Does Size Really Matter? کیا عضو کا سائزاہمیت رکھتا ہے؟

       
    This is a normal physiological and anatomical fact and so should not cause any worry. It should be remembered that the penis is more like a balloon which is fixed to the pubic bone and that it gets the erection from the blood that rushes into its veins and that leads to an increase in size, and since the parts that are attached to the bone does not contain that much of blood as the parts that are free and in front, therefore the anterior portions become more swollen than the portion that is fixed to the pupic bone.

      Some youngsters worry about the size of the penis, even in the retracted state, because there is an erroneous opinion that in this state also it should not be too small. The penis is like a radian antenna, which can be pulled out to its' maximum length when needed and when it is not needed it can be pushed back i.e. when sexual activity contemplated its size reduces greatly so that it does not interfere in a man's locomotion or other activities.

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Causes of Erectile Dysfunction مردانہ کمزوری کے اسباب

As the matter of fact, When a person is unable to get his penis firm enough to penetrate in having sex with his female partner, is called Erectile Dysfunction. Therefore, he feels impotent in eyes of his life partner. Same with this case, One study shows that With this physical Problem, The marital Life gets some serious issues, besides this, other issues get more prominent due to this problem. Because of this , most of wedding knots get untied. There are different causes of Erectile Dysfunction.

1- Physical Causes of Erectile Dysfunction
2-Psychological Causes of Erectile Dysfunction

- Physical Causes of Erectile Dysfunction.                               مردانہ کمزوری کےجسمانی اسباب

• Diabetes
• Obesity
• Sleeping  Irregularities
• Smoking
• Drinking Alcohol
• Rising Blood Pressure
• Surgeries and injuries
• Use of Tranquilizer
• Parkinson's disease
• Rising in Cholesterol Level

- Psychological Causes of Erectile Dysfunction.

• Mental Stress and depression is key to cause Erectile Dysfunction.

• Poor relationship with partner is a big hurdle in erection, due to lack of communication and other factor.

Erectile Dysfunction gets matured when following case is phenomenal. You need to see 

a doctor if you are facing following problems.

• Facing problem in  erection
• Facing problem in keeping an erection 
• Declining Sexual Urge.

Conclusion in Erectile Dysfunction

•   It results in low self esteem
•   Not satisfactory Sex Life.
•   Stress and Depression.
•   Relationship Problem. 

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Why Sex Drive Is Low In Older Age?

Why Sex Drive Is Low In Older Age?

Lack of Sexual desire is linked with many factors in man and woman both. people tend to feel less sex drive in older age than in younger age. However, some people maintain their drive to whole of their life with balanced attitude towards their foods, treatment and medication. Most causes are result of following :

-Treatment with specific medication like antidepressant, beta-blockers, anti-psychotics,      benzodiazepines, and anticonvulsants can cause lack of libido. These drugs affect sex drive with 

variation level.

- Depression is one of the main cause of lack of libido. Because, study shows link of antidepressant with low sex drive.  Depression itself can make a situation that can result in lack of physical desire,  

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How to Improve Sexual Energy and Power?

How to improve Sexual Energy and power?

Naturally, we are more prone to have some pleasures, desires and needs. Some are necessary to make human existence in this world, such as Water, Oxygen and Heat. But some desires and needs are not of such level that human can not live without it, but without it, man feels some hindrances and obstacles in daily household chores, relationship and friendship. one of them is sex. 

It is not obvious that, a man can not live without sex, but not having sex can cause some problems in daily goals and routines. Having sex can relieve anxiety, depression and and can get pleasure feelings. It is an integral part of human need and want. Because suppressing this desire can leave you more stressed and depressed because of not fulfilling this desire. Some people suppress this desire by following some religious obligations, Morales and beliefs which by their understanding are refraining them to fulfill it. But in real, every moral and belief is giving us a balanced and attitude toward sex. 

Anyway we can get some pleasure by balancing it with our social norms, religion and morals.

Some food are said to be more beneficial in this context. 

• Dates – Eat 5 – 7 dates everyday for a week to see surprising sexual stamina.

