Ksr Ed Klaibya

ED 01

Gender Specific diseases of Ayurveda W.S.R. to Male Erectile Dysfunction (Klaibya) Dr. K. Shiva Rama Prasad M.D.(KC), C.O.P. (German) M.A, Ph.D (Jyo)

[email protected]

Ayurveda & Gender specificity ♦ Ayurveda with 8 branches did not give special priority to gender ♦ The term “Purusha” is used to human in general ♦ Women is identified with the special srotases viz. Artava vaha srotas (Yoni) and Sthanya vaha srotas (Breast) ♦ The diseases of the female were discussed with reference to that of Prasooti and Stree roga pertained to female genitalia but not given nay importance of Sex or pleasure the function of the “Guhya” or “Upasta” as given in case of male ♦ Sexual capacity is not an inherent, constant, general property. Capacity to have sexual intercourse with woman differs from person to person and is not constant throughout the life span of a person.

History & Gender specificity ♦

First time in the modern history Dr. William Masters, a gynecologist with his wife and former assistant Mrs. Virginia Johnson, created special packages of training for various sexual problems

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Medically speaking, Impotency is defined as the inability to sustain an erection sufficient for intercourse on at least 25% of attempts

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Anxiety, stress and depression are among the most frequently cited contributors to psychological impotency.

♦ For many reasons, cultural as well as situational anxiety over sexual performance may provoke an intense fear of failure and self-doubt on the part of the individual

ED 02

Erectile dysfunction ♦ Sex has got ups and downs in lifetime. A person looking strong in physical growth may be weak in sexual activities and one who looks weak in physique may be sexually strong, potent and possess many offspring. ♦ Erectile dysfunction (ED) is both increasingly recognized and increasing in prevalence with the aging of our population ♦ Erectile dysfunction is a potentially devastating ailment that affects not only men, but also their sexual partners. The Massachusetts Male Aging Study revealed that age is the single most important variable associated with Erectile difficulty. ♦ Currently, more than 30 million American men suffer some degree of Erectile dysfunction (ED), with projections that up to 47 million individuals will have treatable Erectile dysfunction by the year 2020.

Disease development & Society ♦ The people who are living in the townships became lethargic and diseased rapidly. This was the fault under went by them. ♦ They attained the symptoms such as mental confusion, loss of potency, loss of luster, loss of voice, inconvenience, etc., ♦ All these are conformed only because of “Gramyavasa” i.e. living in the townships. ♦ It is clear and evidential that the “Klaibya” is also one such disease condition developed only because of “Living City day lights of Concrete Jungle” ♦

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ED 03

Purusha – Sukra ♦ Pususha are of Srotomayam, Shaturvimshati tatwa yuktam, Shatdhatu yuktam, Tridosha & Sapta dhatu yuktam, etc. ♦ Out of the very important factor of reproduction is semen i.e. Sukram. ♦ The health of the individual can be estimated through the Ojas and Sukra, which spread all over the body ♦ The Sukra formation, ejaculation till to the development of progeny one reflects its genes and genetic reflections ♦ Klaibya is such a condition where physical, environmental. Psychological, pathological, emotional and many more factors are involved.

Qualities of Sukra ♦ Susruta defines the semen as – crystalline whitish luster’s, liquid, soft, sweet taste and equal to that of honey smelled. In further it resembles the Oil or Honey consistency (Su.Sh.2/20). ♦ The semen is dominant of “Udaka” with its soft (Sowmya) nature but all the bhutas are interrelated and associated (Su.Sh.3/1)

♦

At opine of Charaka the semen is “Vishwaroopasya Roopadravyam” with the qualities of thick (Bahalam), sweet, soft, white and much (Bahu). Such semen is strong

to produce offspring.

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Vagbhata accepts both of the statements (A.H.Sh.1/18)

♦

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♦

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♦

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ED 04

Sukra as a Vega ♦ Sukra in one of the 13 non suppressible natural urges ♦ If Sukra vega is controlled or suppressed following are witnessed. 1. Pain and oedema in the genital organs 2. Uncontrolled excretion of semen 3. Distress in the chest 4. Fever 5. Fatigue and pain all over the body 6. Retention of the urine (Sukrashmari) ♦ According to Charaka – the man may gradually become impotent apart from the condition generated from the excessive sexual indulgence produced Dhatu kshaya, which eventually lead to “Yakshma”.

♦ ♦ ♦ ♦

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The physiology of sexual intercourse •

Sexual intercourse, also known as coitus or copulation, introduces semen into the female reproductive tract. We shall now consider the process as it affects the reproductive systems of males and females.

•

Sex is a harmonious act of two genders with a proper understanding and desire

•

Sex melts the Male and Female to get in to the action of generating the best of the best natures miraculous act of generating the new generations - offspring

•

Sex doesn’t come easy, it depends upon health and it is not just intercourse, it is all about pleasure.

•

Sex is achieved by keeping fit, eating well, having a good relationship, proper communication, fine stimulus, proper arousal, perfect erection, good orgasm and timely ejaculation.

•

The sex act friction generates the flame of Orgasm & the ego burns in inferno

•

Apart from all other reasons erection plays an important role.

