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Male Sexual Dysfunction and Infertility



Erectile dysfunction (impotence) is the inability to get and keep an erection firm enough for sex.
The term is used if it happens most of the times over significant period of time.

Remember mnemonic "HE HAD IMPOTENCE”

  • HE: Heart Conditions
  • H: High cholestrol
  • A: Antidepressants and Antihypertensive
  • D: Diabetes, Depression
  • I: Injury to spinal cord or nerves of pelvis
  • M: Metabolic syndrome; involving high blood pressure, high cholesterol, high fat in the waist
  • P: Peyronies disease, Prostate problems, Prostate surgery
  • O: Obesity
  • T: Tobbaco and smoking
  • E: End Stage Renal Disease
  • N: Narcotics
  • C: Clogged Blood vessels (Atherosclerosis), Cholesterol high
  • E: Excess Alcohol


The best way to prevent erectile dysfunction is to make healthy lifestyle choices and to manage any existing health conditions.

  • H: Healthy life style
  • E: Exercise daily
  • A: Avoid smoking, substance abuse and limit alcohol
  • L: Lose weight
  • T: Treat Diabetes, Blood pressure, Depression
  • H: Have a consult with Urologist, Psychologist, Cardiologist

For most men, a physical exam and medical history are all that's needed for a doctor to diagnose erectile dysfunction and recommend a treatment. If you have an underlying medical condition, you might need further tests or a consultation with a specialist. Tests for underlying conditions might include:

  • Physical exam: Examination of your penis and testicles and checking your nerves for sensation.
  • Blood tests: A sample of your blood might be sent to a lab to check for signs of heart disease, diabetes, low testosterone levels, hormones like Prolactin and other health conditions.
  • Penile Ultrasound Doppler: This test is sometimes done in combination with an injection of medications into the penis to stimulate blood flow and produce an erection. The blood flow patterns in the penis are studied using an ultrasound machine.
  • Psychological exam and counseling: In case of underlying depression or relationship issues a psychological counseling/treatment is sought.

Cardiac evaluation:
In some cases erectile dysfunction may be the first sign of an underlying heart problem as these are generally a disease of blood vessels. A poor blood supply in penis may be associated with a poor blood supply in vessels of the heart! So in some cases with other risk factors for a heart disease, a consult and evaluation by cardiologist may be needed.

Treatment of Erectile Dysfunction
Erectile dysfunction is treated by a Urologist
Depending on the cause and severity of your erectile dysfunction, underlying health conditions, and your preferences, you might have various treatment options. Urologist will explain you benefits and risks of each treatment.

Oral medications
Oral medications are a successful treatment for erectile dysfunction treatment for many men. They include:
  • Sildenafil (Viagra), available in India
  • Tadalafil(available in India)
  • Vardenafil (Levitra), Not available in India
  • Avanafil (Stendra), not available in India
All four medications enhance the effects of nitric oxide — a natural chemical your body produces that increases blood flow to penis and allows you to get a better erection.

Some DO’s and DON’T’s for maximum beneficial effects of these medicines:
  • Taking one of these tablets will not automatically produce an erection. Sexual stimulation is needed first to cause the erection.
  • These medications are not aphrodisiacs, will not cause excitement and are not needed in men who get normal erections.
  • The medications vary in dosage, how long they work and side effects. Possible side effects include flushing, nasal congestion, headache, visual changes, backache and stomach upset.
  • There has to be a time gap between intake of medicine and its effect to start. The timings vary from medicine to medicine.
    For Viagra, kit is generally given 1 hour before sex.
    For Tadalafil, it is given 1-2 hour before sex.
  • The medicines should not be consumed immediately after a heavy fatty meal, as it reduces the efficacy of these medicines. Keep a gap of atleast half an hour between a heavy fatty meal and taking this pill.
  • You may not notice any effect during first few times after starting the pill. Sometimes the efficacy may be noticed after a few days. Sometimes the dose might need to be increased by the urologist if low dose not working for you.
  • Avoid taking pill more than once in a day.
  • NEVER CONSUME THESE MEDICINES WITH NITRATE GROUP OF MEDICINES WHICH ARE USED FOR HEART DISEASES (SORBITRATE is an example of nitrate group of medicines and is used in angina (pain in chest)! Always inform your doctor about any medicine you are taking. Taking these two medicines together can reduce the blood pressure to very low levels and is dangerous.

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