Andrology & Urology Centre in Bangalore | Dr. Praveen Joshi

Tel: 080 - 42070577, +918197371247

Male Sexual Health

Erectile dysfunction is three times more common in Diabetics compared to Non-Diabetics

Erectile dysfunction is much more common than retinopathy and nephropathy.

Erectile dysfunction may be first symptom in 12% of Diabetics

Hypertension and Erectile dysfunction

Erectile dysfunction in hypertensive patients is two times more common

Dyslipidemia and Erectile dysfunction

It has been found that there is an Improvement in Erections after lowering LDL cholesterol

Metabolic Syndrome is also associated with low Testosterone levels and Low Te levels are associated with two times increased cardiovascular risk. Low Te increases insulin resistance and worsens DM, and thus the vicious cycle.

Cardiovascular risks and men's health

Prevalence of silent coronary artery disease in patients with ED is ranged between 8% and 56%. Erectile dysfunction has been independently associated with Cardiovascular Disease.

Relative risk of Cardiovascular Disease is higher among younger patients with Erectile dysfunction, and risk decreasing linearly as age in years increased. Improvement of Testosterone levels by TRT has shown reduction in the mortality by 50%.

Osteoporosis

One in 6 men will sustain a hip fracture by age 90, and risk of death from complications of a hip fracture is 34%.

Treatment includes making healthy lifestyle changes, including getting 1000 mg to 1200 mg of calcium daily

Vitamin D3 should be above 30ng/ml

Use bone forming agents, if Bone mineral Density is -2.5.

Take home message

  • Cardio-metabolic risk assessment is crucial aspect of Men's Health evaluation
  • Lifestyle modification is one of the fundamental pillars of treatment
  • Collaboration with other disciplines is inseparable part of Men;s Health management
  • Multi-disciplinary and holistic approach is very important
  • Irrespective of age, Males should Consult a professional Andrologist, if they are any symptoms. Don't neglect of feel shy to share with family members/friends, as they could assist/direct you to the right medical professional

Erectile dysfunction (ED) is the inability to get or sustain an erection firm enough to have sexual intercourse good enough for partner satisfaction. It's also sometimes referred to as impotence.

ED can be caused by only one of these factors or several. That's why it's important to work with your doctor so that they can rule out or treat any underlying medical conditions.

 

Causes:

There are many possible causes for ED and they can include both emotional and physical disorders. Some common causes are:

  • Cardiovascular disease
  • Diabetes
  • Hypertension
  • Dyslipidemia
  • Smoking
  • Obesity or being overweight
  • Damage caused by cancer/ surgery to the nerves
  • Stress
  • Anxiety
  • Relationship problems
  • Substance abuse
  • Alcohol use

Treatment at Erectile Dysfunction treatment in Bangalore:

 

There are various levels of treatment.

  • Lifestyle modifications
  • Medicines & Like Sildenafil, Tadalafil
  • Low Intensity shock wave therapy
  • Intra cavernosal injections
  • Vaccum erection device
  • Surgery & Venous ligation, Penile prosthesis

It is important to diagnose any Erectile Dysfunction symptoms early-on so to ensure minimal medical intervention.

 

Here is a basic Diagnostic Framework:

ed-treatment

Clinical trials have demonstrated that stem cells can restore enough erectile function to allow previously impotent men to engage in spontaneous sexual activity. Stem cell therapy has also resulted in patients regaining erectile function to engage in sexual activity.

 

Stem cell Regenerative Therapy

Hypothesis is that stem cells can differentiate into a wide variety of cells including endothelial cells, Schwann cells, smooth muscle cells, and neurons. These have beneficial effects, leading the host tissue to initiate a regenerative or healing response to diseased or injured tissue responsible for ED.

One reported case series of seven men treated using Stem Cell Therapy. In this series, 6 out of 7 diabetic patients ranging from 57 to 87 years age regained morning erections. Another phase 2 trial with 12 patients with post Radical Prostatectomy patients have shown significant improvement by 6 months.

It is said Stem cell therapy achieves at least 50% improvement in patients with erectile dysfunction (impotence) after initial administration.