ED 05

The saga of sex … LAPS with Astanga- Maidhuna •

Sex starts from the womb by fondling the genitalia

•

Knowing the sexual anatomy at the adolescence, interest generates to explore

•

Generating the gender-maps (developmental representation - gender identity) and Love-maps (idealized Love & Lover - Affair - Program - Sexoerotic activity projected either imaginary or actual)

•

Leads to either harmonious matrimonial life or to get in to a courtesan (sex worker)

•

Sukra dhatu, which is, present all over the body with its

derangement either in quality or quantity not only leads to defective fertilization but also to the mal formation of the foetus. •

Mutative age of Sex act – as a child Sukra is subtle like the flavor of a bud. Reproductive capacity is expressed by the presence of the semen. At old age as natural degeneration takes place the man loses his sexual urge. Thus the sex act for child under 16 years and old aged of 70 years are prohibited.

• Astanga-Maidhuna - eight Sexes – acts o

Smarana - remembering Lover

o

Keertana - singing for / with lover

o

Kreeda - conjugal play with lover

o

Prekshanam - dancing with lover

o

Guhyabhashanam - secret seductive talk

o

Sankalpa - psycho sex act initiation

o

Adhyavasaya - developing enthusiasm in

o

Kriya nivrutti - submissive withdrawal

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ED 06

Ejaculation ♦ Ejaculation is associated with intensely pleasurable sensations, an experience known as male orgasm. ♦ Several other noteworthy physiological changes occur at this time, including pronounced but temporary increases in heart rate and blood pressure.

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After ejaculation has been completed, blood begins to leave the Erectile tissue, and the erection begins to subside. This subsidence, called detumescence, (The loss of a penile erection) is mediated by the sympathetic nervous system.

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Higher centers, including the cerebral cortex, can facilitate or inhibit many of the important reflexes, thereby modifying the patterns of sexual function.

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In summary, arousal, erection, emission, and ejaculation are controlled by a complex interplay between the sympathetic and parasympathetic divisions of the ANS.

Eight ejaculatory factors ♦ The most important factor that produces ejaculation of the semen, which is spread all over the body, is the sexual intercourse. There are eight factors, which initiates the semen ejaculation other than that of intercourse. They are 1. Pleasure with intention 2. Desire 3. Unsuitability of the semen 4. Sliminess of the semen 5. Heaviness of the semen 6. Capacity to pass through the srotas (Anutwa) 7. Inherent quality to move out of the body 8. Stimulation by Vata ♦ Any physical or psychological factor that affects a single component of the system can result in male sexual dysfunction, also called impotence (The inability to obtain or maintain an erection) i.e. Klaibya.

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ED 07

Premature ejaculation ♦ Ejaculation is commonly called premature if a man climaxes and releases his semen before or within a few minutes after entering his partner's vagina and before his partner has an orgasm. ♦ Premature ejaculation is a problem only if it prevents a couple from having sexual experiences that are satisfying for both partners. ♦ The human experience of orgasm is a complex interplay of psychological, physical, and physiological factors. ♦ To control the timing of ejaculation a man must learn to

exercise

some

control

over

these

factors.

Premature ejaculation is rarely caused by a medical condition. ♦ Premature ejaculation can occur when a man has not had sexual intercourse for a long period of time. Other situations in which there is unusually heightened sexual arousal and excitement may also promote early ejaculation. ♦ Premature ejaculation may happen in a new relationship because the partners have not yet learned each other's stimulation needs for arousal and orgasm.

Gender-map and Love-maps. ♦ Ones stimulus, arousal, erection, orgasm and ejaculation depend upon gender-maps and love-maps. Prof. Dr. John Money of Baltimore, USA, defines the Gender-map and Lovemaps. ♦ The

Gender-map

is

defined

as

a

developmental

representation or template synchronously in the mind and brain depicting the details of one's gender/ identity role. ♦ Where as Love-map is depicting the idealized lover, the idealized love affair and the idealized program of sexo-erotic activity projected in imagery or actually doing sex with lover.

ED 08

Male Sexual Function ♦ Complex neural reflexes that we do not yet understand completely coordinate sexual function in males. The reflex pathways utilize the sympathetic and parasympathetic divisions of the ANS. ♦ During arousal, erotic thoughts, the stimulation of sensory nerves in the genital region, or both leads to an increase in the parasympathetic outflow over the pelvic nerves, which leads to erection of the penis. ♦ The integument covering the glans of the penis contains numerous sensory receptors, and erection tenses the skin and increases their sensitivity. ♦ Subsequent stimulation may initiate the secretion of the bulbourethral glands, lubricating the penile urethra and the surface of the glans. ♦ During intercourse, the sensory receptors of the penis are rhythmically stimulated. This stimulation eventually results in the coordinated processes of emission and ejaculation. ♦ Emission occurs under sympathetic stimulation. The process begins when the peristaltic contractions of the ampulla push fluid and spermatozoa into the prostatic urethra. ♦ The seminal vesicles then begin contracting, and the contractions increase in force and duration over the next few seconds. ♦ Peristaltic contractions also appear in the walls of the prostate gland. The combination moves the seminal mixture into the membranous and penile portions of the urethra. ♦ While the contractions are proceeding, sympathetic commands also cause the contraction of the urinary bladder and the internal urethral sphincter. The combination of elevated pressure inside the bladder and the contraction of this sphincter effectively prevent the passage of semen into the bladder. ♦ Ejaculation occurs as powerful, rhythmic contractions appear in the ischiocavernosus and bulbospongiosus muscles, two superficial skeletal muscles of the pelvic floor. The ischiocavernosus muscles insert along the sides of the penis; their contractions serve primarily to stiffen that organ. ♦ The bulbospongiosus muscle wraps around the base of the penis, and its contraction pushes semen toward the external urethral opening. These contractions are controlled by somatic motor neurons in the lower lumbar and upper sacral segments of the spinal cord.

