This disorder may be present when a person has decreased sexual fantasies and a decreased or absent desire for sexual activity. In order to be considered a sexual disorder the decreased desire must cause a problem for the individual. In this situation the person usually does not initiate sexual activity and may be slow to respond to his/her partner's sexual advances. This disorder can be present in adolescents and can persist throughout a person's life. Many times, however, the lowered sexual desire occurs during adulthood, often after times following a period of stress.
Dr Gupta’s Clinic provides a wide variety of treatments – from medications to a specific form of psychotherapy, which helps virtually everyone with a sexual disorder, no matter what the concern. An ideal treatment involves a team effort between the man/woman, doctors, and trained therapists. Most types of sexual problems are corrected by a variety of psychological, behavioural, medicinal and interpersonal therapies.
From the Director’s DeskDr Govind K Gupta, MBBS from Calcutta National Medical College and Diplomat, American Board of Sexology, is India's most widely acclaimed and experienced sexologist having treated over one lakh patients. Experienced physician in Sexual Problems, Infertility and Sexually Transmitted Diseases.
Sexual dysfunction is the persistent or recurrent inability to react emotionally or physically to sexual stimulation in a way expected of the average healthy person or according to one’s own standards of acceptable sexual response. Sexual dysfunctions are disorders related to a particular phase of the sexual response cycle. It can occur during the desire, excitement, plateau, or orgasm stage of the sexual response cycle. For example, sexual dysfunctions include sexual desire disorders, sexual arousal disorders, orgasm disorders, and sexual pain disorders. If a person has difficulty with some phase of the sexual response cycle or a person experiences pain with sexual intercourse he /she may have a sexual dysfunction.
The Human Sexual Response and Sexual Dysfunctions
The normal human sexual response cycle is conventionally divided into four phases. Disorders of the sexual response can occur at one or more of these phases.
- Desire: Typically this consists of fantasies about, and the desire to have, sexual activity.
- Excitement: The subjective sense of sexual pleasure and accompanying physiological changes, namely penile tumescence and erection in men, and pelvic vaso-congestion, swelling of the external genitalia, vaginal lubrication and expansion in women.
- Orgasm: Sexual pleasure peaks, with release of sexual tension and rhythmic contraction of the perineal muscles and reproductive organs. In men, the sensation of ejaculatory inevitability is followed by ejaculation of semen. In women, contractions of the outer third of the vaginal wall occur.
- Resolution: The sense of muscular relaxation and general well-being. Men enter physiological refractory period post erection and orgasm for a variable period, whereas women may be able to respond to further stimulation.
A person who actively avoids and has a persistent or recurrent extreme aversion to genital sexual contact with a sexual partner may have sexual aversion disorder. In order to be considered a disorder, the aversion to sex must be a cause of difficulty in the person's sexual relationship. The individual with sexual aversion disorder usually reports anxiety, fear, or disgust when given the opportunity to be involved sexually. Touching and kissing may even be avoided. Extreme anxiety such as panic attacks may actually occur. It is not unusual for a person to feel nauseated, dizzy, or faint.
If a male is unable to maintain an erection throughout sexual activity, he may have male erectile disorder. This problem must be either persistent or recurrent in nature. Erectile dysfunction is classified as either primary or secondary in nature. Males suffering from the former have never been able to have intercourse while in the latter males have succeeded in having intercourse once twice or a thousand times before his dysfunction began. Secondary erectile dysfunction is about ten times more common than primary erectile dysfunction. Some males will be unable to obtain any erection. Others will have an adequate erection, but lose the erection during sexual activity. Erectile disorders may accompany a fear of failure. Sometimes this disorder is present throughout life. In many cases the erectile failure is intermittent and sometimes dependent upon the type of partner or the quality of the relationship.
When a male experiences significant delay or total absence of orgasm following sexual activity, he may have male orgasmic disorder. In order to be qualified as a disorder, the symptoms must present a significant problem for the individual.
When minimal sexual stimulation causes orgasm and ejaculation on a persistent basis for the male, he is said to have premature ejaculation. In order to qualify as a problem the timing has to significantly affect the person or the relationship or both. Premature ejaculation is sometimes seen in young men who have experienced this since their first attempt at intercourse.
