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When Performance Deceives Desire-Dr. Vijay Kulkarni

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Erectile Dysfunction is defined as a persistent inability to achieve or to maintain erection adequate for mutually satisfying sexual intercourse.

When Performance Deceives Desire-Dr. Vijay Kulkarni

  1. 1. When Performance Deceives Desire <ul><li>Male Sexual Dysfunction </li></ul><ul><li>Talk at HELP </li></ul><ul><li>Talk to HELP </li></ul>
  2. 2. “ IS IT NOT STRANGE THAT DESIRE SO MANY TIMES OUTLIVES PERFORMANCE ? W. Shakespeare
  3. 4. Dr. Vijay Kulkarni Consultant Andrologist & Microsurgeon LTM Med College & Hospital Bhatia Hospital Raheja Hospital Nat. Inst. for Research in Reproductive Health
  4. 5. MALE SEXUAL DYSFUNCTION (MSD ) <ul><li>Libido + Arousal - Psychogenic </li></ul><ul><li>Erection + Rigidity </li></ul><ul><li>+ Sustainance - Physical </li></ul><ul><li>Penetration - Physical +Techn </li></ul><ul><li>Ejaculation +Orgasm - Reflex act </li></ul>
  5. 6. MSD Three componants <ul><li>Physical </li></ul><ul><li>Psychological </li></ul><ul><li>Mixed </li></ul>
  6. 7. Erectile Dysfunction (ED) Is defined as a persistent inability to achieve or to maintain erection adequate for mutually satisfying sexual intercourse
  7. 8. It is surprisingly common 20 mil. men in U.S.A. suffer from some degree of E.D. 52% men in age 40-70 suffer from some degree of E.D. 5% at age 40 & have total impairment 25% at age 70 ONLY 15% GET TREATED
  8. 9. Facts about ED in S.E.Asia <ul><li>Prevalence of ED much higher in younger age group in our setup </li></ul><ul><li>Because of cultural, social and religious belief elderly people seeking help for ED is uncommon </li></ul><ul><li>E.D. is a man’s problem but couple's concern </li></ul>
  9. 10. Risk Factors for ED <ul><li>Obesity, Smoking, Alcohol abuse </li></ul><ul><li>Diabetes </li></ul><ul><li>Hypertension </li></ul><ul><li>Depression </li></ul><ul><li>Drugs : Antihypertensives, Antidepressants </li></ul><ul><li>Endocrine disorders : Hypothyroidism </li></ul><ul><li>Trauma or Surgery to pelvis/ spine </li></ul>Are identical to those for Heart Disease
  10. 11. Diabetes & Erectile Dysfunction <ul><li>Men with diabetes have more than a </li></ul><ul><li> 3-fold increase in the incidence of ED </li></ul><ul><li>Over 65% develop ED after 10 years of being diagnosed with diabetes </li></ul><ul><li>ED starts early in diabetic population and is more severe </li></ul>
  11. 12. E D Can Be Treated With <ul><li>Counseling & Sex Education </li></ul><ul><li>Oral drugs </li></ul><ul><li>Intra-penile self-injections </li></ul><ul><li>Vacuum erection devices </li></ul><ul><li>Penile implants </li></ul>
  12. 14. ORAL DRUGS <ul><li>Sildenafil </li></ul><ul><li>Vardenafil </li></ul><ul><li>Tadalafil </li></ul>
  13. 15. INTRA-PENILE SELF-INJECTIONS <ul><li>I ntra – C avernosal I njection </li></ul><ul><li>of </li></ul><ul><li>V aso- A ctive D rugs </li></ul>
  14. 16. Commonly Used Drugs <ul><li>Papaverine & Prostaglandin E1 </li></ul><ul><li>In combination </li></ul><ul><li>with other drugs </li></ul>Intra Cavernosal Injection of Vaso Active Drugs (ICIVAD)
  15. 17. Patient’s Guide to Self Injection
  16. 18. ICIVAD Therapeutic Application <ul><li>Therapeutic dose determination </li></ul><ul><li>Training & supervised self injection </li></ul><ul><li>Home self-injection programme </li></ul>
  17. 22. ICIVAD