ED 09

Hormones of the Reproductive System Hormone

Source

Gonadotropinreleasing hormone (GnRH)

Hypothalamus

Folliclestimulating hormone (FSH)

Anterior pituitary

Luteinizing hormone (LH)

Anterior pituitary

Androgens (primarily Interstitial cells testosterone and of testes dihydrotestoster one)

Estrogens (primarily estradiol)

Progestins (primarily progesterone)

Inhibin

Granulosa and thecal cells of developing follicles; corpus luteum

Regulation of Secretion Primary Effects Males: inhibited by testosterone and possibly by inhibin Stimulates FSH secretion, LH Females: GnRH pulse synthesis frequency increased by estrogens, decreased by progestins Males: stimulates Males: stimulated by spermatogenesis and GnRH, inhibited by spermiogenesis through effects inhibin Females: on sustentacular cells Females: stimulated by GnRH, stimulates follicle development, inhibited by inhibin estrogen production, and oocyte maturation Males: stimulated by GnRH Females: Males: stimulates interstitial cells production stimulated to secrete testosterone Females: by GnRH, secretion by stimulates ovulation, formation of the combination of high corpus luteum, and progestin GnRH pulse secretion frequencies and high estrogen levels

Stimulated by LH

Establish and maintain secondary sex characteristics and sexual behavior; promote maturation of spermatozoa; inhibit GnRH secretion

Stimulated by FSH

Stimulate LH secretion (at high levels); establish and maintain secondary sex characteristics and sexual behavior; stimulate repair and growth of endometrium; increase frequency of GnRH pulses

Granulosa cells from mid-cycle through Stimulated by LH functional life of corpus luteum Stimulated by factors Sustentacular released by developing cells of testes sperm (male) and and granulosa developing follicles cells of ovaries (female)

Stimulate endometrial growth and glandular secretion; reducefrequency of GnRH pulses

Inhibits secretion of FSH (and possibly of GnRH)

ED 10

Importance of Women ♦ Women are the “Kshetra” for the progeny. (Ch.Chi.2-1-4) ♦ Woman is the platform and media for sex and considered always potent in sexual activity but she plays passive role in sex, hence Vajikarana is not mandatory for woman. ♦ Women with female physique where they are stationed collectively (the multitude sense objects is only in the female body not anywhere else), beautiful, youthful, endowed with auspicious features, submissive and trained is regarded as the bets aphrodisiac. ♦ The women who is being excellent in terms of age, beauty, voice similar psyche, similar mind, submissive, pleases with partners liking and amorous movements enters in to heart quickly to fortune and by look it self exhilarates the man and arouses the impulse of sexual urge, such women is the best aphrodisiac. . (Ch.Chi.2-1/8-10) ♦ Due to the diversity in liking of the people and fortune of women, the qualities like good appearance etc. get enhanced on finding a suitable man. ♦ ♦

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Reduced Factors of sexual capacity 1) Emaciating diseases that is, Dhatu kshaya including Sukra kshaya 2) Fear complex 3) Worry, Grief, etc 4) Due to Ungrateful and unbelievable natured women 5) Due to unhygienic, diseased, faithless women 6) Due to lack of capacity of sexually rouse the mate by women 7) Abhichara – Black magic etc stated to modify mental faculties 8) Total abstinence from the sexual act ♦

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ED 11

Synonyms of impotency ♦ Ayurveda has clearly explained the situation of inactivity of the male in sex act. It has given different words as synonyms to Impotency are 1. Napumsaka - neither female or male 2. Kleeba - unable do the sex act and produce offspring

Ê´ÉOɽþ{ÉÖι]õ xÉè´ÉätxÉι]õ 3. Shanda (both sex) - Hermaphrodite 4. Vandhya (both sex) - non-conceived male or female 5. Triteeya prakriti - third gender 6. Stapatya - who doesn't have "staman" (strength) 7. Stapathi - who can not achieve Orgasm (Staputa = ups and downs) 8. Kanchuka - male desires to wear ladies garments 9. Varshavara - who develops over-hydrosis by thinking sex act (over sweating) 10. Sama - equal; neither male or female character dominance

Etiological evaluation of impotency ♦ Napumsakata or impotence is going to be bestowed in a child through genetic defect as qualitative or quantitative depletion of semen of father and irregularity in sex postures and psyche attached to another male or any pyogenic conditions in vagina of mother. ♦ Apart from above said causes few dietetic, psychic, exorcists, excessive indulgence in sex act, dhatukshaya, doshavaishamata, sephadosha, etc., causes are also mentioned as etiology of impotency. ♦ We want sex badly enough but just can't be bothered. In this age lack of time and energy made sex difficult, once a day or part night (Paksha Shanda). We began to compromise on our sex life and on our relationships. Sex doesn’t come easy, it depends on health and it is not just intercourse, it is all about pleasure.

