The document discusses male sexual dysfunction, particularly erectile dysfunction (ED), highlighting its prevalence, risk factors, and treatment options. It notes that ED affects a significant number of men, with various psychological and physiological contributors, and emphasizes that both medical and non-invasive treatments exist. The discourse also mentions the importance of addressing such dysfunction comprehensively to maintain marital harmony and overall well-being.

1. When Performance Deceives Desire Male Sexual Dysfunction Talk at HELP Talk to HELP

2. “ IS IT NOT STRANGE THAT DESIRE SO MANY TIMES OUTLIVES PERFORMANCE ? W. Shakespeare

4. Dr. Vijay Kulkarni Consultant Andrologist & Microsurgeon LTM Med College & Hospital Bhatia Hospital Raheja Hospital Nat. Inst. for Research in Reproductive Health

5. MALE SEXUAL DYSFUNCTION (MSD ) Libido + Arousal - Psychogenic Erection + Rigidity + Sustainance - Physical Penetration - Physical +Techn Ejaculation +Orgasm - Reflex act

6. MSD Three componants Physical Psychological Mixed

7. Erectile Dysfunction (ED) Is defined as a persistent inability to achieve or to maintain erection adequate for mutually satisfying sexual intercourse

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

9. Facts about ED in S.E.Asia Prevalence of ED much higher in younger age group in our setup Because of cultural, social and religious belief elderly people seeking help for ED is uncommon E.D. is a man’s problem but couple's concern

10. Risk Factors for ED Obesity, Smoking, Alcohol abuse Diabetes Hypertension Depression Drugs : Antihypertensives, Antidepressants Endocrine disorders : Hypothyroidism Trauma or Surgery to pelvis/ spine Are identical to those for Heart Disease

11. Diabetes & Erectile Dysfunction Men with diabetes have more than a 3-fold increase in the incidence of ED Over 65% develop ED after 10 years of being diagnosed with diabetes ED starts early in diabetic population and is more severe

12. E D Can Be Treated With Counseling & Sex Education Oral drugs Intra-penile self-injections Vacuum erection devices Penile implants

14. ORAL DRUGS Sildenafil Vardenafil Tadalafil

15. INTRA-PENILE SELF-INJECTIONS I ntra – C avernosal I njection of V aso- A ctive D rugs

16. Commonly Used Drugs Papaverine & Prostaglandin E1 In combination with other drugs Intra Cavernosal Injection of Vaso Active Drugs (ICIVAD)

17. Patient’s Guide to Self Injection

18. ICIVAD Therapeutic Application Therapeutic dose determination Training & supervised self injection Home self-injection programme

22. ICIVAD

23. Do not forget PRIAPISM !!! Prolonged Erection Painful Involuntary & NON-SEXUAL

24. Vacuum Erection Devices (VED) BASIC DESIGN Cylinder Vacuum pump Constriction rings

25. Vacuum Erection Devices

27. Vacuum Erection Devices (VED ) Time-tested Non-invasive Select Population

28. Vacuum Erection Devices (VED ) For Elderly patients with limited frequency of coitus – Combination of Intra Penile Inj + VED works well It avoids surgery for Prosthesis

29. Advances in Surgery for Impotence

30. This is not what the penile prosthesis does

31. Beyond medication – Penile Implants TWO TYPES SOLID- Non-Inflatable INFLATABLE

32. Penile Prosthesis Non Inflatable Type (Malleable or Flexible)

33. Beyond Medication- Penile Implants Non-inflatable Shah Penile Prosthesis with hinge

34. Malleable Penile Prosthesis Placement in body – Flaccid State

35. Malleable Penile Prosthesis Placement in the body - Erect state

37. Inflatable Penile Prosthesis Placement in body – Flaccid state

38. Inflatable Penile Prosthesis Placement in body – Erect state

41. ORAL ERECTOGENIC DRUGS Sildenafil Vardenafil Tadalafil REVOLUTIONISED TREATMENT

42. Oral Erectogenic Drugs At present Sildenafil citrate is the most used oral erectogenic drug

43. New Oral Erectogenic Drugs Vardenafil Decreased side effects Quicker onset of action Tadalafil Prolonged duration of action Minimal side effects Unrelated to food intake

44. Oral Drugs-PDE 5 inhibitors Sildenafil-25mg,50mg,100mg Tadalafil- 10 & 20mg Vardenafil- 5 & 10 mg –(not available)

45. Side effects of oral drugs - Headache - Back pain - Dyspepsia - Myalgia - Nasal congestion - Pain in limbs - Visual disturbances - Flushing Brock GB et al. J Urol 2002; 168: 1332-1336.

46. WARNING !! DO NOT TAKE IF YOU USE OR EVEN LIKELY TO USE NITRATES - i.e. medication for cardiac pain DO NOT TAKE WITHOUT CONSULTING YOUR DOCTOR

48. The Pill is Not an aphrodesiac - it does not  libido

49. The Pill does Not make normal erection harder or last longer

50. IT IS NOT SUPPOSED TO MAKE YOU A SUPER ATHLETE ! IT IS MEANT TO HELP YOU NORMALISE YOUR MARITAL HARMONY.

51. Risk Factors are the same for Coronary Artery Disease & Erectile Dysfunction

52. Modern Andrology Can Offer Cure To Nearly All Patients With Impotence

53. Remember a person may be born with ED but he need not die with it