Sexual health is an important aspect of the overall health of an individual. Sexual problems are common and are not only underreported and underdiagnosed, but also often improperly treated. These problems need systematic and scientific evaluation to identify the underlying cause and institute appropriate therapy.
Sex hormone disorders occur when there is either an overproduction or underproduction of the hormones responsible for sexual characteristics and development. Depending on the type of hormone disorder males may experience, the following abnormalities.

Errectile dysfunction (ED) / Impotence :

The inability to achieve and sustain an erection long enough to be suitable for sexual intercourse on a continuous basis (more than 25% of time) is termed as erectile dysfunction (ED). This is a fairly common problem and one of every ten men will suffer from ED at some point during his lifetime. In majority of cases, ED is a symptom of an underlying problem. This condition is not considered normal at any age and should not be confused with premature ejaculation. This is sometimes also referred to as Impotence.

An absence of night time erections, is a very important indicator of ED. Normally, men have 3 to 5 erections per night. Each erection lasts for up to 30 minutes.

A host of factors can cause ED, such as:

• - Diabetes
• - Hypertension
• - Atherosclerosis
• - Stress, anxiety or depression including problems in relationship with your partner
• - Alcohol and tobacco use
• - Some prescription medications, such as antidepressants, pain medicine, antihypertensives, muscle relaxants, diuretics, etc
• - Fatigue
• - Brain or spinal-cord injuries
• - Hormonal problems
• - Hypogonadism (which leads to lower testosterone levels)
• - Multiple sclerosis
• - Parkinson's disease
• - Radiation therapy to the testicles
• - Stroke
• - Some types of prostate or bladder surgery

• - Medical history (any medications taken, past history, addiction to recreational drugs or alcohol etc)
• - Physical examination (penis and rectum)
• - Hormone profile
• - PSA
• - Nerve Testing
• - Nocturnal penile tumescence (NPT) to check for normal night time erections
• - Penile ultrasound to check for blood vessel or blood flow problems

The treatment plan varies depending upon the exact cause identified and may include any of the following options:

Medication

Medications such as sildenafil (Viagra), varderafil (Levita), or tadalfil (Cialis) may help improve sexual function in men by increasing blood flow to the penis. But should be taken only after consultation with the doctor.
Trans urethral pharmacotherapy may be advised- where a suppository (containing the medicine alprostadil) is placed into the urinary tube (urethra) using a plastic applicator. It gets absorbed into the bloodstream and relaxes the blood vessels, allowing blood to flow into the penis.
Men with low levels of testosterone may benefit from hormone replacement

Mechanical aids

Aids such as vacuum devices and penile constriction rings serve as erectile aids for some men.

Penile injection therapy (intracavernosal injection therapy)

Men are taught how to inject medications directly into the erection chambers of the penis to create an erection.
Injection therapy is effective in treating a wide variety of erection issues caused by blood vessel, nerve, and psychological conditions.
The most common side effects are pain and penile scarring (fibrosis).
A painful erection that lasts longer than two to three hours is called priapism and may occur with injection therapy.

Psychology and sex therapies

Psychological causes may contribute to erectile failure even when there is a clear organic cause.
Sex Therapy with a trained counsellor can help a person address feelings of anxiety, fear, or guilt that may have an impact on sexual dysfunction.

Penile prosthesis surgery

Inflatable penile prostheses (Penis implant) are implanted during outpatient surgery. This enables to have an erection whenever the man desires. The use of a prosthesis preserves penile sensation, orgasm, and ejaculation for most men.

HOW IS ERECTILE DYSFUNCTION TREATED?

How erectile dysfunction is treated depends on what things are causing it. After your doctor checks you for medical problems and medicines that might cause erectile dysfunction, he or she may have you try a medicine to help with erectile dysfunction. Some of these medicines are injected into your penis. Other medicines are taken by mouth. Not everyone can use these medicines. Your doctor will help you decide if you can try them.

WHAT OTHER OPTIONS DO I HAVE ?

If the medicines aren't right for you, you could also try using vacuum pump devices, or you could have surgery. Your doctor may send you to an urologist to talk about these options.