Classification of Klaibya – (Charaka) ♦ Four fold Impotency (Charaka): Charaka classify Klaibya by origin as – 1. Beja dosha – due to the defective Pumbeeja (semen) 2. Dhwajopaghta – due to the injury to the genital organs 3. Jara – due to the old age 4. Sukra kshaya – due to the deficiency of semen quantity (Stula Sukra)

ED 12

Classification of Klaibya – Susruta ♦ Six fold Impotency (Susruta) (Su.Chi.26/7-12) 1. Manasika or psychological – due to the bitter thoughts / recollection or a forced intercourse with a disagreeable women who fails to sufficiently rouse up the sexual desire 2. Aharaja – due to the excessive intake of Katu, Amla, Lavana rasa and Ushna veerya dravya, which leads to loss of semen 3. Ativyavayaja – due to addiction to excessive sexual pleasure with out using aphrodisiacs 4. Abhighataja – due to chronic disease of the genitalia (syphilis, gonorrhea, AIDS) or destruction of a local marma by injury 5. Sahaja – (congenital) due to beeja dosha of either mother or father 6. Vegavarodhaja – due to voluntary suppression of natural urge – sex desire ♦

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Symptoms of Klaibya – Impotency ♦ A person is considered impotent in any one or all of the following symptoms are noted. 1) Inability to indulge in sexual act, ever if he desires to with a women who is capable of rousing his desire 2) Dyspnoea and excessive perspiration and fatigue after the act 3) Ineffective stimulation of the genitals with complete lack of semen ♦ According to Vagbhata – 1. Premature ejaculation 2. Pelvic Pain (testis, penis, anus) 3. Swelling in the lower part of body (testis, penis, anus) 4. Fever 5. Chest pain 6. Obstructive urination 7. Testicular swellings 8. Urolithiasis (kidney, urethra) 9. Shandata – Klaibya

♦ ºÉÆEò±{É |É´ÉhÉÉä ÊxÉiªÉ¨É Ê|ɪÉÉÆ ´É¶ªÉɺÉÉÊ{É ÎºjɪɨÉ - xɪÉÉÊiÉ Ë±ÉMÉ ¶ÉèÊlɱªÉÉiEònùÉÊSÉtÉÊiÉ ´ÉɪÉÊnù - · ÉɺÉÉiÉÇκº´ÉzÉ MÉÉjɶSÉ ¨ÉÉäPÉ ºÉÆEò±{É SÉäι]õiÉ: - ¨±ÉÉxÉ Ê¶É¶xɶSÉ ÊxɦÉÔVɺºªÉÉnäùiÉi±Eèò¤ªÉ ±ÉIÉhɨÉ - SÉ®úEò ÊSÉÊEòiºÉ 30/155-156 ♦ ¶ÉÖGòÉkÉi»É´ÉhÉÆ MÉÖÁ´ÉänùxÉɺ´ÉªÉvÉÖV´ÉÇ®ú: ¾þnÂù´ªÉlÉɨÉÚjɺÉÆMÉÉÆMɦÉÆMÉ ´ÉÞnÂùvªÉ¶¨É¹ÉÆb÷iÉÉ: - +¹]õÉÆMÉ ¾þnùªÉ¨É ºÉÚjÉ 4/20

ED 13

Sukra & Sukra vaha srotas in Klaibya ♦ The Sukra or semen (the complete testicular secretions i.e., Semen + Androgens) has synonyms of Retas, Beejam, Varam, Veeryam, Harshajam, Snehu, Powrusham, Suklam and Pradhana dhatu. ♦

The Sukra flows in sukravaha srotas, which are spread all over the body. Shukra is the thing belonging to man, product of 4 proto-elements (Ap, Agni, Pruthvi and Vayu), composed of all six tastes, when deposited in the womb of a woman brings about conception (Cha.Sa2/3)

♦ Retas, the ejaculate (Rupadravya) comes out during intense coital pleasure. (Ca.

Ci.

2/4/48-50, Su. Sa. 2/11). Praharsha (Excitement, Erotic), Dhairya (daring activeness), Priti (Love), Cyavana (to come out), Bala (Energy) and Garbhotpatti (Fertilization) are the functions of Sukra related to sexuality (A.H.Su. 1 1/4, Su. Su. 15/5, Ca. Ci. 15/6). ♦ Any defect in Shukra thus leads to infertility and sexual dysfunction (Ca. Ci. 30/153, Ca. Ci. 30/139-144, Su. Sa. 2/3).

Therefore in man Sukra is responsible for all-reproductive

phenomena and relative psycho-sexo-neuro-endrocrinal dysfunction too (A.S.U. 50/7). ♦ When these are at failure two types of Impotency develops. 1) Sukra vaha sroto dusti with sukra dusti, where erection is possible but unable to produce offspring. 2) Erection is not possible because of local lesion in penis or retovaha sira/srotas. The causes of Sukra vaha srotas dusti are – (cha.chi.30/135-138) 1. Indulging in the several sex act at a time when the person is nor roused with desire 2. Indulging in sex act with animals 3. Withholding the sexual indulgence 4. Excessive sexual indulgence 5. Injury due to the instruments, Kshara and Agni kriya 6. Ahara – Asatmaya and non computable 7. Vihara – masturbation, excess sex acts Eight defects of semen (cha.chi.30/139) 1. Phenila

5. Pooti

2. Tanu

6. Pichchila

3. Rooksha

7.

Anya dhatu samslishtata

4. Vivarna

8.

