SEXOLOGY

How should I know if I have erectile dysfunction (impotence)? When should I go to the doctor?
Erectile dysfunction (impotence) is the lack of arousal or having erection insufficient for finishing sex. It is usually caused by different diseases (hypertonia, diabetes), or as a result of taking some medications (antidepressants, hypotensive drugs, antihistaminic medications, tranquilizing drugs, drugs that suppress appetite). At he beginning of the treatment antidepressants may increase the risk of suicide and even deepen the depression. At the same time depression, stress and anxiety also lead to sexual dysfunctions.

However, there is no need to despair, because you are not alone. With the great amount of information available today, more men with erectile dysfunction began to see a doctor. First of all they are interested in three drugs: Viagra (Sildenafil), Levitra (Vardenafil Hydrochloride) and Cialis (Tadalafil). Therefore, if you have problems with erection, you should go to the doctor. In most cases erectile dysfunction can be cured.

How much effective are those medications?
They are very effective. They do increase erection making it sufficient for a normal intercourse. After intercourse erection disappears. However, remember that the effectiveness of those drugs depends on your major cause of erectile dysfunction. Chronic disease such as diabetes has a great influence on the results of the treatment.

What is the difference between those medications?
There are not great differences between them. Viagra, Levitra and Cialis are the class of PDE5 inhibitor receptor drugs. All medications of this class do act practically the same – erection appears only in case of sexual stimulation. Arousal makes brain send signals about the necessity of nitrogen oxide production to the body. This substance relaxes the unstriated muscles and improves blood circulation to the penis and makes erection. All medications mentioned above help in nitrogen oxide production.

They do differ just in time of acting. Doctors do recommend to take Viagra and Levitra 30-60 minutes before intercourse and Cialis 30 minutes before intercourse. The duration of effect of Vigra and Levitra lasts approximately 4 hours, and Cialis from 24 to 36 hours.

Whom are these medications contraindicated?
Viagra, Levitra and Cialis are contraindicated for men who are taking medications containing nitrate (for example, nitroglycerin that is taken when heart pains). Taking those medications simultaneously may lead to the harsh lowering of blood pressure. For the same reason it is contraindicated taking the combination of medications with alpha-blockers used for the treatment of hypertonia and Prostatic Hyperplasia. Incorrect combination of medications may cause giddiness, fantness, and even heart attack or stroke. Remember that taking following medications may cause erection problems: antidepressants, hypotensive, antihistaminic medications, tranquilizing drugs, drugs that suppress appetite.

Do not take erectile dysfunction medications if sexual activity is contradicted to you. The effectiveness of those medications in treating of sexual dysfunction in women was not proven yet (although there was made Viagra researches in this field).

More often men do not wake up during night ejaculations. Therefore, to find out if you have them or not you could need to perform special test. If you do not have night erection, doctor may search possible medical causes for that, starting from medications you take.

Viagra (Sildenafil) initially was created to treat ischemic heart disease, but during clinical tests patients noticed erection appearing. Besides Viagra there are also two medications: Levitra (Vardenafil) and Cialis (Tadalafil). Those three medications increase blood flow into penis and maintain erection enough for sexual intercourse. The effect of Viagra and Levitra appears in 1-2 hours after their taking. Thanks to Viagra, four in five patients get their sexual functions improved. The effect of Cialis keeps for 36 hours. To make those medications work, there is a need of sexual stimulation. Those medications have next side effects: headache, cold, indigestion.

After sexual intercourse occurs blood outflow from penis, and penis comes back in normal condition. Levitra improves erection in 85% of males. This medication helps to improve potency in diabetics and in those who has undergone operation on prostate gland. The medications are contraindicated for people with significant heart diseases, and also for people taking drugs containing nitrates and alpa-blockers. Acting one with another, those medications may provoke sudden lowering of blood pressure. Medications improving potency are dangerous for men who suffer from coronary heart disease, heart failure, and hypotension.

Before appearing on the market of medications mentioned above, the problem of erectile dysfunction was solved with the usage of injections which were made into penis before sexual intercourse. This method is still used today. In case of right usage, it is a quite effective procedure. Sometimes such injections and other medications do cause priapism (steady long-lasting erection). So they should be used attentively.

Erection may be kept with mechanic devises such as vacuum pumps assuring blood flow into penis, or rubber seals drawing on penis head and preventing blood outflow from penis.

