Conceptual Study-69     ROLE OF MANAS IN THE ETIOPATHOGENESIS        OF MALE SEXUAL DYSFUNCTION AND ITS    MANAGEMENT WITH...
Conceptual Study-70           VAIDYARATNAM P.S. VARIER AYURVEDA                                  COLLEGE,                 ...
Conceptual Study-71                              AcknowledgementI have great pleasure to let out my deep-rooted sense of g...
Conceptual Study-72                                CONTENTSIntroducation                                                  ...
Conceptual Study-73INTRODUCTIONAmong the thousands of species in the animal kingdom on earththe most advanced is considere...
Conceptual Study-74physiological factors and their treatment. But the Influence ofhuman mind in life and the precursor fac...
Conceptual Study-75     In addition to this type of preoccupied anxiety, precedingoccurrence of the disorder in an occasio...
Conceptual Study-763. Gender identity disorders.      Among the three classifications sexual dysfunction is theinability  ...
Conceptual Study-77   1.     Early sexual experiences- includes sexual conditioning          and preoccupied fear.   2.   ...
Conceptual Study-78present study a primary level analysis of mind in relation to sex iscarried out. Mind regulates and con...
Conceptual Study-79organisms including human beings are craving for Sukha, Kamain the desire for Sukha. All willful action...
Conceptual Study-80This work was aimed to study Male sexual dysfunction fromAyurvedic point of view and to evaluate the ef...
Conceptual Study-81evolution; the so far most advanced man manipulates the entireworld itself for his own comfort for the ...
Conceptual Study-82same, why because of the physical, psychic, social and spiritualand behavioral influence on the experie...
Conceptual Study-83each other. Human physiology also reveals the truth that in manpresence of woman and vice versa. While ...
Conceptual Study-84money same time some use sex to promote their business and toachieve their ambitions.      One thing is...
Conceptual Study-85certain organs. Meantime sexuality is diffusely affecting the entirepersonality.      In the life span ...
Conceptual Study-86achieve in the life span (Purushartha) for the final achievement ofmoksha of soul. Kama is the way of l...
Conceptual Study-87respective objects of perception (Vishayas) in association withthe mind conjugated with the soul (Atmas...
Conceptual Study-88continues with procreation and it is the main part of life cycle.Jeevatma (Atma +mana) enters the body ...
Conceptual Study-89family is the ever-unbreakable establishment found exclusively inthe human race. The society, state, an...
Conceptual Study-90imagination (C. Sa 1/20) Our Acharya have described Kama asmanovikara. Susrutha says that, Krodha, Soka...
Conceptual Study-91                                              PART TWO• Normal sexual function-Why dysfunction?• Physio...
Conceptual Study-92Normal sexual function-Why dysfunction?          Sex is nothing but motivation both psychological andph...
Conceptual Study-93affected by relationships with others. By life circumstances andby the culture in which the person live...
Conceptual Study-94pudental nerve then through the sacral plexus into the sacralportion of the spinal cord and finally off...
Conceptual Study-95but become dilated tremendously when arterial blood flowsrapidly in to them under pressure while venous...
Conceptual Study-96      Filling of the internal urethra with semen elicits sensorysignals that are transmitted through th...
Conceptual Study-971.        Leutinizing Hormone (LH)2.        Follicle stimulating Hormone (FSH)L.H – Is the primary stim...
Conceptual Study-98derived from the father.       Susruta states that there are a totalnumber of 500 muscles in the body o...
Conceptual Study-99Susruta has listed 700 sira of which 34 are in kostha (S.Sa 7.7).Eight among them in the sroni are base...
Conceptual Study-                                                                    100daurmanasyam as the first cause fo...
Conceptual Study-                                                                  101initiation of sexual stimulation whe...
Conceptual Study-                                                                     102vayu and teja act in tandem to ex...
Conceptual Study-                                                                   103(Vayu yanthra thanthra dhara Niyant...
Conceptual Study-                                                                                 1043. Vyana and Apana – ...
Conceptual Study-                                                                                     105Organ    Exciteme...
Conceptual Study-                                                                                                 106  Cow...
Conceptual Study-                                                                       107describes 32 types of fore play...
Conceptual Study-                                                                   108      Recently   masturbation     a...
Conceptual Study-                                                                 109      Another belief was women would ...
Conceptual Study-                                                                   110      No Vaginal orgasm is importan...
Conceptual Study-                                                                111Arthasasthram and a number of books on...
Conceptual Study-                                                                          112Table No-2Famous Ayurvedic b...
Conceptual Study-                                                                 113             Different postures assum...
Conceptual Study-                                                                    114and (iii). to offer instructions o...
Conceptual Study-                                                                 115     The second reason for the elabor...
Conceptual Study-                                                                 116midday, and in open places where shyn...
Conceptual Study-                                                                   117basically a medical science, the as...
Conceptual Study-                                                                    118        Ayurveda is a collective w...
Conceptual Study-                                                                   119      In Ayurveda Ahara, Nidra and ...
Conceptual Study-                                                                   120performance of that during grahasta...
Conceptual Study-                                                                   121      Sexual dysfunction is the dis...
Conceptual Study-               122
Conceptual Study-                                                             123                                         ...
Conceptual Study-                                                                   124Sexual dysfunction in maleWhat is s...
Conceptual Study-                                                                              125physiological problems. ...
Conceptual Study-                                                                             126In males erectile dysfunc...
Conceptual Study-                                                                                   127Table No 4.DSM-IV. ...
Conceptual Study-                                                                    128factors cause the disorder in male...
Conceptual Study-                                                                       129       IV.   Cardio vascular di...
Conceptual Study-                                                                130       f.    Reaction to organic facto...
Conceptual Study-                                                                131           a.    Adaptation           ...
Conceptual Study-                                                                   132Sexual Dysfunction, a major Problem...
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ROLE OF MANAS IN THE ETIOPATHOGENESIS OF MALE SEXUAL DYSFUNCTION AND ITS MANAGEMENT WITH MANASAMITHRA VATAKA A DOUBLE BLIND STUDY - RAVISANKARAN. K. MANOVIJNANA DEPARTMENT OF KAYACHIKITSA
VAIDYARATNAM P.S. VARIER AYURVEDA COLLEGE, KOTTAKKAL

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  1. 1. Conceptual Study-69 ROLE OF MANAS IN THE ETIOPATHOGENESIS OF MALE SEXUAL DYSFUNCTION AND ITS MANAGEMENT WITH MANASAMITHRA VATAKA A DOUBLE BLIND STUDY THESIS SUBMITTED TO THE UNIVERSITY OF CALICUT IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE AWARD OF THE DEGREE OF DOCTOR OF MEDICINE (AYURVEDA) By RAVISANKARAN. K. Under the Supervision of Guide Co-GuideDR. C.A. RAVINDRAN DR. A.K. MANOJ KUMAR M.D. (Ayu) M.D. (Ayu)Former Professor & Head Lecturer. SPECIALITY : MANOVIJNANA DEPARTMENT OF KAYACHIKITSA VAIDYARATNAM P.S. VARIER AYURVEDA COLLEGE KOTTAKKAL 2003
  2. 2. Conceptual Study-70 VAIDYARATNAM P.S. VARIER AYURVEDA COLLEGE, KOTTAKKAL C e r t i f i c a t e This is to certify that this thesis embodies the outcome of original observationsmade by RAVISANKARAN. K. on “ROLE OF MANAS IN THEETIOPATHOGENESIS OF MALE SEXUAL DYSFUNCTION AND ITSMANAGEMENT WITH MANASAMITHRA VATAKA - A DOUBLE BLIND STUDY”in partial fulfillment of the requirements for the Degree of Doctor Of Medicine (Ayu)under my direct guidance and supervision. The candidate has taken keen interest in the work and brought out good ideasand original thoughts. He has tried to make distinct advancement on scientific lineson this subject and have contributed considerably to the present knowledge of thesubject. The thesis is strongly recommended for being submitted for adjudication. Dr. C. A. Ravindran M.D. (Ayu) (Former Prof. and HOD) Department of Kayachikitsa V.P.S.V. Ayurveda College Kottakkal
  3. 3. Conceptual Study-71 AcknowledgementI have great pleasure to let out my deep-rooted sense of gratitude to my mostrespected and honorable guide, Prof. Dr. C.A. Ravindran MD (Ay) former HOD. Iextend my sincere gratitude to co guide, Dr. A.K. Manoj kumar MD (Ay), Lecturer ofDept of Kaya chikitsa V.P.S.V. Ayurveda College. Kottakkal for their valuableguidance, super vision, timely help, creative criticism and all source ofencouragement during the period of my research work.My sincere thanks to the most respected Principal Dr. A.P. Haridasan MD (Ay) andthe teachers of Kayachikitsa department Dr. E. Surendran MD (Ayu). PhD Professorand HOD, Dr. M.P. Eswara sarma MD (Ayu), Professor and Dr. C.V. Jayadevan MD(Ayu) Reader for providing the necessary facilities.I remember with respect and gratitude, the readiness offered by Dr. K. Sundaran.M.D (Ay) superintendent Govt. Ayurveda Research Institute for Mental Health,Kottakkal for live discussionsLet me confer my gratitude to all teachers of this institution for their help during thevarious stages of my studyI acknowledge the help rendered by all the staffs of hospital laboratory and collegelibrary. My thanks also go to Sri. Narayanan, (Rtd.) Statistician, Medical College,Kozhikode who spent his time for the statistical Analysis of the study.I am immensely grateful to all of my friends in this institution for their sincere helpduring the period of study.I appreciate Sri. M.P. Gopinath and Sri Syam (Soft-Teck) for their untiring hours atthe Key board Dr. K.Ravi Sankaran.
