Dr. Vrushali Rane

Disorders come in different forms and variety; in short they are like people who come in all shapes and sizes. If you have a sexual disorder it does not mean that something is wrong with you. It only conveys that certain issues can affect anyone at any point of time and maybe for a reason or no reason. While some sexual problems have been tracked with their diagnosis and treatment, there are many which are not yet understood well.

The best part of all this is that if you are affected with a sexual disorder something like erectile dysfunction then there is no need to worry as there is a wide range of treatment. The treatment can range from some specific form to psychotherapy. This can virtually help anyone with the sexual disorder despite the concern.

The only concern associated with sexual disorder is that how is it affecting the person. Is it causing distress in their lives or their behavior is changing and would they like to change their behavior or the problem.

Symptoms of Sexual Disorders:

1. Dyspareunia: Constant and repetitive pain experienced during sexual intercourse in men and women
2. Erectile Disorder (ED): Inability to maintain erection in men
3. Exhibitionistic Disorder: Intense sexual urges and fantasies for over 6 months
4. Female and Male Orgasmic Disorders: Repetitive and constant delay or absence of orgasm post sexual stimulation
5. Female Sexual Arousal Disorder: Constant and repetitive inability of, or maintaining arousal until the sexual activity
6. Fetishistic Disorder: Also known as Fetishism, this involves eroticization of nonliving objects or body parts for sexual gratification.
7. Frotteuristic Disorder: Fantasies and sexual urges that have lasted for more than 6 months
8. Hypoactive Sexual Desire Disorder: Low sexual desire in men
9. Premature (Early) Ejaculation: Early ejaculation, much before the person wishes for
10. Sexual Masochism and Sadism: Fantasies and sexual urges that have lasted for more than 6 months
11. Vaginismus: Spasm of the muscles which cause hindrance in sexual activity
12. Sex Addiction: It is not a recognized diagnostic category at this time.

Treatments of Sexual Disorders:
The most common sexual disorder, erectile dysfunction is readily treated with medication. The drugs prescribed for this are Cialis, Levitra, and Viagra. These medicines are only available if the doctor writes a prescription. They work by increasing the blood flow to the penis and in turn an easy erection in men when sexual stimulation is given. Viagra and Levita, both are effective in 30 minutes, but Levita works a little longer than Viagra.

The effect of both can last up to 4-5 hours. Cialis is believed to work faster that is within 15 minutes and lasts up to 36 hours.

With increasing globalization and lifestyle changes, even general practitioners are getting more and more young patients willing to adopt contraceptive measures. An optimum clinical choice of contraceptive can only be done through a mutual discussion between the physician and patient taking into consideration both clinical aspects and patient's choice. This article gives a brief general summary of the methods of contraception.

Contraception is the process of taking steps to ensure about not becoming pregnant after having sex. There are different types of contraceptive measures. They all have pros and cons. Different methods will be right for different couples, or right at different times in life.

Types of contraceptives:

Hormonal (2-3%)
Intrauterine (5%)
Barrier (10-15%)
Chemical (15-20%)
Physiologic
Sterilization (4%)
* percentages mentioned within brackets are failure rates

Hormonal contraception

It involves the use of estrogen and progesterone to prevent fertilization; associated with a 2-3% failure rate.
Oral contraceptive pills suppress the action of fsh/lh from the pituitary gland, they also suppress the lh surge, alter the cervical mucosa to inhibit penetration by spermatozoa, and they inhibit atrophic change in the endometrium.
Complications: venous thrombosis, pulmonary embolism, cva, mi, htn, amenorrhea, cholelithiasis, hepatocellular adenoma. Risks increase with smoking.

Contraindications: dvt, pe, cvd, cva, pregnancy, cancer, abnormal lfts

Classification

Monophasic (fixed combination: take estrogen and progesterone on days 1-21 and placebo on days 22-28. Increased estrogen increases the side effects of a headache, weight gain, nausea, and edema decreased estrogen and progesterone increase the risk of breakthrough bleeding and increases the failure rate.
Multiphasic: low-dose estrogen with varying doses of progesterone on days 1-21.
Progestin-only pills: not as effective and can cause breakthrough bleeding.
Levonorgestrel: lasts up to five years.
Medroxyprogesterone: lasts three months.
Benefits:

Decreases the risk of ovarian and endometrial cancer and decreased the risk of ectopic pregnancy.

