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Male Sexual Dysfunction and Infertility


  • Myth: They are harmful for heart!
  • Truth: These medicines (Viagra) were initially developed for treatment of heart diseases. Whatever cases you have heard about someone developing a heart attack after taking such medicines were due to someone having a severe or undiagnosed underlying heart problem, rather than the medicine causing it!!
  • Myth: These medicines are habit forming
  • Truth: the medicines are not known to be addictive or habit forming.
  • Myth: They interfere with quality of semen
  • Truth: They have no effect on semen or sperm quality and do not harm fertility potential. They are safe to have if you are trying to father a child.
Before starting any medicine for erectile dysfunction, including over-the-counter supplements and herbal medicines, consult your urologist. Taking these medicines without supervision should be avoided.

Other medications
Other medications for erectile dysfunction include:
  • Intra Cavernosal Self-Injection: With this method, you use a self injection in the penis of some drugs which increase blood flow to the penis and produce erections. Examples include papaverine, alprostadil and phentolamine. Some are not available in our country though!Often these combination medications are known as bimix (if two medications are included) or trimix (if three are included).
    Each injection is dosed to create an erection lasting no longer than an hour. Technique of injection is taught by your urologist in initial visits and then you or partner can administer the injections as and when needed at home.
    Side effects can include mild bleeding from the injection site, prolonged erection (priapism) and, rarely, formation of scar tissue at the injection site.
    Priapism is a surgical emergency. You need to report to your doctor/emergency immediately.
  • Alprostadil urethral suppository: Alprostadil intraurethral (MUSE) therapy involves placing a small suppository inside your penis in the penile urethra, using a special applicator to insert. Not available in India.
    The erection usually starts within 10 minutes and, when effective, lasts between 30 and 60 minutes. Side effects can include pain or minor bleeding in the urethra.
  • Testosterone replacement: Some men have erectile dysfunction that might be complicated by low levels of the hormone testosterone. In this case, testosterone replacement therapy might be recommended as the first step or given in combination with other therapies. Penis pumps (Vacuum Erection Devices) and Penile Implants.
  • Vacuum erection device is a hollow tube with a hand-powered or battery-powered pump. The pump is placed over the penis, and the pump creates a vacuum that pulls blood into your penis.
    Once you get an erection, a tension ring is slipped around the base of penis to hold in the blood and keep it firm. You then remove the vacuum device.
    The erection typically lasts long enough for a couple to have sex. You remove the tension ring after intercourse. Bruising of the penis is a possible side effect, and ejaculation will be restricted by the band. Your penis might feel cold to the touch.
  • Penile implants: This treatment involves surgically placing devices into both sides of the penis. These implants consist of either inflatable or malleable (bendable) rods. Inflatable devices allow you to control when and how long you have an erection. The malleable rods keep your penis firm but bendable.
    Penile Implants have a high degree of satisfaction among men who have tried and failed more-conservative therapies. As with any surgery, there's a risk of complications, such as infection.

    Recent studies have found that exercise, especially moderate to vigorous aerobic activity, can improve erectile dysfunction. However, benefits might be less in some men, including those with established heart disease or other significant medical conditions.

    Psychological counseling
    If your erectile dysfunction is caused by stress, anxiety or depression — or the condition is creating stress and relationship issues, you may need to visit a psychologist or counselor.

    Alternative medicine
    Before using any supplement, check with your doctor to make sure it's safe for you — especially if you have chronic health conditions.


    What Is Premature Ejaculation?
    There is no fixed time when a man should ejaculate during sex. But it’s probably too soon if you have an orgasm before intercourse or less than a minute after you start. It’s a problem because when you ejaculate you lose your erection and can’t continue having sex. You and your partner may feel dissatisfied.

    What Causes It?
    Cause is not really known. Probably men who have low levels of the chemical serotonin in their brains tend to take a shorter time to ejaculate.
    Emotional factors can play a role:
    • Stress or depression
    • Performance anxiety
    • Guilt
    • Relationship problems
    When Should I See the Doctor?
    Meet a urologist if PE is bothering you or your partner.

    How Is It Treated?
    Ninety-five percent of men are helped by behavioral techniques that help control ejaculation.
    Stop and start: You or your partner stimulate your penis until your feel like you’re going to have an orgasm. Stop the arousal for about 30 seconds or until the feeling passes. Start the stimulation again and repeat three or four more times before you actually ejaculate.
    The Squeeze: It works the same way as the start and stop method. But, when you feel like you’re reaching orgasm, you or your partner squeezes the head of your penis until you lose the erection. Repeat this a few times before ejaculating.
    Some men find that if they think of something else during sex they can last longer.
    These above methods are probably difficult to follow in practice! And most would seek some form of medical therapy.

    What Medications Can Treat PE?

    These include: Antidepressants(SSRIs) : A side effect of some selective serotonin reuptake inhibitors (SSRIs) is delayed orgasm.
    Anesthetic creams or sprays: You put these on the head of your penis to make it less sensitive. Leave it on for about 30 minutes. It must be washed off before sex so you don’t lose your erection or cause loss of sensation for your partner.

    Do any exercise Help?
    Kegel’s Exercises: Weak pelvic floor muscles sometimes contribute to PE. Kegel exercises may help strengthen them. Find the right muscles to tighten by stopping your urine in midstream. Hold them tight for 3 seconds and then release them for 3 seconds. Do this exercise 10 times, at least 3 times a day.

    Sensory Dorsal Neurectomy
    The penile dorsal nerve is the sensory nerve for the glans and penis. Patients with primary PE have penile hypersensitivity. The principle of surgical treatments is to decrease sensitivity of the glans penis by cutting some branches of this nerve.

    Glans Penis Augmentation (GPA)
    GPA by subcutaneous injections of Hyaluronic Acid(HA) gel was initially developed to augment a small glans penis and some patients reported improved PE . The postulated principle of GPA with an injectable gel is to form a barrier between tactile stimuli and the dorsal nerve ending receptor and it does not induce permanent sensory loss or sexual dysfunction .

    Erection problems and premature ejaculation are very common seen in up to 30 % of population.
    The problem is that in our society patients hesitate and feel shy in seeking help of a doctor. Physicians likewise often do not ask their patients about their sexual problems.
    This results in many patients being deprived of simple pleasures of life!
    Many times erectile dysfunction may be a first indicator of an underlying serious medical condition which might be missed.
    Most of these problems are easily correctable with simple measures and medications which are safe to use.
    So one should come out of the dark and seek help!

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