Q-A on SEX

DIFFERENT DISORDERS AND SEXUAL LIFE
What are the most common sexual dysfunctions among diabetics?
Erectile dysfunctions are common amongst diabetics. The causes could be vascular, neurological or psychological. In diabetic impotence, the history is suggestive of the presence of desire but decline in erectile ability at all times. Usually, the onset is gradual. In some, the presenting symptom could be premature ejaculation and rarely retrograde ejaculation. Diabetic women sometimes complain of reduction in lubrication and difficulty in reaching orgasm. Monilial infection may further reduce lubrication and associated itching makes intercourse uncomfortable. Monilial infection often leads to balanit is (inflammation of the glans penis).
What limits should one observe?
There is nothing like a limit in sex, either you indulge or you do not. A heart attack could have occurred even otherwise, like while passing urine or going to the toilet. However the best person to advise you would be a cardiologist because the treatment needs to be tailored according to individual needs. The following precautions may be usefuls-
(1) Avoid clandestine sexual activity as it tends to increase the heart rate more than usual.
(2) Avoid elaborate meals and alcohol prior to the sex act as lot of energy and blood flow would be utilized for digestion.
(3) It is advisable to do regular physical exercise, so that sexual exercise need not be an unaccustomed exertion.
(4) One may keep a nitroglycerine tablet or spray handy, if anticipating chest pain.
Is the female superior position advantageous to males with cardiac problems?
Scientific research has proved that alternation in sexual positions such as taking the bottom position or assuming a passive role has no significant energy saving advantage. The blood pressure and heart rates have been directly measured and have been found to be almost the same in men in the male superior as well as the female superior positions. The same holds true for females with cardiac problems.
Has high blood pleasure anything to do with sex ?
There is a marked increase in blood pressure during sexual intercourse. Very high blood pressure does pose a danger of cerebral haemorrhage and my cordial infection. However, it is desirable to control high blood pressure. Once controlled, the danger of catastrophic event is negligible with the short-terms changes that occur during intercourse and other physical activities. It is equally, if note more, important to inform the patients about the likely side-effects of anti-hypertensive drugs on their sexual response.
Which anti-hypertensive medicines have the least sexual side effects ?
No generalization can be made. However, diuretics, ACE inhibitors and vacillators have the least sexual side-effects. Yoga and Transcendental Meditation with biofeed back could be a safe adjunct.
"Whatever anti-hypertensive medications I use, my sex desire and potency get reduces consortial.... What should I do.... reduce the dose, stop the drug or stop sex ?"
Consult a competent physician. On most occasions, the medication can be changed to a drug which has the same effect on the target symptom, without polarizing the sexual system.
What precautions should one take during coitus if one is suffering from bronchial asthma?
The sex act per se is not very stressful. Shortness of breath is a natural response during the sex act and more so if one suffers from bronchial asthma. It becomes more intense if accompanied by anxiety. Use of a bronchodilator prior to sexual activity could be helpful.
What sexual problems can a man with kidney failure have ?
He may have less desire and inadequate erection due to anaemia, uraemia and testicular dysfunction. Like in any other chronic disease, psychological problems like depression and anxiety, leading to decline in sexual desire, are common.
What is Peyronie's disease ?
This is an uncommon condition usually found in men who are in their fifties and above. A fibrous plaque develop in the penis, leading to curvature of the penis which become apparent during erection. It may cause discomfort and, at times, pain during intercourse. Usually, this is a self-limiting disease. Operative procedures are rarely resorted to.
What are the causes of blood in semen ?
Any condition which can give rise to congestion and inflammation of the prostate and seminal vesicles can lead to blood in semen. Trauma and urethritis may also lead to blood in semen.
Can hepatitis (jaundice) lead to sexual problems ?
Yes, it kills the appetite for sex. In addition, the fear of transmitting or acquiring the disease (Type B) via sexual contact adds anxiety to the existing problem.
Can one indulge in sex during jaundice ?
