For the want of a child to hold close to heart...

Dr P Dharmaraj | 01-May-2014

The heart-warming sound of the titter-tatter little feet in the living room indeed makes life on earth a celebration. But in today’s fast paced life, many delay the arrival of this wonderful bliss in their life. But when they finally get ready for it, so many hurdles come up on the way. Recent studies suggest stress is one reason that makes difficulty in women getting pregnant. Researchers say stress causes lack of libido and reproductive dysfunction in both men and women. Dr P Dharmaraj, head of Andrology and Sexology Department at CRAFT Hospital, Kodungaloor, talks to SUMITHRA SATHYAN  about the causes and remedies for this dreaded malfunction in one’s life

By Dr P Dharmaraj

From time immemorial infertility has always been considered a woman’s disease. That’s definitely not correct and in fact it is a prejudice that should undergo an immediate reversal. It is not a gender specific issue. Both women and men can have fertility management issues. About a quarter of infertility cases are caused by female fertility problems and the other quarter due to male fertility related issues. On an average male fertility factors contribute to around 50% of all infertility cases. Male fertility can depend largely on modifiable factors, such as diet, lifestyle, sexual habits, and occupational exposures. In some cases, simple changes can increase male fertility. Heavy alcoholism, drugs, smoking, age, environmental toxins including pesticides and lead, kidney disease, hormone problems, few medicines, radiation treatment and chemotherapy for cancer may affect the health or number of sperms. One of the major causes of male infertility other than semen parameters is Erectile Dysfunction (ED) which is a commonly neglected parameter.

Erectile Dysfunction (ED) or impotence is sexual dysfunction characterised by the inability to develop or maintain an erection of the penis during sexual performance. A penile erection is the hydraulic effect of blood entering and being retained in sponge-like bodies within the penis. The three main causes can be categorised as Psychological, Vascular and Neurogwenic.

The process is often initiated as a result of sexual arousal, when signals are transmitted from the brain to nerves in the penis. The most important organic causes are cardiovascular disease and diabetes, neurological problems (for example, trauma from prostatectomy surgery), hormonal insufficiencies (hypogonadism) and drug side effects.

Psychological impotence is where erection or penetration fails due to thoughts or feelings (psychological reasons) rather than physical impossibility; this is somewhat less frequent but often can be helped. Notably in psychological impotence, there is a strong response to placebo treatment. Erectile dysfunction can have severe psychological consequences as it can be tied to relationship difficulties and masculine self-image generally.

Emotional fear

Case history-I

A couple came to see me after eight years of marriage .They used to have regular physical relationship as stated by them but no babies as yet. Both of them were satisfied with the sexual intimacy they had. But on further communications the wife revealed that the husband had not even once penetrated her. In other words she was still a virgin. This case was more of a psychological issue than medical correction. On counselling it was revealed that it was the husband’s fear of sustaining his erection that had caused this problem. A few sessions fortunately cleared his emotional disturbances and they now lead a happy life.

Psychological factors

The major psychological factors include apprehension and anxiety, premarital sexual relations that might have been a disaster, partner oriented sexual preference and in many cases these days orientation towards same sex. In such cases psychotherapy and counselling usually clear the issue.

Increasing ED

Coming to the medical and surgical cases, these days the incidence of ED is seen to be increasing in young men. Common causes include hypertension, stress related issues, hypercholestrol, obesity and diabetes mellitus. The absence of all these also may cause ED termed idiopathic issues. One of the major medical issues is Vascular Erectile Dysfunction - Vascular ED occurs due to insufficient flow of

Venous leak

Another issue is Venous leak.Venous Leak, also called Venogenic Erectile Dysfunction and Penile Venous Insufficiency, is a cause of Erectile Dysfunction in males, often inflicting young men, unlike other organic causes of Erectile Dysfunction. It is an inability to maintain an erection in the presence of sufficient arterial blood flow through the artery. The defect lies in the drainage of the tissue of the penis, which under normal function provides high resistance to venous blood flow from the penis during an erection.eMost men suffering from Venogenic Erectile Dysfunction start having trouble with their erections from a young age.