Male Infertility & Identification and Treatment Methods

Male infertility means a male's inability to cause pregnancy in a fertile female.

Approximately 15% of couples are unable to conceive after one year of unprotected intercourse.

 

Male factors contributing to infertility

  • Oligo, Astheno, Teratozoospermia
  • High DNA Fragmentation Index
  • Poor acrosomal capacitation
  • Unexplained
  • Azoospermia
  • Erectile dysfunction
  • Anejaculation and Retrograde ejaculation

Indications of the problem includes:

  • Mild male infertility
  • Unexplained infertility
  • Mild Endometriosis, Cervical factors
  • Erectile dysfunction
  • Anejaculation during the intercourse but can give sample by masturbation

There are different routes to treat this problem. The approaches may include-

  • Hormonal balancing
  • Varicocele ligation
  • Antioxidants
  • Surgical sperm retrieval
  • Correction of erectile and ejaculatory disturbances

Definition

A varicocele is when veins become enlarged inside your scrotum (the pouch of skin that holds your testicles). These veins are called the pampiniform plexus. Varicoceles often produce no symptoms but can cause low sperm production and decreased sperm quality, leading to infertility.

 

Impact of the Disorder and its occurrence in Males

  • 15% overall male population
  • 35-50% primary infertility
  • 69-81% secondary infertility
  • 70% of asymptomatic males with varicocele have abnormal, semen analysis

Presence of Abnormality

  • Abnormal dilatation of the pampiniform plexus
  • Impairment of a counter current heat ex-change mechanism
  • Impaired spermatogenesis and steroidogenesis

Unfavourable Factors

  • Cryptorchidism
  • Testis tumors
  • Trauma
  • Torsion or infection

Book an appointment for timely diagnosis, treatment and remedy.

About

Stem Cell Therapy and its advanced research has indicated promising results in the treatment of Erectile Dysfunction. This is considered to be a type of #regenerativetherapy with the hypothesis that the stem cells can differentiate into a wide variety of cells including endothelial cells, Schwann cells, smooth muscle cells, and neurons. Interestingly, Stem cells have beneficial effects lead the host tissue to initiate a regenerative or healing response to diseased or injured tissue responsible for Erectile Dysfunction.

 

Prevalence

Worldwide prevalence of ED is between 10% and 20%, and it is strongly correlated with aging. Among younger men, 8% of 20- to 29-year-olds and 11% of men ages 30-39 experience ED. Also, about 52% of men ages 40-70 experience ED and 71% of men over 70 experience ED.

Failing to address these issues on time may lead to further health vulnerabilities like increased stress levels, delay in addressing any underlying cardio-vascular diseases and more.

Book an appointment to address on priority.

Erectile Dysfunction itself is often related to an underlying problem, such as heart disease, diabetes, liver disease, or other medical conditions. Other factors like depression, anxieties, stress, relationship problems, and other mental health concerns can also interfere with sexual wellbeing.

The Men;s Attitudes to Life Events and Sexuality (MALES) study assessed the prevalence of erectile dysfunction (ED) and related health issues in the general male population in Europe and North and South America, and examined the attitudes and behavior of men in relation to these health issues.

In Phase I, 27,839 men (20-75 years) from eight countries (United States, United Kingdom, Germany, France, Italy, Spain, Mexico, and Brazil) were interviewed using a standardized questionnaire.

Phase I compared the prevalence of hypertension, angina, increased cholesterol, diabetes, and depression/anxiety in men with ED vs men with no ED. Prevalence was significantly higher in men with ED for all co-morbidities assessed (p - 0.0001).

Rosen RC, Fisher WA, Eardley I, et al. The multinational Men's Attitudes to Life Events and Sexuality (MALES) study: I. Prevalence of erectile dysfunction and related health concerns in the general population. Cur Med Res Opin. 2004;20(5):607 617.

