SEXUAL AVRSION DISORDER

Definition

Persistent or recurrent extreme aversion to, And avoidance of, all(or almost all) genital sexual contact with a sexual partner.

Sexual aversion is severe irrational fear to sexual activity which leads to avoidance of sexual situations. It affects males as   well as female.

The disturbance causes marked distress or and interpersonal when confronted by a sexual opportunity with a partner. The aversion to genital contact may be focused on a particular aspect of sexual experience (e. g. genital secretion).some individuals experience generalized aversion to all  sexual stimuli including undressing, touching  and kissing. The intensity of  reaction may range from moderate anxiety to extreme psychological distress. Some individuals may experience profound sweating, panic attacks, feeling of terror, faintness , nausea, diarrhea, palpitation, dizziness and breathing difficulties. There may be markedly  impaired interpersonal relations  and marital dissatisfaction. The individual may avoid sexual situations by covert strategies like going to sleep early, using substances or being over involved in work.   

 

Cause

1. Severely negative parental sex attitudes

2. History of sexual trauma

3.Gender identity confusion

 

Treatment  

The goal of the treatment is to reduce the fear and avoidance of sex by the individual. Systematic desensitization: all the anxiety-provoking stimuli are arranged in an ascending level sand the individuals is exposed to, one by one, from the least anxiety-provoking stimulus to the most anxiety provoking stimulus. Initially, the individual is gradually exposed to imagination under relaxation and then to the actual sexual situation that generates anxiety.

Marital therapy is used for correction of relational problems

Supportive psychotherapy

Education, permission-giving. Sensate focus (matual pleasuring)

Explained.

Posted by Dr. Ramesh Maheshwari, Wnho Clinic, 2014 sadashiv peth, Tilak road, Pune. Free to call for further information.
 

 

PREMATURE EJACULATION

 

Definition:

Presistent  or recurrent ejaculation with minimal sexual stimulation before, on, or shortly after penetration and before the person wishes it.

It has been difficult to define ‘Premature ejaculation ‘ since there is a great variation in physiology of ejaculation. International Society for Sexual Medicine (ISSM) has defined (PE) as “Ejaculation in less than 60 seconds from start of intercourse.

PE is seen in young men from their first attempt at intercourse. Later they acquire ability to delay the orgasm after a adequate function. PE can create tension in relationship. Wife’s estimate of duration of time from the beginning of intercourse until ejaculation , as well as her judgment of whether PE is a problem, can be quite misleading. PE can create tension in relationship.

Patients may misinterpret secretion from bulbo-urethral glands as semen and label himself suffering from P.E. Some may see prolonged period of intercourse in blue flims and feel it as standard. Some may think that anything short of ability to prolong till wife’s orgasm is PE. Some think duration mentioned by friend is normal.                                                                             Patient try their own way to prolong the period by diverting attention, pinching self, using a condom during the intercourse, drinking alcohol or masturbating prior to intercourse. All these are found to be unproductive techniques. In attempting to control orgasm, man is distracting himself from stimulation of touch and arousal, and he fails to enjoy his sexual feelings and may lose erection. Therefore emphasis should be on increasing penile stimulation and not avoiding it.

Causes:

Anxiety.   Hurried sexual experience.Excessive sensitivity of glans.Rapid ejaculatory reflex.                                                                               Fear of losing erection.                                                                        Prolonged abstinence.                                                                              Fear of detection.

Treatment:

Counseling:

Counseling  of Couple is done. It is emphasized that problem is not in genitals, problem is in the brain.

Sex Therapy:

It is based on systemic desensitization to bring about behavioral modification.

Posted by Dr. Ramesh Maheshwari, Wnho Clinic, 2014 sadashiv peth, Tilak road, Pune. Free to call for further information.
 

 

MALE ORGASMIC DISORDER

Definition:

Persistent or recurrent delay in, or absence of, orgasm following a normal sexual excitement phase during sexual activity.

In this disorder a male cannot reach orgasm during intercourse although can ejaculate by partner’s manual or oral stimulation. Some can ejaculate only during masturbation. Some have ejaculation during sleep but not in waking period.

Orgasm and ejaculation though occur simultaneously, are different entities. Orgasm can occur in absence of ejaculation and vice versa.