Finally, special devises may be inserted surgically into penis. Those semirigid structures are quite firm for sexual intercourse but they are quite flexible to remain invisible underwear.

Erectile dysfunction (impotence) is a condition when penis gets erected incompletely. Term “erectile dysfunction” is used to describe full erection inability, erection instability or ability to short erections. In other words, erectile dysfunction is a persistent inability to get erection, necessary for a normal intercourse. Erection is a difficult process in which are involved emotions, circulatory system and three independent parts of nervous system.

How much dangerous is erectile dysfunction?
Erectile dysfunction usually signalizes about serious disorders in the body.

Erectile dysfunction causes
There are many causes of erectile dysfunction, which can be divided into six groups;
1.Psychological. As specialists say, in 10-20% of cases of erectile dysfunction play role such psychological factors as stress, anxiety, feeling of guilt, depression, low self-esteem and failure in the bed.
2.Taking medications. Smoking, alcohol and taking drugs leads to hypoactive desire. Taking different medications such as antidepressants, ataraxics, allergy medicines, blood pressure lowering medications may negatively influence on erection.. Ask your doctor if there are such medications among medications you take.
3.Vascular diseases, blood circulation disorder. In atherosclerosis, the artery walls become less elastic. This can lead not just to heart attacks and blood-stroke, but also to problems with blood supply in penis.
4.Neurological diseases. On human nervous system can have negative influence diabetes, traumas, spinal cord diseases, prostate gland operations.
5.Endocrine problems. The level of testosterone can be lowered because of endocrine disorders and other diseases, for example, because of liver cirrhosis.
6.Penis traumas or penis diseases. Erectile dysfunction can be caused by Peyronie’s disease or priapism. In the first case, for some unknown reason, occurs proliferation of tissues of penis and as a result penis deformation. Priapism is a long erection, little by little getting down sexual function. One more reason for priapism development are injections increasing erection. In case of appearing of painful erection immediately go to the doctor.

Diagnostics
Feeling of unsatisfaction with erection is a reason to undergo medical examination which will help to reveal possible causes of erectile dysfunction. Many men have erection during sleep. If night erections do exist for a long time then emotional causes are excluded.

There is no exact definition for normal sexual life. Everybody has its own sexual life that is determined by personal preferences. Frequency varies from several times a week to several times a year. Sex not necessarily means sexual intercourse. It is not necessarily felling the onset of orgasm in each partner. In fact, any person can have periods of sex cool down. There is no common sex standard, so sometimes it is difficult to say if the couple has sexual problems or not.
There are particular signs which help you to find out if you have sexual problems:
- the problem occurs permanently or it repeats quite often at length
- the problems causes stress – it makes man feel upset and greatly worries him
- the problem results in difficulties in the relationship and breaks down chemistry with sexual partner

Two last signs are most important. In many people libido change and lowering of sexual function do not cause stress and do not influence on relationship with the partner. In this case there is no sexual problem. However, when a man suffers greatly from these changes, then we can say that the sexual problem exists.
Another difficulty is that sexual disorder is caused not just by one factor, it may be caused by the complex of physiological and psychological factors. Normal sexual function means passing through all sex stages:
1.Excitement
2.Blood flush into genitalia (erection in men, lubricant exudation and genitalia increase in women)
3.Orgasm
4.Feeling of satisfaction and satiation

Breakdown can occur on any stage of this cycle and it can be caused by a number of factors. Finally it results in sexual disorders.

The role of bad habbits and diseases

Sexual disorders can be caused by the next factors:
- diabetes
- cardiovascular diseases
- neurological diseases (insult, brain injury and spinal cord trauma, multiple sclerosis)
- trauma or operation on pelvic organs
- side effects of drugs
- chronic diseases (kidney failure, hepatic failure)
- endocrine profile disorders
- drinking and taking drugs
- smoking
- aging changes

Psychological factors:
- stress on the work
- anxiety about problems in the family or with friends
- mental disorders (depression, anxiety)
- past unsuccessful sex

Associated diseases and disorders make people worry about their sexual function and namely this problem is added to the existing problem. In case of appearing of serious sexual problems first you should find out if they are connected with taking of some medicines, hormonal disorders, mental diseases (depression, anxiety) or mental trauma. If it was detected one of these problems then it may be removed by the doctor. Otherwise the relationship in the couple must be analyzed. Sexual disorder may appear just in a certain situation. It means that problem exists just in one partner in a certain situation. In this case both partners should consult psychologist.

