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Comprehensive Treatment of Male Psychogenic Sexual Dysfunction by Sex Therapy and Psychotropic Drugs (Without 5PDEIS)

Comprehensive Treatment of Male Psychogenic Sexual Dysfunction by Sex Therapy and Psychotropic Drugs (Without 5PDEIS)

In predominantly organic sexual dysfunction, psychogenic component varies from culture to culture. It is significant in conservative Muslim societies like Pakistan. In psychogenic sexual dysfunction predisposing, precipitating and maintenance psychological factors lead to performance anxiety or acute stress. The increased sympathetic tone and increased level of adrenaline (epinephrine) and noradrenaline (norepinephrine) is there. This presents as erectile dysfunction, ejaculatory dysfunction, orgasmic dysfunction and libido psychosocial method by combining sex therapy with pharmacotherapy.

In severe performance anxiety or acute stress of performance failure, PSE 5 inhibitors are nonresponsive and if responsive drug dependence and later non responsiveness are major issues. Sexual response is normalized by sex therapy and balancing the autonomic nervous system by psychotropic drugs. The basic pathology in psychogenic sexual dysfunction is imbalance of autonomic nervous system leading to dysfunctional sexual response cycle. Psychological factors that predispose, precipitate and maintain psychogenic sexual dysfunction are treated by psychosexual therapy (sex therapy) which integrates cognitive–behavioral interventions, system/couple interventions and sometimes psychoanalytic interventions. Imbalance of autonomic nervous system, causing Performance anxiety or acute stress in sexual dysfunction, is treated by SSRI, benzodiazepines supported by yohimbine and testosterone and some time by I/C injection This pharmacological intervention facilitates early recovery.

Psychogenic sexual dysfunctions are very common in conservative Muslim society like Pakistanis where masturbation and sex education is a taboo and late marriage is common. Masturbation and semen loss is perceived as cause of sexual dysfunction. Guilt feeling of premarital and extramarital sexual activities due to religious beliefs and fear of impotence by masturbation leads to sexual neurosis and is cause of high incidence of psychogenic sexual dysfunction in Muslim societies. In my clinic in Lahore and Islamabad since 1996 more than 85% of patients are below 40 years of age and in these more than 90% present with psychogenic sexual dysfunction. (This is almost reverse ratio to European and American studies).

In organic sexual dysfunction the psychogenic element is significant due to the social impact of being impotent i.e. ‘Not a Man’ (called Namard in Urdu). The most common complaints are less erection or no erections, less ejaculation time and white semen drops on sexual stimulation leading to erection failure. The exclusion criterion is patients with H/O psychiatric treatment or major symptoms of depression. I treated psychogenic sexual dysfunction patients by sex therapy counseling, SSRI’ (fluoxetine 10 to 25mg per day) and Benzodiazepines (clobazam 5-10mg per day) supported by Yohimbine (5-15 mg per day), testoviron inj 250mg and in some cases I/C alprostadil. Aphrodisiac food and regular physical activity is advised. In unmarried men, masturbation was advised to confirm the improvement in sexual dysfunction and advised to marry and avoid extra marital relations. In married couples regular sexual activity with reference to age is advised. In organic sexual dysfunction mostly diabetics and vascular problems psychogenic element is significant due to cultural reasons. Treated psychogenic element as above and in good number of patient’s normal sexual function is restored. Normal sexual functions restored in 10 weeks of weekly sessions of sex therapy and pharmacotherapy. Drugs are tapered off after 10 weeks.

In conclusion, in male psychogenic sexual dysfunction normal sexual function is restored by sex therapy, counseling and psychotropic drugs (SSRI, Benzodiazepines). This reduces PDE5 inhibitor dependence and later on non-responsiveness to PDE5 Inhibitor.

Conference: AOFS Busan 2016
Areas of Interest / Categories: Androgen Therapy, AOFS 2016

AOFS 2016

The History of Condoms

The condom has been used to prevent unwanted pregnancy as well as sexually transmitted diseases throughout human history since Crete or ancient Egyptians era. In Asian countries, ancient Chinese used the silk made condom with oil lubricant and Japanese also used the leather made hard condom with dual purpose of disease prevention and penile supporter. 

Complex Nutrition Necessary for Erectile Function in Aging Man

The quality of sexual function and desire in aging male will change. Normal age-related change in erectile function will affect sexual desire. These symptoms include a decrease in blood flow to the scrotum and penis; reduced tensing of the scrotal sac and delayed erection. Penile sensitivity also decreases with age. Aging contributed to the process of erectile dysfunction through increased oxidative stress–one of which is due to induced eNOS uncoupling, endothelial dysfunction in the penis, structural changes of the artery, and reduced level of sex hormones in circulation. Many of these changes can be related to or exacerbated by several causes. 

Sex History in Korea

As in the Mediterranean and most of the other parts of the world, Korea in the Neolithic era was a matriarchal society. The so called Hong San culture of Ancient Korea, now in north-eastern China, proves it with many remains including the ‘Goddess of Fertility’. However, with the establishment of political community and patriarchy in 3 millennium BC, it changed to a male dominant society. During the Three Kingdom and Unified Shilla Period, Koreans enjoyed relatively free sex and intermarriage was not strange, especially in the Royal Family of Shilla. Unlike in China.

Unexplored Problems of PCOS Patients

Aim: Studies have shown sexual dysfunctionality in 20-25% of infertile couples. Polycystic Ovarian Syndrome (PCOS) is the most common hormonal disorder among women of reproductive age and is a leading cause of infertility. Infertility may alter a woman’s sexual expression by causing or exacerbating sexual problems as a consequence of the diagnosis, investigation and treatment of infertility. Adequate sexual function can contribute to the success of fertility treatments. This study aims to assess sexual function in infertile and PCOS women in relation to their age, body mass index and duration of infertility. The prevalence of Female Sexual Dysfunction (FSD) and PCOS in infertile women and its correlation with infertility was also evaluated. And to find the relationship between Female Sexual Dysfunction and testosterone levels in women with Polycystic Ovary Syndrome (PCOS).

Significance to maintain morning erection in even over 60 year-old men for active well aging

The ultimate aim of Andrological medicine is the study of the maleness, creating the health and well-being of human male. So that, even though the fundamental study of andrology is very essential, we should finally reach to clinical andrology.

Recruiting Endogenous Stem Cells: A Novel Therapeutic Approach for Erectile Dysfunction

Studies on Exogenous Stem Cells (SCs), owing to their regenerative capacity, represent one of the most promising methods to restore Erectile Dysfunction (ED). However, insufficient source, invasive procedures, ethical and regulatory issues hamper their use in clinical applications. The endogenous SCs/progenitor cells resident in organ and tissues play critical roles for organogenesis during development and for tissue homeostasis in adulthood. Even without any therapeutic intervention, human body has a robust self-healing capability to repair the damaged tissues or organs. Therefore, SCs-for-ED therapy should not be limited to a supply-side approach.

A Study of Sexuality and Sexual Knowledge among Sexually Active Adults in Mongolia

This study was designed to examine the relationship between sexual activity, sexual behaviour, sexual problems, lifestyle and sexual knowledge among sexually active women and men. We describe measures of sexual partnerships, sexual practices, sexual problems, attitude towards sex and sexual knowledge. We compare measures of sexuality for those 18-73 years old, by age, separately for men and women using sexual function questionnaire, IIEF-5, FSFI and Sexual complaints screener for women. We evaluated the prevalence of sexual activity, behaviours, and problems in a sample of 400 adults.