Sexual dysfunction, infertility, contraception, male breast; climacteric changes in men

1. Sexual Dysfunction,
Infertility, Contraception,
Gynaecomastia and
Climacteric Changes
Ms Alisha Talwar

2. Sexual Dysfunction

3. Sexual Dysfunction
 Sexual dysfunction refers to a problem occurring
during any phase of the sexual response
cycle that prevents the individual or couple from
experiencing satisfaction from the sexual activity.
 The sexual response cycle includes excitement,
plateau, orgasm, and resolution.

4. Disorders of Male sexual function
 Erectile Dysfunction (Impotence)
 Disorder of Ejaculation

5. Erectile dysfunction/Impotence
 Inability to achieve and maintain erection
necessary to accomplish coitus.
 Two main mechanism connected with erection
 Vascular
 Neurological

7. Etiology
 Inflammation
 Prostatitis
 Seminal vesiculitis
 Peripheral neuritis
 Diabetic neuropathy
 Bilateral testicular failure
 Vascular Aortic obstruction
 Neoplasm
 Trauma
 Iatrogenic (Radical perineal
prostatectomy
 Accidental Injury
 Psychogenic
 Drugs- Narcotics,
tranquillizers etc.

8. Assessment & Diagnostic findings
 Comprehensive History- Health, sexual and
psychosocial history
 Colour Doppler for arterial supply
 Glucose & Lipid profile

9. Management
 Eliminate the fear
 Reorienting the involuntary behavioural pattern
 Reassurance
 Penile prosthesis

10. Infertility

11. Infertility
 Conception depends on the fertility potential of
the male & female partner.
 Infertility is the inability of a couple to become
pregnant after one year of unprotected
intercourse.

12. Common causes of Male Infertility
 Defective spermatogenesis:
 Undescended testis
 Orchitis
 Genetic (47xxy)
 Testicular toxins (drugs,radiation)
 Endocrinal (thyroid dysfunctions, gonadal
deficiency)
 Varicocele
 Primary testicular failure

13. Contd…
 Obstruction of efferent duct-
 Congenital-Absence of vas deferens
 Young’s syndrome
 Acquired-Infective (tuberculosis gonorrhea)
 Surgical trauma-herniorraphy, vasectomy

14. Contd…..
 Failure to deposit sperms high in vagina.
 Impotency
 Ejaculatory failure
 Retrograde ejaculation
 Hypospadias
 Bladder neck surgery
 Psychosexual
 Drug related

15. Contd….
 Defect in sperm & seminal fluid.
 Immotile sperm
 Oligostheno teratozoospermia
 Low fructose content
 Sperm antibodies

16. Assessment findings
 History
 Age
 Duration of marriage
 Medical history with STDs
 Orchitis after puberty
 Any surgery

17. Contd…
 Occupational history-exposure to excessive heat
or radiation.
 Sexual history, heavy smoking & alcohol
 Physical examination-examination of reproductive
system, size & consistency of testicles, presence
of varicocele

18. Investigations
 Routine blood and urine examination
 Seminal fluid analysis (Coitus to be avoided 2-3
days prior test)
 Normal sperm count is over 20 million
spermatozoa per ml & progressive motility is 25%

19. Others
 Serum FSH, LH, Testosterone, prolactin & TSH
 Testicular biopsy
 Fructose content in seminal fluid
 Transrectal USG
 Vasogram- to evaluate ejaculatory duct obstruction
 Karoyotype analysis
 Immunological test
* Assure the confidentiality of the couple and
Counselling may require

20. Contraception

21. Contraception
 The deliberate prevention of conception or
impregnation by any techniques, drugs or devices.

22. Need of Male contraception
 More recognition for the need of shared
contraceptive responsibility
 Reduce the burden traditionally placed almost
exclusively on the female partner
 Specially in cases where female cannot adapt for
contraception due to medical or surgical problems

23. Contraceptive
Methods
Spacing Method
Natural
Barrier
Hormonal
Terminal
Method
Sterlization
Coitus
Interrupts
Condom
Male pills
Injection
(RISUG)
Vasectomy

24. RISUG
 Reversible inhibition of sperm under
guidance (RISUG), formerly referred to as the
synthetic polymer styrene maleic
anhydride (SMA), is the development name of
a male contraceptive injection developed at IIT
Kharagpur in India by the team of Dr. Sujoy K.
Guha. Phase III clinical trials are underway in
India, slowed by insufficient volunteer.