• Aswagandha – It is a gift for Indians. Consume Aswagandha lehyam (paste) 10 grams for instant sexual stamina. You can find the result in few hours. You can find aswagandha in the nearest ayurvedic shop.

• Chocolates – There are antioxidants in chocolates. These are good for the body as it increases the excitement. The chemical called phenylethalmine is there in these foods and enhances the sexual drive of the people.

• Pumpkin seeds – These are rich in zinc and this is good for boosting the sperms of men. This again improves the deficiency of testosterone in some men. The seeds are full of vitamins that give energy to the libido of any human being.

• Fishes – The sea water fishes are rich in Omega 3 fatty acids and these helps in improving the libido. This enhances the sexual stamina and the sexual urge for men and women. Eating of fish can diminish depression and give new hope and bright mood. The brain function is also improved with the omega 3 fatty acids and hence is good for all over improvement of sexual urge. Some such fishes are – trout, Tuna, Sardines, Herring, Anchovies, Mackerel and Wild Salmon.

• Onions – These are vegetables with aphrodisiac properties to help the libido. If you think you have low libido, you can take this by crushing them and frying them in butter. You must add honey with the golden onions and eat them in empty stomach for improving the sexual drive.

• Watermelon –Some experts have touted watermelon as the latest love drug. Since it contains citrulline amino acids, it helps relax the very blood vessels that enhance the sex drive in a person. If you want to get your partner in the mood, then prepare a watermelon sorbet and share it with him.

• Asparagus –Not only does asparagus have a suggestive shape, but it is also rich in a Vitamin B known as folate!This fosters the production of histamine, which is important for a healthy sex drive both in men as well as in women.If you want, you can even grow your own asparagus or buy it fresh from the Farmer’s Market.

• Avocados ­ – Not only are avocados known as fruits that increase the brain levels, but they are now being touted as love drugs.

• Celery –Eating celeries may be the last thing you would think of to boost the libido, but research goes to show that it increases the pheromone levels in the sweat of a person and makes the males more attractive to the females.

• Figs – Legend has it that figs were a hot favorite with Queen Cleopatra. The ancient Greeks also thought it improves the fertility levels of a person.

• Banana –This fruit that is rich in potassium can help boost your libido and your sexual performance.

• Red hot chilli peppers –Naturally hot and spicy, this food is known to boost both the libido of a person, as well as their sexual performance.

• Eggs –Eggs can help balance the hormone levels of a person and improve the sexual performance of a person by decreasing their stress levels.

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Night Fall

It doesn’t matter how often you have a wet dream (nightfall).

Many times boys/men discharge the semen during sleep (nightfall).

This discharge is invariably accompanied by a sexual dream.

It is a normal, natural and uncontrollable response to sexual tension that gets built up within the body.

There is no reason to be worried, frightened or feel guilty about a wet dream.

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What Are Ejaculation Disorders?

Ejaculation Disorders?

Different Types of disorders are found in males:-

   Premature ejaculation: This is when Ejaculation occur very       rapid after penetration.

  Inhibited or retarded ejaculation: This is when ejaculation is    slow to occur. 

  Retrograde ejaculation: This ejaculation occurs when orgasm    goes back to bladder instead of leaking out of penis out of        urethra. 

  In some cases, premature and inhibited ejaculation are caused by psychological factors, including a strict religious background that causes the person to view sex as sinful, a lack of attraction for a partner, and past traumatic events. Premature ejaculation, the most common form of sexual dysfunction in men, often is due to nervousness over how well he will perform during sex. Certain drugs, including some antidepressants, may affect ejaculation, as can nerve damage to the spinal cord or back.

Retrograde ejaculation is common in males with diabetes who suffer from diabetic neuropathy (nerve damage). This is due to problems with the nerves in the bladder and the bladder neck that allow the ejaculate to flow backward. In other men, retrograde ejaculation occurs after operations on the bladder neck or prostate, or after certain abdominal operations. In addition, certain medications, particularly those used to treat mood disorders, may cause problems with ejaculation.

