Male sexual dysfunction
Male sexual dysfunction can be devastating not only for the mental and physical health of any man, but also for the overall relationship with his spouse. Male sexual dysfunction could be of following types:
- Inability to achieve erections( Hardness of Penis) Erectile dysfunction ( ED)
- Rapid ejaculation (Premature Ejaculation)
- Inability to ejaculate ( Retarted or Anejaculation)
- Reduced desire to have sexual activity ( Loss of Libido)
Management of Erectile dysfunction (ED) is primarily by using medications like “VIAGRA” (Sildenafil Citrate). However medicines are not a sure shot treatment and a set of patients almost one third to one fourth of all newly diagnosed patients with erectile dysfunction may not respond to the medical treatment alone. This happens particularly in men who have undergone a pelvic surgery (e.g. prostate removal, cancer surgery)and men with Diabetes.
To help men who do not achieve adequate response by the medical management, surgical implantation of silicone devices can be done.
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Surgery for Male sexual dysfunction-Impotence
Sexual dysfunction can be devastating for any man and his partner. Not only does it impair the quality of life, but also exposes the individual to a horde of psycho social problems. Erectile dysfunction is typically treated with oral medication, Sildenafil (Viagra) being the first of such drugs approved by the FDA for such use. However, use of medical treatment of erectile dysfunction (or more commonly known as Impotence) has a certain failure rate which ranges from 30 - 45%. The failure of medical treatment is more with men in the older age group, cases with surgery on the pelvic organs (e.g. surgery for cancer of prostate, or accidental injury to the bony pelvis etc.), and men with diffuse disease of blood vessels ( Atherosclerosis), Diabetes Mellitus and any other organic disorder of nerves and blood vessels. Such situations can be salvaged by surgical implantation of devices which mimic physiological erection in the male organ.
- What are penile implants?
- Who should go for such a treatment?
- What are the pre requisites for this type of surgery?
- How is the surgery performed?
- What is the usual recovery period?
- What are the risks involved?
- What are the various implants available?
- How does one choose the implant?
Silicone Penile Implants for Impotence (Sexual Dysfunction)
A wide range of these devices are available. One could choose to have simple semi rigid silicone rod like implants to a sophisticated Inflatable device. The advantage of an inflatable device is that the device could be inflated using a small pump located in the scrotum and after sexual activity, it can be deflated so that it can be comfortably concealed in the clothing, simulating a natural function. The problem with semi rigid rods is the difficulty in concealing the implant as the organ would appear to be in a perpetually erect state. However there is substantial difference in the cost of the two.
Viagra and heart disease
Millions of men worldwide are suffering from erectile dysfunction, and this is only going to be increased with increasing ageing population. The present estimates of erectile dysfunction range from 12.9% to 28.1%. Erectile dysfunction or ED is a measure of endothelial dysfunction and therefore before prescribing any form of treatment, it is important to assess the functional status of a man .This is especially relevant in men who have not been undertaking any physical activity, so that they may not be allowed into performing strenuous activity, which may be life threatening.
Occult cardiac insufficiency can not only cause serious harm to such a patient but also bring disrepute to the treating physician and the treatment modality used. It is therefore necessary to consider the cardiovascular status of their patients prior to initiating any treatment for erectile dysfunction especially PDE5 inhibitors. Certain underlying conditions could be adversely affected by vasodilatory effects of sildenafil, especially in combination with sexual activity.
The following precautions must be taken before prescribing PDE5 inhibitors, keeping in mind the cardiac status.
- Use of PDE 5 inhibitors along with nitrates in any form is contraindicated. It is best to replace nitrates with other medication such that PDE5 inhibitors may be used.
- Performance status may be judged as the ability
a) to walk for 15 minutes at a pace of 4 km/hr ,or
b) climb two flights of (20) stairs
without any angina or angina equivalent.
In men with borderline performance status, sexual activity may be allowed with the “usual partner” in usual circumstances.