagnosed with diabetes
• ED starts early in diabetic population and is more severe
E D Can Be Treated With
• Counseling & Sex Education• Oral drugs• Intra-penile self-injections• Vacuum erection devices• Penile implants
ORAL DRUGS
• Sildenafil
• Vardenafil
• Tadalafil
INTRA-PENILE SELF-INJECTIONS
Intra – Cavernosal Injectionof
Vaso-Active Drugs
Commonly Used Drugs
Papaverine & Prostaglandin E1
In combination
with other drugs
Intra Cavernosal Injection of Vaso Active Drugs (ICIVAD)
Patient’s Guide to
Self Injection
Patient’s Guide to
Self Injection
ICIVAD Therapeutic Application
• Therapeutic dose determination
• Training & supervised self injection
• Home self-injection programme
ICIVAD
Do not forget PRIAPISM !!!
ProlongedProlongedErectionErection
•PainfulPainful•InvoluntaryInvoluntary &&•NON-SEXUALNON-SEXUAL
Vacuum Erection Devices (VED)
BASIC DESIGN
• Cylinder
• Vacuum pump
• Constriction rings
Vacuum Erection Devices
Vacuum Erection Devices (VED)
Time-tested
Non-invasive
Select Population
Vacuum Erection Devices (VED)
• For Elderly patients with limited frequency of coitus –– Combination of Intra Penile Inj + VED
works well– It avoids surgery for Prosthesis
Advances Advances in in
Surgery for ImpotenceSurgery for Impotence
This is not what the penile prosthesis does
Beyond medication – Penile Implants
TWO TYPES
•SOLID- Non-Inflatable•INFLATABLE
Penile Prosthesis
Non Inflatable Type (Malleable or Flexible)
Beyond Medication- Penile Implants
Non-inflatable Shah Penile Prosthesis with hinge
Malleable Penile Prosthesis
Placement in body – Flaccid State
Malleable Penile Prosthesis
Placement in the body - Erect state
Inflatable Penile Prosthesis
Placement in body – Flaccid state
Inflatable Penile Prosthesis
Placement in body – Erect state
ORAL ERECTOGENIC DRUGS
• Sildenafil• Vardenafil• Tadalafil
REVOLUTIONISED TREATMENT
Oral Erectogenic Drugs
At presentSildenafil citrate is the most used
oral erectogenic drug
New Oral Erectogenic Drugs
• Vardenafil– Decreased side effects– Quicker onset of action
• Tadalafil– Prolonged duration of action– Minimal side effects– Unrelated to food intake
Oral Drugs-PDE5inhibitors
Sildenafil-25mg,50mg,100mg
Tadalafil- 10 & 20mg
Vardenafil- 5 & 10 mg –(not available)
Side effects of oral drugs
- Headache - Back pain - Dyspepsia - Myalgia - Nasal congestion - Pain in limbs - Visual disturbances - Flushing
Brock GB et al. J Urol 2002; 168: 1332-1336.
WARNING !!• DO NOT TAKE
IF YOU USE OR EVEN LIKELY TO USE NITRATES- i.e. medication for cardiac pain
• DO NOT TAKE WITHOUT CONSULTING YOUR DOCTOR
The Pill is Not an aphrodesiac -
it does not libido
The Pill does Not make normal erection harder
or last longer
IT IS NOT SUPPOSED TO MAKE YOUA SUPER ATHLETE !
IT IS MEANT TOHELP YOU NORMALISE YOUR MARITAL
HARMONY.
Risk Factorsare the same for
Coronary Artery Disease&
Erectile Dysfunction
Modern Andrology Can Offer Cure
To Nearly All Patients With Impotence
Modern Andrology Can Offer Cure
To Nearly All Patients With Impotence
Remember a person may
be born with ED but he
need not die with it