Nowadays more than 50 million of men have made vasectomy (sterilization). That is about 5% of married men in reproductive age. If we compare it with women, you should know that 15% of families choose female sterilization as birth control method.

Vasectomy is a male operation to make a man sterile (unable to child fetation). This is the most popular method of male contraception for life. According to statistics, in the USA every sixth male over 35 years was exposed to the operation. In some countries female sterilization and female contraception precede vasectomy by popularity.

Male sterilization is an easy way to prevent from unplanned pregnancy, it is 100% effective and relatively safe method, that has no influence on sexual life. However, preventing from pregnancy, vasectomy is not protecting from sexually transmitted diseases.

Essence of the procedure

The essence of vasectomy is to prevent sperm hitting into ejaculate that is eliminated during sex. Sperm containing male reproductive cells is produced in testes. Moving via spermoducts it is hitting other testes glands where it is mixing with ejaculate. In consequence of vasectomy those spermoducts are cut and blocked. So hitting of sperm into ejaculate is prevented and it is just utilized by organism. Naturally, fetation without sperm is impossible.

Existing Techniques

Usually the operation lasts 30-40 minutes. Traditional method means that one side of the cod should be injected with anaesthetic. Then doctor makes there two small discissions and cuts spermducts and removes a small part of them. The ends of canals are tied and cod cuts are sewed. The same is performed on another side too.

Sometimes operation is performed without making cuts. With a special device doctor makes a small prick, stretches skin, cuts and tires ends of spermoducts. In this case blood loss is less and there is no need in stitching. This is a new method, it is less painful and causes less complications in comparison to traditional operation.

Is it painful?

To perform operation more often is used local anaesthesia what makes operation less painful. It is noticed just low discomfort caused by anaesthetic injection and when doctor pulls canal via cut. After operation several days you will feel bad. Minimum for one day is prescribed bed regime. Operations without scalpel are not so painful. Special bandage supporting cod, cold compresses and anaesthetics that do not contain aspirin stanch your pain. Follow doctor’s instructions and everything will be okay.

Complications

Operations of both types can cause complications. Serious side effects occur rarely. Usually they are connected with infection (infection can be brought via cut or via canals). Address your doctor if you have next symptoms of infection: high temperature, issue of blood, pyorrhea from cut, great pain and inflammation.

Other possible problems:

1. bruise (soon after operation it passes off). In rare cases hematoma occurs. So there is need in medical screening.

2. Sperm keeps on flowing from spermoducts in 18% of cases after operation. As a result under skin can be formed a bump (granuloma). Granuloma resolves by itself, but sometimes there is need in surgical intercourse.

3. More rarely occurs abscess.

Hypoactive desire can be one of many symptoms of testosterone lowering. In older age this lowering is natural. But it can be caused by some diseases, medicines and fatness. Visual signs often are not clear. To find out if you really have low testosterone, you should make blood analysis.

Insufficient production of testosterone is called hypogonadism. Symptoms:

• tiredness
• difficulty concentration
• depression
• hot flashes
• osteoporosis

Testosterone is a hormone responding for manhood reflex, so next symptoms can point at the testosterone lowering:

• erectile dysfunction
• loss of facial and body hair-covering
• slight increase size of breasts
• infertility
• muscle loss

Hypogonadism can be inherent or acquired. It can be resulted from orchiopathy or dysfunction of brain which stops transfer signals to testes about necessity of testosterone production. Also it can have the next causes:

• genetic abnormalities (Klinefelter syndrome) – presence of extra X chromosome in male. It causes testicular insufficience and low testosterone in blood.
• cryptorchism
• diseases of hypothalamus and hypophysis – organs controlling production and level of testosterone. This can appear when cancer, trauma, inflammatory processes or autoimmune diseases.
• trauma or inflammatory processes of testes
• diabetes
• testis cancer and its treatment
• dysfunction of liver and nephros
• thyroid gland diseases
• high concentration of ferrum in organism (hemosiderosis)
• fatness
• alcoholism after-effect
• admission of some medicines:

1) some kinds of corticosteroids
2) antifugnal drugs
3) some kinds of diuretic and antiepileptic drugs
4) immunosuppressant drugs

Hypogonadism treatment depends on the main cause of that disease. Sometimes it is necessary to use testosterone therapy in form of injections, plaster or gel. Side effects of such therapy is prostatic hyperplasia, infertility and sleeping difficulties. If you think you have hypogonadism, you should visit a doctor, and if necessary you should test the level of testosterone in your blood.

