Page 136 - fbkCardioDiabetes_2017

112 Cardio Diabetes Medicine 2017

Erectile Dysfunction: Endothelial Dysfunction;

Emotional Disturbance

Prof. Dr. Deepak K Jumani

Senior Sexual health Physician & Counselor, Mumbai, INDIA,
Asst. Prof of Medicine Sir JJ Govt Group of Hospitals & Grant Medical College,, Hon. Sexologist:
Mumbai Police Hospital & Apollo Sugar Clinic, Mumbai.

India is the oldest civilization in the world, where sex- spent in each phase varies from person to person.
uality is illustrated in literature, sculptures, scriptures, As per DSM V Classification include:
2
and religion and dressing attires. India played a sig-
nificant role in the history of sex, from writing the first 1. Male Hypoactive Sexual Desire Disorders
literature that treated sexual intercourse as a science 2. Erectile Disorders (Erectile Dysfunction)
“The Kama sutra by Rishi Vatsayana “ which even in
modern times has been instrumental as the guide for 3. Premature ( Early) Ejaculation
the philosophical focus for new-age groups towards 4. Male Orgasmic Disorder: Delayed Ejaculation
the understanding and attitudes on sex. India also
pioneered the use of sex education through art and In today’s modern world the most common sexual
literature. dysfunction in males is Erectile Dysfunction.
There have been not enough or relevant surveys or Its highly prevalent across the globe to the extent of
studies related to sexual functions and dysfunctions 20 to 60 percent and less talked about and hence
in India. While human sexuality has long been the undertreated .
subject of intense interest, it’s only since last 5 to 6 It is Persistent or recurrent inability of a male to attain
decades this has become an area of legitimate sci- or maintain adequate erection until complete sexual
entific interest. activity. Penile erection is the most valid indicator of
One of the most important and exciting work has male sexual arousal.
been the four stage model of sexual response, which Penile erection is a complex neurovascular phenom-
they described as the human sexual response cycle . enon that depends upon neural integrity, a functional
The human sexual response cycle set the foundation vascular system, and healthy cavernosal tissues.
for studying and categorizing sexual dysfunctions in
men and women Normal erectile function involves 3 synergistic and
simultaneous processes:
This human sexual response cycle is characterized
1
by • neurologically mediated increase in penile - arterial
inflow
• Excitement phase (initial arousal)
• relaxation of cavernosal smooth muscle
• Plateau phase (at full arousal, but not yet at or-
gasm) • restriction of venous outflow from the penis
• Orgasm The incidence of Erectile Dysfunction almost doubles
and triples with co morbid conditions such as Diabe-
• Resolution phase (after orgasm) tes, Hypertension, obesity and dyslipidaemia.
Both men and women experience these phases, al- Besides Ageing other vascular causes which include
though the timing usually is different. It is unlikely venous leak, Peyronies disease, smooking and con-
that both partners will reach orgasm at the same sumption of excess of alcohol.
time. The intensity of the response and the time
The hormonal causes of Erectile Dysfunction are Hy-

GCDC 2017