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research in Sexual health

research in Sexual health

DIABETES AND SEXUALITY

There are about 40 million people with Diabetes (fasting blood sugar >126 mg per dl) in our country, it is twice the number than in China and 3 times from USA. In another 15 years, it is going to be double. There are another 77 million with pre diabetes (fasting blood sugar 126-140 mg per dl). Our country has the dubious distinction of being the diabetic capital of the world.

 

About 35-65% of people with diabetes suffer from Sexual Dysfunctions. It is due to narrowed blood vessels, obesity, Neuropathy and weakening of muscles.

Effect on blood vessels – About 70 % diabetics will have complications involving blood vessels causing narrowing of lumen, loss of stretchibility of vessel wall and hypertension. Blood supply to the genital organs is reduced, especially on arousal, causing poor erection or failure to maintain the erection due to poor veno – occlusive mechanism in males and loss of lubrication in females.

Neuropathy – There is a lot of discussion on effects of neuropathy on body parts like foot but its effects on sexual health are not given the importance it deserves. Effect on somatic nerve supply from genitalia impairs the arousal response by manipulation of genital organs causing poor erection / lubrication and poor orgasmic response. Its effect on Parasympathetic Neurons causes reduced impulses reaching corpora cavernosa from the L3–S1 centre in spinal cord, loss of production of Nitric Oxide gas and reduced erection again.

Diabetes is associated with obesity – So exercise tolerance is reduced, poor muscle tone, poor rigidity and pre mature ejaculation.

It lowers the immunity and more prone to have genital infections and catch STD – It may cause pain on having sex and emit foul smell from genitals, causing aversion to sex, and loss of desire.

Cardiac Problems are associated in up to 70% of patients – It leads to poorer blood supply, easy fatiguability and fear of further cardiac problem due to sex, resulting in ED and Loss of lubrication 6- Hormonal Imbalance – Diabetics have lower serum testosterone level due to altered metabolism, causing reduced desire and ED.

Psychogenic Issues – Stress of controlling blood sugar, fear of another failure to satisfy the partner, side effects of medicines to control hypertension, cardiac problem, high cholesterol, psychiatric problem worsen the situation, causing poorer control of diabetes and more sexual dysfunction.

Curvature of Penis – Repeated microvascular injury in penile blood vessels causes bleeding and formation of fibrous tissue. Slowly it leads to bigger and palpable plaques, resulting in painful erection and bending of penis from shaft. It is called Peyronie’s Disease. It is a dangerous complication.

CARDIAC DISEASE AND SEX PROBLEM

If you have ED, it is a matter of concern because it results in taking away the joy from life, low self esteem, marital discord, stress and low level of satisfaction but there is a bigger reason.

There are many reasons why ED could be a sign of impending cardiac problem –

Both Heart and Sex Organs are basically vascular structures, depends greatly on hormonal, psychological and neuronal factors for optimum functioning so adequate blood supply is an essential pre requisite.
Heart is supplied oxygen via coronary arteries and male organ by cavernous and helicine arteries.
Heart disease is a result of narrowing of Coronary artery due to deposition of cholesterol or spasm due to tobacco. Same thing happens in penis. Helcine artery is the narrowest artery in body so impairment due to narrowing of blood vessels appear in penile tissues before coronary arteries, resulting in ED.
Reduced blood supply when needed (at the time of erection in penis and added load in heart) cause dysfunction in either organ.
Research tells that 40-50 % of people with ED have vascular insufficiency as a sole/contributory cause.
Risk factors for ED and CAD are common as Diabetes, Hypertension, Hyperlipidemia, Smoking, Stress/Depression, Obesity, Sedentary life style.
Causes of ED after MI -(Heart Attack) –

MI DOESN’T CAUSE ED, FACTORS CAUSING MI DOES

Wife becomes over protective and discourages intimacy for fear of further attack.
There is phobia of sex in the person himself.
Performance anxiety – self doubts of being able to satisfy the partner.
Post MI depressive disorder and other psychiatric morbidity.
S/E of medicines being taken like beta blockers, statins, diuretics, many hypertensives like calcium antagonists.
Sedentary life style adds to the risk.
WHEN TO START SEX LIFE AFTER HEART ATTACK –

Do you think that post MI, your sex life is finished. No, it is a myth. The fact is that once the crisis of MI is over and condition is stabilized, you can resume your sex life as early as 8-10 weeks after the episode, provided the heart beat is regular. You are not taking beta blocker or diuretics and there is no CHF. You should start gradually by intimacy and should not hurry about penetration. When you start daily walk 20-25 minutes and TMT is normal, penetrative sex can be initiated. But if at any time you feel discomfort with sweating, excessive tiredness, unusual palpitation you should stop and consult your cardiologist.