Causes:

Dislike for partner.                               Testosterone deficiency.Religious restrictions.                         Myopathy, Neuropathy.Maturbation guilt.                               Spinal cord lesion.Guilt regarding nocturnal.                   Retrograde  ejaculation.     Emission.                                                                                                           Fear of pregnancy.                               Drugs.       Inadequate sexual stimulation.          High threshold of ejaculatory                                                                                             reflex.Low         Libido.                                            Mental Block.

 

Treatment:

Sensate Focus exercise (mutual pleasuring) is employed daily for first 3 days. Since sex is not allowed, it eliminates the pressure to perform. 

Once this is achieved, she stimulates him to highest degree and as man approaches ejaculation she inserts penis in vagina in woman on top position. If man is unable to ejaculate she again stimulates him manually and again reinserting whe ejaculation is imminent.

Vibrators: 

Used for stimulation of penis.

Posted by Dr. Ramesh Maheshwari, Wnho Clinic, 2014 sadashiv peth, Tilak road, Pune. Free to call for further information.

 

MALE ERECTILE DISORDER (IMPOTENCE)

 

Definition

Persistent or recurrent inability to attain, or to maintain until completion of sexual activity, an adequate erection.

This is also know as erectile dysfunction.

The disorder may cause marked distress or interpersonal difficulty. There are different patterns. Some individuals report inability to obtain erection from the beginning of sexual experience ;while others report being able to experience erection only during masturbation or on awakening, but not during the coitus. Some experience adequate erection,lose it when attempting penetration. Still other report that have an erection that is sufficiently firm for penetration, but they lose erection before or during thrusting.

Male erectile disorder is frequently associated with anxiety, fear of failure, pressure of sexual performance, and decreased sexual excitement and pleasure. This can disrupt marital relationship and may be the cause of unconsummated marriage and infertility.

 

Etiology

Aging:with advancing age,

                 The orgasm is less intensive,

               The ejaculate is reduced

The interval between the two successive acts is increased.

 

Psychological factors:

Fatigue,

Depression,

Stress,

Mental disorders,

Guilt,

Fear of failure,

Low self esteem

Religious restrictions

Homosexuality

Long/serious illness

Traumatic initial experience

Negative feelings towards the partner

Vascular causes

Use of tobacco/Alcohol

Atherosclerosis

Peyronie’s disease

Diabetes

Hypertension

Venous leak or occlusion

Trauma

Surgery

Radiation

Harmonal causes :

Hypogonadism

Hyperprolactinemia

Diabetes

Thyroid disease

Androgen deficiency

Estrogen excess Adrenal

pituitary of Hypothalamic disease

Neurogenic causes :

Peripheral Neuritis

Autonomic neuropathy (in Diabetes)

Multiple sclerosis

Spinal cord disease

Drug related casuses :

Antiandrogens

H2receptor antagonists

Diuretics

Antihypertensive

Anticholinergics

Antidepressants

Antipsychotics

CNS Depressants

Substance abuse

 

Miscellaneous

Rental failure

Prostatectomy

 

 

 

Diagnostic tests

Stamp Test :A long strip of postal stamps in wound around the base of the penis at night before going to bed. Next morning if the perforations of the strip are found to be torn off, impotence is supposed to be of psychological in origin.

Peno-brachial index : The ratio of penile systolic blood pressure to that of brachial systolic blood pressure is normally 0.6. If found to be low, impotence is vascular in origin .

Papaverine Injection Test :  Papaverine is a vasoactive drug. Using a 26 gauge needle, 30 mg papaverine is injected at the mid-shift of Corpus cavernosum  of penis. He is isolated, asked to stoke the penis and expose to erotic literature. Erection will occur in 10 to 15 minutes. If the erection is short-lived or partial, then impotence is considered as vasculogenic.  If the erection is full, then impotence is considered to be neurogenic or psychogenic. In origin.

Caution : This test should be performed in a hospital setting or where the facilities for detumescence  are available. The patient should be observed for next few hours till the erection subsides.

Rigiscan Test :

This is a gold standard for evaluation of Nocturnal Penile Tumescence and Rigidity (NPTR). This test is based on the physiological principle that a male gets erection 3 to 5 times during REM sleep. Atnight before going to sleep one ring of Rigiscan is slid over the base of the penis and the over the tip. Next morning, the tracing obtained are studied. This test can quantify erectile tumescence and rigidity. Rigiscan tracing indicates whether the impotence is organic or psychological in origin.