Common complaints

A chronic soft erection insufficient for sexual intercourse, position-dependent erectile rigidity, and difficulty achieving erections, difficulty maintaining erections without constant manual stimulation and a soft glands of the penis during erection.

Evaluation of all cases includes complete redressal of hormone profile, sexual history and clinical examination. A medical history for any other serious illness is also compiled. The state of the genitals, prostrate and other assesory sexual glands are also evaluated. Lab evaluations are also performed including blood tests and penile doppler to know about the grade and severity of erectile dysfunction. Here special devices are made use of like the RIGI scan to know the advanced level issues. In many cases initial oral medications which improves sexual functions are made use of. In case of no response to medicine due to the severity of the issue , and intolerance to medications surgical management is often required.

Here in surgical management  is where artificial prosthesis will be placed under penis and during intercourse with normal stimulation normal erection is resulted. Here there are two categories, flexible and inflatable penile prosthesis.

Insufficient blood flow

Case history-II

Rajeev (name changed) 42 yrs, a bank manager and his wife Lalitha (name changed) 38 yrs , a college librarian came to us after 18 years of  marriage seeking a solution for diagnosed infertility. They were a seemingly happy couple. When interviewed both husband and wife were satisfied with each other. However, when hormonal tests and other primary investigations yielded no results we sent the couple for individual interviews. What was revealed was shocking -- the marriage was still un- consummated. On further examination, Rajeev was diagnosed with insufficient blood flow to penis which cannot be corrected with medications. He was sent in for a penile prosthesis --implant surgery. After 18 years of marriage they celebrated the first honeymoon and now have a 2-year old baby.

Hidden issues

In our country wives consider it below dignity to blame their husbands for any issues during sexual intercourse. Often the real issue is kept under wraps for a long time and hence the right solution is never found. This is a typical case of ignorance and fear of society . Many such patients now have found an easy way out. They live apart and sometimes after undergoing severe emotional trauma decide to divorce or separate. There have been cases where the male partner has run away to escape the society.

Early treatment

Early treatment is very crucial for erectile dysfunction. Delay in treatment not only causes physical issues and infertility but also drains the individual with emotional trauma. Many divorce cases are being reported, and many of the patients report fear of losing jobs etc due to stress related issues. The solution may be simple. It is the mindset that has to undergo a change. Maybe going to the right doctor at the right time may save many marriages and happy lives. Sexual dysfunctions are not a crime- rather a medical condition most of which having easy solutions these days.

When and how stress happens 

It is possible to reduce stress levels in one’s life to a great extent if he knows what causes stress and what happens when he is stressed            

By FM Bureau

Stress is what you feel when you have to handle more than you are used to. When you are stressed, your body responds as though you are in danger. It makes hormones that speed up your heart, make you breathe faster, and give you a burst of energy. This is called the fight-or-flight stress response.   

Some stress is normal and even useful. Stress can help if you need to work hard or react quickly. For example, it can help you win a race or finish an important job on time.

But if stress happens too often or lasts too long, it can have bad effects. It can be linked to headaches, an upset stomach, back pain, and trouble sleeping. It can weaken your immune system, making it harder to fight against diseases. If you already have a health problem, stress may make it worse. It can make you moody, tense, or depressed. Your relationships may suffer, and you may not do well at work or school.

Some ways to manage stress

The good news is that you can learn ways to manage stress. To get stress under control:

• Find out what is causing stress in your life
• Look for ways to reduce the amount of stress
• Learn healthy ways to relieve stress and reduce its harmful effects

Measure your stress level

Sometimes, it is clear where stress is coming from. You can count on stress during a major life change such as the death of a loved one, getting married, or having a baby. But other times it may not be so clear why you feel stressed.

It’s important to figure out what causes stress for you. Everyone feels and responds to stress differently. Get a notebook, and write down when something makes you feel stressed. Then write how you reacted and what you did to deal with the stress. Tracking your stress can help you find out what is causing your stress and how much stress you feel. Then you can take steps to reduce the stress or handle it better.  