ERECTILE DYSFUNCTIONS

WHAT IS ERECTILE DYSFUNCTION?

Erectile Dysfunction (ED) is a common multifactorial Dysfunction affecting 40%of men over age of 40 years and 70% above age of 70 year. With increasing incidences of life style diseases like hypertension, diabetes, cardiac problem, obesity, sedentary life style and drug abuse, incidences of ED are increasing day by day. It is traditionally divided in two types: psychological and physical .Not discussing your problem with right person or taking advice from a quack can be disastrous.

Causes of Erectile Dysfunction

Most common is reduced Blood flow to penis at the time of arousal. It is just like your heart beat: when you do the exercise, more blood flow is required by heart. Similarly, erection need 10-15 time more blood flow into penis. If is impaired due to any reason, you are likely to have ED.

      As ED is a multifactorial disorder, it is important to try to find out the possible factors contributing to ED in every case.

Investigations  

For Assessment of Blood flow: combined Intracavernosal Injection of vasoactive substance and stimulation test, Rigidometry, penile perfusion index and penile Doppler are helpful.
For Psychological factors: careful history taking, questionnaires for different problems are recommended.
For Neurological factor: SSEP in Dorsal nerve of penis is suggested.
For Hormonal factors: Blood test is done to determine sex hormone level.
Other Blood Biochemistry: like liver function test, kidney function test, Blood sugar test are very important.
NPT- Something we need to find out presence or absence of erection, its duration; or differentiate psychological type from physical ED. this test is very helpful to differentiate the two conditions. This test is done overnight when an instrument is strapped on your thigh with sensors attached to penis. It records all overnight penile activity; the data once obtained are transferred to computer and analyzed.
TREATMENT OF ERECTILE DYSFUNCTION

Counselling:

In many cases, counseling along may be quite helpful especially in cases where ED is present with one partner but absent with another. Ideally, it should be couple sex counseling. If you are patient enough to, it can be quite rewarding.

Medicines:

There are many medicines available to improve blood flow into penis; the testosterone supplement is also recommended.

Intrapenile injection:

Vasoactive substance is a mixture of Papaverine,Chlorpromazine and Prostaglandin . It is  injected at 10 O” Clock or 2 O Clock position either by the doctor in chamber or it can be taken home to be injected by self or partner. It should be followed by usual sexual fore play..

Caution:

After taking injection, if hardness persists even after 4 hours, it can be dangerous. In this case you need to rush to a neighborhood doctor. We give our patient a priapism letter, explaining the steps to be taken by your medical practitioner in medical emergency.

Vacuum Erection device (VED):

In this method, a plastic cylinder is fitted over the penis; and controlled negative pressure created. This pressure helps in retention of blood in the penis, thereby erection is achieved. A ring is fixed at the base of penis to maintain it for a maximum of 30 minutes. You should remove the ring before 30 minutes; otherwise ischemic changes may damage your penis.

Penile prosthesis:

If medicines are contraindicated, or have intolerable side effects, or do not work; if intrapenile inj. are not accepted, or had resulted in priapism, or there was a curve of more than 45 degree,  penile prosthesis is recommended. This is a very effective, safe, permanent and irreversible mode of treatment. It stays for 12-15 years. You need to stay in hospital for 10-14 days and get training about how to operate the device. You may find a minor change in the size but overall satisfaction level, as reported by the couples, is very good after surgery.

EFFECT OF WATCHING PORN ON SEX LIFE

It is becoming increasingly apparent that online porn can cause  erectile dysfunction (ED) and delayed ejaculation (DE) in otherwise healthy men in their sexual prime. In one study, male porn users reported increasing difficulty in being turned on by their real-world sexual partners. When asked if this phenomenon had any relationship to viewing pornography, subjects answered that it initially helped them get more excited during sex, but over time it had the opposite effect. There is the phenomena of habituation  so the amount of excitement with the same stimulus decreases with time.  So, thanks to pornography, growing numbers of women now find themselves in relationships with men who are suffering from sexual dysfunction, which affects the women as much as the men. After all, if your man can’t get it up, keep it up, or reach orgasm, your sexual pleasure is likely to be diminished.

Common complaints about porn-induced male sexual dysfunction include:

1-   He has no problem achieving erection or orgasm with pornography, but in person, with his willing partner, he struggles with one or both.
2-  He is able to have sex and achieve orgasm with his partner, but reaching orgasm takes a lot longer than it used to and his partner says he seems disengaged.
3- He can maintain an erection with his partner, but can only reach orgasm by replaying clips of Internet porn in his mind.
4- He increasingly prefers pornography to real-life sex, finding it more intense and engaging.
5- He keeps porn-related secrets from his partner (amount of time spent looking at porn, types images seen, etc.)
6- His partner feels like “the other woman.”