  4. 4. Conceptual Study-72 CONTENTSIntroducation 1Conceptual study 8Part I Sex or Sexuality 9Part II Normal sexual function and why Dysfunction? 18Part III Sexual dysfunction in male 45Part IV Premature ejaculation its importance. 69Part V Ayurvedic treatment modalities 84Part VI Selection of Drug and reasons 100Clinical stud 106Materials and method 106Observations 120Effect of therapy 143Discussion 148Summary and Conclusion 177Bibliography 185Appendex
  5. 5. Conceptual Study-73INTRODUCTIONAmong the thousands of species in the animal kingdom on earththe most advanced is considered as human by whom the worldis ruled. This is only due to the special attributes endowed tohuman brain as the abilities to think and react appropriately tothe circumstances which my be oriented to two kind ofexperiences pleasure and pain (Sukha and Dukha) The influence of this two perception always regulateshuman mind creates harmony in life and vice versa. Inadequatefulfillment of basic instinct for food, sex and survival createsmental discomfort to man rather than other species. In sexuality,no other species in the universe give that much importance likeman; generally sex is considered as a biological process and alsonot bothered about the response of the partner. But in man it isnot a simple biological process, beyond that multiple psychicand social factors influence human sexuality. Sexologistsenumerate these as the predisposing factors of sexual disorders.Unlike the other animals, which spend life without any sexualproblems, the most intelligent human being encounters numeroussexual problems and which leave them in the domain ofdistraction. Studies and maneuvers to overcome these sex problemscould be seen in the Western and Eastern medical field. InAyurvedic field ancient classics like Charaka, Susruatha andAshtanga Sangraha have not contributed much towardsdiscriminating the sexual complaints assigned to psychic factors,even though they have given importance to functional and
  6. 6. Conceptual Study-74physiological factors and their treatment. But the Influence ofhuman mind in life and the precursor factors of well being, havebeen vividly explained. Prevalence of sexual disorders not caused by organicreasons are intensively pervasive now a days. Sexologistspostulate the matter as the impact of incorrect knowledge dueto lack of sex education and victimization of the misused mediaadvancements and adulteration of the facts. In a surveyconducted in America by masters and Johnson classified withproof that 50% of normal healthy men were suffering from severalsexual problem, this shows the progressive nature of the disorder. According to Indian culture predomination of male can beseen in the family set up and thus in sexual matter also theinitiation and responsibility are allocated normally to malepartner. This makes them over tensed and susceptible to sexualdisorders than female participants. Just before marriage or when a sexual encounter isimpending Indian men become so much bothered about thesame. The common reasons are.1. Am I adequate with sexual ability and power?2. Am I having normal penile length and sustained erective power to satisfy my partner?3. Do my previous sex life or masturbation will hamper my performance in the present sexual act?4. If I fail what will be her response?
  7. 7. Conceptual Study-75 In addition to this type of preoccupied anxiety, precedingoccurrence of the disorder in an occasion also haunt the personto a great extent. Sexologists with humor sense simplify the patient’s doubtswith two interesting examples. One is about the penile lengthand other is about the essential time duration to satisfy thepartner. How much length is necessary for human penis?Answer- it just as our leg needs only sufficient length to reach theground. Next how long we have to maintain erection andperform in sexual act? Answer is that, it is upon you and thepartner. How long you can laugh enjoying your friend’sinteresting joke. This two are very thoughtful opinions, which mayenlighten our wrong beliefs.Mind and its role regarding sex and sexual disorders Modern Psychologists / Sexologists take sexuality as amatter difficult to define and they are not taking it as a separateentity due to its complex behavior in man. Each and everyindividual differs in the matter of sexual behavior. Personality,social environment, and behavioral factors, all influence onpsychic development and that plays a great role in sexuality.Hence they introduced a new term in this regard is‘psychosexuality’. The problems regarding with sex are newlytermed as psychosexual disorders as all the problems are activelyor passively connected with mind to some extend .The mainpsychosexual disorders are-1. Sexual dysfunctions2. Disorders of sexual preference.
  8. 8. Conceptual Study-763. Gender identity disorders. Among the three classifications sexual dysfunction is theinability to perform sex satisfactorily. Disorders of sexualpreference are any deviation in the choice of sexual object orthe sexual act itself. Thirdly the Gender identity disorders are theclashes develop in between the individual’s preferred genderrole and biological sex. Then the role of mind in the abovepsychosexual disorders is apparently appreciated. Sexual Dysfunction is only a part in the broad heading ofpsychosexual disorders and being the objective of thesis thisstudy focus into Male Sexual Dysfunction only. It is againsubdivided into four- 1. Loss of libido-Lack of sexual desire. 2. Arousal disorder- erectile dysfunction. 3. Orgasmic disorder-Premature ejaculation / Delayed ejaculation. 4. Pain disorder- Burning ejaculation / Post coital painThere are a few instances in which this disorders can be occurredby other non-psychological factors it is considered as organic orpharmacological substance induced so we exclude them as amatter beyond our study. In this study the Male SexualDysfunction strictly due to psychological factors are taken intoaccount.Causes of Male Sexual Dysfunction, in perspective of modernPsychologists / Sexologists.
  9. 9. Conceptual Study-77 1. Early sexual experiences- includes sexual conditioning and preoccupied fear. 2. Performance anxiety – most probably triggered in the experience with a new partner. 3. Frequency of sex. 4. Inter personal conflicts / Lack of love. 5. Fear of pregnancy. 6. Low sexual desire. 7. Guilty consciousness regarding sex as a forbidden thing. 8. Situation – It is important to note that. In appropriate situation can hamper the whole possibilities of entertainment.From the above opinions- Modern authorities have evidently proved mind and its rolein sexual relation ship. Healthy enjoyable sex is possible onlybetween clearly understanding partners and only in promptCircumstances and situation. During the occasion a differentworld of their own is created. In the psychosexual disorders also itis vividly observed that disturbance of mind can humiliate thetotal encounter. Sexual Union might be possible but never resultsin satisfaction.Anyhow it is observable through the Medias itself; the impacts ofthe problem in male adult life are crucially beyond ourimagination. Hence I took the subject for further evaluation.Being the disorder strictly psychosexual, the study ofpsychological part of the disorder is quite inevitable. So in this
  10. 10. Conceptual Study-78present study a primary level analysis of mind in relation to sex iscarried out. Mind regulates and controls the normal function anddysfunction of sex as well. The out come of the various studiesalso shows the psychic influence rather than psychologicalproblems. In addition there is no apparent correlation in Aired to someof the disorders coming under the group of sexual dysfunctionespecially in the ancient classics. Here an attempt is made tomake an apparent correlation. Mental diseases as well as sexual disorders are purelysubjective in mater. Hence to rule out the severity of the same isa tough task for medical professionals. Even though, animprovised scoring scale to examine Manasikabhava (status ofmind) on sexual parlance; which was, recently formulated andpracticed in IPGT&RA Jamnagar, also, has been taken in thisstudy as a parameter to assess psycho sexual status of thesubjects, along with other parameters.Importance and Relevance of the study Sex is considered as one of the basic instincts of human lifeas in all other creatures in general. In Aired also the four humanobjects in life (Purushartha) are considered as Virtuous acts(Dharma), Acquirement of wealth (Artha), Gratification of desire(Kama) and final Emancipation (Moksha). Aired has been writtenonly for the fulfillment of this itself without any constraints likediseases. Good health makes the man capable of achievinggoals up to Moksha. Life without happiness is not worth living.Kama is the prime among them. Synonym of Kama is Sukha. All
  11. 11. Conceptual Study-79organisms including human beings are craving for Sukha, Kamain the desire for Sukha. All willful action (Prayatna) is meant forSukha, in other words Sukha is the inspiration for all acts. In this present work Kama synonymously used directly forindicating sex only, even though this term has a broad meaning.Sexual Union of male and female is proposed for reproduction inmajority of living beings. But in man unlike the other living beingsthe major portion is imparted for sexual entertainment. In this study Male Sexual Dysfunction, prevalence,classification, causes and its impacts in normal life are taken in toaccount. The main Male Sexual Dysfunctions are Loss of libido,Erectile dysfunction, Premature ejaculation and Pain disorders. Inwhich Premature Ejaculation is more prevalent with a highpercentage of 40. .Selection of the Drug The psychosexual disorders are considered as prominentlyinfluenced by mental faculty. So, in the management processAyurvedic statutes advice to follow a specific protocol; that thevitiated Manodosha (mental morbidity) should be pacified first.The traditional physicians of Kerala for pacifying mental disorderssince many years are using Manasamithra vataka. It isrecommended for augmenting Prajna, Medha and Prathibhathose are liable for mental health. Other institutes and eminentScholars of Aired also reported the efficacy of the druguniformly. But no sound works have been done to prove theirclaims till now. Hence Manasamithra vataka is selected for thisclinical trial
  12. 12. Conceptual Study-80This work was aimed to study Male sexual dysfunction fromAyurvedic point of view and to evaluate the effect ofManasamithra vataka in premature ejaculation. Keeping theidea in mind a placebo-controlled double blind study was undertaken on twenty patients of premature ejaculation. Thenidanatmaka part was done, by compiling all available datafrom Ayurvedic classics, modern textbooks and other publicationsincluding different websites.Introduction Sex or sexuality is neither a forbidden thing nor a vulgarity toavoid; while it is a universal phenomenon transformed to thepresent generation having, as a heritage, which has undergonemultiple metamorphoses during the centuries passed by. It isdiffusely extended to personnel life, human relationships, sociallife, spiritual thoughts, and cultural activities. Sex is quite naturaland during the course of evolution from unicellular organisms tohuman beings it has under gone to a series of changes. In theprimitive organisms of the animal kingdom, the union of any twokind of sexual identities like male and female did not effect thereproduction. But even in the primary living being also theattraction and aversion to likes and dislikes can be noticed, theystick on the favorable situations this is a natural approved theoryregarding the drives on basic instincts. Even though, an effort tomake the environment favorable can be seen during thedevelopment of all living being. At last it is reached to human
  13. 13. Conceptual Study-81evolution; the so far most advanced man manipulates the entireworld itself for his own comfort for the time being. This isconsidered as the human effort for satisfaction by the action ofmind and sensory faculties. Mind is considered as the mostpowerful equipment man does have which contributes to thehuman enquiry for pleasure. Regarding sex the approach of the person is playing agreat role, which is, attributed to human mind that influence theexperience in different ways of which he gets satisfaction anddissatisfaction. Due to ignorance, over control (forced celibacy)religious approach, and by indulgence of free sex he looses thegod’s gift of pleasure. We can see in the study of sexology, the impacts of theabove dialectical influence of these different approaches clearlyof in a hidden manner, in different generations. Almost all kind of sciences have taken the subject to studyin their own perspective like philosophy, religions, psychology,psychiatry, anthropology, sociology, physiology, cosmetology,Gynecology, endocrinology, Ethologic (Moral philosophy),Nomology, (science of law) arts and literature.What is sex? Both words love and sex are very much familiar to us in dayto day life since centuries, but when we think to define it or toanalyze it, during the attempt only identify the difficulty to do the