HOW DO I KNOW WHICH TREATMENT FOR IMPOTENCY IS BEST SUITED FOR ME?

The decision about treatment option should be discussed with your physician. Your choice of treatment will depend on personal preference and economic factors. Both you and your partner should be comfortable with your choice.

IS IT NECESSARY FOR MY SEXUAL PARTNER TO BE INCLUDED IN DISCUSSIONS ON MY IMPOTENCE?

She helps the doctor understand the problem and must agree with the treatment choice.

CAN ANY OF THESE TREATMENT OPTIONS REVERSE IMPOTENCE?

Most impotence is irreversible. While none of the three treatment options reverse a man’s impotence, they do offer a solution to the problem.

HOPE THROUGH RESEARCH

Advances in suppositories, inject able medications, implants, and vacuum devices have expanded the options for men seeking treatment for ED. These advances have also helped increase the number of men seeking treatment. Gene therapy for ED is now being tested in several centers and may offer a long-lasting therapeutic approach for ED.
The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) sponsors programs aimed at understanding the causes of erectile dysfunction and finding treatments to reverse its effects. NIDDK's Division of Kidney, Urologic, and Hematologic Diseases supported the researchers who developed Viagra and continue to support basic research into the mechanisms of erection and the diseases that impair normal function at the cellular and molecular levels, includingdiabetes and high blood pressure.

POINTS TO REMEMBER

• • Erectile dysfunction (ED) is the repeated inability to get or keep an erection firm enough for sexual intercourse.
• • ED affects 15 to 30 million American men.
• • ED usually has a physical cause.
• • ED is treatable at all ages.
• • Treatments include psychotherapy, drug therapy, vacuum devices, and surgery.

=> Reduced Libido: Reduction in libido or sexual desire is also a common problem. I may occur transiently due to psychological factors and stress. However, it may also indicate an underlying disorder like thyroid disease, testosterone deficiency (hypogonadism) or prolactinoma (increased levels of a hormone called prolactin). Appropriate blood tests are needed to diagnose these disorders. In a majority of cases, these problems can be satisfactorily treated.

=> Premature Ejaculation: Premature ejaculation is a very common complaint in which the ejaculation occurs very early during sexual intercourse. It often has a psychological basis and may signify underlying performance anxiety. After a proper evaluation, it can usually be treated satisfactorily with behavioral therapy and certain drugs.

=> Gynecomastia: Gynecomastia is the enlargement of breasts in men. This is a normal occurrence during puberty. It may also occur because of obesity and certain hormonal disorders like increased prolactin secretion from pituitary gland and hypogonadism. Simple blood tests can identify the underlying cause and can usually be treated with drugs.

=> Hypogonadism: Hypogonadism is the reduced production of hormones like testosterone from testes. It can be because of a testicular problem like infection, trauma; or a pituitary disorder in which there is reduced secretion of regulatory hormones like Follicle Stimulating Hormone and Luteinizing Hormone. Hypogonadism may lead to low libido, erectile dysfunction, low mood, depression, reduced hair on body and in beard area, muscle wasting and reduction in bone density (osteoporosis). Hypogonadism is easily treated with injections or tablets after a thorough evaluation. A proper follow up is necessary to avoid any long term complications of such therapy.

=> Andropause: Andropause is the reduction in testosterone production by testis which occurs with age. It is also called late onset hypogonadism. It can lead to problems in sexual function, depression, frailty and osteoporosis. It is very important to identify and treat this disorder as it severely impairs the quality of life of an individual.

=> Infertility in Men: Infertility in men may be because of reduced or abnormal sperm production by testis. This may be because of infection or trauma to testis, testosterone deficiency, thyroid disorders, varicocoele or obstruction to the flow of sperms from testis. A thorough evaluation may include blood tests, semen analysis and ultrasound of testis. Once the underlying cause is detected, appropriate therapy can be given under expert guidance.

The treatment is directed towards reducing the hormone disbalance and sexual disorders. Following options are tried alone or in combination :-

• - Scrotal ultrasound
• - Semen Analysis
• - Hormone Therapy
• - Behavioral Therapy
• - Surgical Treatment
• - Medications