Sexual performance anxiety can become a major issue within a relationship - and the more important the relationship is to you, the more anxious you are likely to become about sex and your own performance. Whether one suffers from premature ejaculation, impotence or some other sexual difficulty, anxiety around sex only makes things worse. Ultimately, a vicious circle is created, when worrying about your performance exacerbates the original problem, until the sexual performance anxiety becomes a problem in itself.
Sexually Transmitted Diseases such as HIV and Hepatitis B are thought to not normally be transmitted through mouth-to-mouth contact, although it is possible to transmit some STDs between the genitals and the mouth, during oral sex. It is also responsible for the increased incidence of herpes simplex virus 1 (present orally) in genital infections and the increased incidence of the type 2 virus (more common genitally) in oral infections. Infections like Cytomegalovirus infections, Herpes simplex virus (especially HSV-1) and Infectious mononucleosis are primarily transmitted through oral medium and may be caught through direct oral contact such as kissing, or by indirect contact such as by sharing a drinking glass or a cigarette.
It is one of the most common sexually transmitted diseases. The Centers for Diseases Control and Prevention estimates that more than 3 million cases of chlamydia occurs every year. The type of infection is bacterial in nature from Chlamydia trachomatis strain which lives in vaginal fluid and semen. The mode of transmission is mainly through vaginal and anal sex, although it is much less common it can also be passed on via oral sex and hand to eye contact.
It is a sexually transmitted disease caused by the bacteria Treponoma pallidum. It is often called the "Great Imitator" because syphilis symptoms resemble those of other common diseases. The majority of syphilis sufferers are male, accounting for about 60% of all cases. If caught early on in a syphilis test, syphilis can be easily treated. However, if left untreated, syphilis can cause heart problems, psychological disorders, blindness, and death. Syphilis also increases the risk of contracting HIV, the virus that causes AIDS, by up to five fold. The type of Infection is bacterial. Syphilis is almost always transmitted through sexual contact with an infected person. The syphilis bacteria can easily spread from the ulcers on an infected person to the mucous linings of the mouth, genitals, and anus of an uninfected sexual partner. Though unlikely, it is possible to contract the infection by coming into contact with the broken skin of an infected person. Syphilis can also be passed from an infected mother to her unborn child. To prevent being infected with syphilis, contact with open sores needs to be avoided. Condoms will not completely safeguard from getting syphilis, as sores can occur on other parts of the body. Use of a dental dam during oral sex is another preventive method.
There are eight types of human herpes virus. It is the herpes simplex virus types I and II - known as HSV-1 and HSV-2 - that are responsible for genital herpes. HSV-2 is more frequently transmitted by sexual contact and is one of the most prevalent STDs worldwide. In general HSV-1 infects the mouth, lips or nose, causing cold sores. HSV-2 infects the genital and anal area. Although genital and anal infections used to almost always be caused by HSV-2 infection, HSV-1 is becoming more common in these parts of the body due to greater numbers of people having oral sex.
This is the oldest and most common form of STD. it is passed by any form of sexual contact ranging from sexual intercourse to fellatio, anal intercourse and infrequently cunnilingus or even kissing. A woman who has intercourse once with an infected man has a fifty percent chance of getting gonorrhea while a man who has intercourse with an infected person has a twenty to twenty five percent chance of getting infected.
The newest and most frightening STD to come to public awareness was first documented in 1981. Current evidence suggests that the number of new cases is doubling or tripling every year. It appears to be an unusually fatal disease, and in fact some researchers believe that no one survives a full blown case. These two facts – a high rate of increase and a high fatality rate combine to produce a public health threat almost without parallel in recent times. It is primarily spread through sexual contact with a virus HTLV-3. Non sexual transmission can also occur in cases of blood transfusion and needle sharing.
Counseling and sex therapy are sometimes effective in helping patients with sexual problems, especially when these are caused by sexual ignorance and psychological factors like performance anxiety, stress, interpersonal disturbance, poor and faulty communication between couples.
Counseling and sex therapy are sometimes effective in helping patients with sexual problems, especially when these are caused by sexual ignorance and psychological factors like performance anxiety, stress, interpersonal disturbance, poor and faulty communication between couples.