  14. 14. Conceptual Study-82same, why because of the physical, psychic, social and spiritualand behavioral influence on the experience. The words we useverbally to explaining sex like copulation, coitus, inter course,sexual relationship are not able to cover the apt meaning, it issome thing more than that. The basic meaning of sex is still indefinite and imperfect. It isnot a mere act of coitus with or without the aim of reproduction.Man can live without intercourse but he is not able to continuelife without the expression of sex in any way.Sex and Sexuality. In English language the word sex in used to indicate manwoman relation ship. But presently the word altered to sexualityto indicate the same and sex in popularly used to denote genderidentity only. Now this concept is considered as more scientific. The word sex in derived from a Latin word ‘Secare’ meansto cut and separate. In a Greek legend it is told that previouslyman was an awkward animal as a combination of man andwoman having four hands and four legs which lived very muchsatisfaction. Seeing this Greek god Zeus became jealous andseparated them with the propulsion of a lightning which he usedas his weapon and droved them to distant provinces of theworld. It is considered that since then the separated male andfemale are seeking their better halves due to the inspiration of‘love’ in between them. According to Holy bible the women aremade up of male’s ribs and the Hindu concept regarding this asthe sovereign soul divided itself to be the male and female,everything shows the intrinsic attraction in between as made for
  15. 15. Conceptual Study-83each other. Human physiology also reveals the truth that in manpresence of woman and vice versa. While being separateindividuals, there are several similarities and dissimilarities in manand woman Even though the perpetual curiosity seen in them tojoin each other is considered as love that exists in all living being.Why sex / Kama is important? Continuity of mankind is through reproduction and thesame is connected to sexual intercourse also. Even though sexualact is not meant for reproduction only, sexual act becomesinevitable only in the latest species of animal kingdom. In theprimitive species like amoeba and bacteria it is entertained inother methods like self-division in to two independent organisms.There is no discrimination like male and female also. That meanswithout sexual instinctive and act itself generation can becontinued, like wise without reproduction man and woman canenjoy pleasure of sex is also a fact. Normally sex is related withreproduction but the purpose of sex in not only reproduction butalso it undergoes to other measures. The most common habit ofmasturbation itself questions the necessity of a female partner.Masturbation, Adultery, Erotic talks, Lustful interaction, Interest topornography, Normal sexual act during marital life, premaritalsex, sex after menopause is never intended for reproduction. Physiologist consider reproduction as natural commitmentwhile Divine worshipers consider it as divine, some persons think itis meant only for reproduction very few persons induce so muchimportance to sex and consider it is providing the unbreakablebinding to the social relations, some people sell sex for earning
  16. 16. Conceptual Study-84money same time some use sex to promote their business and toachieve their ambitions. One thing is definite, sex reduces mental tension, andsatisfactory sexual experience provides a vision to approachproblems in a more relaxed manner. It adds to wishful thinkingand abolishes loneliness. An active attempt, to understand evenone other person, through love will be occurred. The close bodilyrelation will lead to deep and sincere love and sustained mentalrelation.Different approaches. There were so many wonderful approaches and visionsregarding sex in practice. Previously, ancient people wereadopting different Gods, stars and sovereign soul as thesubstratum of different attributes of human life. In the same wayin the sexual approach also natural forces like sun, moon and thegods of different entity have been empowered to rule us. As thegods of Kama, Kama deva and his wife Rathidevi are consideredin Indian Mythology. Examples having the same nature can beseen in different continents.. Religious laws are ruling sex now aday also. Some religions are adorning sex as divine and sametime; some betray it as a sin. Some consider celibacy is betterthan sexual life. In history we can see several examples of thedifferent approaches of people like the commitment of sexualact like intercourse, Homosexuality etc and prostitution in thetemple premises itself. Matured sexuality is capable ofreproduction and the ability of reproduction is centered to
  17. 17. Conceptual Study-85certain organs. Meantime sexuality is diffusely affecting the entirepersonality. In the life span at different time sequences sex (Kama) givesmeaning and inspiration for attaining the objectives. If therewere no sexual instinct there should have some other inspirationfor the initiation of human effort. Anthropologists also observe sexas the cause of the development of human culture. In order to humanize the basic sexual drive and expressionseveral sexual rules of morality was introduced but exploitationand violation of the rules were common.Concepts Regarding Kama (Sex). The concepts about sexual matters are always developedform the society, parents, friends, and media. Then we assumethe experience as our own and frame our concepts. The resources of sexual drive like brain, physique, mind andconcerned organs will be more or less unique in different personsbut their sexual responses may be apparently quite different. Some of them many are violently desirous in sex and it timesome may be very gentle in sexual approach. The reasonobserved for this may be the difference of heredity, constitutionof genes, hormones and the peculiarity of the circulatory system..What ever it may be no one is like other person. They will havetheir own approach and perspective.Similarities of Kama to Sex. The most apt word to comprise sex is Kama only. The wordis from the eastern school of thought originated from India. Kamais considered as one of the great goals, which a person should
  18. 18. Conceptual Study-86achieve in the life span (Purushartha) for the final achievement ofmoksha of soul. Kama is the way of life for Indians to eternal bliss.In Indian culture Kama is connected with divinity. The destinyreaches moksha through the effective conduction of moral life.All Indian Vedas, Upanishads are directing us to act virtuously forthe final attainment. In the preface of Kama suthra itself it ismentioned that only for the morality of the mankind the book iscreated. Kama was considered as an inevitable factor in day-to-day life and hence it advises to control the utilization of Kama ina virtuous manner other wise we can’t attain moksha. Yasodhara in Jayamangala commentary of Vatsyayana’sKamasutra has lucidly explained the importance of Kama inIndian culture and the quintessentially Indian thought streamreflected in various ancient schools of philosophy. Kamavadisargue that even among the purushartha, by virtue of being thehetu, it is Kama that is of paramount significance (Kamasutra,sadharanam Adhikaranam. PI). Jayamangala explain that arthais required for nourishment and growth of sarira, Kama forbestowing happiness on manas, dharma for the sake of buddhi,and moksha to fortify Atma. In their absence the body becomesin active, the mind sinks in to despondency, the intellect faltersand the soul weakens. Even though moksha is the ultimate goal,to achieve it the help of artha and Kama earned throughrighteous means (dharma) is essential. Vatsyayana describes Kama as being of two types VIZ.Samanya and Visesha. (Kamasutra II P12) The favourable kinetics(anukulytha pravrithi) of the five sense organs (Indriya) in their
  19. 19. Conceptual Study-87respective objects of perception (Vishayas) in association withthe mind conjugated with the soul (Atmasamyuktena manasa) isreferred as samanya Kama. For perception to fructify it isessential for the mind to act as the bridge connecting the atmaon one end and the indriyas on the other. The aspirations of theself are reflected through the mind. This is samanya Kama. Herethe Kama is considered in a broad sense. The pleasure expectedin life is from all the five sense faculties. Then in the next versespecial emphasis is given on the sexual aspect of Kama. It isabout vishesha KamaVisesha Kama. The visesha Kama is of two types. Apradhana andPradhana. The pleasurable feelings experienced, courtesysparsanendriya, by kiss, embrace, caress, etc of the cheeks,breasts, groin region etc is apradhana Kama. When such activityis prolonged for some time sperm ejaculation and climatic joyassociated with it, is experienced. This is pradhana Kama.Vatsyayana says that unlike woman, who experience joy throughout the sex act the male experience pleasure only at the end, onejaculation. (Kamasuthra, samprayogikam adhikarnam. I-p83).A different explanation equates the urge of sensual gratificationby the soul to samanya Kama and the desire motivated kineticsto visesha Kama.Importance of Sex in Human LifeWhy sex is important among purushartha? Sex is only one among them but the continuity of humanrace in possible with that only, human existence in this world
  20. 20. Conceptual Study-88continues with procreation and it is the main part of life cycle.Jeevatma (Atma +mana) enters the body at the time of malefemale union. The other two parts of Purushartha, Dharma(Action) and Artha (Wealth) are achieved for sukha. For a manwho is not capable for enjoying sukha, his struggle for wealth isfutile. Longevity is also a curse whether he is lacking wealth.Sukha is the fulfillment of Kama only. In this instance Kama holdthe paramount importance in the purushartha. Moksha is thedestination beyond human life. Hence the entire struggle wecould see during life in the universe is for the fulfillment of Kamaonly.How Kama becomes more important in man? Reproduction can be seen in all kind of living organism inthe world. It may be without sex in the primitive organism likeamoeba etc. there is even male female differentiation is alsoabsent. But during the evolution male female demarcation,more developed sexual organs, nervous system and over allcontrolling (Inhibition and stimulation) systems developed. At thetime of human evolution more significant changes took place inthe shape of body as well as in male and female sexualcharacteristics. Man become selective in choosing his partner,they attracted each other by some unknown forces. They startedto keep the connection for long duration, thought them as madefor each other; they started to look after the children producedfrom their sexual union. In such a way marriage agreementsestablished in between couples, so the sex between male andfemale became the basement of human family concept. The
  21. 21. Conceptual Study-89family is the ever-unbreakable establishment found exclusively inthe human race. The society, state, and country are based on it.Vast resources, of human effort and creativity for growth inspiredfrom it. The under lying bondage in this setup is sex or Kama only. Basically the whole matter in this universe belongs to two-category living and non-living. In which human beings belong tothe chethana dravya group (Living thing) is provided withequipments of comprehension and action (mind, sensory andmotor faculties). It is a proved fact that all living beings from theprimitive species (Unicellular organisms) itself have the basicinstincts for survival and the characteristics like Iccha (like) dvesha(dislike) sukha (Joy) dukha (sorrow) prayatna (attempt) andbuddhi (intellect). This is common in all living beings in differentratio. Mean while, in man certain additional characteristics canbe seen like drithi (control) smruthi (memory) and ahankara(proud of identity), which is only due to the development ofhuman mind. Charaka has accounted this as atma linga.Actually the abilities of human mind are reckless.Mind and Its Relation to Sex The object of human mind is infinite: i.e., all that thinkable, isits object; there is no boundary, (C.Su. 8/16). In the lower speciesan effort to gain food, for survival and an attraction and rejectionto favorable and unfavorable conditions may be observed,prayatna is limited to this extend. But in man human mind neverretires till the attainment of the goal. Here thinking includes all sorts of higher mental activitiessuch as contemplation, evaluation, deduction meditation and
  22. 22. Conceptual Study-90imagination (C. Sa 1/20) Our Acharya have described Kama asmanovikara. Susrutha says that, Krodha, Soka, Bhaya, Harsha,Vishada, Irshya, Abhyasooya, Dainya, Matsarya, and Kama aremanovikara. Ashtanga Hridaya simplifies them as mental diseasescaused by external factors (Aganthu). At first we may think thisas contradictory to previous description, because it comes underpurushartha. The fact is different that these all manasika bhavaare basically condition of mind originated from Rajo guna. Rajoguna and thamo guna are considered as manodosha. Andwhen the raga (desire) becomes intensified and morbid it causesmental disorders. ‘Raga is the undeveloped form of Kama that isemotion formed from rajas – Raga is the base of all problems.While Kama, is the base of life and every activities of life.