To find out how stressed you are right now, use this Interactive Tool: What Is Your Stress Level? calculator.gif

How can you avoid stress?

Stress is a fact of life for most people. You may not be able to get rid of stress, but can look for ways to lower it. You can try some of these ideas:

Learn better ways to manage your time. You can do more with less stress if you make a schedule. Think about which things are most important, and do those first.

Find better ways to cope. Look at how you have been dealing with stress. Be honest about what works and what does not. Think about other things that might work better.

Take good care of yourself. Get plenty of rest. Eat well. Don’t smoke. Limit how much alcohol you drink.

Try out new ways of thinking. When you find yourself starting to worry, try to stop the thoughts. Or write down your worries and work on letting go of things you cannot change. Learn to say “no.”

Speak up. Not being able to talk about your needs and concerns creates stress and can make negative feelings. Assertive communication can help you express how you feel in a thoughtful, tactful way.

Ask for help. People who have a strong network of family and friends manage stress better.

Sometimes, stress is just too much to handle alone. Talking to a friend or a family member may help, but you may also want to see a counselor.

How to relieve stress

You will feel better if you can find ways to get stress out of your system. The best ways to relieve stress are different from person to person. Try some of these ideas to see which one works for you:

Exercise: Regular exercise is one of the best ways to manage stress. Walking is a great way to get started.

Writing: Write about the things that are bothering you

Let your feelings out: Talk, laugh, cry, and express anger when you need to with someone you trust

Do things you enjoy: A hobby can help you relax. Volunteer work or work that helps others can be a great stress reliever.

Learn ways to relax your body. This can include breathing exercises, muscle relaxation exercises, massage, aromatherapy, yoga, or relaxing exercises like tai chi and qi gong.

Focus on the present: Try meditation, imagery exercises, or self-hypnosis. Listen to music. Try to look for the humour in life. Laughter really can be the best

Food for healthy living

Following  are  some of the elements that need to be discontinued from  our lifestyle for healthy living

Although initially you will feel rejuvenated after consuming the following products, they will only last for a short while and in the long term, can actually do damage to your body.

Caffeine: Caffeine is found in drinks such as coffee, tea and carbonated

drinks. The problem with caffeine is that it forces the body to release adrenalin

into the system, which causes stress. If caffeine is taken in small doses

periodically, it can prove effective as it makes the body alert (think about the

alarm stage of stress). If too much caffeine is consumed, then this can cause

a high level of stress, high blood pressure and nervousness (think about the

resistance and exhaustion stages of stress).

Sugar: Sugar contains no vital nutrients whatsoever. It should therefore be

totally disregarded if you are focusing on a diet. Too much sugar can force the

body to use reserved resources. This will result in short term problems such

as lack of concentration and fatigue. Sugar also forces the pancreas to over

work. This can lead to problems in the long term, such as diabetes.

Fats: In moderation, fats are essential to the body. However, you should

avoid any food that contains high volumes of saturated fats. These are the

‘bad’ fats that can lead to obesity, heart conditions and cancer.

Alcohol:

Alcohol has proven to be a worthwhile drug to consume if taken in moderation. People always say one small glass of wine a day can benefit

areas in your body such as the heart. This statement is only true however

when you are not under any stress. The trouble is that many people drink

alcohol under stress, which in turn has the reverse effect on the body.

Alcohol will make the body release large amounts of adrenaline that result in

nervousness, lack of sleep, anxiety and skin irritation. Alcohol will also

increase the amount of fatty deposits around the heart when consumed under stress.

Smoking: Cigarettes contain nicotine, which people take as a sedative. It would appear that smoking removes the presence of stress in the short term. However, the damage done is hidden initially and will appear again in the long  term, where the damage done will be more significant. Smoking is very harmful to the body and the benefits in the short term are completely eclipsed by the number of long term problems that a person can suffer from. Smoking is responsible for a number of cancers, tension, breathing illnesses and heart disease.

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