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Loss of Libido

Libido is conscious or unconscious sexual desire. Loss of libido is a sexual dysfunction relating to loss of sexual desire or sexual drive and is also termed hypo active sexual desire disorder (DSM-IV). Loss of libido must not be confused with other sexual dysfunctions as these can impair libido. Epidemiology

It is a common problem but it is difficult to quantify because:

» Definitions may vary. » There is a wide ‘normal’ range.
» Few sufferers consult a doctor even when it may be the cause of relationship difficulties.

A review of articles revealed some interesting points:

» In Hong Kong a telephone survey showed a high prevalence of sexual problems generally and in women a 25% prevalence of loss of interest in sex. Sex-related knowledge, perceived importance of sex, perceived physical health status and sexual satisfaction were predictors of sexual problems.1

» Gender differences and strong cultural influences were apparent. Moreover, sexual problems and sexual satisfaction were associated with mental health, quality of life indicators and overall life satisfaction.1,2

» It is normal for sexual drive to diminish with the passage of years3 but the degree is highly variable. Elderly people often enjoy sex into later life, often beyond the expectations of others.4 Diminished sexual potency and vaginal dryness may contribute to reduced libido.

» It also seems that qualitative aspects of sexual activity may change and improve with age.5 It would be a mistake to link libido with either ‘performance’ or sexual satisfaction.

PRESENTATION
It is fairly uncommon for a patient to present directly with a complaint of loss of libido. It is more likely to be a component of other complaints. Many people are still reluctant to discuss such matters and feel embarrassed. It is often introduced into the consultation by patients as an apparent after thought. The following are likely to need consideration:

* What does the patient mean by loss of sexual drive? Is it loss of the will or loss of the way?
* Is there a problem with performance? If so, which came first?
* How long ago did it start? Was it gradual or sudden? Has it been progressive?
* How is the relationship? If it is problematical, which came first?
* Has there been criticism from the partner or even a sympathetic discussion?
* How does the patient feel about the loss of libido? Perhaps the patient feels that it is not really a problem, except for the demands of the partner.
* Ask about sexual difficulties including erectile dysfunction or dyspareunia.
* Whose idea was the consultation? Is the patient here willingly or under duress?
* Are there any other problems of health? Are there any chronic diseases? What medication is taken? Has there been any recent change?
* Ask about alcohol intake.
* If a woman of appropriate age, ask about symptoms of the climacteric.
* If appropriate, ask about contraception. There may be fear of pregnancy.
* Ask about mental health too. Screening for depression in general practice can be performed with just 2 questions:
o During the last month, have you often been bothered by feeling down, depressed or hopeless?
o During the last month, have you often been bothered by having little interest or pleasure in doing things?
* Ask about work. Are there pressures there? Are there financial problems or family difficulties?
* Ask what may be the most revealing question of them all. “What do you think is the reason for your loss of sexual drive?”
* Difficulties with sexuality may lead to problems with libido.

DIFFERENTIAL DIAGNOSIS
* Any form of mental illness is likely to be associated with loss of libido. The commonest of these is depression. Other features of depression may be clear or a tool such as the Hospital Anxiety and Depression Scale may be needed to test the diagnosis or to convince the patient.
* Libido is associated with wellbeing. Hence illness will depress libido. Loss of libido is very common during cancer treatment.
* Overwork, chronic tiredness and anxiety can all depress libido.
* Falling levels of hormones may impair libido. This can occur in the climacteric or with the treatment of carcinoma of prostate.
* Some drugs may induce loss of libido, perhaps through an element of depression. Antihypertensives are the most notorious.
* Loss of libido after having a baby is not uncommon. Hormonal fluctuation can be a problem. There may have been vaginal trauma and there may still be some tenderness. There may have been a change in self image. Mothers with small babies are often very tired and may be frequently disturbed at night.
* Chronic high intake of alcohol depresses sexual desire and cirrhosis can depress androgen levels.
* If sex is not fulfilling, then interest will wane. There may be erectile dysfunction, premature ejaculation, failure of ejaculation or performance anxiety due to criticism. Dyspareunia, often due to vaginal dryness or even susceptibility to recurrent cystitis, may take the pleasure from sex and hence the drive.
* Libido will suffer if there are problems within a relationship. Sex may be less attractive to one who thinks that the partner is having an affair.
* Sex may have become ritualistic and mundane. There may be differences in ambition and imagination between partners when considering how to enliven their sex life.