  23. 23. Conceptual Study-91 PART TWO• Normal sexual function-Why dysfunction?• Physiology of male sexual act• Physiology of sexual act in Ayurveda• Importance of Mind in sex• Involvement of Vatha• Details of various kind of sexual act• Sexual aberrations• Ignorance related to sex• Ayurvedic ruling on sex• Sexual dysfunction and abnormal sex
  24. 24. Conceptual Study-92Normal sexual function-Why dysfunction? Sex is nothing but motivation both psychological andphysiological, for behavior associated with procreation andexotic pleasure. The abnormalities related with sexual enjoymentare considered as sexual dysfunctions. Sexuality is a complexentity involving several aspects, including desire, libido, pleasure,sexual life, intercourse, erection, ejaculation, orgasm, happinessetc. It cannot be defined easily. Actually the purpose of sexualfunction is connected with reproduction. But it is not meant onlyfor procreation. As mentioned early, in higher grade living beingsonly male female union takes part in reproduction. So, sex in notessential for reproduction. Modern science achievements, liketest tube baby, clowning also reveals the facts. In this type ofcreation sex is fully absent and this becomes the dull materialistpart of reproduction. But sex has got infinite meanings in theabstract personification. It is the base of man womanrelationship. It is the base of family, society, country and universeitself. Even in the condition of bedridden, the attachmenttowards spouse never looses. So sex is the base of love and it isdivine. Ancient Indian seers have identified the importance ofsex very much. Hence they wrote so many scientific booksaccordingly. Normal sexual function This might be different in each and every individual. This isdue to the complexity of Human behavior. Sexuality is diverseand determined by a complex interaction of factors. It is
  25. 25. Conceptual Study-93affected by relationships with others. By life circumstances andby the culture in which the person lives it changes. Humans,unlike other animals have got interest in sex with out regard oftime. There is no mating seasons or any time of choice and inman it is not mere an act having a limited time schedule. Man isalways having love and sex in his mind that may not benecessarily ending in sexual act often. Even though, WilliamMasters and Virginia Johnson have framed a progressive timeschedule for sexual response from the point of stimulation to theend of the response. For better understanding of the normal sexual function justto go through the physiology of male sexual act will bebeneficial.Physiology of Male Sexual Acta. Psychic element of the Male sexual Stimulations Simply thinking, Sexual thoughts, or dreaming the act ofintercourse is being performed can initiate the male act,culminating in ejaculation.b. Neuronal Stimulus:- The most important source of Sensory nerve signals forinitiating the male sexual act is the glans penis. The glanscontains an especially sensitive sensory endorgan system thattransmits impulses into the central nerve system that specialmodality of sensation is called sexual sensation, the slipperymassaging action of intercourse on the glans stimulates thesensory endorgan and the sexual signals in turn pass through the
  26. 26. Conceptual Study-94pudental nerve then through the sacral plexus into the sacralportion of the spinal cord and finally off the cord to undefinedarea of the brain. Stimulation of the anal epithelium, the scrotumand perineal structures in general can send signals into the cordthat add to the sexual sensation, also from seminal vesicles, testis,urinary bladder, prostate and Vas deferens. Indeed one of thecauses of Sexual drive is filling of the sexual organs with secretionsc. Integration of male Sexual Act in the Spinal cord The male sexual act results from intense reflex mechanismsintegrated in the sacral and lumbar spinal cord and thesemechanisms can be initiated by the psychic stimulation from thebrain on actual sexual organs, but usually it is a combination ofboth.Stages of Male Sexual actPenile erection – The Role of parasympathetic nerves. Penile erection is proportional to the degree of stimulation,whether psychic or physical Erection is called byparasympathetic impulses that pass from sacral portion of thespinal cord though pelvic nerves to the penis. Theseparasympathetic nerve fibers in contrast to most otherparasympathetic nerve fibers are believed to secrete nitric oxideand vasoactive intestinal peptide in addition to acetyl choline.The nitric oxide especially relaxes the arteries of the penis, as wellas relaxes the trabecular meshwork of smooth muscle fiber in theerectile tissue of corpus cavernosa and corpus spongiosum in theshaft of the penis. This erectile tissue is nothing more than largecavernous sinusoids which are normally relatively empty of blood
  27. 27. Conceptual Study-95but become dilated tremendously when arterial blood flowsrapidly in to them under pressure while venous out flow is partiallyoccluded. High pressure with in the sinusoids causes ballooningof the erectile tissue to such an extent, that the penis becomeshard and elongated. This is the phenomenon of erection.Lubrication - A parasympathetic function. During sexual stimulation, the Parasympathetic impulse inaddition to promoting erection causes the urethral glands andbulbourethral glands to secrete mucous. This mucous, passthrough the urethra, during intercourse, is to aid in the lubricationof the coitus.Emission and ejaculation – Function of sympathetic Nerves. Emission and ejaculation are culmination of the male sexualact. When the sexual stimulation becomes extremely intense,reflex enters the spinal cord begin to emit sympathetic Impulsesthat leave the cord at T12 to L2 and pass to the genital organsthrough hypo gastric and pelvic sympathetic nerve plexus toinitiate emission. Emission begins with contraction of vas deferensand the ampulla to cause expulsion of the sperm to internalurethra. Then the contraction of the muscular coat of theprostate gland followed finally by the contraction of the seminalvesicles expels prostate and seminal fluids also into the urethraforcing the sperm forward. All these fluids mix in the internalurethra with mucous already selected by bulbo urethral gland toform the semen. The process to this point is emission.
  28. 28. Conceptual Study-96 Filling of the internal urethra with semen elicits sensorysignals that are transmitted through the pudental nerve to thesacral regions of the cord, giving the feeling of sudden fullness inthe internal genital organs. Also these sensory signals furtherexcite the Rhythmical contraction of the internal genital organsand cause contraction of the ischio cavernous and bulbocavernous muscles that compress the bases of the penile erectiletissue. These effects together cause rhythmical wave likeincreases in pressure in both the erectile tissue of the penis andthe genital ducts and urethra, which ejaculates the semen fromthe urethra to the exterior. This final process is called ejaculation.At the same time rhythmical contraction of the pelvic musclesand even of some of the muscles of the body trunk causesthrusting movement of the pelvis and penis, which also help topropel the semen into the deepest recesses of the vagina andperhaps even slightly into the cervix of the uterus this entire periodof emission and ejaculation is called the male orgasm. But in itstermination, the male sexual excitement disappears almostentirely with in one to two minute and erection ceases, a processcalled resolution.Control of the male sexual function by hormones from thehypothalamus and anterior pituitary A major share of the control of sexual function in both maleand female begins with secretion of Gonadotropin ReleasingHormone (GNRH) by the hypothalamus. This hormone in turnstimulates the anterior pituitary gland to secrete two otherhormones called gonadotropic hormones.