Male contraceptive choice never was large. Beside condoms, vasectomy and continence there was no methods to practice safe sex. However everything can change in the coming years. Scientists as never before came closer to invention of male contraceptives. Those pills can appear in pharmacies in about 5 years, and special implants even earlier.

Advantages of male contraceptives

Men fear of side effects similar to those that occur with women when taking contraceptives, but tests showed that this possibility is insignificant. The advantages are:

• safety
• effectiveness
• security
• reversibility
• low cost
• possibility to control process of fetation
• both partners are responsible for their protection

What are male hormonal contraceptives?

Male hormonal contraceptives act the same as women ones. Women birth control pills contain hormones preventing from eggs production. Male birth control pills contain hormones preventing from sperm production.

Eventually for men will be created pills, creams, gels, injections (that should be made once in three months), plasters, implants that will be implanted under skin. Specialists say that first will be available implants and injections. According to researches, male ability to fetation restores in 3-4 months after injections.

Alternatives

In present time clinical tests on Adjudin® are held. This is a medicine from cancer, which has such side effect as infertility. Adjudin® greatly reduces sperm production. Animal tests showed that in case of overdose there are possible serious side effects. Small doses have not caused any side effects. The amount of sperm production normalizes in two months after stopping to take this medicine. The medicine is prospective enough but before it appears on sale scientists have to work a lot.

One more direction into male contraceptive development are injections which stop protein production responding on male fertility. This medicine was successfully tested on monkeys. After stopping of making injections most of men could again be fertile. Injection should be tested on humans.

Nowadays scientists continue to develop male contraceptives but they are not available on sale yet.

Sexually transmitted diseases

Male contraceptives are expected to prevent effectively from pregnancy but not from sexually transmitted diseases. To protect from sexually transmitted disease it is necessary to use condoms.

1) Refusal from sex

Continence excludes possibility of sperm-egg collision and, as a result, pregnancy.

Pros: the risk of venereal disease infection is missing.

Cons: most of men can hardly refuse completely from sex. Besides, reviving sexual life a man can be unprepared or he can forget about necessity to use contraceptives.

Medical risks and side effects:no observed.

Effectiveness: 100%.

Petting (sex without penetration) means sex play. Unlike regular sex, it does not consider male penis to enter vagina and excludes sperm and egg joining.

Pros: this method is absolutely free. It can be used when other methods are inaccessible. It prolongs foreplay and intensifies orgasm.

Cons: sometimes the excitement can prevent from stopping. It is possible to move to vaginal sex (with contraceptive or without).

Medical risks and side effects: when anal or oral sex via body fluids can be transmitted venereal diseases.

Effectiveness:pregnancy is not excluded in case when sperm or ejaculate drops fall on woman genitalia.

2) Barrier Methods

Male Condoms. Condom is a protecting cover placed over the erect penis to avoid sperm penetration into vagina. Usually condoms are made from thin latex, vinyl or natural materials. The effectiveness of condoms depends on how you use them. Here are some recommendations on their usage which will help you increase their safety.

• use condoms with spermicides
• do not apply oil-based lubricants on latex condoms (vaseline)
• you should wear condom correctly: drop 1-2 spots of water-based lubricant on the tip of condom. Put condom on erected penis head. Leave the room at the top (about 1cm) for ejaculate. Move foreskin aside and roll condom down the penis. Check if there were no left any air bubbles.
• take condom off by holding its base

Pros: availability (you can buy condoms in supermarkets and pharmacies), low cost. It helps to avoid premature ejaculation. The process of condom wearing can be an interesting part of foreplay. When using them along with other contraceptives, they do prevent from sexually transmitted diseases.

Cons: the reduction and loss of sensibility are possible. Condom can tear and sperm can penetrate into vagina. That is why it is recommended to use condom with spermicide to neutralize sperms and prevent from pregnancy. Condoms from natural materials do not protect from HIV.