EXAMINATION
Examination is likely to be unrewarding unless there are specific indicators from the history. However, it may be reassuring to the patient to show that the doctor is taking the issue seriously and there is no physical abnormality. Investigations If the diagnosis is already clear, then further investigations are not required.
* A tool such as the Hospital Anxiety and Depression Scale may be useful.
* FBC is a good, general screening test. A raised MCV may point to excessive alcohol consumption.
* U&E will check for renal disease and Na and K may be deranged in adrenal disease.
* LFTs may also suggest excessive intake of alcohol, especially if gamma GT is raised.
* TFTs may demonstrate hypothyroidism.
* FSH, LH, prolactin and either oestradiol or testosterone may indicate hormonal inadequacy. This may be due to drugs or alcohol.
* If erectile dysfunction appears to be a problem, and poor performance may have led to loss of interest, then fasting glucose and cholesterol are in order as there is a strong link between erectile dysfunction and coronary heart disease.

ASSOCIATED DISEASES
* Probably the most frequent co-existent disease to discover is depression.
* Hormone inadequacy, including hypothyroidism is less common.
* Problems with relationships are common.

MANAGEMENT
Management depends upon cause.

* If there are problems with the relationship, then counselling may be required. An agency such as Relate, may be very valuable.
* If the problem is over-work, financial worries and associated anxiety, lifestyle needs to be considered. The relationship between work and the rest of life needs to be examined by the patient and spouse. If there is worry over financial matters these may need appropriate professional help and advice.
* Depression may need treatment. Some of the antidepressants have been associated with loss of libido but it may be difficult to know if the cause is the drug or the underlying depression.
* Antipsychotics such as phenothiazines and haloperidol raise prolactin. Raised prolactin is associated with dampened sexual arousal.
* Counselling may be required with regard to alcohol use.
* If hypotensive treatment is thought to be a problem, a change in the type of medication may be tried.
* If hypothyroidism has been diagnosed, then thyroxine is started to suppress the level of TSH.
* If a woman’s hormones are thought to be inadequate and this is the problem, then HRT can be used but with the same caveats and precautions as at any other time. However, a recent American consensus panel felt that use of HRT to promote libido was not appropriate on the balance of efficacy and risks.6
* The value of androgen patches for treating hormone deficient men is somewhat dubious. The effects of the hormone on liver and cholesterol may be adverse and an opinion from secondary care would probably be wise. The use of testosterone in men is controversial and in women even more so.7
* If there seems to be an underlying problem of a psychosexual nature, then an appropriate referral may be offered. Relate may be a useful source of help. Medication (such as Sildenafil) may be valuable if there is erectile dysfunction.
A review in the Journal of Sexual Medicine concerning female hypoactive sexual desire concluded, “There is a rapidly expanding knowledge base concerning the diagnosis and treatment of HSDD. However, the contemporary clinician is faced with the absence of an approved treatment for this disorder and the lack of clear guidelines concerning the indications and safety of the use of non-approved agents”.8 A multidisciplinary approach to treatment has been recommended by others which reflects the diverse factors in causation.9
HORMONES OF LOBIDO

The suggestion that the cause of impaired libido is a deficiency of hormones is usually over simplistic. It does seem that male hormones have an important role in libido for men and women. Lack of androgen and excess of prolactin10 both appear to be important.

The changes in reproductive capacity and their relationship with reproductive behaviour are complex.11,12
In women with symptoms of the climacteric, HRT with 17-ß-oestradiol was less effective than tibolone in raising libido.13 Tibolone has androgenic properties. In both males and females with growth hormone deficiency, adding dihydroepiandrosterone (DHEA) to growth hormone improved wellbeing and libido and more in women than in men.14 A trial of testosterone replacement in depressed men did show improvement in libido and sexual performance but this was no more so than with the placebo.15