Oral Medication: Depending on the nature of problem and other intervening factors medications are prescribed.
Testosterone is the major male hormone that gives men their sexual characteristics (deep voice, beard, chest hair). As men age, their level of testosterone decreases (andropause) and this may have an adverse effect on sexual performance. In proven cases of andropause, testosterone preparations may enhance potency and improve sex drive. However, this therapy must be only offered under expert medical supervision because many side effects can occur. Other endocrine disorders causing low testosterone, elevated prolactin, and other abnormal hormonal states, will require specialized endocrinological attention.
The need for the use of injections has declined enormously since the advent of orally effective drugs like Viagra for ED. Papaverine, phentolamine, prostaglandin E1, and combinations of these drugs may be self-injected into the penis with a fine, small gauge hypodermic needle. Men must first be taught the procedure in the physician's office. These drugs produce erections of good quality for about 75-85% of patients who select this option. Not too many injections are used nowadays. Erections obtained by injection usually last 30-60 minutes and may not subside when a man has an orgasm or ejaculates, and may interfere with the patient's social/business agenda. An overdose can cause a prolonged and painful erection (priaprism) that may require medical or surgical intervention.
A penile prosthesis (implant) is a fixed or mechanical device surgically implanted within the two corpora cavernosa of the penis, allowing erection as often as desired. Penile prosthetic implantation surgery gives good results and high satisfaction ratios with low complication rates when performed at centers of excellence. The incidence of side effects is low. Penile prostheses are available in semi-rigid, self-contained 2-piece inflatable, and 3-piece inflatable models. Newer advances in implant design have reduced the complication rates and increased satisfaction rates further.
Marriage counseling can be a very effective tool in restoring faith back in the marriage when it seems to be in trouble. Often marital counseling for a client can start with pre marital counseling, which may be carried forward after marriage to iron out adjustment difficulties. Workshops are also conducted for developing interpersonal skills, communication and conflict resolution as a part of marital and relationship enhancement counseling. Counseling helps couple to manage their interaction better, resolve differences and create harmony in day to day interaction. Marriage Counselling can be short term counseling may be between 1 to 3 sessions or long term like 5-10 weeks. It includes suggesting coping strategies to enable the partners to relate to each other meaningfully and happily and also helps couples introspect into their idiosyncratic behavior and response mechanism.
Most relationships will get strained at some time, resulting in their not functioning optimally and producing maladaptive patterns. These patterns may be called negative interaction cycles. There are many possible reasons for this, including insecure attachment, strifes with in –laws, ego, arrogance, jealousy, anger, greed, poor communication/understanding or improper problem solving skills, ill health, infidelity and so on. Marriage counselling can offer good insights into each of these troubled areas and suggest ways for improving functioning. Each person in a marriage has to be committed to making the relationship work. The dynamics of the family also influences the difficulties that could arise in a marriage.
Couple counseling is not just restricted to intimacy and sexual counseling but also include areas like building communication , negotiation , parenting , conflict resolution affairs- trust issues , relationship and dynamics vis a vis inlaws, expectation and individual space as well. In Indian setup there is a constant time constraint owing to over demanding work life and nuclear setup which creates lot of pressure at work and at home , with expectations always on the rise. This takes a toll on the couple and creates distance , resentment and dissatisfaction. This affects the intimacy and puts the marriage on cross roads. Often talking takes the matter into a myriad rather than a solution
In such situations taking the matter up with an expert unbiased person in a professional and confidential setting often helps in resolving issues and establishing back proper channels of communication and goodwill in the relationship. No. of sessions required vary, between 5 to 10, depending upon the level of crisis.
Kolkata - Girish Park
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Q. 1) Why Sexual problem treatment is necessary?
Sexual health, like emotional, mental, and physical health, is one important dimension of overall health. Sex can be pleasurable, but it can also be risky. Sexually transmitted diseases (STDs) can be uncomfortable or painful; they can have severe, long-term effects that include the loss of fertility and have the potential to be life-threatening.