Arterial insufficiency  and venous leaks can also be suspected on the basis of Rigiscan graphs. Patients with purely artery disease have low levels of rigidity but of adequate duration. Patients with venous leak will have varying rigidity levels with shortened duration.

Penile Ultrasound :

This test is for evaluation of functioning of the penile areteries. A simple acoustic Doppler emits auditory singnals or a colour Doppler can help visualization of arteries. Cavernosometry  & cavernosography: this haemodynamic  test is useful for diagnosing    veno-occlusive dysfunction of the corpora. Biothesiometry, electromyography , nerve conduction studies: these are for evaluation of neurogenic impotence.

 

Treatment      

Counseling

Sexual dysfunction is a marital unit problem and therefore both, husband and wife, should attend. Counselling is towards strengthening marital relationship. Wife is requested to co-operate. Client is requested to quit smoking and alcohol. He is advised relaxation exercise, yoga. The couple is educated about anatomy, physiology of sexual organs sexuality are countered. Their myths and misconceptions about  sexuality are countered. They are also explained that he does not have to do anything to have an erection. Erection is a physiological response to effective stimuli.

Posted by Dr. Ramesh Maheshwari, Wnho Clinic, 2014 sadashiv peth, Tilak road, Pune. Free to call for further information.

 

FEMALE ORGASMIC DISORDER

Definition:

Persistent or recurrent delay in, or absence of, orgasm following a normal sexual excitement phase . It was formerly known as inhibited female orgasm. Some researchers called it Female Orgasmic Dysfunction.

Causes:

Strong negative signals from psychosocial system results in female orgasmic disorder . In our culture the female has been forbidden to accept herself as a sexual being. Girls as they grow up, deny their sexual feelings in order to conform to society’s image of “good” behavior. Later, as a woman, she resists the experience of orgasmic response. Anxiety and guilt feeling due to religious orthodoxy can cause this dysfunction . The idea that it is woman’s duty to satisfy her husbands makes her inhibit her own sexual response. Woman may have orgasm with masturbation by stimulating her clitoris, with partner’s manipulation or with oral-genital stimulation, but not during intercourse. Similarly, a woman may be orgasmic during intercourse, but not with other kinds of stimulation.

The organic causes for this dysfunction are multiple sclerosis, spinal cord trauma or tumor, nutritional deficiencies, diabetic  

Neuropathy and severe arteriosclerosis . Chronic illnesses impair orgasmic responsiveness by affecting libido and generalHealth.

 

Treatment

The treatment is based upon the information indicating woman’s attitude towards sex, the degree of her open-mindedness and her physical responsiveness. The first goal is to help the couple to stop behaving toward each other in hostile or in negative ways, so that they can create erotic aura in their relationship. They are provided information about sex to counter myth and misunderstandings that stand in the way of woman’s response to sexual stimuli.

The couple is given instruction to practice ‘Sensate Focus’ exercise for 3 days. On the next 3 days, after the couple has experienced feelings of closeness and intimacy in pleasuring each other, they proceed to genital play.    

 

Posted by Dr. Ramesh Maheshwari, Wnho Clinic, 2014 sadashiv peth, Tilak road, Pune. Free to call for further information.

DYSPAREUNIA (PAINFUL COITUS)

DYSPAREUNIA (PAINFUL COITUS)

Recurrent or persistent genital pain associated with sexual intercourse in either male or a female.

In females, the pain may be superficial during penetration or deep during penile thrusting. The intensity of pain may range from mild discomfort to sharp pain. On examination, no genital abnormalities are seen. Repeated genital pain during coitus may result in the avoidance of sexual activity, disrupting existing sexual relationships.





Females : Dyspareunia can be of psychogenic or organic in origin.

Pain in vaginal outlet and clitoris : If the hymen is intact, this is a source of irritation. Episiotomy scar can cause pain. Smegma accumulated under the foreskin of clitoris

Irritates the area and causes intense burning.

