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
Occupational history-exposure to excessive heat
Sexual history, heavy smoking & alcohol
Physical examination-examination of reproductive
system, size & consistency of testicles, presence
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%
Serum FSH, LH, Testosterone, prolactin & TSH
Fructose content in seminal fluid
Vasogram- to evaluate ejaculatory duct obstruction
* Assure the confidentiality of the couple and
Counselling may require
22. Need of Male contraception
More recognition for the need of shared
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
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.
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.
Gynecomastia is most commonly caused by an
imbalance between the hormones estrogen and
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 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.
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
31. There are many other conditions that can cause
gynecomastia. These include:
Lack of proper nutrition
Tumors in the testicles or adrenal glands
32. Certain drugs can also cause gynecomastia, including:
Anabolic steroids for improved athletic performance
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
A firm rubbery disk of tissue, located directly
beneath the nipple area, is felt during examination
The lump is easily moveable within the breast
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
Andropause is also known as male menopause or
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
Loss of muscle mass and energy
Obesity, gynecomastia (enlarged male breast)
Erectile dysfunction, loss of libido, premature
ejaculation and anejaculation and decreased
Baldness (Alopecia), varicocele and protastic
Emotional and behavioural changes or mood
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
44. Precautionary Measures
Check the weight and body mass Index (BMI)
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