Sexual experience and satisfaction are closely correlated with overall quality of life. Consistent mutual sexual pleasure increases bonding within a relationship. The health benefits of sex extend well beyond the bedroom. Sexual expression has many positive physical, intellectual, emotional, psychological, and social benefits.
- Sex Relives Stress: A big health benefit of a healthy sex life is, it lowers blood pressure and overall stress reduction.
- Boosts Self-Esteem & Improves Mood: A healthy sex life leads to long-term satisfaction with one's mental health and enhances your ability to communicate honestly and intimately.
- Better Emotional Wellbeing: Sexual satisfaction lessens tension among couples, which results in full concentration at work and growth in career.
- Sex Improves Immunity: Chances of having heart problems decrease if you stay sexually active. It adds as a booster to the body's ability to fight infection.
- A Better Future: A healthy sex life ultimately results in a healthy and sound child.
Many people wait a long time before seeking a solution to their sexual concerns whether it’s knowledge about the body or information about treating a specific condition. At Dr Gupta’s Clinic take the right steps to get education and any counselling you might need to protect your sexual health.
Q. 2) What is Premature Ejaculation?
Premature ejaculation is uncontrolled ejaculation either before or shortly after sexual penetration, with minimal sexual stimulation and before the person wishes. It may result in an unsatisfactory sexual experience for both partners. This can increase the anxiety that may contribute to the problem. Premature ejaculation is one of the most common forms of male sexual dysfunction and has probably affected every man at some point in his life.
Most cases of premature ejaculation do not have a clear cause. With sexual experience and age, men often learn to delay orgasm. Premature ejaculation may occur with a new partner, only in certain sexual situations, or if it has been a long time since the last ejaculation. Psychological factors such as anxiety, guilt, or depression can cause premature ejaculation. In some cases, premature ejaculation may be related to a medical cause such as hormonal problems, injury, or a side effect of certain medicines.
Q. 3) What is Erectile Dysfunction?
Erectile dysfunction (ED) is the inability to get or keep an erection firm enough to have sexual intercourse. It is also sometimes also referred to as impotence.
Occasional ED is not uncommon. Many men experience it during times of stress. However, frequent ED can be a sign of health problems that need treatment. It can also be a sign of emotional or relationship difficulties that may need to be addressed by a professional.
Q. 4) How does a doctor know whether you have Erectile Dysfunction?
Doctors once believed that most erectile dysfunction (ED) was caused by psychological problems. That is no longer thought to be the case. Some erection problems are psychological. However, doctors now recognize that many cases of ED are caused by underlying medical problems. A physician’s initial evaluation for ED will typically involve taking a simple medical history and performing a physical examination. If this initial evaluation suggests a physical cause for your ED, diagnostic tests may be necessary to determine the underlying cause.
A variety of different tests can be used to identify the cause of your ED.
A detailed physical exam can help your doctor assess your overall health. Your doctor will likely check your blood pressure and ask about any recent injuries or illnesses. They will ask about your current medications or supplements. They will examine the penis and testicles for changes in sensitivity.
The doctor may want to assess whether any psychological problems could be contributing to your ED. You will probably be checked for signs of stress, depression, and anxiety. Your doctor may ask about your relationship with your romantic partner. Detailed questions about your sex life may also be asked.
Nocturnal Erection Test
Men usually have erections at night as they sleep. Because there are so many different highly coordinated physiologic systems that are required to achieve an erection, the presence of night time erections can help determine whether your ED has a physical or mental cause.
A nocturnal erection test can determine if you have night time erections. According to the Mayo Clinic, this test involves placing a ring of special tape on the penis before sleep. If you have an erection, the tape will separate overnight. If there is genuine dysfunction of the muscles, blood vessels, hormones, or nerves required to produce an erection, then nocturnal erections will be absent.
This could be due to underlying medical conditions such as stroke, high blood pressure, diabetes, or multiple sclerosis. On the other hand, if all of the biologic systems needed for an erection are functional and the cause of ED is psychological, then nighttime erections will still be present during the deep slumber typical of the REM phase of sleep.
Blood and Urine Tests
Blood and urine tests can detect signs of diseases associated with erectile dysfunction. Such diseases include:
- Heart disease
- Kidney disease
These tests can also indicate if hormone levels might be playing a role in your ED.