  29. 29. Conceptual Study-971. Leutinizing Hormone (LH)2. Follicle stimulating Hormone (FSH)L.H – Is the primary stimulus for the secretion of testosterone by thetestis.F.S.H – Stimulates spermatogenesisPsychic factors that affect gonadotropin secretion and sexualactivity Many psychic factors feeding especially from the limbicsystem of the brain into the hypothalamus can affect the rate ofsecretion of GNRH by the hypothalamus and therefore can alsoaffect most other aspects of sexual and reproductive function inboth male and female. Most men however begin to exhibit slowly decreasingsexual function in their late 40s and 50s and one study showedthat the average age for terminating inter sexual relations was 68years. This decline is due to decline in testosterone activity. Thedecrease in male sexual function is called male climacteric.Physiology of sexual act in Ayurveda For proper appreciation of physiology of any body functionit is imperative to have a proper understanding of the structuralanatomy. Therefore, before delving into physiology of erection,some points in anatomy may be considered.Anatomical consideration: Of particular interest in anatomy are mamsa, sira, dhamani,srotas, kala etc. Ayurveda consideres all firm attributes have thefetus and the tissues of sukra, dhamani Asti, kacha etc. to be
  30. 30. Conceptual Study-98derived from the father. Susruta states that there are a totalnumber of 500 muscles in the body of which 10 are in thevamkshana, 3 in guda, 2 each in vrishana and vastisira. There areone muscle each in medhra and sivani. A unique concept thatayurveda forwards in consideration of structural anatomy is, thatof kala about which various commentators have offered differentand often conflicting views. The seventh kala is called sukradharakala. (S.Sa 4/193) Thiskala is said to be spread all over the body and it is described thatjust as ghee is present in the whole of the milk and jaggery ispresent in the whole of the sugarcane juice sukra is all-pervasivein the body. It is expressed during sexual stimulation, collects twoangula below and to the right of the bladder (dvangule dakshineparshwe vastidvarasysa chapyadhah), and is ejected out thoughthe urinary outlet (mutrasrota). Gananath sen, inPratyakshasarira, modifies this reference of collection on the rightside alone as dvangule dakshine vame; implying that collection isat either side, Ghanekar is in agreement with this modification.The sukradhara kala itself has been equated by him to themucous membrane of the vesiculae seminalis, vas deferens etc.Interestingly, in the whole of charakasamhita, there is no mentionof kala. Susrutha describes 30-adhogami dhamani in the body ofwhich two are responsible for the formation of sukra and two, forits expulsion (S.Sa.9/7). The adhogami dhamani are invested withthe function of dharana and yapana of pakvasaya, kati, mutra,pirisha, guda, vasti, medhra and sakthi. Sira are described astraversing through mamsa as lots stalks are enmeshed in a pond.
  31. 31. Conceptual Study-99Susruta has listed 700 sira of which 34 are in kostha (S.Sa 7.7).Eight among them in the sroni are based in guda and medra.These are about siras pertaining to vata. Similar sira if pitta,kapha and rakta are also to be counted. The siras in the middleof the medra are to be selected for siravedha in parivartika,upadamsa, sukakosha and sukravyapat (S.Sa-8/17). There aretwo pairs of sira on medra near romaraji, which have to be savedfrom siravedha. Ghanekar considers these as inferior epigastricvessels. Regarding srothus, Charaka considers vrishana (Testicles)and sepha (Penis) as the moola of sukravahasrothus, (C-Vi-5/9).Susruta considers vrshana and stana (breasts) as the mula ofsukravahasrotas, trauma to which causes klaibya, chiratpraseka,or raktasukrata. Medhra, along with vasti, is considered as themula of mutravaha srotas by Susruta. Trauma to these sites issupposed to cause stabdamutrata. (S.Sa-9-12).Importance of mind in sex: Dealing with sexual aberration, measures of their choice thesukravahasira of these subjects swell up and dilate due toexcitement, pleasure and stimulation, resulting in erection of thepenis (s.sa 2/45). In a different context, Susrutha says thatejaculation of sukra occurs when the mind is happy andpleasurable, and the body is engaged in sexually stimulatingcongress with a desirable woman (S.Sa 4/45). Charaka says thatejaculation during coitus is a result of chesta as well as sankalpa.Thus it is evident that the mind plays a paramount role in sexualgratification. In fact, without the favorable disposition of theexcitement fails even to be initiated. Charaka has listed
  32. 32. Conceptual Study- 100daurmanasyam as the first cause for causing avrshya, andsankalpa as the foremost among vrshya (C-Su 25/29). In reality,the two indiriya that maintain proximate relationship with thephysiology of erection are the mind and the penile organ itself.The intermediary or vehicle that establishes connection betweenthe mind and the sense organ is the principle of vata, says Susruta(S Ni 1/10). Since the experience of climatic sexual joy isessentially tactile, the role of tvak and sparsana cannot andshould not be overlooked. In fact, sparsanendriya is the gatewayfor all sensory perception (C-Vi 1/29). In gardhavakrantisarira,charaka says that sparsa, sparsnam, preranam, dhatuvyuhanam,and chesta are vayvatmaka (C-Su-4/12). Tvak is the seat of vataand sparsanendriya. Here, it would do well to remember theobservation of susruta in Nidanasthana that vitiation of vata inthe tvak causes supti where tactile response is dimmed. It is saidthat the mind cannot function without tvak (tvacho yogomanasajnanakaranam). Therefore mind cannot functioneffectively if tvak is affected as in supti. When vata vitiates issukra it leads to apravrtti or vikrtapravrtti of the dhatu. . Vitiatedvata in in the organs of sensory perception cause indriyavadha(S. Ni-1/24/25) While dealing with sexual perversions many unusualbehaviors were described for instance, that irshyaka is stimulatedby mixoscopia, asekya by fellatio, sugandhi by cunnilingus andother olfactory stimulations etc. A normal person on the otherhand, is excited by thought, imagination or fantasy. In all theseinstances what we are really speaking about is psychogenic
  33. 33. Conceptual Study- 101initiation of sexual stimulation where the mind plays a dominantrole. Sankalpa, chinta, harsha, etc. can actually be attributed tothe mind. Even perverted people are actually aroused by theiraberrant behavior as pleasurable. Thus the mind is the chiefinitiator, and a prime factor in physiology of erection. As in thecase of perception of any knowledge where atma, mans, indriyaand artha have to act in tandem, the mind in the instance too,indriya and artha have to act in tandem, and the mind in theinstance too, cannot act in isolation. The connections areprovided by the vata factor. Stimulation is sustained throughmessages received chiefly through the sparsanendriya and tvakas well as other indriyas. Upastha or anandendriya according toVatsyayana too plays its role. What happens next after thethreshold of harsha is reached is dilation (sphutatva) ofsukravahasira. Ayurveda believes that it ultimately causeserection (dhvajocchraya). The beauty of this description is that it is totally compatiblewith the basic mechanics of erection as recognized by themodern day physiologists. They believe that erection is initiatedas a psychogenic even owing to various stimuli that go on tocause dilation and filling of lacunar spaces by blood leading toerection. True, ayurvedic treatises do not sufficiently explain themechanics of quantities of blood entering the blood sinuses tocause erection. Perhaps they thought this was too obvious tomerit mentioning. Susruta, however, has mentioned in passingthat during sexual congress the vayu produces teja, and that
  34. 34. Conceptual Study- 102vayu and teja act in tandem to express sukra into the yoni (S. Sa-3/4) Reasons for ejaculation of Sukra Ayurveda enumerates 8 factors responsible for theejaculation. They are described under:-1. Harshath : Excitement (sexual fantasizing which may lead to erection, Production and ejaculation of sukra)2. Tharshath : Passionate strong desire for sex (women)3. Sarathwath: Fluidity of semen4. Paichilyath : Sliminess5. Gouravath : Heaviness6. Anuthwath : Atomicity7. Pravanabhavath: Tendency to flow out8. Druthawath Maruthasya : By the force of Vayu, which will help in the flow of semen. In the analysis of the above 8 factors it can be noticed that3 to 7 factors are clearly the quality of semen and the 1,2 and 8are the propagating factors. Hence, when these 3 factorsbecome abnormal that cause to premature ejaculation..For the details of the involvement of Manas and Vayu in thematter of ejaculation Among the 3 primordial factors vatha, pitha and kaphawhose normalcy is conductive to health and abnormal stateleads to morbidity. The prime factor vatha is considered as thecausative and controlling factor, which propagates all activitiesof the body. Vatha is described as the agent who restrains andimpels mental activities.
  35. 35. Conceptual Study- 103(Vayu yanthra thanthra dhara Niyantha pranetha cha Manasa:Sarvendriyanamudyogakara). It is responsible for the functional format of mind. Thecontrol and the stimulation are the bipod activity of sameinitiation, which is antagonistic in nature. A balance betweenthese two is necessary for an optimal arousal activity andachievement of target action. Activated vatha may causemental activities adversely in different dimensions. By the undermentioned part of verses it can be understood easily. The normalfunction of vatha leads to.a. Chesta vega pravarthanab. Budhi Hridayendriya Chitha dhrukc. Praya Sarvakriyastasmin prathibaddha etc. All the sub components of vatha have influence onphysiology of sukra datu. Out of the five-sub component ofvatha, prana, udana, vyana and apana have direct connectionin the psycho memo physiology and haemo dynamics of thesexual response cycle in the male.1. Prana – Manodharana, Budhidharana (holding proper intellect and mental function)2. Udana –Function of Manodheedhruthi smruthi bodhana – Bodhana denote samvahana – carrying out excitation so it is responsible for the recollection, imagination, fantasizing etc. along with a control over the stimulation so prana and udana united make the cognitive aspects of sexual response.
