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What is Erectile Dysfunction (ED)/Impotence?
ED may consist any of the following:
• Inability to achieve an erection.
• Lack of enough hardness/rigidity of the erection to permit penetration.
• Loss of erection before intercourse/sex is finished.
• Arterial diseases like, high blood pressure (BP), diabetes, atherosclerosis (calcification in the arteries leading to low blood flow) and heart diseases.
• Hormonal issues like low testosterone
• Obesity
• Nerve diseases like spinal cord injury and stroke, back or pelvic injuries, multiple sclerosis, Parkinson’s disease.
• Stress/Anxiety
• Depression/Sadness
• Nervousness about sexual performance
• Addiction to substances/drugs like marijuana, cocaine, or opioids/narcotics.
• Excessive alcohol consumption.
• Smoking.
• Sedentary habits and lack of physical activity or exercise.
• Anti-depressants.
• Some anti-hypertensives/Blood pressure control medicines and diuretics.
• Anti-cancer medicines.
• Anti-histamines.
• Muscle relaxants.
• Inability to achieve an erection.
• Lack of enough hardness/rigidity of the erection to permit penetration.
• Loss of erection before intercourse/sex is finished.
• Occasional normal erections, but with frequent unsatisfactory episodes.
• Any of the partner experiences diminished sex satisfaction because of erection issues.
• An erection is accompanied by a curved penis or pain resulting from curved penis.
• Inability to insert during sexual intercourse due to curvature of penis.
• Absence of nighttime or early morning erections.
A common method of diagnosing this condition is:
• Physical examination of penis to find curvature or any specific problems with the penis.
• Detailed history taking through questionnaire about the problem.
• Conducting blood tests like blood sugar levels for diabetes mellitus/ lipid profile for high cholesterol/ measuring serum testosterone hormone levels.
• In case history suggestive of heart diseases will require detailed cardiac evaluation.
• Any other relevant tests if history or examination is suggestive of any underlying health conditions.
• Penile ultrasound to check for scarring and blood flow to the penis.
• Sleep study at home to measure nighttime erections.
Treatment depends on treating underlying cause along with assistance with below therapies:
• Medicine:
• Oral medicine to enhance erection.
• Oral/injectable testosterone supplements as hormonal replacement therapy for low testosterone levels.
• MUSE (medicated urethral system for erections) therapy: Medications administered via a thin applicator tube. The tube is inserted into the urethral orifice, which is situated at the tip of the penis. A pellet (tiny pill particle) is inserted into the urethra. Pellet dissolves and improves erectile function.
• Vacuum pump therapy: A ring is attached to the pump device. By applying pressure to the penis via the pump to achieve erection and then delivering the ring will maintain/facilitate erection.
• Penile implant/prosthesis surgery: There are broadly two types of penile prosthesis/implant procedure are available and includes:
1. An inflatable three-piece implant/prosthesis: Two cylinders, a pump, and a reservoir comprise this. A fluid can be used to inflate the cylinders, which facilitates erection; they can be deflated after the completion of sex.
2. A semi-rigid malleable/two-piece implant/prosthesis: This is comprised of two rods of silicone. The rods contribute to the penis rigidity. Furthermore, they are flexible, allowing the penis to assume a straight position during sexual activity and curve downward after completion of sexual activity.
• Surgery to improve blood flow to the penis: A blood vessel from a nearby anatomical site is anastomosed with the blood vessel of penis to allow blood to flow which eventually bypass the damaged or blocked blood vessels.
• Lifestyle modifications: like exercising, quitting smoking and losing weight.
Clarify what is Premature Ejaculation (PME)?
• Premature ejaculation occurs when a man experiences orgasm/climax sooner than his partner would like. Ejaculation may occur prematurely prior to or immediately following penetration.
How long a male ought to "last" during sexual activity is not predetermined.
• When a male has an orgasmic experience before he wants to, will lose erection and is unable to continue sexual activity.
• Untimely/premature ejaculation can cause embarrassment and frustration. Male partner might feel as he lacks the time necessary to enjoy sex. Difficulties in satisfying the female partner/companion may arise.
• Embarrassment about PME may negatively impact their relationship and cause intimacy problems.
• In males, premature ejaculation is a prevalent issue. Between 30 and 40 percent of males experience this issue at some point in their lives.
There are several psychological/emotional and physiological/physical factors which can lead to premature ejaculation.
• It could happen if a man experiences excessive stimulation or excitement, or if his penis is exceptionally sensitive.
• It can also occur when a male is uneasy or nervous around a new partner.
Additional causes comprise the following:
• Men with low amount of a special chemical called serotonin in their brain may experience premature ejaculation.
• Performance anxiety
• Depression/stress/relationship problems/guilty feelings.
• In most cases, not.
• Rarely, injuries to the nervous system caused by trauma or surgery, may give rise to premature ejaculation.
What is a meant by a tight frenulum?
• Frenulum is a thin band of skin which connects the underside of tip of penis to the proximal foreskin.
• In some men, it is tight especially leading to pain while erection at the underside of the tip of penis or unable to retract the foreskin completely.
What is the treatment of a tight frenulum?
• It requires a simple surgical procedure to lengthen the tight thin band of skin which is called as frenuloplasty.
There are several possible methods for delaying orgasm:
• Behavioral methods: Over 95% of men who experience premature ejaculation find behavioral methods beneficial. Ejaculation control is practiced individually or with the partner during this form of treatment.
• Distraction method: Practicing mental/thought distractions. While being sexually stimulated, think about the names of players from favorite sports team.
• Start-and-stop method: you or your partner will stimulate your penis until you feel like you are about to have an orgasm. Then the stimulation stops for about 30 seconds. Once you regain control, stimulation begins again. This process is repeated few times (3-4) before allowing yourself to have an orgasm.
• Squeeze method: When you feel like you are about to ejaculate, you or partner will gently squeeze the head of your penis for about 30 seconds so that you begin to lose your erection. This process is repeated few times prior to allowing yourself to reach orgasm.
• Psychological treatments:
• Seeking help with psychologist, psychiatrist, or sex therapist to treat anxiety, depression, other emotional issues, and relationship problems.
• Medical treatments:
• Selective serotonin reuptake inhibitors (SSRIs): like dapoxetine and is available with your doctor's prescription. It may cause side effects such as dry mouth, drowsiness, or low sexual desire.
• Topical anesthetic sprays: to apply locally over penis to delay sensation. Typically applied 5-10 mins before intercourse over erect penis. Drying it is essential before penetration otherwise may also lead to vaginal numbness and loss of interest of female partner.
• Barrier method: A few men may find that using a condom can assist in delaying ejaculation by slightly reducing the sensitivity of the penis.
What is meant by phimosis?
• The skin fold that extends over the tip of the penis (foreskin) contracts leading to phimosis.
• It may be difficult or inability to draw the foreskin back over the head of the penis in this condition.
What are the causes of phimosis?
It occurs naturally in infants and a child up to 3 to 4 years of age.
Other causes may include:
• Infections
• Injuries
• Poor hygiene leading to inflammation and contraction of foreskin.
What are the signs or symptoms?
May include some or all:
• Unable to pull back the foreskin.
• Ballooning of the foreskin while passing urine.
• Burning and painful urination.
• A weak urinary.
How is this condition diagnosed?
By physical examination by the urologist/doctor.
What are treatments available or how this condition is treated?
• If occurring in infants and children (up to 4 years of age), it may improve with time.
• In all other cases, it requires a surgical procedure to remove part of foreskin [called as circumcision (stapler/ZSR circumcision or suture circumcision)]