This will depend upon the cause of jaundice. Of the many causes of jaundice, the one that should cause maximum concern is viral hepatitis, the reason being the sexual transmission of the disease to the spouse, who then may or may not manifest jaundice but may yet harbour the virus. Roughly speaking, the changes of transmitting the virus are maximum in the early stages of illness, especially in the programme phase which immediately precedes the onset of jaundice. The Hepatitis 'B' virus and possibly 'C' and 'D' virus being the important culprits, it would be prudent to consult the physician at the earliest and get both the partners investigated for the same.
Vaginal and even oral sex may transmit the virus. Barrier contraception (condom) does provide an effective method of protection against the sexual transmission; however, it would still be advisable to get the spouse vaccinated at the earliest as per the expert's advice.
Once the patient with jaundice has developed immunity (antibodies) to the virus and the spouse is already protected (with vaccination which takes up to weeks), normal sexual intercourse can be resumed.
Hepatitis D (delta) does not require any additional vaccination apart from that for Hepatitis B. Hepatitis C is rarely transmitted due to sexual contact. Using barrier contraception during sexual activity is advisable.
How does arthritis affect sexual relationships ?
In arthritis, pain and deformity usually lead to difficulty in the sex act, especially when the hip, knees or the back are involved. Factors like frustration, anger, dependency and low self-image due to deformity lead to depression. Steroid side-effects, e.g., obesity and moon-face complement this depression. Thus, arthritis debilitates sexual relationships both physically as well mentally.
What are the treatment options available ?
Discussion with the partner about alternatives and more comfortable positions is the best option. Speak to your partner about the areas which arouse you the most and inform him / her about the painful areas. Plan your drug schedule in such a way that you take pain relievers prior to the sex act. Select the best time for coitus, i.e.,, osteoarthritis is at its worst in the evening and better in the morning and the reverse is true for rheumatoid arthritis. This precaution will make the sexual encounter more comfortable. A shower or a tub bath together with warm water will act as a good foreplay activity, in additional to diminishing stiffness and pain. Use of lubricants can enhance the pleasure. It is particularly useful in Sjogren's syndrome, where along with a reduction of other sescretion of the body, there is a reduction in vaginal lubrication. Advice will vary with individual cases.
Can a man have sexual intercourse after a prostate operation ?
Yes, he can. Currently, the greatest number of prostatectomies are done via the transurethra route. After surgery, the quality of erection remains the same at the time of climax and men experience the same pleasure. The ejaculation usually remains unaffected though, in some individual, the quantity of ejaculate outside may be less or absent because of retrograde ejaculation.
What is the effect of mastectomy on a woman's sexuality ?
Though anatomically mutilating, theoretically a radical masterdom should have no effect on a woman's sexuality as her physiology remain unchanged. However, the physical mutilation may wreak a psychological trauma which can affect a woman's self-image and self-esteem to a great extent. She may begin to harbour the feeling that she has become less feminine and hence less attractive. This feeling may depress her and make her withdraw from social and sexual contacts. The surgeon must explain to the patient the operative procedure, the interpretive risks, the possible outcome and that it is being performed as a potentially life-saving curative / palliative procedure. To patients who are very apprehensive about the disfigurement, the surgeon may explain that reconstructive mammoplasty can be performed if so desired.
Can a woman lead a normal sex life after hysterectomy ?
Yes. Women who are sexually active before hysterectomy continue to remain so even after the surgery. Sexual life remains unchanged, as the coital function is preserved. Hysterectomy usually involves the removal of the uterus, but if it necessitates the removal of the ovaries as well, then the patient may require hormone supplementation.
Is there any relation between sex and obesity ?
On the face of it, sex and obesity may have no connection at all. Often sexual inadequacy may lead to anxiety and/or depression which may result in increased food intake in some individual. Hormonal disturbances may also lead to obesity. This factory may produce interference with normal sexual functioning and lead to overall sluggish behaves. Seen try habits and lack of exercise are common in obese individuals. This lifestyle may result in flabby muscles and sexual pleasure may decrease when the specific muscles that play a part in love making get easily fatigued.
Can smoking hinder sexually response ?