Pain in the vagina : One of the common causes is failure to lubricate. This happens when the women has no affection, respect or understanding for her husband. Because of various fears like fear of pregnancy or of coitus, her natural responces will be inhibited. Many woman do not lubricate because of aging. Thin walls of vagina crack and bleed easily during the intercourse, causing discomfort that lasts for hours to days. Homosexual women will not lubricate in heterosexual activity. Infections of vaginal or urinary tract will give rise to burning, itching or pain in the vagina. When there is itching and burning but no infection, sensitivity to the rubber of condom is apossibility.

Pain deep in pelvis : Laceration or tears in the ligaments which support the uterus, caused by gang rape or criminal abortion may result into pain deep in pelvis. It is associated with backache, throbbing in pelvis, tired feeling

And painful menstruation . Endometriosis, infection in cervix, uterus, and tubes cause pain during thrusting . Infection can be due to gonorrhea or of E.coil.Hysterectomy, tumors and ovarian cysts can cause pain deep in the pelvis.


: Some men do not retract the prepuce during masturbation. Their glans of penis remains hypersensitive to touch. They find pain during coitus. In men with poor hygiene, the smegma accumulates on the glans, causing pain during coitus. Phimosis can cause pain during coitus. Allergy to condom rubber, jellies, foams and douching materials can give hypersensitivity reaction to the males. Infection of vaginal canal causes burning and itching. Fibrosis of penile tissue following a trauma causes pain during masturbation and intercourse.
: Reassurance, countering myths and misconceptions and supportive psychotherapy will be helpful in dyspareunia of psychogenic origin. Insufficient foreplay may lead to failure of lubrication in females. Thick hymen will need excision. Accumulation of smegma needs cleaning daily. Senile vaginitis requires hormonal replacement. Homosexual women are not amenable to any treatment.




Posted by Dr. Ramesh Maheshwari, Wnho Clinic, 2014 sadashiv peth, Tilak road, Pune. Free to call for further information.

This Leaflet is for those who want to be in partnership with Wnho Clinic. Earn extra with your existing premises.

SEX FACTORS HELPFUL IN TREATING INFERTILITY

1. If the couple involves in foreplay including the stimulation of nipple and clitoris of the female, and she goes into the plateau phase of sexual response, there is ballooning of inner end of vagina that acts like a receptacle for holding the semen os of the uterus widens and the cervix of the uterus dips down in the pool of semen. 

2.In Man-on-top position of intercourse, if woman keeps a pillow under her buttocks, separates and flexes her things on her abdomen deeper penetration and ejaculation near the os is possible. If she remains in this position after the intercourse it discourages semen from escaping out of vagina.

3. In knee-elbow position of the female during the intercourse, the cervix of the uterus gains easier access to the seminal pool, especially if the uterus is retroverted.

4. Intercourses during the ‘Fertility Period’ (around the ovulation period),the chances of fertilization are more

5. During the fertility period the woman should remain in bed in a supine position for about 30 min after the intercourse. During this period, there is a chemical reaction between the constituents of the semen. The clotting enzyme of prostatic fluid causes the fibrinogen of seminal vesicle fluid to form a weak coagulum, which then dissolves during the next 20 min. because of lysis by fibrinolysin.  In the early minutes after ejaculation, the sperms remain relatively immobile because of viscosity of coagulum. However, after the coagulum dissolves, the semen becomes colorless and watery thin and the sperms become highly motile.

6. Infertility due to Unconsummation  :

It is not uncommon to come across a couple refractory to the management of unconsummation , especially when it is due to Vaginismus, Premature ejaculation, relative impotence or due to hypersensitive glans

The couple needs counselling prior to the procedure and should be informed that the child is born by the union of a sperm and an ovum; and that the role of the penis in fertility is no more than a syringe to convey the sperms to the vagina. Using a syringe for fertility does not harm the baby in any way.

7. Infertility due to male orgasmic Disorder:

This is not uncommon in our country. Some are able to ejaculate in sleep but not by masturbation or during the coitus. In such males, before going to sleep, they may be asked to wear a condom that has been repeatedly washed under water and is thoroughly dried. The semen collected in the condom can be deposited in the vagina with the help of a 5ml.Syringe.

Posted by Dr. Ramesh Maheshwari, Wnho Clinic, 2014 sadashiv peth, Tilak road, Pune. Free to call for further information.