26. Gynecomastia

27. Gynecomastia
 Gynecomastia is an enlargement or swelling of
breast tissue in males. It is most commonly
caused by male estrogen levels that are too high
or are out of balance with testosterone levels.

28. Etiology
 Gynecomastia is most commonly caused by an
imbalance between the hormones estrogen and
testosterone.
 Males produce a small amount of estrogen and
females produce a small amount of testosterone.
Male estrogen levels that are too high or are out of
balance with testosterone levels cause
gynecomastia

29. Contd….
 Gynecomastia occurs naturally at different times
in a male’s life. These phases are:
 After birth- Newborn boys are still under the
effects of the estrogen they received from their
mothers while developing in the womb.
 More than half of newborn males are born with
enlarged breasts. The gynecomastia goes away
within two to three weeks after birth.

30. Contd….
 At puberty -Hormone levels are changing during
puberty (usually 12 to 14 years of age).
 Breast enlargement usually goes away six months
to two years after the start of puberty.
 At mid-life and beyond-Breast enlargement often
peaks in men between the ages of 50 and 80.
About one in four men in this age range have
breast enlargement

31.  There are many other conditions that can cause
gynecomastia. These include:
 Obesity
 Lack of proper nutrition
 Tumors in the testicles or adrenal glands
 Liver disease
 Hyperthyroidism
 Hypoandrogenism
 Hypogonadism
 Kidney failure

32.  Certain drugs can also cause gynecomastia, including:
 Anabolic steroids for improved athletic performance
 Estrogens
 Finasteride for enlarged prostate
 Spironolactone (Aldactone), digoxin, amiodarone
(Cordarone), and calcium channel blockers
 Cimetidine and proton pump inhibitors for heartburn
 Diazepam (Valium) for anxiety
 Ketoconazole for fungal infections
 Metronidazole (Flagyl) for bacterial infections
 Human chorionic gonadotropin for fertility problems
 Amphetamines, marijuana, heroin, methadone (“street”
drugs) and alcohol.

33. Assessment & Diagnosis
 Physical symptoms, breast exam, medical history
and medication review
 Breast pain and tenderness are common
symptoms
 A firm rubbery disk of tissue, located directly
beneath the nipple area, is felt during examination
 The lump is easily moveable within the breast
tissue

34. Contd…
 Mammogram
 Hormonal Levels

35. Management
 No treatment is needed
 Most cases of gynecomastia lessen with time.
 Surgery is usually not recommended unless the
gynecomastia is causing severe pain and
tenderness or embarrassment

36. Climacteric Changes
in Males

37. Andropause
 Andropause is also known as male menopause or
male climacteric.
 It can be defined as a physiological phenomenon.
Most men undergo this between the ages of 40 to
55, there is deficiency of testosterone resulting in
decreased physical, mental and sexual activity.

38. Signs and Symptoms
Some of the signs and symptoms of andropuase
are-
 Loss of muscle mass and energy
 Obesity, gynecomastia (enlarged male breast)
 Osteoprorosis
 Cardiovascular problems

39. Contd….
 Erectile dysfunction, loss of libido, premature
ejaculation and anejaculation and decreased
penile size
 Baldness (Alopecia), varicocele and protastic
hypertrophy
 Emotional and behavioural changes or mood
changes
 Loss of interest in daily activities like sports,
business, home Improvement and profession

40. Cause and Pathophysiology
 Testosterone production begins to slow down (after
late 30s) and the production of sex hormone binding
globulin increases. Rather than stopping, production
of testosterone simply traps and prevents it from being
used by the body. Most men produce more
testosterone hormone to combat the trapping effects
of SHBG. But some men cannot overcome the SHBG.
They will suffer from andropause

41. Predisposing factors
 Obesity
 Diabetes
 Alcoholism
 Drug abuse
 Smoking
 Lack of exercise or sedentary life style

42. Diagnosis
 Physical examination
 Measuring the level of testosterone
 SHBG 7 semen analysis will reveal the onset of
andropause.

43. Management
 Hormone replacement therapy
 Acne, baldness, breast enlargement, liver
damage etc. may develop as side effect

44. Precautionary Measures
 Check the weight and body mass Index (BMI)
regularly
 Undergo annual health check up
 Check the level of testosterone
 Do regular exercise, sport activity and yoga
 Include vegetables and fruits in the diet
 Avoid sweet, oily food and high calories