Intrauterine contraception

It involves the insertion of a small device into the uterus with the hopes of inhibiting implantation, altering tubal motility, or inflaming the endometrium.
Intrauterine contraceptive devices are associated with a relatively low failure rate (2-4% pregnancy rate) but do suffer from a higher rate of complications (e. G, four times increased the risk of ectopic pregnancy).
Types:

Intrauterine device (iud) with progestogen: it releases progesterone and must be replaced annually.
Iud with copper-t: it contains copper and can last up to 4-6 years.
Side effects:

Increased blood loss and duration of menses, increased dysmenorrhea

Complications:

Expulsion of iud, pregnancy, perforation of the uterine wall when inserted, increased risk of tubo-ovarian abscess (esp. Among younger nulliparous females with greater than ;1 sex partner). Pid is not as common with the newer iuds but still a significant risk factor.

Indicated for: multiparous women greater than 35 years who smoke.

Concerns about pelvic infections and subsequent fertility often limit the use of iucds to women who are at low risk for sexually transmitted disease and to those less likely to desire further children, i. E, monogamous multigravid patients.

Barrier methods

It involves the use of an artificial device to inserted into the vagina or fitted to the penis with the intent to retain the products of intercourse.

Types:

Condoms: condoms have a 2% failure rate in consistent couples and a 10% failure rate in occasional users. They are best indicated for std prevention.
Vaginal diaphragms: they have a 15-20% failure rate, but when combined with a spermicidal jelly and left in for 6-8 hours post-coitus failure rate declines to 2%. Diaphragms are associated with side effects of bladder irritation and cystitis, also colonization with s. Aureus if left in too long.
Cervical caps: they must be properly fitted and can be left in for a longer time than the diaphragm.
Chemical contraception

It has a 15- 20% failure rate and involves the use of sponges and spermicides.
Spermicides contain surfactants to disrupt cervical membranes; placed in the vagina up to 30 minutes before intercourse.
Physiologic contraception

It involves the avoidance of intercourse from an onset of menses to 2-days post ovulation.

Sterilization

This method involves manipulation of parts of male and female anatomy such that conception is prevented by failure and gametes to combine.

Types:

Vasectomy: lesser than 1% failure and can be successfully reversed in some cases.
Tubal ligation: lesser than 1% failure rate. Increase risk of ectopic.
Emergency contraception pills - emergency contraception can be used if one had sex without using contraception; or if someone had sex but there was a mistake with contraception.

Emergency contraception options are usually very effective if started within 3-5 days of unprotected sex. The earlier you take this pill, the more effective it is. It works either by preventing or postponing ovulation or by preventing the fertilized egg from settling in the womb (uterus).

A proper patient counseling informing the success rate and complication of contraception should be an integral part of the treatment regime.

Caffeine is said to be good for the body, if it is consumed in limited quantity. It is also to be kept in mind that the form in which it is consumed is also important, and green tea is said to be very good. But what about having green tea very soon after a meal is finished?

Green tea as a drink, has a reputation for being a wonder drink, and quite rightly so, it is to be kept in mind that having green tea along with or just after meals is not the best idea a person can have. But why does this happen? Well, there are chemicals, which exist in green tea which are known as phenols. What happens with these phenols if the green tea is taken not long after a meal, is that they can interfere with the absorption of the iron present in the food.

In addition to not drinking green tea at mealtime, or post meal time, it is perhaps also a good idea to stay away from drinking it when milk and items which are made from milk such as cheese are being consumed. There is a reason why this is the case is due to the fact that the proteins which exist in milk do not let green tea have its normal effect on the metabolism of the person i.e. raising the metabolism and making the challenge of losing weight a bit easier.

If it is still the case that drinking green tea with or after a meal is a habit, which has no chance at all of being shaken off, then what can be done is that the meals should be changed to an extent so as to contain a greater amount of iron rich food. This will go some way in counteracting the effect the phenols have. Apart from just iron rich food, food that is rich in vitamin C is also to be consumed.

However, that being said, people who are anyway deficient in iron are better off steering clear of green tea consumed after a meal. Instead, what they can do if have it between meals and also at the start of a day. What this will accomplish is that all the benefits of the green tea can be imbibed by the body and none of the nutrition value of the food is lost either. Furthermore, green tea drunk between meals can also reduce the appetite and help weight loss. What could be better? If you wish to discuss about any specific problem, you can consult a doctor.