  36. 36. Conceptual Study- 1043. Vyana and Apana – By considering the location, activity and other features of vyana vayu the above description is suitable for explaining the haemodynamics in the mechanism of erection. At the peak level of continuous stimulation, vyana vayuitself responsible for the emission of sukra, which is controlled bysympathetic activity. The further steps of ejaculation, i.e. antegrade ejaculation with forceful spurts and bladder neck closure iscontrolled by apana vayu, apana vayu is responsible for theNishkramana of sukra, moothra etc.Normal Sexual Function in Male. Normal sexuality is difficult to define. Sexual behavior isdiverse and determined by a complex interaction of factors.Sexual response is a true psycho physiological experience.Normal men and women experience a sequence ofphysiological response to sexual stimulation. William Masters andVirginia Johnson observed the different physiological responsesduring sexual response. It includes four stages viz. excitementplateau, orgasm and resolution. DSM IV consolidates the Master’s Johnson excitement andplateau phase into a single excitement phase. In the plateauphase high levels of sexual arousal are maintained and intensifiedpotentially setting the stage for orgasm. For men who havedifficulty in controlling ejaculation, this phase may beexceptionally brief. Male sexual response cycle given in IVthedition of Diagnostic and statistical manual (DSM-IV) isreproduced here (Table No-1).Table No-1 Male Sexual response cycle
  37. 37. Conceptual Study- 105Organ Excitement phase Orgasmic phase Resolution phase Lasts several minutes to several hours; heightened 10 to 15 minutes; if excitement before 3 to 15 seconds no orgasm, ½ to 1 orgasm, 30 seconds to 3 day minutesSkin Just before orgasm sexual Well developed flush Flush disappears in flush inconsistently reverse order of appears maculopapular appearance, rash originates on inconsistently abdomen and spread to appearing film of ant.Chest wall, face, neck perspiration on and can include soles of feet and shoulders and forearms. palms of hand.Penis Erection in 10 to 30 Ejaculation; emission Erection: partial seconds caused by phase marked by three to involution in 5 to 10 vasocongestion of four contraction of 0.8 seconds with erectile bodies of corpus seconds of vas, seminal variable refractory cavernosa of shaft; loose vesicles, prostate; period, full of erection may occur ejaculation proper marked detumescence in with introduction of by contraction of 0.8 5 to 30 minutes. asexual stimulus, loud second of urethra and noise; with heightened ejaculatory spurt of 12 to excitement, size of glans 20 inches a age 18, and diameter of penile decreasing with age to shaft increase further seepage at 70.Scrotu Tightening and lifting of No change Decrease tom scrotal sac and elevation baseline sizeAnd of tests; with heightened because of loss oftestes excitement, 50% increase vasocongestion; in size of testes over testicular and unstimulated state and scrotal descent flattening against within 5 to 30 perineum, signaling minutes after impending ejaculation orgasm; involution may take several hours if no orgasmic release takes place. Table Contd…..
  38. 38. Conceptual Study- 106 Cowpe 2 to 3 drops of mucoid No change No change r’s fluid that contains viable glands sperm are secreted during heightened excitement Other Breasts: inconsistent nipple Loss of voluntary muscular Return to baseline control. state in 5 to 10 erection with heightened Rectum: rhythmical minutes excitement before orgasm contractions of sphincter. myotonia: semispastic contractions H.R: up to 180 beats a minute of facial, abdominal, and BP: up to 40 to 100 mm systolic; 10 to 50mm intercostals muscles diastolic. Respiration: up to Tachycardia: up to 175 a 40respiration a minute minute, B.P. rise in systolic 20 to 80 mm; in diastolic 10 to 40 mm, Respiration: increasedDetails of various kind of sexual act In Ayurvedic concept of sexual act, fore play should beperformed which may have soft caressing, hugs and kissesthrough that all mental tension and dislikes between partners willbe relieved and released. This may make each of them happyand will make each other in a sensual mood. While describingfore play the author of kamasutra says the male partner shouldhave a gentle approach in sexual matters i.e. the embrace(Alingana), kissing (chumbana), Nail pinches (Nakhachedas), softbites (Dasanachedas), thrashing (prahanana) and grunting(silkritha) would have to be performed slowly and softly toincrease Raga (Raga sandhu kshanartha). Vatsyayana, (Insamprayogikam adhikaranam) advises many methods, for sexualexpression and sexual intercourse. He divides it into 8 anga-eachcontains 8 steps- totally it is 64, these 8 anga are, Alingana,Chumbana, Nakhacheda, Dasanacheda, Samvesana,Seelkritha, Purushayitha and Auparishtaka. The first 4 angas
  39. 39. Conceptual Study- 107describes 32 types of fore play and the rest of Three describes theperformance during actual sexual intercourse and the last eighttype is regarding oral sex. Whether these sixty-four kind of sexual acts are discrete inthe description it is not limited to this number they are infinite withlittle changes in the approach, time duration and based onapplying pressure. Regarding with the sexual act itself persons aredescribed into 3-category Mandavega, Madhyavega, andChandavega and their approach will be different in the sexualunion. These descriptions help the sexually illiterate people toperform sexual act better. The various techniques of fore playand after play detailed by Vatsyayana were with an intention toimprove the quality of sexual practice in common man.Sexual aberrations Sexual aberrations are sexual deviations, more or lesspsychological. As mentioned early, Sexual behavior is not asimple biological process; so many factors psychological,circumstantial, social and parental play their own role indeveloping sexual orientation and behavior. Anyhow somepersons deviate from normal sexual orientation to other defectivehabits. Some of the popular sexual aberrations are masturbation,anal sex, homosexuality fetishism, fetishistic transvestism,voyeurism, pedophilia, necrophilia, sadomasochism,exhibitionism, frotteurism, bestiality, incest etc.
  40. 40. Conceptual Study- 108 Recently masturbation and homosexuality are notconsidered as a severe sexual perversion, now masturbation isthought as a normal and natural sexual activity from the periodof child hood to old age. But this viewpoint was not alwaysaccepted. Masturbation is abnormal when it is the only type ofsexual activity performed in adult hood and when it becomesfrequently compulsive. Homosexuality is a legally approved life style now inAmerica. The psychiatrists say that sexual orientation alone is notto be regarded as a disorder. This change reflects a change inthe understanding of homosexuality, which is now considered asan alternative life style. The other sexual perversions areconsidered as severe sexual aberrations and which are harmfulto self and society. The sexual perversions come under antisocialbehavior.Ignorance Related to Sex Even in educated people also sexual knowledge is very less.Especially in a country like India this ignorance is very crucial. Inthe educational institutions also sexual education is not providedpromptly. As a bad consequence, of this affects the curiouschildren in many ways. They collect the wrong information fromnon-educated elder friends, pornographic Media etc. This ledthem to many wrong beliefs. There are so many misconceptionslike this for egs. It was a very popular belief that the masturbationhabit in male will lead to severe body injury.
  41. 41. Conceptual Study- 109 Another belief was women would never do masturbation.Both are false information. There are several scientists haveworked on this matter. They have revealed many misbelieve.The name of Dr.Wardel.B pomeroi is very much famous in thismatter. The in formations he collected and his reply is writtenbelow.1. ‘Sexual problems can be very easily managed.’ No it is not an easy task and only possible under thesupervision of an efficient sexual therapist.2. Women liberation movement is the reason for increasing sexual problems. No they are not making any problems to Gents. A fewwomen who are tough and having non-adjusting nature are theproblem makers.3. Masturbation is safe and more satisfactory experience than sex with opposite sex. False, masturbation might have more intensity but thestable friendship and sexuality in between male and female islong-lived and more committed, no doubt.4. Orgasm in women is a violent and uncontrollable emotional extreme. No, some of them may make some noises. This may not becommon in all.5. There is no difference between vaginal orgasm and clitoral orgasm.
  42. 42. Conceptual Study- 110 No Vaginal orgasm is important and clitoris is only astimulatory factor that leads to vaginal orgasm.6. Size of penis need not to be considered in the case sexual satisfaction. Not often correct length and size is not that muchimportant. But women like to feel the stiffness of penis in side.7. Sex is good for health Psychologically correct, but healthy body can only enjoysex and over indulgence is not appreciated.8. Those who adjust with marital sex alone have some problem No definitely not. It is only an appetite to build a secludedsatisfactory life like made for each other.9. Young and old aged people are alike in sexual motivation. No. In old age sexual urge declines. Misbelieves like this ever continuing. There is only onesolution is sexual education starting from the appropriate age.Regarding the normal sexual developments and abnormaldevelopments, structure of genital organs, it’s functions, age wiseproblems, and virtuous practice of sex, every thing aboutpregnancy and childbirth, personal hygiene should be taught.More emphasis should be given to virtuous behavior, and forsocial interaction with opposite sex. Whenever this misbelievespread in the society become clear and understandable to thestudent then only the purpose sexual education is fulfilled. Thousand years ago itself Indian seers have identified thenecessity of sexual education. Manusmrithi, Neethisaram,
  43. 43. Conceptual Study- 111Arthasasthram and a number of books on sexology includingKamasutra teach the virtuous sexual practice and ideal living.The Indian Kamasutra had been translated to almost alllanguages in the world. It shows the authenticity of the book.The good availability of the multiple sexology books in differentcenturies shows the importance given to the science by Indianseers. Some of the names of the authors of famous books arewritten below.
  44. 44. Conceptual Study- 112Table No-2Famous Ayurvedic books on sexology Sl. Name of book Author No. Period 1. Amanga Rangam AD 16th Century Kalyanamalla 2. Arthasasthram BC 4th Century Koudilyan 3. Kandarpachoodamani AD 16th Century Veerabhadradevan 4. Kamasutra AD 2nd Century Vatsyayanan 5. Kalavilasam AD 10th Century Kshemendran 6. Kuttaneematham AD 7th Century Damodaraguptha 7. Chandrolsavam AD 15th Century Anonymous 8. Nagarasarvaswam AD 10th Century Padmasree. 9. Panchasayakam AD 14th Century Jyothireesan 10. Rathikelikuthuhalam AD 19th Century Madhava Prasad 11. Rathi Manjari AD 15th Century Jayadevan 12. Rathi RatnaPradeepika AD 15th Century Devaraga Kavi 13. Rathi Rahasyam Not known Kokkokam 14. Rathi Samrajyam AD 19th Century Nalappattu Narayana Menon 15. Leelathilakam AD 14th Century Anonymous 16. Vysikathanthran AD 11th Century Anonymous 17. Sringara Manjari AD 17th Century Akbar Shaw Sexual satisfaction what? Sexual response in truly a psycho physiological experienceyet we can consider it as a satisfactory experience in betweenmale and female expected to be ending in orgasm of both. It ismore or less a mental relaxation giving more confidence, moreattachment, more security feeling and more commitmentbetween partners.
