Loss of libido in women may be due to workload, family disharmony, unemployment
of husband or her, medical diseases, worries pertaining to her own father /mothers
sickness , divorcé(new relationship) ,
adjustment disorders either with in Laws or in case of divorce with new
partner and related stress , not
forgetting raised serum PRL .Some Phrama
company are selling gels which
may be applied to her private parts
prior to sex may improve the sexual disorders but the role of sex counselor remains
paramount .
ABC of male sexual disorders:
There are for six kinds of male sexual disorders. Type 1 disorders:-
Premature ejaculation. This is most annoying
and is a matter of a great concern for
the couple. As a matter of fact as many
as 40% of men suffer from PE(premature ejaculation) at some point of time .This(PE)
symptom
is more common in young age. We know
that the sudden process of ejaculation
is a like a sneezing reflex and often uncontrollable by himself as its center at
L-4 segment of spinal cord thetre is LET
cell plexus which control time of firing( ejaculation) . Type 2 disorders: By
contrast ED(failure of achieving sufficient erection inspite of having strong
desire of sex which is termed as libido ) is commoner after 45 yrs. The other 4 abnormalities of “Male
Sexual Diosrder “ are Type 3 disorders 3) Delayed ejaculation more than 20 minutes of
deep and repeated thrusts . Type 4
disorders: 4) Retrograde ejaculation and very uncommonly Type 5 disorders is anejaculation which may or may not be associated without orgasm of male . The most annoying
type of male sexual diosrder is Type 6 disorders: This is complete loss of
libido-no sexual interest even if wife responds favorably! Nonresponse of
partner( be it wife/ female relative/ girl friend) is not an issue in such kind of obstinate ‘difficult –to-cure ‘ male sexual disorder .This is absolutely of cerebral cause ,
involving pre frontal cortex, amygdaloidal nucleus and later hypothalamus .
Such syndrome is unrelated to spinal cord diseases ( as is in cases of spinal
cord .) Those who have been brought up
in religious families or strict environment they may have such problem of lack
of any sexual interest even after attaining
puberty. We the gynaecologits just can’t
treat them and have to refer such men to
sexologist and later Psychitriast .No point in refering to andrologist or surgeon,.
How far we the gynaecologits can help such a man knowing fully well that the treatment
offered by us will be suboptimal ?? What to do? To what extent r say how far we
the gynaecologist can help such an young men?? Ans; At least we can partly guide
them .,
History is very important. Many a drug cause erectile
diosrder and loss of libido. Clinical examination by Gynaecologist himself/
herself if ethically acceptable may reveal some local problem including
phimosis, or ant scrotal, penile operation varicocele. Hernia for which he is worried but can’t express to
any one neither share his partner/
friends In such a situation the honest advice
will be to refer him to a sexologist / clinical Andrologist. Unfortunately most
men are reluctant to attend sex counselor not to speak of Psychtriatist. The “dropout
rate”-- from their clinic is very high and will almost invariably insist on the
local practioner/ Gynaecologits for some drug to cure/ temporarily ameliorate
PE .If andrologist is unavailable at least a genl surgeon maybe consulted if
not available in the locality Andrologist. Sexologist consulation, and later some
drugs may help him to ameliorate PE(premature ejaculation). Few of us know that
ICD-9 have classified PE(premature ejaculation)
as “ If ILT
i.e. Intra vaginal latency time is less
than 1 minute. So ejaculation after 1 minute can’t be termed as PE. –that means
after the erect penis is introduce in birth canal . Regarding PE(premature ejaculation ) the treatment
should always be entrused to sex
counselor but if unavailable / unaffordable then one can prescribe Dejact-T
kind of drugs (discussed below) which
will serve the purpose temporarily .
Premature ejaculation –First and last tr is behavioural
therapy. But not all em will practice t as directed by sex counselor though
wife/. Partner will help and guide as instructed by Counselor with different diagrams
. But if he doesn’t respond to behavioural therapy:-The
recognised drugs for amelioration of premature ejaculation if he really reluctant to vist a sexologist then he
can take SSRI drugs, like : A) Fluoxetine, 20mg
OD B) Paroxetine 12.5 / 25 mg C) Dapoxetine 30/ 60mg -D) sertraline
25—50mg-ven100 mg (not to drive himself next mooring) for (erectile disorders which is
now approaching 40% in Indian males 20-50 yrs) ) –then again one has to seek
help of a professional sex counselor. But, in reality, as happens the male
partner denies going or stops visiting to such specialist for social stigma. In
such cases it is the responsibility of Gynaecologist to offer some drugs rather
than allowing the couple to “suffer in silence.”
I think it won’t be out of context to mention
the magnitude of problem of erectile
disorders & variety of so called safe
drugs for ED (erectile disorders):-There are some common drugs used for
3 decades with repute and satisfactions are (Phospho diesterase Inhibitors- PDE
5 Inhibitors) which will take care of
erection –A) Sildenafil, B) Tadalafil, C) Vardenafil,(Brand name). However the sildenafil is sold under the brand names of Androz(Sandoz):
Juan(Cadila), Viralkes(Pfizer), Manforce(Mankind), Edegra(Sun) & recent
addition is Levitra 10/ 20 mg( Filmtableten-Bayer ). is Edafil-20
–Ajanta Phrama)
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