An ultrasound uses sound waves to see inside the body. It is a very effective way of examining blood flow. When a man has ED, an ultrasound can check blood flow in the penis. An ultrasound wand is simply moved over the blood vessels that supply the penis.
Sometimes, an injection may be used to stimulate an erection before this test. Then an ultrasound can check whether blood flow increases appropriately. Pain from the injection is rare. If you do have discomfort, it will likely be mild and go away quickly. However, if you are afraid of injections, talk to your doctor. It may be possible to use an erectile dysfunction drug, such as sildenafil (Viagra), before the test instead.
Q. 5) What is Peyronie’s Disease?
Peyronie's disease is caused by scar tissue, called plaque, which forms along the length of the penis in the corpora cavernosa. This plaque is not visible, and depending on the severity of the condition, the plaque can cause the penis to bend, making sexual intercourse difficult and occasionally painful.
The cause of Peyronie's disease is unclear. Many researchers believe the plaque of Peyronie's disease can develop following trauma (hitting or bending) that causes localized bleeding inside the penis. The injury or trauma may not be noticeable. Other cases, which develop over time, may be genetically linked or inherited (passed on from parents to children through genes). The disorder could be caused by a combination of both factors.
Q. 6) What is Azoospermia & Oligospermia?
Azoospermia is the medical condition of a man not having any measurable level of sperm in his semen. It is associated with very low levels of fertility or even sterility, but many forms are amenable to medical treatment. In humans, azoospermia affects about 1% of the male population and may be seen in up to 20% of male infertility situations.
Oligozoospermia, refers to semen with a low concentration of sperm and is a common finding in male infertility. Often semen with a decreased sperm concentration may also show significant abnormalities in sperm morphology and motility (technically "oligoasthenoteratozoospermia").
Q. 7) What is Herpes?
Herpes simplex viruses -- more commonly known as herpes -- are categorized into two types: herpes type 1 (HSV-1 or oral herpes) and herpes type 2 (HSV-2, or genital herpes). Most commonly, herpes type 1 cause sores around the mouth and lips (sometimes called fever blisters or cold sores). HSV-1 can cause genital herpes, but most cases of genital herpes are caused by herpes type 2. In HSV-2, the infected person may have sores around the genitals or rectum. Although HSV-2 sores may occur in other locations, these sores usually are found below the waist.
Herpes simplex type 1, which is transmitted through oral secretions or sores on the skin, can be spread through kissing or sharing objects such as toothbrushes or eating utensils. In general, a person can only get herpes type 2 infections during sexual contact with someone who has a genital HSV-2 infection. It is important to know that both HSV-1 and HSV-2 can be spread even if sores are not present.
Pregnant women with genital herpes should talk to their doctor, as genital herpes can be passed on to the baby during childbirth.
For many people with the herpes virus, which can go through periods of being dormant, attacks (or outbreaks) can be brought on by the following conditions:
- General illness (from mild illnesses to serious conditions)
- Physical or emotional stress
- Immunosuppression due to AIDS or such medications as chemotherapy or steroids
- Trauma to the affected area, including sexual activity
Q. 8) What is Syphilis?
Syphilis is a highly contagious disease spread primarily by sexual activity, including oral and anal sex. Occasionally, the disease can be passed to another person through prolonged kissing or close bodily contact. Although this disease is spread from sores, the vast majority of those sores go unrecognized. The infected person is often unaware of the disease and unknowingly passes it on to his or her sexual partner. Pregnant women with the disease can spread it to their baby. This disease, called congenital syphilis, can cause abnormalities or even death to the child.
Syphilis cannot be spread by toilet seats, door knobs, swimming pools, hot tubs, bath tubs, shared clothing, or eating utensils.
Q. 9) What is the normal reproductive organ of women?
The female reproductive system (or female genital system) contains two main parts: the uterus, which hosts the developing fetus, produces vaginal and uterine secretions, and passes the male's sperm through to the fallopian tubes; and the ovaries, which produce the female's egg cells. These parts are internal; the vagina meets the external organs at the vulva, which includes the labia, clitoris and urethra. The vagina is attached to the uterus through the cervix, while the uterus is attached to the ovaries via the Fallopian tubes.
