DISORDERS OF SEXUAL RESPONSE

Medications like Phentolamine, Papavarine hydrochloride and Alprostidil (PGE1 analogue) PGE1 analogues are given as intra-cavernosal injections in the treatment of erectile dysfunction.

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

Ref: Clinical Manual of Sexual Disorders By Richard Balon, R. Taylor Segraves, Pages 230-35; Contemporary Issues in Prostate Cancer By Jeanne Held-Warmkessel, Pages 338-41; Erectile Dysfunction: Current Investigation and Management By Ian Eardley, Krishna Sethia, Pages 55, 101; K D Tripathi Textbook of Pharmacology, 5th Edition

B i.e. 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

A i.e. Sildenafil

• Sildenafil is only approved & effective oral agent for erectile dysfunctionQ. It is useful in wide range of e.d.

including – pyschogenic, diabetogenic, vasculogenic, post radical prostatectomy (nerve sparing procedure) & spinal cord injury.

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

PIPE therapy (PapaverineQ/ Phentolamine Induced Penile Erection)

–          Androgen

Intraurethral – alprostodil (PGE1)

Penile prosthasis, vaccum constriction device

• Master Johnson technique is for premature ejaculationQ

p Blockers can cause erectile dysfunctionQ

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

Ans. Nocturnal penile tumescence

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. is ‘a’ i.e. Nymphomania [Ref Concise Textbook Of Forensic Medicine & Toxicology by Sharma p. 130]

• Nymphomania is excessive sexual desire in female where she enjoys having multiple sexual partners or desires excessive sexual activity.