The treatment of sexual offenders is an issue that raises concern. Reduction in androgen levels can be achieved by the use of cyproterone or goserelin (rather than by surgical castration). There is some evidence that hormone suppression may reduce the rate of re-offending and that this result may be comparable with that obtained by cognitive and behavioural therapy.16 However, sexual offenders are a very heterogeneous group and good trials comparing like with like are lacking.17 Numbers tend to be small and controls are poor. Libido may not be the underlying problem. Rape is about abuse of power rather than sexual gratification. In both rapists and paedophiles, negative affect is a crucial component in the chain that leads to deviant sexual behaviours.18

DOCUMENT REFERENCES

1. Lau JT, Kim JH, Tsui HY; Prevalence of male and female sexual problems, perceptions related to sex and association with quality of life in a Chinese population: a population-based study. Int J Impot Res. 2005 Nov-Dec;17(6):494-505. [abstract]

2. Lau JT, Kim JH, Tsui HY; Prevalence and factors of sexual problems in Chinese males and females having sex with the same-sex partner in Hong Kong: a population-based study. Int J Impot Res. 2006 Mar-Apr;18(2):130-40. [abstract]

3. Araujo AB, Mohr BA, McKinlay JB; Changes in sexual function in middle-aged and older men: longitudinal data from the Massachusetts Male Aging Study.; J Am Geriatr Soc. 2004 Sep;52(9):1502-9. [abstract]

4. Helgason AR, Adolfsson J, Dickman P, et al; Sexual desire, erection, orgasm and ejaculatory functions and their importance to elderly Swedish men: a population-based study.; Age Ageing. 1996 Jul;25(4):285-91. [abstract]

5. Hurd Clarke L; Older women and sexuality: experiences in marital relationships across the life course. Can J Aging. 2006 Summer;25(2):129-40. [abstract]

6. Ettinger B, Barrett-Connor E, Hoq LA, et al; When is it appropriate to prescribe postmenopausal hormone therapy?; Menopause. 2006 May-Jun;13(3):404-10. [abstract]

7. Margo K, Winn R; Testosterone treatments: why, when, and how?; Am Fam Physician. 2006 May 1;73(9):1591-8. [abstract]

8. Segraves R, Woodard T; Female hypoactive sexual desire disorder: History and current status.; J Sex Med. 2006 May;3(3):408-18. [abstract]

9. Wylie K, Daines B, Jannini EA, et al; Loss of sexual desire in the postmenopausal woman. J Sex Med. 2007 Mar;4(2):395-405. [abstract]

10. Corona G, Petrone L, Mannucci E, et al; The impotent couple: low desire.; Int J Androl. 2005 Dec;28 Suppl 2:46-52. [abstract]

11. Randolph Jr JF; The Endocrinology of the Reproductive Years. J Sex Med. 2008 Jul 1. [abstract]

12. Wylie KR; Sexuality and the menopause. J Br Menopause Soc. 2006 Dec;12(4):149-52. [abstract] 13. Somunkiran A, Erel CT, Demirci F, et al; The effect of tibolone versus 17beta-estradiol on climacteric symptoms in women with surgical menopause: A randomized, cross-over study.; Maturitas. 2006 Jul 8;. [abstract]

14. Brooke AM, Kalingag LA, Miraki-Moud F, et al; Dehydroepiandrosterone (DHEA) improves psychological well-being in male and female hypopituitary patients on maintenance growth hormone replacement.; J Clin Endocrinol Metab. 2006 Jul 18;. [abstract]

15. Seidman SN, Roose SP; The sexual effects of testosterone replacement in depressed men: randomized, placebo-controlled clinical trial.; J Sex Marital Ther. 2006 May-Jun;32(3):267-73. [abstract]

16. Hall GC; Sexual offender recidivism revisited: a meta-analysis of recent treatment studies.; J Consult Clin Psychol. 1995 Oct;63(5):802-9. [abstract]

17. Grossman LS, Martis B, Fichtner CG; Are sex offenders treatable? A research overview.; Psychiatr Serv. 1999 Mar;50(3):349-61. [abstract]

18. McKibben A, Proulx J, Lusignan R; Relationships between conflict, affect and deviant sexual behaviors in rapists and pedophiles.; Behav Res Ther. 1994 Jun;32(5):571-5. [abstract]

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