Avasadi

ED 14

Klaibya reemphasized as Napumsaka SHANDA: - (Nara/nari Shanda) A child born of an act of fecundation foolishly or ignorantly effected during the menaces of its mother by its progenitor by holding her on his bosom during the act is called a Shanda and invariably exhibits effeminate traits in his character. A daughter born of a woman riding on her husband during the act of sexual intercourse will develop masculine traits in her character. Here Klinefelter's and Turner syndrome are applicable, which are said to be the beeja dosha or chromosomal anomalies. ASEKYA: - A child born of scanty paternal sperm becomes an Asekya and feels no sex desire with out previously drinking the semen of another man. SOUGANDHIKA: - A child begotten in a sordid vagina is called a Sougandhika, whose organ does not respond to the sexual desire without smelling the genitals of others. KUMBHIKA: - The man who first becomes a passive member of an act of sodomy and able to act as man with good erection is called as Kumbhika. IRSHAYAKA: - The man who can not copulate with a women without previously seeing the sexual intercourse of another is called as Irshaka (Voyeurism). KLEEBA: - Kleeba is defined as a person with ED under various etiological factors.

Napumsaka (Klaibya) reclassified Napumsaka are classified as under. 1. Asukra Napumsaka i) Beeja dowrbalya or beeja dosha a) sukra dosha - nara shanda ; Klinefelter's syndrome b) artava dosha - nari shanda ; Turner syndrome ii) Garbha dosha - pseudohermaphroditism iii) sukra dhatu vaha sroto dosha iv) Retovaha sira dosha or sosha v) retovaha sroto dosha

ED 15 2. Sasukra Napumsaka A) Sukra and Sukravaha sroto dusti i) Impotency - unable to produce offspring Azospermia Oligospermia Defective morphology of semen ii) 8 varieties Vata, pitta, kapha, Kunapa gandhi, Grandhi, Ksheena Pootipooya, Mutrapureesha gandhi B) Retovaha (Seminal duct) sroto and sira dusti i) temporary ED or emotional ED ii) Semi permanent ED or kleeba Beejopaghata - non production of semen leading to ED Organic - Heart problems Metabolic - Diabetis Jara - geriatric ED Loss of vigour loss of strength Sukra kshaya - loss of semen leading to ED Dwaja bhanga - ED Krimija - infective ED Pootigandha - Fungal Infections leading to ED Viseerya mani - wound at glans Viseerya medhra - injury to shaft Viseerya mushka - wound at testis iii) Paraphilic ED or napumsaka Asekya - Mukha yoni - Erection after Swallow of semen Sougandhika - Nasa yoni - Erection after smelling others genetelia Kumbheeka - catamite; Erection after anal penetration Ershayaka - Drig yoni - Erection after Voyerism

ED 16

Classification of sexual disorders The following people are said to be suffering from 'Sexual Disorders' ♦ Those individuals who are unable to participate in a sexual relationship and carry out the sexual activity to their and their partners' satisfaction ♦ Those who lack interest in the heterosexual act and fail to have normal psycho-physiological responses necessary for sexual interaction ♦ Fail to experience orgasm ♦ These disorders are: 1) Sexual dysfunction: a) Lack or loss of sexual desire – In women it is known as 'Frigidity'. b) Sexual aversion and lack of sexual enjoyment c) Failure of genital response; In men: Erectile dysfunction difficulty in developing and maintaining an erection required for coitus In female: Vaginal dryness. d) Orgasmic Dysfunction e) Premature ejaculation: Inability to control ejaculation. f) Vaginismus: Spasm of the muscles surrounding the vagina leading to difficulty in the coitus. g)

Dyspareunia:

Pain

during

sexual

intercourse h) Excessive Sexual desire 2) Gender identity disorders a) Trans-sexualism: Desire to live and be accepted as a member of opposite sex. They ask for 'Sex change operation'. b) Transvestism: Wearing of clothes of opposite sex and enjoy being the member of opposite sex for short periods.

ED 17 3) Disorders of sexual preference: a) Fetishism: Getting sexual arousal and satisfaction with articles like clothes, shoes of the opposite sex. b) Exhibitionism: Exposing genitalia to the members of opposite sex and getting sexual satisfaction. c) Voyeurism: Getting sexual satisfaction by looking at people engaging in sexual act. d) Paedophilia: Sexual preference for children e) Sadomasochism: Sexual preference for infliction of pain during sexual activity. f) Homosexuality: Preference for member of the same sex for sexual activity and gratification. IV. Dhat Syndrome (Culture Bound Syndrome) ♦ Dhat Syndrome is specific to Indian subcontinent. ♦ As people wrongly believe that masturbation is bad and leads to sexual weakness, loss of semen leads to sexual weakness as well as sterility; ♦ They start worrying about masturbation and semen loss. ♦ They develop multiple somatic complaints like general weakness, easy fatigability, decreased concentration, memory, black rings around the eyes, loss of hairs or graying of hairs, premature ejaculation, Erectile dysfunction, fear of being sterile and attribute these symptoms to 1.

Masturbation

2.

Nocturnal emission

3.

Sexual fantasies

4.

Passing semen in urine

5.

Frequent sexual intercourse

They have to be reassured and educated to remove these beliefs.