Medical risks and side effects:allergy on latex.
Effectiveness: 86 – 98%.

3) Surgical Methods
Sterilization. If you are totally sure that you do not have a wish to have a baby in any time of your life, then you can make sterilization. Reversal surgery is difficult and is not always successful. Any partner can make sterilization.

Vasectomy. During this operation doctor separates, ties up or cuts off spermoducts that are canals through which sperm goes from testis into penis. There is no need in general anesthesia during that operation, more often it is made outpatiently. In 75% of cases the results of vasectomy are reversible during two years after operation. At the end of this term sperm can be taken from testis using artificial methods.

Pros: there is no need to use any other methods of birth control before, during or after sexual contact. There is no negative effect on endocrine profile. You can enjoy making sex without thinking about unplanned pregnancy. Here the price and quality are good enough.

Cons: it requires surgical interference. It happens that life conditions do change and the man regrets about his decision. The reversal operation is quite difficult. Vasectomy does not protect from sexually transmitted diseases.

Medical risks and side effects:
There is possible moderate bleeding or introduction of infection after operation, reaction on anaesthesia, infection progressing, clotting in testis or behind them, or temporal ecchymoma, edema or painfulness of scrotum. Because of sperm leak next to testis can be formed small tumors.

Effectiveness: 99,5 – 99,9 %.

Premature Ejaculation

You are alone with your partner. The events develop quickly and you intend to prolong your pleasure. But everything ends before it begins.

It is normally if this sometimes happens. It can happen during foreplay or right after penis touches vulvar lips or enters vaginal opening of the woman. However, if it happens regularly it is abnormal and here we can talk about premature ejaculation.

First of all in that case do suffer man’s self-rating and also relationship with his partner. It is not necessarily to bear with that because premature ejaculation can be treated.

What’s the reason?

There is no unambiguous answer. There are several reasons of premature ejaculation:

1. psychological factors (depression, stress, feeling of guilt, low self-rating, excessive nervousness owing to sex)

2. diseases (problems with thyroid gland, prostate infective diseases, changing of level of particular hormones and substances produced by brain).

Premature ejaculation of young people is connected with inexperience (they do not know yet their body very well). Some men have premature ejaculation as a result of erectile dysfunction.

Diagnostics.

For premature ejaculation diagnostics the doctor should find out many things from the past and present patient’s state of health and also all about medicines the patient is taking. The doctor has to ask in details about sexual relationship with the partner.

It is very hard to talk about sexual problems with the doctor, but it is important to ask honestly his questions. Here is a approximate list of the questions:

• How long premature ejaculation is observed?

• Does this problem appeared recently or it exist from the very beginning of sexual life?

• Does the premature ejaculation occur every time or just sometimes?

• Does it occur with only one partner or with every women?

• How often do you make sex?

• Do you take drugs or alcohol?

To find out potential medical reasons of the problem the doctor can appoint complex examination.

How it can be treated?

The main method of treatment is psychological, sexual, pharmacological therapy. In some cases helps the only one way of treatment, in other cases it necessary to use them in complex.

Psychological therapy.

Speaking with psychologist often can be very useful. Patient can come to consult the doctor along with his partner. Specialist will help to release stress and to improve quality of sexual life.

Sexual therapy.

There are some exercises that help to learn to delay ejaculation, that can be done alone or with the partner.

1. Compression method. Partner stimulates your penis with her hand until his erection. When she feels that ejaculation is coming she compresses penis head for several seconds. Erection is coming down partially. In 30 seconds partner stimulates penis again. It should be repeated several times and finally ends with ejaculation.

2. Interrupter method. Partner stimulates penis until ejaculation. At this moment she stops stimulation and waits until the man cools down. Then again she starts to eat penis with her hands. It repeats until ejaculation.

Pharmacological therapy.

1. Antidepressants. Drug side effect of some medicines belonging to that group (paroxetine, flouxetine) is orgasm delay. That is why they can be used on doctor’s orders to treat premature ejaculation. If those medicines do not help then doctor prescribes another type of antidepressant called clomipramine.

2. Creams containing local anesthetic (for example, lidocaine) are used for many years to treat premature ejaculation. Cream application on head of penis opiates sensation and delays ejaculation. Before sex cream should be washed off to avoid its contact with woman’s genital organs.