Epispadias
Daniel Yachia in Text Atlas of Penile Surgery, 2007
In epispadias the penile size is variable, but it is always much shorter than the average penile size. This shortness and severe dorsal curvature seriously affect the ability of the patient to perform penetrative sexual intercourse. Because of these reasons and the placement of the epispadic meatus this anomaly requires a meticulous and often a staged surgical repair. Usually epispadic patients do not suffer from erectile dysfunction if their blood supply to the corpora was not injured during their several repair attempts for urethral reconstruction, penile elongation, and straightening. Even after a successful repair, the main problem for these patients is sexual or psychosexual dysfunction caused by their penile size, and infertility because of a lack of ejaculation or very poor semen quality (Figure 13.4).
Sexual problems in men with cardiac conditions
Clive Handler, Gerry Coghlan, Nick Brown in Management of Cardiac Problems in Primary Care, 2018
The willingness of men to discuss their sexual problems depends on their age, culture, religion, upbringing, marital status, the impact the problem has on their life and also their understanding of the problem and its causes. It is important that general practitioners offer patients and their partners the opportunity to discuss erectile dysfunction in the same way as one might ask routinely about angina or breathlessness. Erectile dysfunction is more common in individuals who smoke, or who have hypertension, diabetes or hyperlipidaemia. Sexual dysfunction and cardiovascular disease are commonly associated with each other. Erectile dysfunction is understandably common in men during and after any illness or hospitalisation. Sexual activity is generally safe and is encouraged as part of a normal healthy lifestyle in male and female patients with heart disease. Sexual matters for patients, particularly for those with cardiac conditions, are as important as other lifestyle issues and should be given equal consideration and care.
Sex
Jeanine Connor in Reflective Practice in Child and Adolescent Psychotherapy, 2020
This chapter explains the sexual behaviour of children and young people. It discusses clinical vignettes of young people who engage in sharing and viewing sexual images, masturbatory fantasies, sugar daddying, erectile dysfunction and fetishes. The chapter presents a brave and honest approach that includes psychoeducation and is informed by psychodynamic thinking. The sexual landscape and language have changed immeasurably over the last thirty years or so and it’s imperative that we challenge our own attitudes to sex, sexuality, sexual orientation and gender issues. Film and television storylines and documentaries can raise awareness about sex, sexuality, sexual abuse and gender, including transgender and gender reassignment. Often young people bring sexual experiences to therapy that are risky and dangerous, sometimes even illegal. The chapter presents case examples to illustrate ways to respond to young people to help them make sense of their sexual experiences.
Erectile dysfunction is strongly linked with decreased libido in diabetic men
Published in The Aging Male, 2004
S Nakanishi, K Yamane, N Kamei, M Okubo, N Kohno
Erectile dysfunction frequently occurs with diabetes mellitus. A survey of diabetic men was conducted by anonymous questionnaire to investigate the associations of erectile dysfunction with various predictive factors. A total of 112 diabetic males without an obvious history of erectile dysfunction were available for analyses. The mean age and duration of diabetes were 53.7 ± 12.2 years and 10.2 ± 8.6 years (mean ± standard deviation), respectively. The questionnaire included questions on the presence or absence of smoking, hypertension, libido and subjective symptoms of diabetic neuropathy that may be associated with erectile dysfunction. Analysis of the answers to the questionnaire revealed that 40% of the patients complained of erectile dysfunction (erection ‘always insufficient’). Erectile dysfunction was significantly correlated with age (p = 0.005), but not with duration of diabetes (p = 0.25), adjusted for age. Erectile dysfunction was also associated with sensory neuropathy and reduced libido, independently of age. The logistic regression analysis revealed that erectile dysfunction was positively associated with reduced libido and age. The odds ratio of erectile dysfunction for reduced compared to unreduced libido was 18.21, suggesting that psychogenic factors have a marked influence on erectile dysfunction. It is concluded that the presence of erectile dysfunction should be considered when symptoms related to diabetic neuropathy are observed; psychological approaches, such as sexual counseling, could be applied for the treatment of erectile dysfunction.
Erectile dysfunction and coronary atherothrombosis in diabetic patients: pathophysiology, clinical features and treatment
Published in Expert Review of Cardiovascular Therapy, 2006
The current review reports recent data available in the literature on the prevalence of erectile dysfunction and the association of erectile dysfunction with overt and silent coronary artery disease in patients with diabetes mellitus. The mechanisms by which erectile dysfunction is associated with coronary artery disease and potential clinical implications of this association have been extensively analysed. In particular, the role of endothelial dysfunction in the pathophysiology of erectile dysfunction and the potential clinical usefulness of erectile dysfunction to identify diabetic patients with silent coronary artery disease have been outlined. Finally, recent guidelines on the treatment of erectile dysfunction with phosphodiesterase-5 inhibitors in diabetic patients with and without coronary artery disease have been reported and discussed.
Fluvoxamine-induced erectile dysfunction responding to sildenafil
Published in Journal of Sex & Marital Therapy, 1998
Sildenafil, a peripherally acting inhibitor of cyclic guanosine monophosphate (cGMP), has been reported highly effective in treating erectile dysfunction of various etiology. Erectile dysfunction is a common sexual side effect of various antidepressants. Various agents have been used in the treatment of antidepressant-induced erectile dysfunction; however, there are no reports on the use of sildenafil for this indication. This case report describes the successful use of sildenafil in fluvoxamine-induced erectile dysfunction. A possible mechanism of action of sildenafil in this type of erectile dysfunction is discussed.