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Graphical view of the PENIS

chart 

Erectile problems related to serious health issues:

It is important to know and build awareness about Erectile problems and its possible hidden or underlying health signals. Erectile problems can also be a key indicator of serious health issues.

chart

Recommended Treatment includes:

  • Lifestyle changes
  • Risk factor modification
  • Education Counseling

PDE 5 Inhibitors

Phosphodiesterase 5 Inhibitors (PDE5Is) are now widely used in the management of Erectile Dysfunction(ED). Their ability to improve symptoms of ED was discovered while researchers were examining their potential use for high blood pressure and angina. PDE5 inhibitors is usually used to treat ED caused by poor blood flow to the penis.

 

Treatment for ED Caused by Physiological Factors

It is important to note that PDE 5 Inhibitors is typically used to treat ED caused by physiological factors and not psychological ones especially stress and anxiety.

The four major types of PDE5 inhibitors available include:

 

Recommended Treatment includes:

  • sildenafil (Viagra)
  • tadalafil (Cialis)
  • vardenafil (Levitra or Staxyn)
  • avanafil (Stendra)

Common side effects include:

  • Headaches
  • Nausea
  • Indigestion
  • Dyspepsia
  • Nasal congestion
  • Altered vision
  • NAION (Non-arthritic anterior ischemic optic neuropathy)

PDE5 inhibitors have a vasodilating effect on the penis, primarily, helping the blood vessels relax and increasing blood flow. It is important to note that these drugs have to be administered only under the guidance of a physician.

Erectile dysfunction (ED) is a major health problem that seriously affects the quality of life of patients and their partners. Gene therapy approaches are discussed in terms of the possible role of gene therapy for the treatment of ED, potential targets for gene transfer, vectors to carry targeted genes, and gene strategies for ED in certain disease states, such as diabetes, ageing, arterial and venogenic insufficiency, and cavernous nerve injury.

Recent preclinical and clinical trials have demonstrated that gene therapy strategies may be feasible for these purposes. Gene therapy offers a minimally invasive option to treat men who do not respond to traditional pharmacologic therapies or do not want surgery. It is believed that gene therapy will become a therapeutic treatment in the near future.

Genes that stimulate smooth muscle cell relaxation, such as neuronal, inducible, and endothelial nitric oxide synthase, or that inhibit smooth muscle cell constriction can restore erectile function in aging, diabetic, and other model systems.

The future of erectile dysfunction gene therapy may lie in the use of tissue specific and regulated gene expression, advanced viral vectors, or the combination of multiple genes to fine tune smooth muscle relaxation. Maxi-K ion channels, are transferred to the penile tissues. Tunica albuginea has slow turnover rate facilitating the study of prolonged gene action. Maxi-K ion channel activators increase potassium currents and thereby increasing the relaxation of smooth muscles.

Body Dysmorphic Disorder

This is a mental health condition that disrupts how you see and feel about your own body and appearance. This has a societal bearing, wherein, people experience low esteem, or low confidence, accompanied by a sense of shame about their body, especially their genitalia. This affects their sense of wellbeing in the long run, bringing in many disorders like stress, anxiety and personality disorder.

 

Penile Dysmorphic Disorder

Penile dysmorphic disorder, sometimes abbreviated as PDD, is a manifestation of body dysmorphic disorder where the main bodily area of fixation is the size of the penis. PDD on its own is not a recognized disorder. In such cases, the size or shape of the penis causes them discomfort and under confidence. An individual with penile dysmorphic disorder often has a debilitating or excessive fear of judgment by others.

 

Perceived Fears and Inhibitions

In cases of PDD, the person has a perceived notion of what is normal. Even though the organ functioning is normal, the appearance becomes the bane. The person experiences a sense of body shaming, and a gnawing feeling that the person cannot fit in, does not look good or is not normal. The person is so troubled, disturbed and affected, that it becomes an obsession to deal with. It is of serious concern, when the person takes to different means of addressing it. One approach is to go to cosmetic upliftment that is not recommended, taking medicines that is unnecessary or meeting quacks! This is highly dangerous and one is recommended not to pursue this path.

One has to learn to accept some shortcoming in one's personality and accept it, rather than approaching it with doubt, and taking up wrong means to address, when in reality, the problem does not require any form of medical intervention at all.