  45. 45. Conceptual Study- 113 Different postures assumed during coitus In Kamasutra there are so many postures described. Itconsists of different types, man on top, women on top and side-by-side positions. Each one is for giving novel experience to thecouple and but this positions are not appreciated in Ayurveda.Ayurveda is always against undesirable postures and insists on aparticular posture for sexual relation that female must be in asupine position (uthanasayana) that means man on top position(missionary position) is much appreciated in Ayurveda than theother postures. Even though different innovative postures havebeen mentioned in kamasuthra, this is the position invariablyaccepted in the treatises of Ayurveda. Being profoundly ascience of health this may be considering the health of theprogeny and to accerlate the chances of conceiving. Inpregnancy time the lying in supine position is banned, that timeAyurveda is against intercourse also.Ayurvedic Ruling On SexMaithuna niyamah: Rules of coitus The beauty of Ayurvedic principles is that they seem tocover every conceivable aspect of human life and endeavor,including sex. It seems that the rules of coitus laid down inAyurvedic treatises aim to achieve three main objectives; (i). tomodulate the frequency and periodicity of one’s sexual activitywith a view to protect the body from the deleterious effects oftoo much sex. (ii). to give guidelines and principles of safe sex,
  46. 46. Conceptual Study- 114and (iii). to offer instructions on the best way to derive maximumpleasure out of sex.Vagbhata, in Ashtangahrdaya, advocates the frequency of sexin relation to the various seasons. (AH.Su 7/3)1. Sex, to one’s desired number of times in hemanta and sisira, the body being prepared with proper resource to vajikarana therapy.2. Sex, once in three days in vasanta and sarat.3. Sex, once in fifteen days in varsha and greeshma. The above gives a fair idea of the ratio of desired sex invarious seasons, and is based on the body’s own innate strengthor weakness in different seasons detailed in ritucharya. It has tobe noted that the natural strength of the body is at its peak inhemanta and sisira, at its nadir in grishma and varsha andmedium in vasanta and sarat. (AH Su 3/6). Vagbhata goes on tostate that disregard to this rule of periodicity of sex would result inbhrama, klama, urusada daurbalya, pumstva nasa,indriyakshaya or even maranam, On the other hand, thoseseeking sex in a judicious way are bestowed with smrti, medha,ayu, arogya, pushti indiyabala, yasobala and these people ageslowly. (Mandajara) (AH Su 7/74,75). Charaka forbids sex beforethe age of sixteen and after seventy if the man is desirous oflongevity, describing that by sex in young age, the dhatu dry uplike the little water in a shallow pond. Like a moth-eaten treecrumbles on touch, the elderly too perishes by overindulgence(C.Ch 2/39).
  47. 47. Conceptual Study- 115 The second reason for the elaborate list of do’s and don’tsin sex described in Ayurveda is presumably to impress upon itsfollowers the idea of safe sex. Safely, here does not relate tocontraception and the notions of safe period etc. and it is interms of health. More specifically, in terms of avoidance ofdiseases, abrasions, wounds etc. of the penis, ensuring goodhealth and longevity of the offspring, Susruta says as a generalprinciple, that one should be on constant vigil as far as personalhygiene is concerned and should maintain cleanliness inexcretion of wastes, in sex, in food intake, as well as in sodhanatherapy. Women who are not to be selected for sex include thosewho are menstruating, those not inclined for sex, those who aredirty, those who belong to higher class, those older than oneself,those affected by diseases, those deficient in appendages, thosewho harbor ill-will, those with yoniroga and those who arepregnant. The wife of one’s teacher and those who are in pursuitof spiritual upliftment should not be welcomed for sex. Similarly,those not to be approached include one’s mother-in-law,daughter etc. (avagamya). The place selected for sex shouldnot be dirty either. One should not indulge in sex when hungry, illor mentally disturbed. The healthy male should also avoid sexwhen natural urges of urine, faeces and passing flatus are felt,when one is thirsty or when one is weak. Tiryagyoni (sex withanimals etc.), ayoni (oral sex etc.), and dushtayoni (sex withwomen having diseases of genital organs etc.), are notrecommended. Early morning sex and sex during midnight or
  48. 48. Conceptual Study- 116midday, and in open places where shyness is experienced,should be avoided. Giving the reasons for these strict instruction,Susruta says that sex with menstruation women apart from nothaving religious sanction, robs one’s drshti, ayu and teja.Longevity is affected by seeking sexual gratification from one’sown teacher, from one taken to asceticism; one’s elder and attimes mentioned above. The foetus is also seen affected in sexwith pregnant woman and one’s strength is depleted with sexwith a woman having diseases. Sexes with women deficient inappendages (handicapped), with those who harbors enmity,those not inclined for sex, with those who are frigid, and in dirtyand open places cause kshaya of both sukra and manas. Earlymorning sex aggravates vata whereas sex in midnight pitta. Sexin tiryakyoni, ayoni and dushtayoni culminates in upadamsa, vatavitiation and sukranasa. Sex during times when other urges are present would leadto diseases like sukrasmari (S.Ch 24/1/10). Sukravega should notbe forcefully represses either. Charaka says this would causeimpotence (sukravega nirodhah shandyakaranam). He has alsooutlined certain rules for sex in Sarirasthana; He prohibits sex onfull stomach, when one is hungry or thirsty, when anxious,frightened, disturbed, sorrowful or angry. The man should notindulge in sex with a woman who remains insatiate, and vice-versa. He should not pair with women who are too young, tooold, afflicted for long with diseases, and vice-versa (C.Sa-8/8).Charaka also prohibits sex in various innovative positionsmentioned as of Kamasutra, saying that; Ayurveda, which is
  49. 49. Conceptual Study- 117basically a medical science, the aspect of health of the progenygains precedence over simple sexual gratification of the partners.In Ashtangahrdaya, Vagbhata too dwells upon the pointsmentioned above in some detail. In addition, he says that sexwith women who are either very obese or very lean, should beavoided. Sex with a woman who is not one’s lawfully weddedwife is taboo. Similarly innovative sexual practices not involvinggenital organs (anangam) as well as beating on the sira, hrdayaetc. are to be avoided (AH – Su 7/71). Rendering thecommentary on that, Sri. Govindan Vaidyar says such practicescould cause myriad problems like guhyaroga, tvagroga, kasa,kshaya etc. as also paurushanasa. If often happens that too much of restrictive rules tend to killwhat should essentially be simply a pleasurable experience.Charaka himself has said the various pronouncements of manualslike Kamasutra may not always agree with the principles ofAyurveda. In Ayurveda, the guidelines of sex are given with theview of ensuring optimum health, both of the offspring as well asof the sexual partners. In Kamasutra on the other hand, the chiefaim is to offer guidelines for deriving maximum conjugal pleasure.It should not however be understood that there could be nomeeting point between the two sciences. Sexual practicesshould be performed only after due consideration of oneself, theprevalent practices of the region, the permitted activities basedon time, custom and textual references (K.S-Samprayogikam-Adhi-9).
  50. 50. Conceptual Study- 118 Ayurveda is a collective wisdom, a large body ofknowledge gathered from innumerable sources, mainstream orotherwise. Inputs from little known health care systems, prevalentpractices in isolated pockets, folklore medicine etc. that do notcome under mainstream Ayurveda and are not in curricularsyllabus, also form part and parcel of Ayurveda, the science oflife. The sex-act itself, for better understanding, has to be brokenup into its three basic components viz. foreplay, coitus, and afterplay. A critical analysis would reveal to anyone that thoughclassical Ayurvedic treatises have dealt with the latter twoaspects, the aspect of foreplay has not been sufficientlyaddressed, even if that is advised.Necessity of regulating sexual act Desire for food, sleep, sex and sense of fear is common foranimals and human beings. But the viseshajnana is the peculiargift which discriminately humans from animal. Hence the humanspecies is considered as intelligent (viveki) otherwise, man comesto the level of the low-grade animals which are living forsatisfactory its basic instincts only. The rules one mentioned in the classics gives warningsabout the negative effects of the rules. One should keep in mindthe verge from Hatayoga pradeepika while indulging in sex(Chithayatham Nrinam Sukram Sukrayathamcha jeevithamThasmat Sukram manaschaiva Rakshaneeyam Prayatnatha)Sukrastaira is Manastairya and life depends on Sukra. So preserveit.
  51. 51. Conceptual Study- 119 In Ayurveda Ahara, Nidra and Abrahmacharya areconsidered as the three pillars, which support life. The strength ofa building depends up on pillars, likewise the longevity andsuccess of human life rests on these supports. Food, sleep andsex are the basic needs of life. It one gets these needscompletely satisfied, all the rest of life’s blessings will naturallycome along. Even though these three are the basement of life,inadequate, unwholesome some and excessive utilization ofthese will affect adversely and may gradually lead to thecomplete destruction of life satisfaction and success. So onAcharyas on the basic of their knowledge and insight acquiredfrom their experiences, investigations, brilliance of intelligenceand meditations gave emphasis on the necessity for thecontrolling and conditioning of these three basic needs. As toldabove they had designed certain rules and regimens for thesuccessful practice of the same. Ayurveda being the science oflife, the science helps one to achieve longevity and prosperity inlife, there it is the relevance of certain charyas (practices)adopted for Ahara, Nidra and Maidhuna. Reference regardingthe same can be seen in our classics. Ayurveda did not give emphasis on naishtikabrahmacharya. It is the science of health and life. One’s lifecannot be termed as complete without sex and marred life.Ayurveda also considers Dharma, Artha, Kama and Moksha aspurushartha, what a man should attain as the main destiny of life.The term Abrahmacharya is better to use, as vaivahikabrahmacharya is controlled sex in married life. By the
  52. 52. Conceptual Study- 120performance of that during grahastasrama one can enjoy thebenefits of both vivaha and brahmacharya. For the comfortable and creative understanding betweenindividuals in the society controlling of sexual life purely in sidemarried couple is inevitable. Sexual perversions, pre marital,extramarital sex should be avoided. In between allied couplelove and commitment should be preserved. Discrepancy shouldbe avoided maximum before the assignment to live together. As the satisfactory sex is the strong base of family life, themission to satisfy each other should be undertaken. For thatmaximum commitment and will full attempt is necessary. Asatisfied partner will never seek joy from out side. In most of thebroken families it is frustration of unsatisfied sex is leading toabnormal behavior that causes serious harm to self, family andsociety.Sexual dysfunction and abnormal sex. In the above two categories almost the causes are thesame but the effects are different. Both are psychosexualdisorders. As the causes of both, several factors can beconsidered.1. Sexual assault in child hood2. Misguidance during upbringing3. Lack of sex education4. Failure of primary attempts5. Psychological Immaturity.6. Lack of healthy social interaction.