Smoking results in construction of the blood vessels, leading to an inadequate supply of blood to the genital organs which may, in turn, lead to sexual inadequacy. Discontinuation of smoking by a heavy smoker leads to an increase in the desire and many have reported better erectile ability.
Do routine X-rays induce impotence ?
No
Are there any diseases associated with increased sexual desire ?
Increase in sexual desire can be seen during mania where there is acceleration of activity in all spheres. Sometimes, there is increased sexual desire in schizophrenic patients, perhaps because of loss of inhibitors. Organic diseases, like a tumour in the frontal lobe of the brain or disturbances following head injuries or the post-octal stage following an epileptic attack, may be associated with increased sexual desire.
Is masturbation after marriage normal ?
Yes. Masturbation is normal even in married individual. It may be encouraged during period of separation, illness and in conditions where one partner's sexual needs are beyond the sexual capacity of the other.
What physical changes occur in the sexual apparatus when one grows older ?
As a man grows older, erection takes a longer time to occur. Similarly, in women, lubrication takes a longer time to occur. A man may often required direct physical stimulation to achieve erection and the same task also true of a woman's lubrication. With the passage of time, the colour of the semen changes from white to light yellow, the consistency gets thinner and the quantity decreases. When people are not informed about these facts, anxiety can be generated, as there is a vast discrepancy between the unrealistic expectation and the real experience. This factor hampers the sexual response, leading to avoidance of sexual overtures. Older persons tend to become obese because of sedentary lives, lack of exercise and changes in hormonal levels. Exercises to tone up the muscles and good functioning to beautify are essential. Such exercises help in improving the self-image and promotion a better sex life.
What are the most common conditions which could decrease one's sex drive in the later years ?
The common reasons for a reduced sex drive in later years are :
• Monotony and lack of interest
• Changes in physical appearance.
• Misconception about one's warning sexuality.
• Lack of communication.
• Depression.
Does the female sexual desire increase or decrease at menopause ?
Some women report an increase, while others report a decrease, in sexual desire at menopause. Increase in sexual desire may be because of relative freedom from pregnancy and, hence, one may reopens and perform with greater enthusiasm. Some women harbour the misconception that menopause marks the end of their sexual career and this fear increases their sexual drives as an affirmation of their femininity. Daring menopause (or even a few years earlier), a reduction in the secretion of the ovarian hormones may cause atrophy of the vaginal epithelium which leads to reduction in lubrication and hence pain at the time of sexual intercourse. This development causes a decline in sexual desire and a woman tends to avoid sexual overtures.
Is oestrogen therapy at menopause safe ?
It is advisable to consult a gynaecologist for the use of hormornal preposition during menopause. Sturgeon replacement can avoid atrophic vaginites which leads to painful intercourse and can also help in preventing osteoporosis which usually leads to frequent fractures. It would be best to take oestrogen with progesterone in monthly cycles.
Does benign prosthetic hyperbolas (BPH) increase libido ?
No. it does not increase libido.
Which sexual position is useful to individual with localized low back pain ?
The affected partner should lie on his / her back with the hips flexed. In this posture, the muscles are relaxed and the vertebral column remains flat on the bed; hence this position is comfortable.
Can obese individuals be helped in matters of sexual activity ?
Extreme obesity primarily inhibits sexual pleasure on account of mechanical inreference. Side-by-side positions where neither partner bears the other's weight and, at the same time, has all limbs free from embrance, can be advantageously.
Which positions are comfortable for the woman during late pregnancy ?
The lateral positions are generally found to be more comfortable.
Doctor, is there any sexual position which allows better grip ?
Yes, the rear entry (doggie) position and the woman's legs crossed position allow better grip as compared to other solutions. In the woman's legs crossed position, the intercourse is performed in the missionary position, where later, the woman crosses and keeps her legs inside her male partner's legs. This enhances arousal and both these positions are helpful in those males who face difficulty in reaching orgasm.
What is meant by retarded ejaculation ? Does diabetes have a part to play in cases of retarded ejaculation ?
Retarded ejaculation is the opposite of premature ejaculation. Western researchers observed that undetected diabetes is the most common cause of impotence. Diabetes may also cause ejaculatory disturbance, but it seems to impair the erectile mechanism more .