This problem is not due to the frequency of masturbation and orgasm; it is more related to the fact that men in general are both visually stimulated and turned-on by new stimuli. Essentially, a man who spends 70, 80, or even 90 percent of his sexual life fantasizing and masturbating to porn — countless images of young, exciting, constantly changing partners and sexual experiences — is, over time, likely to find his in-the-flesh encounters less stimulating than the endless parade of new material in his head. So what we are now seeing on a relatively wide scale is an emotional disconnect with real-world sex partners that is manifesting not only physically as sexual dysfunction, but emotionally as a lack of interest in real-world intimate connections. And sexual enhancement drugs — Viagra, Cialis, Levitra, and the like — won’t fix things because these drugs only dilate the blood vessels to sustain an erection, not to create one. The brain and body need to become aroused first of their own accord. Without that, no dose of “erection enhancing” drugs will help.

PENIS SIZE- DOES IT MATTER?

From purely medical view point- you need erect size  of more than 3 inches for normal sex. but socially ,a large number of males  are crazy to have bigger penis and females hunt for men with bigger organ.. Boys compare themselves to their friends or  models in Porn movies and Girls try to chase the ecstacy as shown in porn movies where a man of king size is having sex with a woman , sending her to dizzying heights of sexual frenzy. In many cases , boys refuse to marry and girls pass insulting judgements to their husbands or boy friends. Is their any way to make you look better? The answer is yes! it is not with unknown and untested medicines but with scientific means

1- Plastic Surgery– It is the best option . Here both the length and girth can be changed. The extent of change can vary from person to person. This can be done in one sitting or 2 sittings as decided by the surgeon. the final results can take up to 6 months to appear but generally results are good

2- Penile Lengthener– It is an instrument for rehabilitation and altering the length of penis. It needs to be worn for 4-6 months for 4-6 hours a day inside your pents. It also gives a fairly satisfactory result

3- Medications– in cases of hypogonadism where sex organs are poorly developed, sex hormone supplimentation can be done. It needs 3-4 months of treatment The results are good in carefully selected patients.

We perform these procedures routinely at our hospital.

GOOD SLEEPING HABITS ARE GOOD FOR SEX

How is Good Sleep related to Sex –

During sleep, anabolic hormones like testosterone and growth hormone are released in surges. These hormones repair the tissues already present and  make new tissues as per the need of the body. The Sympathetic tone is reduced  and parasympathetic  tone is increased so that your heart rate is lesser in morning than in evening. The cardiac muscles get good blood supply , as was shown by  a large study showing increased CAD in people sleeping less than 7 hours. Many times, ED is improved  by improving sleeping habits

The most important sleep hygiene measure is to maintain a regular wake and sleep pattern seven days a week. It is also important to spend an appropriate amount of time in bed, not too little, or too excessive. This may vary by individual; for example, if someone has a problem with daytime sleepiness, they should spend a minimum of eight hours in bed, if they have difficulty sleeping at night, they should limit themselves to 7 hours in bed in order to keep the sleep pattern.

Good sleep hygiene practices include:

·      –   Avoid napping during the day. It can disturb the normal pattern of sleep and wakefulness.

·          Avoid stimulants such as caffeine, nicotine, and alcohol too close to bedtime. While alcohol is well known to speed the onset of sleep, it disrupts sleep in the second half as the body begins to metabolize the alcohol, causing arousal so the quality of sleep with alcohol is poor and non relaxing

.

·         Exercise can promote good sleep. Vigorous exercise should be taken in the morning or late afternoon. A relaxing exercise, like yoga, can be done before bed to help initiate a restful night’s sleep.

·         Food can be disruptive right before sleep.  Stay away from large meals close to bedtime. Also dietary changes can cause sleep problems, if someone is struggling with a sleep problem, it’s not a good time to start experimenting with spicy dishes. And, remember, chocolate has caffeine.

          Ensure adequate exposure to natural light. This is particularly important for older people who may not venture outside as frequently as children and adults. Light exposure helps maintain a healthy sleep-wake cycle.

·         Establish a regular relaxing bedtime routine. Try to avoid emotionally upsetting conversations and activities before trying to go to sleep. Don’t dwell on, or bring your problems to bed.

·         Associate your bed with sleep and sex  only  It’s not a good idea to use your bed to watch TV, listen to the radio, or read.If you have to read before sleeping off, use the living room. Don’t make the bed a negotiation place for your demands or discuss family matters full of emotions. These are better done in some other room.

