DISORDERS OF SEXUAL RESPONSE

Medications like Phentolamine, Papaverine hydrochloride and Alprostadil (PGE1 analogue) PGE1 analogues are given as intracavernosal injections in the treatment of erectile dysfunction.

Phenylephrine is a selective alpha-agonist that is used to reverse the erections of intrathecal injections. It cannot be used in the treatment of erectile dysfunction.

Ans:B-Premature ejaculation 

Master and Johnson’s Technique

• It is dual sex therapy i.e. patient alone is not treated but both partners are treated together.
• Types

Ans:A-Sildenafil

Sildenafil is only approved & effective oral agent for erectile dysfunction. It is useful in wide range of erectile dysfunctions including – pyschogenic, diabetogenic, vasculogenic, post radical prostatectomy (nerve sparing procedure) & spinal cord injury.

• It acts by inhibiting phosphodiesterase – 5 (PDE-5) & releasing Nitric Oxide from nerve endings & endothelium
• Other t/t for Erectile dysfunction are:

PIPE therapy (Papaverine/ Phentolamine Induced Penile Erection)

–          Androgen

Intraurethral – alprostodil (PGE1)

Penile prosthasis, vaccum constriction device

• Master Johnson technique is for premature ejaculation

Beta Blockers can cause erectile dysfunction

Ans. B: Vascular

ED is essentially a vascular disease.

It is often associated with other vascular diseases and conditions such as diabetes, hypertension, and coronary artery disease.

Other conditions associated with ED include neurologic disorders, endocrinopathies, benign prostatic hyperplasia, and depression.

Conditions associated with reduced nerve and endothelium function, such as aging, hypertension, smoking, hypercholesterolemia, and diabetes, alter the balance between contraction and relaxation factors.

These conditions cause circulatory and structural changes in penile tissues, resulting in arterial insufficiency and defective smooth muscle relaxation.

In some patients, sexual dysfunction may be the presenting symptom of these disorders.

Additionally, ED is often an adverse effect of many commonly prescribed medications.

Some psychotropic drugs and antihypertensive agents are associated with ED.

Ans. Psychological

The most common cause of erectile dysfunction in

• Young and middle-aged men: Psychological 
• Older men: Organic (atherosclerosis)
• Overall: Organic (atherosclerosis) 

Ans.A- Nocturnal penile tumescence

• When a man has problems with erections, it is sometimes difficult to know if the cause(s) are physical, psychological, or both. The nocturnal penile tumescence (NPT) test can give the doctor some clues.
• Men typically have 3 – 5 erections per 8 hours of sleep, usually at night. This is called nocturnal penile tumescence (NPT). The NPT test shows whether these erections have occurred.
• The test may be done at home or at a sleep lab. The most accurate method involves a special electronic device with two rings connected to it. One ring is placed at the tip of the penis; the other is placed at the base.
• While the man sleeps, the device monitors his nocturnal erections, including how many occur, how long they last, and how rigid they are.
• The NPT test is not used often and is not a routine way to evaluate erectile function. It might be used for hard-to-diagnose cases, for young patients, or in legal cases. But otherwise, its use is rare. 
• The test has some limitations, too. There is not much scientific data to support its use. Men need to sleep using the device for two consecutive nights, which can be inconvenient. It is also an expensive method and is not widely available.
• If a man has nocturnal erections, it is likely that psychological issues are affecting his erectile function. The fact that he can have erections during the night shows that his body is working normally. Men might consider seeing a sex therapist or counselor at this point, although a physician should always be consulted for erection problems.

Ans. Satyriasis

Satyriasis is excessive sexual desire in male where he enjoys having multiple sexual partners or desires excessive sexual activity.

The female-specific term for the same condition is Nymphomania.

* A fetish is an abnormal stimulus or object of sexual desire.

  – Fetishism means the use of such objects of sexual gratification leading to orgasm. For exmaple underclothing, brassiere, petticoat, stocking, shoes, etc.

Frotteurism :

* Sexual satisfaction is obtained by rubbing against persons in crowd.

* If they attempt intercourse, they have a premature ejaculation or they are impotent.

* It is an uncommon perversion and rarely occurs alone

Ans.A. Nymphomania

•  Nymphomania is an excessive sexual desire in females where she enjoys having multiple sexual partners or desires excessive sexual activity.
• Satyriasis is an excessive sexual desire in males where they enjoy having multiple sexual partners or desire excessive sexual activity.

Types of Sexual perversions

• These are persistently indulged sexual acts in which complete satisfaction is sought and obtained without sexual intercourse.

a) Sadism :

• Sexual gratification is obtained or increased from acts of physical cruelty or infliction of pain on one’s partner.
• It is seen more commonly in men. To obtain sexual gratification, the sadist may bite, beat, whip, produce cuts on the victim, etc.

b) Lust murder :

• In extremes of sadism, murder serves as a stimulus for the sexual act and becomes the equivalent of coitus, the act is accompanied by erection, ejaculation, and orgasm.

c) Necrophagia : (Necros =corpse; phagia = to eat) :

• This is an extreme degree of sadism in which the person after mutilating the body, sucks or licks the wounds, bites the skin, drinks blood, and eats the flesh of his victim to derive sexual pleasure.

d) Masochism :

• Sexual gratification is obtained or increased by the suffering of pain.
• Masochists get pleasure from being beaten, abused, tortured, humiliated, enslaved, degraded, or dominated by their sexual partner.

e) Necrophilia :

• In this condition, there is a desire for sexual intercourse with dead bodies.
• It is said to have a sadomasochistic foundation and that decomposition, foul smell, and coldness act as stimulants.

f) Fetishism :

• A fetish is an abnormal stimulus or object of sexual desire.
• Fetishism means the use of such objects of sexual gratification leading to orgasm. For example underclothing, brassiere, petticoat, stocking, shoes, etc.

g) Transvestism = Eonism:

• A transvestite (trans = opposite, vista = clothing) is a person whose whole personality is dominated by the desire of being identified with the opposite sex.