This history is absolutely essential and, in a large number of individuals suffering from sexual inadequacy, ignorance about the sex act may be a major factor. Adequate explanation abou the act of coitus and methods to enhance orgasmic pleasure may improve the majority cases.
What could be the reason for buckling of penis during penetration ?
Such buckling usually takes places because of reduced axial pressure following trauma or fracture of penis. In this condition all tests, including NPTR and Doppler will be normal but the patient will give a history of bending / buckling of penis at any attempt .
Are people with a single testicle impotent ?
No. A single "normal" testicle secretes enough hormones to maintain an individual's vitality.
What is the most common cause of erectile dysfunction ?
An occasional episode of an erectile failure, due to functional or situations like fatigue, tension or pressure to respond bad perform , is one of the common causes of erectile disjunction. This anxiety, fire-lived during subsequent, similar encounter, would result in related failures.
How can one distinguish a psychological erectile problem from an organic one?
If a man reports an erection of adeuqte quality and sustenance none situation and not in antihero, one can conclude that the problem is largely psychological.
Can alcohol lead to impotence ?
Yes.
How does one treat alcohol-induces impotence?
The treatment programme needs to be tailored according to individual needs and circumstances. The physician must determine whether the sexual dysfunction is connected with an isolated episode of drinking or is related to the long-term consumption of alcohol. He must confirm the status of the erectile and ejaculator components after history tacking and a careful physical examination. If the impotence is secondary to an isolated episode of alcohol intake, then the physician may reassure the patient that the sexual function may revert to normal if the latter completely abstains from alcohol. He should also then be made aware that his preoccupation with fear of failure can hamper his sexual responses. Necessary sexual techniques, with adequate blending of supportive psychotherapy and behaviour modification, may prove extremely beneficially. It is advisable to counsel the partner as well. She could be of great help in the treatment programme if she can understand the situation and is prepared to provide the supportive atmosphere.
What are the most common causes of organic impotence ?
Diabetes, vascular disorders and radical cancer cancer surgeries of the abdomen and pelvis are amongst the most common causes of organic impotence.
Is semen analysis necessary in a patient affected by impotence ?
Absolutely not. The absence or deficiency of sperms neither indicates nor results in impotence. Sterility and virility are two entirely different concepts and depend upon different types of cells present in the tests.
Which investigations are helpful in the diagnosis of sexual dysfunctions ?
Along with metabolic, hormonal and routine physical examination, one should also check the tone of the anal sphincter. Evaluation of the autonomic nervous system is a must in cases of impotence. The following procedures are important -
NPT monitoring : Nocturnal penile tumescence monitoring can help in determining whether one is getting erections or not. This procedure, however, does not give any idea about the rigidity of the penis.
NPTR monitoring : This procedures along with the preceding one gives an idea also about rigidity and sustenance of the erection.
EMG : Electromyographic studies could help diagnose neurological lesions causing impotence and reduction in pleasure and squirting of semen at the time of orgasm.
Intrapenile injection : This procedure involves an injection of vasoactive drugs (Papaverine, Papaverine mixed with Chlorpromazien or Phenotolamin, Prostag land in E1) directly into the lateral aspect of the penis. Depending upon the erectile response which the patent has and the amount of drugs which is injected gives a conceal a clue to diagnose inorganic, psychogenic or vasculogenic erectile dysfunction.
Doppler examination : This is a non-invasive technique which helps in determining the potency of the superficial and deep blood vessels of the penis. Its graphic representation are useful in judging the blood flow. On colour Doppler, blood flow can be clearly visualized.
Penile blood pressure : Penile systole blood pressure (by using a Doppler probe and a special cuff tied round the penis) divided by the systolic blood pressure of the arm, gives the penile bronchial index (PBI). If the reading is abnormal, it is probably indicative of vascular insufficiency.
Infusion cavernosometry and cavernosography
Infusion studies with normal saline are helpful in diagnosing venous leaks responsible for inadequate erection. Cavernosography with a contrast medium helps in detecting the presence of abnormal drainage channels responsible for erectile inadequacy.