  18. 23. Do not forget PRIAPISM !!! <ul><li>Prolonged </li></ul><ul><li>Erection </li></ul><ul><li>Painful </li></ul><ul><li>Involuntary </li></ul><ul><li>& </li></ul><ul><li>NON-SEXUAL </li></ul>
  19. 24. Vacuum Erection Devices (VED) BASIC DESIGN <ul><li>Cylinder </li></ul><ul><li>Vacuum pump </li></ul><ul><li>Constriction rings </li></ul>
  20. 25. Vacuum Erection Devices
  21. 27. Vacuum Erection Devices (VED ) <ul><li>Time-tested </li></ul><ul><li>Non-invasive </li></ul><ul><li>Select Population </li></ul>
  22. 28. Vacuum Erection Devices (VED ) <ul><li>For Elderly patients with limited frequency of coitus – </li></ul><ul><ul><li>Combination of Intra Penile Inj + VED works well </li></ul></ul><ul><ul><li>It avoids surgery for Prosthesis </li></ul></ul>
  23. 29. <ul><li>Advances </li></ul><ul><li>in </li></ul><ul><li>Surgery for Impotence </li></ul>
  24. 30. <ul><li>This is not what the penile prosthesis does </li></ul>
  25. 31. Beyond medication – Penile Implants <ul><li>TWO TYPES </li></ul><ul><li>SOLID- Non-Inflatable </li></ul><ul><li>INFLATABLE </li></ul>
  26. 32. Penile Prosthesis Non Inflatable Type (Malleable or Flexible)
  27. 33. Beyond Medication- Penile Implants Non-inflatable Shah Penile Prosthesis with hinge
  28. 34. Malleable Penile Prosthesis Placement in body – Flaccid State
  29. 35. Malleable Penile Prosthesis Placement in the body - Erect state
  30. 37. Inflatable Penile Prosthesis Placement in body – Flaccid state
  31. 38. Inflatable Penile Prosthesis Placement in body – Erect state
  32. 41. ORAL ERECTOGENIC DRUGS <ul><li>Sildenafil </li></ul><ul><li>Vardenafil </li></ul><ul><li>Tadalafil </li></ul>REVOLUTIONISED TREATMENT
  33. 42. Oral Erectogenic Drugs <ul><li>At present </li></ul><ul><li>Sildenafil citrate </li></ul><ul><li>is the most used </li></ul><ul><li>oral erectogenic drug </li></ul>
  34. 43. New Oral Erectogenic Drugs <ul><li>Vardenafil </li></ul><ul><ul><li>Decreased side effects </li></ul></ul><ul><ul><li>Quicker onset of action </li></ul></ul><ul><li>Tadalafil </li></ul><ul><ul><li>Prolonged duration of action </li></ul></ul><ul><ul><li>Minimal side effects </li></ul></ul><ul><ul><li>Unrelated to food intake </li></ul></ul>
  35. 44. Oral Drugs-PDE 5 inhibitors <ul><li>Sildenafil-25mg,50mg,100mg </li></ul><ul><li>Tadalafil- 10 & 20mg </li></ul><ul><li>Vardenafil- 5 & 10 mg –(not available) </li></ul>
  36. 45. Side effects of oral drugs <ul><li>- Headache - Back pain </li></ul><ul><li>- Dyspepsia - Myalgia </li></ul><ul><li>- Nasal congestion - Pain in limbs </li></ul><ul><li>- Visual disturbances - Flushing </li></ul>Brock GB et al. J Urol 2002; 168: 1332-1336.
  37. 46. WARNING !! <ul><li>DO NOT TAKE IF YOU USE OR EVEN LIKELY TO USE NITRATES - i.e. medication for cardiac pain </li></ul><ul><li>DO NOT TAKE WITHOUT CONSULTING YOUR DOCTOR </li></ul>
  38. 48. <ul><li>The Pill is Not </li></ul><ul><li>an aphrodesiac - </li></ul><ul><li>it does not  libido </li></ul>
  39. 49. <ul><li>The Pill does Not make </li></ul><ul><li>normal erection harder </li></ul><ul><li>or last longer </li></ul>
  40. 50. IT IS NOT SUPPOSED TO MAKE YOU A SUPER ATHLETE ! IT IS MEANT TO HELP YOU NORMALISE YOUR MARITAL HARMONY.
  41. 51. <ul><li>Risk Factors </li></ul><ul><li>are the same for </li></ul><ul><li>Coronary Artery Disease </li></ul><ul><li>& </li></ul><ul><li>Erectile Dysfunction </li></ul>
  42. 52. Modern Andrology Can Offer Cure To Nearly All Patients With Impotence
  43. 53. Remember a person may be born with ED but he need not die with it

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