ED 18

INTERVENTION OF AGNI IN IMPOTENCY ♦ Dhatwagni influences two types of Dhatwagnipaka, prasada and kitta where transformation of nourishing material and waste products takes place respectively. ♦ The specific functions of dhatwagni are synthesis of particular dhatu and continuous replenishment by nutrients. ♦ The main dhatwagni vyapara of Sukra is stated by some Acharyas as production of Ojas and Vagbhata considers it as mala of Sukra. ♦ Function of Sukra is said as reproduction. It not only means perpetuating the progeny but also cell division in the body. ♦ The stula sukra (semen) and Sukradhatu are different entities. Sukra gata Kusta, where Sukradhatu and sukragni are involved in pathogenesis influences the repair and healing process or a loss of regeneration, and more over it carries to the offspring. ♦

A non-regenerative cell media leads to an individual depressed and physically week body states, resulting into a temporary or permanent Impotency.

The Male Climacteric in Aging ♦ Changes in the male reproductive system occur more gradually than do those in the female reproductive system. The period of change is known as the male climacteric (The agerelated cessation of gametogenesis in males due to reduced sex hormone production). ♦ Levels of circulating testosterone begin to decline between ages 50 and 60, and levels of circulating FSH and LH increase. ♦ Although sperm production continues (men well in to their eighties can father children), there is a gradual reduction in sexual activity in older men. ♦ This decrease may be linked to declining testosterone levels (Sukra dhatu in the body). Some clinicians are now tentatively suggesting the use of testosterone replacement therapy to enhance libido (sexual drive) in elderly men. ♦ The inability to contract the ischiocavernosus and bulbospongiosus muscles would interfere with a male's ability to ejaculate and to experience orgasm.

♦ As the result of parasympathetic stimulation in females during sexual arousal, there is engorgement of the Erectile tissues of the clitoris, increased secretion of cervical and vaginal glands, increased blood flow to the walls of the vagina, and engorgement of the blood vessels in the nipples.

ED 19

Physiology of erection -The penis and Erectile function ♦ The penis is composed of the corpus cavernosum, two parallel spongy columns of Erectile tissue, and the corpus spongiosum ♦ Erectile tissue is rich in tiny pool-shaped blood vessels (cavernous sinuses), surrounded by smooth muscles and supported by elastic fibrous tissue composed of collagen. ♦ In the flaccid, or un-erect, state of the normal penis, the small arteries leading to the cavernous sinuses contract, reducing the in flow of blood. ♦ The smooth muscles of the many tiny blood vessels within the penis are also contracted, and the blood they contain leaks out of the surrounding spongy tissue, when a man becomes aroused, his central nervous system stimulates the release of a number of chemicals, including acetylcholine and nitric oxide, that relax the smooth muscles in the penis, allowing blood to flow into the tiny pool-like sinuses and flood the penis. ♦ The spongy chambers almost double in diameter due to the increase in blood flow. ♦ The veins surrounding the corpus cavernosum and corpus spongiosum are squeezed almost completely shut by the pressure of the Erectile tissue ♦ They are unable to drain blood, causing the penis to become rigid. ♦ Oxygen-rich blood is critical for Erectile health. ♦ Oxygen itself affects two substances that are important in achieving erection; it suppresses transforming growth factor beta I(TGF-BI) and enhances prostaglandin E1. ♦ The smooth muscles produce TGF-B1, a component of the immune system, its role is to produce collagen. ♦ Collagen contributes not only to structural tissue in the body but is also the material that comprises scar tissue. ♦ Prostagladin E1 is produced during erection by the muscle cells in the penis; it activates and enzyme that results in calcium release by the smooth muscle cells, which in turn, relaxes them and allows blood flow. ♦ Prostaglandin E1 also suppresses collagen production. Oxygen levels vary widely from reduced levels in the flaccid state very high in the erect state. ♦ During sleep, for instance, oxygen levels are high and a man can normally have three to five erections per night, each one lasting from 20 to 40 minutes.

ED 20

Pathophysiology of Erectile dysfunction (impotence) ♦ Impotence or Erectile dysfunction is the inability to achieve or maintain an erection sufficiently rigid for intercourse, ejaculation or both. ♦ It does not affect sexual drive or the ability to have an orgasm. ♦ Rarely does Erectile dysfunction signify a chronic problem. ♦ When a consistent pattern of sexual dysfunction extends over a prolonged period of time. ♦ However, a physical or serious emotional disorder may be indicated. Impotence is not new in the medical texts or in human experience. ♦ It is not easily or openly discussed, however. ♦ Our cultural expectations of male to sexuality have forced many men to refrain from seeking help for a disorder that can, in most cases, benefit from medical treatment.

Mechanism of impotency ♦ It is being observed the erection is under the Neurovascular control as emotional control, where chemicals are released and physically filling the vessels of penis and making hard with proper erection. ♦ So the neuro-vascular control in normal man stress when sexually aroused. The brain activates and releases Nitric oxide in the spongy tissues. It activates the enzyme Guanylate cyclase that produces cyclic guanosina mono phosphase (cGMP). ♦ The cGMP relaxes the spongy tissues and increases the blood flow to the penis. ♦ The penis stiffens as the auteries and the spongy tissues dilate and squeeze the vein shunt. ♦ It withstands till the venous drain leakage takes place. Otherwise erection flags when another enzyme called phospho diesterase type 5 (PDE5) neutralises the cGMP. The spongy tissues compress and blood drains out through vein. ♦ Usually anxiety or fear leads to the situational impotency. A temporary impotency mostly achieved by verious leakage or any metabolic disorders such as stoulya (obesity). Out of the various groups of impotency beejadosha janya or sukra dhatu gata mapumsakata can not be treated. We can make a prophylactic treatment for father and mother before conception there by they want give birth to child of impotency. The other group, temporary impotency are situational impotency can be treated best out of Ayurveda.