Q. 10) What are AMH, FSH, LH, Prolactin?
Anti Mullerian Hormone (AMH) is produced by ovarian follicles containing eggs. The level of AMH found in the blood is an indicator of a woman's ovarian reserve. As the level of Anti-Müllerian hormone found in the blood does not fluctuate throughout the month, it is the most reliable single predictor of whether a woman is still fertile and how many eggs she has left in her ovaries.
FSH (Follicle Stimulating Hormone) triggers the follicles within ovaries to begin preparing for the release of an egg. High levels of FSH are generally an indicator that egg reserves are running low.
LH (Lutenizing Hormone) controls egg development. LH helps regulate the menstrual cycle and egg production (ovulation). The level of LH in a woman's body varies with the phase of the menstrual cycle. It increases rapidly just before ovulation occurs, about midway through the cycle (day 14 of a 28-day cycle). This is called an LH surge. Consistently high levels of this hormone in one's body can prevent this release, and might also be an indicator of Polycystic Ovary Syndrome.
Prolactin is a stress hormone that is released by the pituitary gland. High levels of prolactin can prevent the release of FSH and LH. Both of these hormones are responsible for helping your eggs to develop and mature in the ovaries, so that they can be released during ovulation. When you have excess Prolactin in your bloodstream, ovulation is not triggered. Prolactin is the hormone that also eventually stimulates the production of breast milk.
Q. 11) What are Free Testosterone and Total Testosterone?
The testosterone molecules that are bound neither into SHBG (Sex Hormone Binding Golbulin) nor into the protein called albumin are called Free Testosterone. As Free Testosterone is not bound into anything, it just circulates in the veins and can be instantly utilized by the body, which makes it very effective. One can say that the Free Testosterone is responsible for all of those great benefits that testosterone brings to a man, as this is the form of testosterone that one's body constantly uses to support the following functions – sexual stamina, increased muscle growth, rapid fat loss, deeper voice, aggressive behaviour, energy, confidence, motivation, and a host of other cool stuff.
Total testosterone is the result that one will most likely get when asked for a hormone test. It’s the combined total of all the forms of testosterone that a man has in his body – these forms include the testosterone molecules that are bound into SHBG (Sex Hormone Binding Globulin), testosterone molecules that are bound into a protein called albumin. The bound testosterone is really important as it is reserved for any kind of sudden exercise and one's hypothalamus controls the release of it.
Q. 12) What is Vasodilatation?
Vasodilation (or vasodilatation) refers to the widening of blood vessels. It results from relaxation of smooth muscle cells within the vessel walls, in particular in the large veins, large arteries, and smaller arterioles. In essence, the process is the opposite of vasoconstriction, which is the narrowing of blood vessels.
When blood vessels dilate, the flow of blood is increased due to a decrease in vascular resistance. Therefore, dilation of arterial blood vessels (mainly the arterioles) decreases blood pressure. The response may be intrinsic (due to local processes in the surrounding tissue) or extrinsic (due to hormones or the nervous system). In addition, the response may be localized to a specific organ (depending on the metabolic needs of a particular tissue, as during strenuous exercise), or it may be systemic (seen throughout the entire systemic circulation).
Drugs that cause vasodilation are termed vasodilators.
Q. 13) What is the role of Dr. Gupta’s Clinic?
At Dr Gupta’s Clinic, we provide a wide variety of treatments – from medications to a specific form of psychotherapy, which helps virtually everyone with a sexual disorder, no matter what the concern. An ideal treatment involves a team effort between the man/woman, doctors, and trained therapists. Most types of sexual problems are corrected by a variety of psychological, behavioural, medicinal and interpersonal therapies.
Underlined problems are treated successfully: Premature Ejaculation, Male Infertility, STD (Gonorrhoea, Herpes), Couple Counselling, Female Infertility & Sex Problems
Q. 14) Where are the centres of Dr. Gupta’s Clinic?
Exide More, Girish Park, Sodepur, Medinipur, Burdwan, Siliguri, New Delhi
Q. 15) What is the success rate of Dr. Gupta’s Clinic?