Make sure that the sleep environment is pleasant and relaxing. The bed should be comfortable, the room should not be too hot or cold, or too bright.
        –Keep the bed room  and bedsheet clean with nicely made bed

HOW DOES SOMEONE KNOW IF HIS OR HER SLEEP HYGIENE IS POOR?

Sleep disturbances and daytime sleepiness are the most telling signs of poor sleep hygiene. If one is experiencing a sleep problem, he or she should evaluate their sleep routine. It may take some time for the changes to have a positive effect. Adopting healthy sleep pattern is a preventive life style routine to prevent ED.

HOW DO I KNOW THE BEST SLEEP HYGIENE ROUTINE FOR ME?

If you’re taking too long to fall asleep, or awakening during the night, you should consider revising your bedtime habits. Most important for everyone is to maintain a regular sleep-wake schedule throughout the week and consider how much time you spend in bed, which could be too much or too little

Besided everyone with sex problems should be made aware of these habits to get a better sex life.

100 REASONS TO HAVE SEX

I’m not sure who asked the question to begin with (as though you needed a reason!), but here are 100 reasons to have sex . Though there can be 140 more to have sex

1. I was ”in the heat of the moment.”

2. It just happened.

3. I was bored.

4. It just seemed like ”the thing to do.”

5. Someone dared me.

6. I desired emotional closeness “(i.e.,” intimacy).

7. I wanted to feel closer to God.

8. I wanted to gain acceptance from my friends.

9. It’s “exciting,” adventurous.

10. I wanted to make up after a fight.

11. I wanted to get rid of aggression.

12. I was under the influence of drugs.

13. I wanted to have something to tell my friends.

14. I wanted to express my love for the person.

15. I wanted to experience the physical pleasure.

16. I wanted to show my affection to the person.

17. I felt like I owed it to the person.

18. I was attracted to the person.

19. I was sexually aroused and wanted the release.

20. My friends were having sex and I wanted to fit in.

21. It feels good.

22. My partner kept insisting.

23. The person was famous and I wanted to be able to say I had sex with him/her.

24. I was physically forced to.

25. I was verbally coerced into it.

26. I wanted the person to love me.

27. I wanted to have a child.

28. I wanted to make someone else jealous.

29. I wanted to have more sex than my friends.

30. I was married and you’re supposed to.

31. I was tired of being a virgin.

32. I was ”horny.”

33. I wanted to feel loved.

34. I was feeling lonely.

35. Everyone else was having sex.

36. I wanted the attention.

37. It was easier to ”go all the way” than to stop.

38. I wanted to ensure the relationship was ”committed.”

39. I was competing with someone else to ”get the person.”

40. I wanted to ”gain control” of the person.

41. I was curious about what the person was like in bed.

42. I was curious about sex.

43. I wanted to feel attractive.

44. I wanted to please my partner.

45. I wanted to display submission.

46. I wanted to release anxiety/stress.

47. I didn’t know how to say ”no.”

48. I felt like it was my duty.

49. I wanted to end the relationship.

50. My friends pressured me into it.

51. I wanted the adventure/excitement.

52. I wanted the experience.

53. I felt obligated to.

54. It’s fun.

55. I wanted to get even with someone “(i.e.,” get revenge).

56. I wanted to be popular.

57. It would get me gifts.

58. I wanted to act out a fantasy.

59. I hadn’t had sex for a while.

60. The person was ”available.”

61. I didn’t want to ”lose” the person.

62. I thought it would help ”trap” a new partner.

63. I wanted to make someone else jealous.

64. I felt sorry for the person.

65. I wanted to feel powerful.

66. I wanted to ”possess” the person.

67. I wanted to release tension.

68. I wanted to feel good about myself.

69. I was slumming.

70. I felt rebellious.

71. I wanted to intensify my relationship.

72. It seemed like the natural next step.

73. I wanted to be nice.

74. I wanted to feel connected to the person.

75. I wanted to feel young.

76. I wanted to manipulate him/her into doing something for me.

77. I wanted him/her to stop bugging me about sex.

78. I wanted to hurt/humiliate the person.

79. I wanted the person to feel good about themselves.

80. I didn’t want to disappoint the person.

81. I was trying to ”get over” an earlier person/relationship.

82. I wanted to reaffirm my sexual orientation.

83. I wanted to try out new sexual techniques or positions.

84. I felt guilty.

85. My hormones were out of control.

86. It was the only way my partner would spend time with me.

87. It became a habit.

88. I wanted to keep my partner happy.

89. I had no self-control.

90. I wanted to communicate at a deeper level.

91. I was afraid my partner would have an affair if I didn’t have sex with him/her.

92. I was curious about my sexual abilities.

93. I wanted a ”spiritual” experience.

94. It was just part of the relationship ”routine”.

95. I wanted to lose my inhibitions.

96. I got ”carried away.”

97. I needed another ”notch on my belt.”

98. The person demanded that I have sex with him/her.

99. The opportunity presented itself.