ED 21

How Is Impotence Diagnosed? Medical and personal history ♦ There are several tests available to assist physicians in diagnosing impotence and its causes. ♦ The first step is, of course, talking openly the patient must be as frank as possible in order to assist his physician in making a diagnosis. ♦ In addition to reporting any past and present medical problems, the patient should report any medications or drugs he is taking and any history of psychological problems, including stress, anxiety, or depression. ♦ The physician also requires a sexual history. This should include the nature of the onset of the dysfunction, and the frequency, quality, and duration of- any erections, and whether they occur at night or in the morning. ♦ The physician might also ask about the specific circumstances when Erectile dysfunction occurred, details of technique, the man's motivation for and expectations of treatment, and whether problems exist in the current relationship. ♦ The man should not interpret these questions as intrusive or too personal if he expects to obtain help; they are very relevant and important for determining the proper approach to the problem. ♦ If appropriate, the physician might also interview the sexual partner. ♦ Apart from this a Physician may use battery of tests, both laboratory and invasive along with a detailed examination to diagnose impotence.

Management of ED (Klaibya- IMPOPENCY) ♦ Impotency is of Neuro-vascular disorder, needs of counseling reassurance and correction. ♦ The counseling includes taking information of situation and careful & perfect analysis ♦ Second step is reassurance the patient and correcting the problem. ♦ Venous leak correction or penile prosthesis, etc. treated with surgical interventions. ♦ Erectile dysfunction due to metabolic disorders, emotional or attention deficit disorders (ADD) are considered specifically or minimal brain dysfunction also leads one to develop Impotency. ♦ Apanavata – Vyanavata – Sadhakapitta – Manas – axis leads to Sukra dusti & ED to be regulated along with general health maintenance

ED 22

Medicinal classification used in ED ♦ Many medicines are told for the ED, apart from surgical, instrumental and exercises ♦ The non drug therapy are of psychological – out of the best is “A perfect Female” ♦ Drug therapy includes – 1. Sukra janaka – which increases the semen quantity to rouse the person – eg. Sukra janana varga - Mudgaparni, Mashaparni, Shatavari, Jatamamsi, Karkata srungi, Dugdha, Masha, Amalaki, Bhallataka majja, etc, 2. Sukrala or Sukra utpattikara – generates semen – Aswagandha, Sharkara, Musali, etc. 3. Sukra pravartaka or Sukra rechaka – surges the semen – Bruhati, Kantakari, Bhallataki, etc. 4. Sukra janaka pravartaka – increases the quality and quantity and surges semen well in time – Ksheera, Masha, Amalaki, etc. 5. Sukra shodhaka – eliminates the seminal problems – Sukra shodhaka gana – Kusta, Elavaluka, Katphala, Samudra phena, Kadamba niryasa, Ikshu, Kandekshu, Ikshurakam, Vasuka, Usheera, Saireyaka, Gunja, etc. 6. Sukra stambhaka – retards the ejaculation and enhances the longevity of intercourse – Jatiphala, Ahiphena, Udakeerya, Vatsanabhi, Koshamra, Poogeephala, Tinduka, Vakula, Babboola, Akarakarabha, etc. ♦ Apart from these – we have many drugs which can act at their pharmacological properties with specific alkaloids present in them as – Vajeekara, Sukrala, Vrushya, Dhatu pustikara, Kamottejaka, etc. are – eg. Kapikacchu, Gokshura, Kakamachi (DM), Taalaphala, Mocharasa, Kumari (for female), Palasha, Kharjura, Kushmanda, Eranda, Sariba, Tamboola, Bakuchi, Latakasturi, Twaka, Shireesha, etc. ♦ Our of Rasa dhatu – Swarna, Abhraka, Parada, Swarna makshika, Vajra bhasma, etc. ♦ Vrushya varga – Madhura rasa, Snigdha Guru Guna, Brumhana, Jeevaneeya dravya and Manollasakara vihara always useful to rectify ED Some Vajikarana Yoagas are used at ED Akarakarabhadi vati (Bh.Pr.Ut)

Rativardhana Yoga (Bh.Pr.Ut)

Bruhatchagalyadighruta (Bh.Rt.74/312-336)

Shatavari Ghruta (Ch.chi.2-3/18)

Brumhani Guti (Ch.chi.2-1/24-33)

Vajikarana ghruta (Ch.chi.2-1/33-37)

Kameswara modaka (Bh.Pr.Ut)

Vanariguti (Bh.Pr.Ut)

Mamsa Guti (Ch.chi.2-4/11-14)

Vidaryadi churna (A.H. Ut.40/21-22)

Narasimha choorna (Chakradatta)

Vrushya Ghruta (Ch.chi.2-2/21-23)

Poogapaaka (Bh.Pr.Ut)

Vrushya Guti (Ch.chi.2-4/30-32)

ED 23

Uttravasti in ED and orgasmic problems - ultimate management ♦ Modern medicine has hardly any drugs or therapy to benefit patients with Inhibited Sexual Desire (ISD) ♦ Uttaravasti with vatahara and sukradoshahara dravyas either in the form of taila or kashaya to be introduced per urethra at the quantity of 10 to 15 ml according to the procedure. It relieves the diseased state and normal equilibrated state is introduced in the body humors and tissues.

