1. Sexual Dysfunction

2.  SD is a complex disorder that encompasses a number of pathophysiological processes  Can happen at any age in male or female  Can lead to anxiety, fear, relationship breakdown and general disharmony within family unit

3.  Erectile dysfunction  Ejaculatory dysfunction  Reduced libido  Gender identity problems  Infertility  Decrease in beard and body hair growth  Increase in body fat  Decrease in size or firmness of testicles  Decrease in muscle mass  Development of breast tissue  Loss of bone mass (osteoporosis)  Premature ejaculation Symptoms

4. Erectile dysfunction (ED) is defined as the persistent inability to achieve or maintain penile erection sufficient for satisfactory sexual performance Erectile Dysfunction

5. Prevalence In the UK ED affects an estimated 2.4 million men It is thought that half of men in the UK age between 40 and 70 will experience an episode of ED at some point Affects about 6.5% of men between the age of 20 and 29 and 77.5% of men over 75yrs

6. Factors that aids erection  Neural factor  Vascular factor  Hormonal factor  Psychological factor

7. Physiology of erection Peripheral nervous control NERVE Erection is brought about under the influence of parasympathetic nerve stimulation Neurochemical control HORMONE Neurotransmitters released from parasympathetic nerves include acetylcholine and nitric oxide Vascular changes BLOOD SUPPLY Arterial dilatation and relaxation of vascular sinusoids leading to increased arterial inflow and increased pooling of blood in the penis This results in swelling of the penile spongy tissue

8. Psychogenic ED originates from the mind, mental or emotional processes Organic ED originate from physical causes e.g. nerve, blood supply or hormonal Causes of Erectile Dysfunction

9. Characteristics of Organic ED  Gradual onset (often over several years)  Lack of tumescence (i.e. engorgement with blood)  Normal libido (except in hypogonadism)  Medical history e.g. diabetes, cardiovascular disease or other risk factors  Surgery or radiotherapy e.g. radical prostatectomy  Medication  Smoking, alcohol, recreational drug use

10. Characteristics of Psychogenic ED  Sudden onset  Early collapse of erection e.g. on penetration  Presence of nocturnal and early morning erections  Premature ejaculation or inability to ejaculate  Relationship changes or problems (e.g. new partner)  Major life events e.g. bereavement, job loss, diagnosis of major illness

11. Sexual Dysfunction FEMALE

12. Female sexual dysfunction (FSD)  It is estimated that over 40% of women suffer from some degree of SD  Unfortunately, it is still an under studied area

13. Signs and symptoms of Female Sexual Dysfunction  Sex avoidance  Lower sexual interest and desire  Inhibited sexual arousal  Orgasmic dysfunction  Painful sexual intercourse

14. TESTOSTERONE a steroid hormone that stimulates development of male secondary sexual characteristics, produced mainly in the testes, but also in the ovaries and adrenal cortex

15. Low testosterone levels  Testosterone does not only enable having erection and sexual desire (libido), it is also important for:  maintaining muscles  healthy bones  positive mood and physical energy

16. Clinical picture of testosterone deficiency Emotional  Depression  Low self esteem  Poor concentration/drive Physical manifestation  Decreased muscle  Abdominal obesity  Loss of libido  Hot flushes/palpitations  Decreased body hair  Anaemia  Gynaecomastia Reproductive system  Sub fertility  Decreased genital size  Thinning/loss of pubic hair  Sexual dysfunction Complications  Osteoporosis  Lipid metabolism  Insulin resistance

17. Measuring testosterone level

18. Back to ED

19. TREATMENT

20. Treatment options  Vacuum Therapy - 1950  Injection Therapy - 1960  Intra Urethral Therapy - 1990  Penile implants - 1970  Testosterone replacement - 2006 Viagra - 1998 Levitra - 2002

22. Treatment options  Injection Therapy

24. Treatment options  Intra Urethral Therapy

26. Treatment options  Penile implants

28. Can cost up to $20,000, depending on the type of implant chosen

29. Treatment options Viagra Levitra

31. Ejaculatory Problems Premature Delayed Retrograde

32. Premature ejaculation Male ejaculates too quickly during sexual intercourse It is the most common ejaculation problem A study looking at 500 couples from five different countries found the average ejaculatory time was around 5.5 minutes There is no definition of how long intercourse should last A number of surveys have found around one in three men reported being affected by premature ejaculation It affects around one in 50 men in England Occasional episodes of premature ejaculation are common and not a cause for concern

33. Premature ejaculation Management Distraction Desensitizing cream Use of thick condoms Stress reduction Address relationship problems Reduce sex anxiety Counselling regarding previous traumatic sexual experiences Treatment for depression Medication side effect

34. Priligy It is used to treat premature ejaculation in men Dapoxetine works by increasing the activity of serotonin in the nervous system Serotonin is a neurotransmitter that is involved in passing messages between nerve cells It has various functions in the body and is involved in sending the nerve messages that result in ejaculation Increasing the activity of serotonin in the nervous system helps to increase the time it takes to ejaculate and improve control over the ejaculation The medicine is taken a couple of hours before you intend to have sex to help you last longer before you climax.

36. Delayed ejaculation Classed as either: a significant delay before ejaculation is possible Inability to ejaculate Persistent (unwanted) delayed ejaculation up t0 60 minutes

37. Delayed ejaculation treatment There are no drugs that will make a man come Good chance of putting things right through counselling,

38. Retrograde ejaculation Rare type of ejaculation problem Happens when sperm travels backwards and enters the bladder instead of coming out of the end of the urethra Main symptoms of retrograde ejaculation include: producing no semen or small amount during ejaculation producing cloudy urine when especially after intercourse Does not pose a danger to health but can affect fertility

39. Retrograde ejaculation treatment Drugs are used to treat retrograde ejaculation e.g. Ephedrine These medications help keep the bladder neck muscle closed during ejaculation

40. Summary Sexual dysfunction does not just affect men alone SD does not only affect sexual performance Many successful treatment options are available

42. Q

43. Too much sugar intake leads to erectile dysfunction Drinking AKAMU helps sperm production Hot weather can affect conception When trying to conceive it is better to have sex more often Woman on top does not encourage conception