100. I wanted to see what it would be like to have sex while stoned “(e.g.,” on marijuana or some other drug).

This list comes from a University of Texas study published August 2007 issue of the Archives of Sexual Behavior (Study PDF). It asked 400 students and volunteers why they had sex. Keep in mind, most of the subjects were college-agen

EFFECT OF AGING ON SEX

Lots of men come to me with a coyish look  and  ask ” Though I am 45 now but stillI I thought there must be some years left to enjoy my sex life” !!

Too many misconceptions exist regarding the age till one should have sex . These beliefs get reinforced by the commonly found reduction in sex desire with the passage of time in a couple. Does it mean that men tend to have lesser desire as they age? The answer is “NO” . It is only the instant desire for your partner that goes down with time , the one present when you were in 20’s . It is probably due to habituation , a phenomena of reduced response of pleasure and arousal with the same stimulus over a period of time. People get more arousal with newer stimuli so chances of extra marital relationships increase . Surely the desire doesn’t go down as such .

What actually happens is that response of body to sexual cues change . You can enjoy sex as much as you wish and till any age as you can keep yourself physically and mentally fit. Of course you need to have a equally responsive and physically fit partner as well .

It is a very important to understand these changes because a large number of couples suffer in silence in the four walls of their bedroom  , many of them develop anxiety, frustration or negative self esteem . NO WONDER Many couples coming to me describe their relationships like a brother and sister over the last few years

Changes in desire- Frequency of sex is maximum in the initial 6 months to 2 years of marriage. It starts declining after that . Some of the decline is due to nitty and gritty of every day life , plans  to extend the family , financial burden and family burdens . Sex no longer occupy the privileged place in the list of everyday priorities, rather is pushed to the last chore to be done after everything else is finished . so people find that they no longer feel that passion for sex . You can’t have passionate feelings for something you don’t value. so the possible reason for perceived reduction in sex desire is due to misplaced priorities, not the real numbers .

In fact a lot of people have increased desire due to a release phenomena. Many rate sex after age 40 as the best of their lives .

Sounds crazy!!!!!! But it is a fact . Getting rid of worries of settling kids, stable finance and no worries for pregnancy can make women enjoy sex of lifetime after 50 . There are factors other than ageing alone who can kill desire like stress, low testosterone, high prolactin or some medicines causing side effects

Effects on Arousal – Arousal is the process of preparing for sexual inter course

Men get erect penis and women have lubrication in vagina. Ageing have some changes on the response. Men will take longer to get ready , degree of hardness is lesser, it will need more direct stimulation as compared to 20’s when a fleeting thought would get the system ready to fire. Too many patients come to me for treatment so that they can perform like they used to do in 20’s . Well folks, it is impossible. It is useless to search for “that hardness” because you only need to enter , not drill inside. In fact, delayed response can be a great advantage. People get better and better in the art of love making with experience and if they get time to utilise their expertise , the results are terrific. Another change is the persistence of hardness. It gets to wax and wane a bit during the whole episode of intimate moments but you are able to complete without a fuss . So don’t panic at the sight of slightest loss of hardness. It is transitory most probably . You better focus on the pleasure .

Effects on Ejaculation-  It is the process of ejecting semen from urinary canal. It is associated with extreme pleasure (orgasm or climax) and contraction of pelvic muscles . With ageing, the volume of semen will be lesser, the force of expulsion  of semen is reduced, the duration and degree of pleasure may be reduced but it can be compensated by your increased repertoire of ways to find pleasure .

Latency- Men are programmed by nature to experience one sex cycle at a time which consists of desire, arousal, ejaculation and resolution . Last stage is the process where all the extra blood pooled in genitalia goes back to main blood circulation. They can have another erection only after complete recovery. Time taken to recover fully can vary a lot in person to person and in the same person from time to time. But this time increases steadily with age . It means you need more time to get ready for next peace of action . For some it may be in days . It can be very frustrating if you keep on expecting the response you had many years back so if you adjust your expectations accordingly and don’t equate sex with intercourse, you will have much better sexual life .

Orgasm- The duration of climax  also reduces from 10-14 seconds to 3-5 seconds and intensity also a bit milder but you can improve your experience by varied fore play.