  53. 53. Conceptual Study- 121 Sexual dysfunction is the disturbance in the sexual responsecycle or pain with sexual intercourse. In this the person suffers theproblems subjectively as the in ability for healthy sex. In theabnormal sex it is purely sexual aberration and deviation from thenatural socially approved sexual behavior. They include disordersof sexual preference shortly are deviations in the choice of sexualobject or the sexual act itself. The sexual dysfunctions create more problems to self andfamily while abnormal sex create [problem actively and directlyto society.
  54. 54. Conceptual Study- 122
  55. 55. Conceptual Study- 123 PART THREE• Sexual dysfunction in male• Causes of sexual dysfunction• Sexual dysfunction a major problem• Impacts of sexual dissatisfaction• Sexual dysfunction caused by drugs• Sexual dysfunctions described in Ayurveda
  56. 56. Conceptual Study- 124Sexual dysfunction in maleWhat is sexual dysfunction? According to IVth of Diagnostic and statistical Manual ofMental Disorders (DSM – IV) a sexual dysfunction is defined as adisturbance in the sexual response cycle on as pain with sexualintercourse. Seven major categories of sexual dysfunctions arelisted in DSM – IV.1. Sexual desire disorders2. Sexual Arousal disorders3. Orgasm disorders4. Sexual pain disorders5. Sexual dysfunction caused by general medical condition6. Substance induced sexual dysfunction7. Sexual dysfunction not otherwise specified. Sexual dysfunctions can be symptomatic of biological(biogenic) problems or intra psychic or interpersonal(psychogenic) conflicts or a combination of these factors. Sexualfunction can be adversely affected by stress of any kind, byemotional disorders, or by ignorance of sexual function and by
  57. 57. Conceptual Study- 125physiological problems. The dysfunction may be like long oracquired that is it can develop after a period of normalfunctioning. The dysfunction may be generalized or limited to aspecific partner or a certain situation. In some cases a patientsuffers from more than one dysfunction for example prematureejaculation and male erectile disorder. According to the 10th revision of international statisticalclassification of diseases and related health problems (ICD – 10)sexual dysfunction refers to a person’s inability to “participate in asexual relationship as he on she would wish”. This dysfunction isexpressed in various ways; as a lack of desire or of pleasure or asa physiological inability to begin, maintain or complete sexualinteraction. Because, sexual response is considered more or lessas psychosomatic. It may be difficult to determine “the relativeimportance of psychological and or organic factors”. Here in the present study, we considered only the MaleSexual Dysfunctions not caused by organic disorder or disease.Accordingly the classifications of Male Sexual Dysfunctions as perICD-10 and DSM IV are shown in table No.3 and 4.Table No. 3ICD-10 Classifications F52 Sexual dysfunction not caused by organic disorderon disease.F52.0 Lack or loss of sexual desire.Normal sexual responsiveness but sexual activity less frequent and lesswanted.F52.10 sexual aversion.Strong negative feelings or anxiety associated with prospect of sexual activity withsubsequent avoidance.F52.11 Lack of sexual enjoyment.Sexual activity occurs but is not enjoyed.F52.2 Failure of Genital response.
  58. 58. Conceptual Study- 126In males erectile dysfunction.F52.3 Organic Dysfunction.Lack or delay of orgasm.F52.4 Premature EjaculationInability to control ejaculation sufficiently to allow both partners to enjoy sex.May occur before vaginal penetration or in the absence of erection.F52.7 Excessive sexual driveUsually in late teens on early adulthood. May be secondary to mania or earlydementia.F52.8 Other sexual dysfunction not caused by organic disorder or disease.F52-9 Unspecified sexual dysfunction not caused by organic disorder ordisease.
  59. 59. Conceptual Study- 127Table No 4.DSM-IV. Phases of sexual response cycle and associateddysfunction.Phases Characteristics DysfunctionsDesire This phase is distinct from any Hypoactive sexual desire identified solely through physiology disorder; sexual aversion and reflects the patient’s disorder; hypoactive sexual motivations, drives, and desire disorder due to a general personality. The phase is medical condition (male or characterized by sexual fantasies female; substance induced and the desire to have sex. sexual dysfunction with impAyurveda desire.Excitement This consists of a subjective sense Female sexual arousal disorder; of sexual pleasure and male erectile disorder; male accompanying physiological erectile disorder due to a responses noted in Masters and general medical condition; Johnson’s excitement and plateau dyspareunia due to a general phases are combined and occur medical condition (male or in this phase. female) substance – induced sexual dysfunction with impAyurveda arousal.Orgasm This phase consists of a peaking of Female orgasmic disorder; male sexual pleasure, with release of orgasmic disorder; premature sexual tension and rhythmic ejaculation; other sexual contraction of the perennial dysfunction due to a general muscles and pelvic reproductive medical condition (male or organs. female); substance induces sexual dysfunction with impAyurveda orgasmResolution This phase entails a sense of Post coital dysphoria; post coital general relaxation, well-being and headache muscle relaxation. During this phase men are refractory to orgasm for a period of time that increase with age, whereas women are capable of having multiple orgasms without a refractory periodImportant causes of sexual dysfunction There several causes that actively or passively induce sexualdysfunction in male. As I have mentioned early that severalfactors physiological, psychological, social, behavioral etc.influence human sexual response cycle in the same way multiple
  60. 60. Conceptual Study- 128factors cause the disorder in male. Even though, we can classifythem in to 3 divisions for convenience.A. OrganicB. PhysiologicalC. Psycho social.A. Organic causes. This can be divided in to six categories. I. Local genital pathology a. Priapism b. Congenital Malformation c. Surgical procedures on pelvic region egs:- perineal prostatectomy d. Mumps e. Elephantiasis g. Hydrocele or varicocele. II. Endocrine disorders a. Diabetes mellitus b. Dysfunction of pituitary adrenal testis axis. c. Testicular atrophy egs: secondary to dystrophia myotonica, hemachromatosis cirrhosis d. Thyroid dysfunction. III Neurological disorders. a. Autonomic Neuropathy eg: Diabetes mellitus b. Spinal cord lesions- eg: transverse myelities c. Third ventricle tumors d. Brain damage especially in temporal lobe. e. Multiple sclerosis.
  61. 61. Conceptual Study- 129 IV. Cardio vascular diseases a. Leriche syndrome. V. Any severe on debilitating systemic illness. VI Alcohol and drug abuse. (see the table 5. for details).B. Physiological causes. Certain physiological factors also produce sexual dysfunction. a. Penile hypersensitivity b. Missing of internal cues c. Shortness of nerve latency lime. d. Increased rapidity of all reflexes. e. Prolonged abstinence from sex.C. Psycho social causes The different causative factors in this group can be classified separately as psychological, social and behavioral I. Psychological causes of sexual dysfunction predisposing factors. a. Restrictive upbringing b. Disturbed family relationship. c. Inadequate sexual information d. Traumatic early sexual experience. e. Early insecurity in psycho sexual Role. II. Precipitants. a. Discord in the general relation ship. b. Infidelity c. Unreasonable expectations d. Dysfunction in their partner. e. Random failure.
  62. 62. Conceptual Study- 130 f. Reaction to organic factors. g. Ageing. h. Depression and anxiety i. Traumatic sexual experience.III. Maintaining factors. a. Performance anxiety. b. Anticipation of failure c. Guilt d. Loss of attraction between partners. e. Poor communication between partners f. Discord in general relation ship. g. Fear of Intimacy. h. ImpAyurveda self Image. i. Inadequate sexual information j. Sexual myths. k. Restricted fore play. l. Psychiatric disorder.II. Social factors. (Inter personal, environmental and cultural) a. Developmental factors. b. Ignorance / Misconceptions. c. Partners contribution d. Male prerogative ness and endorsed responsibility.III. Behavioral
  63. 63. Conceptual Study- 131 a. Adaptation b. Early experiences of hurried sexual encounter. All the above-mentioned factors cause, sustain the varioussexual dysfunctions found in male.
  64. 64. Conceptual Study- 132Sexual Dysfunction, a major Problem Loving, sexually satisfying relationship contributes a greatdeal to our happiness, and if we are not in such relationship weare apt to spend a great deal of time, effort and emotionalenergy looking for them. Sexuality is a central of our lives,influencing with whom we fall in love and mate and how happywe are with them and with ourselves. But what is regarded as normal sexual intercourse andtherefore what is thought to be impAyurveda or unsatisfactory,depends in part on the expectation of the two peopleconcerned. One couple may be normal with one situation whileother may seek treatment. But to a medical practitioner, always there is a knockingpopulation, concerning sexual satisfaction so, what is sexualdissatisfaction? For men – Repeated impairment of normal sexualdesire(interest) and/or performance. For women – Repeated unsatisfactory quality of theexperience (sexual intercourse can be completed but withoutenjoyment)Causes of sexual dissatisfaction Generally, sexual dissatisfaction results from variety ofcauses, but commonly can be classified as(1). Sexual and gender variants

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