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