ED – Other Managements (Select patient either for Drug Therapy or Drugless) 1. It is best to maintain general health to regulate under the stipulations of Dinacharya and Rutucharya as a prophylactic measure. 2. Erection frequenter technique – repeatedly exciting erection withdrawal technique 3. Kegel Exercise – is simple used at urinary incontinence – inhibiting the urinary reflex and tightening and releasing pelvic muscles at least 10 –15 times at each episode 4. Reducing causative medication - such as ACE inhibitors 5. Psychotherapy and Behavioral therapy - it is a part of counseling and reassurance 6. Injections – Alprostadil or Prostaglandin E1 urethral injections, Papvarine injections in to spongy tissue 7. Oral Drug Therapy – Sildenafil – acts over PDE5, cGMP, effective with in 20 –30 minutes 8. Other experimental oral drugs - Phentolamine, Apomorphine, Pentoxifylline (for rich Oxygen delivery), Naltrexone, etc. 9. Hormone Replacements – Testosterone therapy 10. Tropical medicine – Aerosol spray of Minoxidil, SS cream (Herbal), etc. 11. Vacuum devices – plastic cylinder emptiness at penis creates more blood rush 12. Penile implants – surgical procedures implants “Hydralic implant” or “Prosthesis” – a semi rigid bendable rod resembles erect penis 13. Vascular surgery – bypass or revascularisation with venous legation 14. Folklore / Herbal medicines – Yohimbine, Ginkgo, Ginseng, 15. Ayurvedic Aphrodisiacs - Patient medicines for ED or ISD from Ayurveda (I tried) Actiforte (Anuja)

Himcolin (Himalaya)

Spy (Yogi)

Afrol (Solumics)

Mustong (TTK)

Tentex Forte (Himalaya)

Amber Forte (Anuja)

Neo (Charak)

Vigorex (Zandu)

Confido (Himalaya)

Rathi (Capro)

Vimfix (Sandu)

Desirex (Anuja)

Senzine (J&J)

ED 24

Conclusions 1. Sex act is equal responsibility, sharing and inter personal communication of partners. Both of sex partners are equally responsible for the ED development 2. Sex disturbances are common and need not be always a psycho pathology 3. Mother is responsible for genesis of impotency in child by her psyche, dietetics, behavioral or genetically intervention 4. Growth (proper cell division) is directly proportional to Libido / sex arousal 5. Apart from many symptoms nervousness, over sweating and pseudo anasarca are predominate symptoms of Erectile dysfunction 6. The situational or temporary ED can be treated effectively with Vata hara, Sukra shodhaka modalities of management and any structural imparities are well managed with surgical procedures 7. Uttara vasti is a best shodhaka and also shamaka management in ED 8. Vajikarana is a management told in samhita much times misinterpreted as Sexology, which can not be accepted 9. Vajikarana is intended to facilitate potent offspring is a Male dominate and meant for Males either to relieve penile problems or to initiate sex even to get abundant semen for enerating the healthy successive generation other wise it is “Eugenics” I.e. improvement of the qualities of a race by control of inherited characteristics 10. Vajikarana (Aphrodisiacs) is that which potentates a man to traffic in to women like a horse and also sustenance in the same mainly the animal relationship example are – ♦ Chataka - (Sparrow) multiple short span conjugation with small amount of semen ♦ Gaja - (Elephant) once in a while long time conjugation with abundant semen discharge ♦ Vrusha - (Buffalo) regular stable seasonal conjugation with more quantity sperm (Semen) ♦ Ashwa - (Horse) regular forceful dynamic conjugation with less qualitative semen ♦ Vajikarana is Long lasting since the descend of Ayurveda it needs initial purification of the body cleansing through “Panchakarma Shodhana” “Temptations” towards female and there by a chemical reaction occurs in the body through the buffered “Vajikarana Dravya” the probable action is a - psycho-neuro-motor activity enhances the blood flow to the Male genitalia, so it erects and ejaculates well to produce a child

ED 25 ♦ Sexology is ... A science which is based on mutual consent, gratification, seduction and conjugal satisfaction of either gender where birth of child is not essential ♦ Sex is other wise a materialistic pleasure of either gender, some times it is of the same gender initiated by PDE5, cGMP & NO and lacks of it gives rise to ED ♦ A patient of ED or Perfect Sex of an individual is assessed by – 1. MSP - my sexual persona, 2. GRISS - Golombok-Rust Inventory of sexual satisfaction 3. GRIMS - Golombok-Rust Inventory of Marital state 4. HARDS (HAR) - Hospital A&D score & Stress score 5. Libido score 6. Frequency of NPT 7. Penile Erection score 8. Penile Rigidity score 9. Semen Ejaculation score 10. Orgasm score 11. Androgen deficiency score ♦ Woman is the platform and media for sex and considered always potent in sexual activity but she plays passive role in sex, hence Vajikarana is not mandatory for woman is a statement of ancient. ♦ Not only Vaginismus, Dyspareunia, Sexual fantasies, masturbation and Premature ejaculation and/or orgasm problems are becoming common in female. ♦ At present many occasions it is found and researches are going on with the “Female sexual dysfunction” and Female ED.

From the Desk of Dr.

Next topic of interest is “Female sexual dysfunction”

K. Shiva Rama Prasad, M.D.(KC), C.O.P. (German) M.A, Ph.D (Jyo)