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KLAIBYA (ERECTILE DYSFUNCTION)-A BIRD EYE VIEW THROUGH AYURVEDA AND MODERN SCIENCE

Authors:
  • Govt ayurved college osmanabad
  • Smt. K G Mittal Punarvasu Ayurved Mahavidyalaya, Charni Road, Mumbai 02

Abstract

Impotency as a medical and social problem has acquired global dimensions and its incidence is supposed to be gradually increasing by every decade. Despite great advances made by medical science in understanding the actual cause, but still this problem is persist, due to which impotency is still a catastrophe. A great success of married life is hidden in the sexual harmony of the couple. The common cause which always prevents a man from enjoying sexual interplay with his female partner is called as "Klaibya" in Ayurved and in medical term it is called as "erectile dysfunction (E.D.)". It is commonly known as "Impotency". It is the worst calamity one can encounter in his life which takes away all the pleasure and bliss of his beautiful youth. The problem of sexual dysfunction are getting more and more common now a days. This review article attempts to explain etio-pathology & diagnostic approach Klaibya mentioned in ayurvedic & modern literature and it's over all effects on human being. This review article calls upon initiating research in this area so that the claims of ancient ayurvedic science could be substantiated and may be utilized by modern science. Introduction:
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Journal of Ayurveda and Holistic Medicine | October, 2013 | Vol 1 | Issue 7 13
REVIEW ARTICLE
KLAIBYA (ERECTILE DYSFUNCTION) - A BIRD EYE VIEW THROUGH AYURVEDA
AND MODERN SCIENCE
BAGDE A. B.1, SAWANT R. S.2
1Assistant Professor, Dept. of Sanskrit Samhita Siddhant, Govt. Ayurved College, Osmanabad-
413501(Maharashtra).
2Assistant Professor, Dept. of Rasa-Shastra and Bhaishajya Kalpana, Govt. Ayurved College,
Nanded-431601 (Maharashtra).
Corresponding author email address: drabbagde@gmail.com
Access this article online: www.jahm.in
Published by Atreya Ayurveda Publications, Ilkal-587125 (India) All rights reserved.
Received on: 14/09/2013, Revised on: 30/09/2013, Accepted on: 07/10/2013
Abstract:
Impotency as a medical and social problem has acquired global dimensions and its incidence is supposed to
be gradually increasing by every decade. Despite great advances made by medical science in understanding
the actual cause, but still this problem is persist, due to which impotency is still a catastrophe. A great
success of married life is hidden in the sexual harmony of the couple. The common cause which always
prevents a man from enjoying sexual interplay with his female partner is called as “Klaibya” in Ayurved
and in medical term it is called as “erectile dysfunction (E.D.)”. It is commonly known as “Impotency”. It
is the worst calamity one can encounter in his life which takes away all the pleasure and bliss of his
beautiful youth. The problem of sexual dysfunction are getting more and more common now a days. This
review article attempts to explain etio-pathology & diagnostic approach Klaibya mentioned in ayurvedic &
modern literature and it’s over all effects on human being. This review article calls upon initiating research
in this area so that the claims of ancient ayurvedic science could be substantiated and may be utilized by
modern science.
Keywords: Klaibya, Impotency, Erectile Dysfunction, Shandha, Napumsakatwa, Eunuch, Unmanliness
Introduction:
The well-known and ancient authoritative text of
Indian erotic literature Kama Sutra considers
Kama (love and sex) as an art. This literature
deals with all the aspects of love and sex, with
its personal, social, cultural and medical
importance. It has been mentioned about 64 art
forms of sex. In Kama Sutra, Acharya Vatsayana
has given more importance to fore play, before
actual sexual intercourse. The time in which we
are living presently is no doubt wonderful due to
various useful modern technologies, which
exists today. These technologies have given us
so much profits and comforts that no one can
imagine to live without them. With the help of
computers and machines and other useful
instruments, man has been able to achieve great
targets of his life, within very short span of time
and with less manpower.
Though these things have proved to be a boon to
mankind, but they also have a dark side. This
technology has involved the man so much in
itself that he has no time left for himself. He is
very much engaged in competitive life and job
responsibilities. The modern day lifestyle
consisting of faulty food habits like fast food,
Bagde A. B., Sawant R.S.: Klaibya (erectile dysfunction) - A bird eye view through Ayurveda and modern science
Journal of Ayurveda and Holistic Medicine | October, 2013 | Vol 1 | Issue 7 14
canned food and preserved food, highly irregular
meal timings, mental factors like fear, anxiety,
stress and tension lead to disturbed physical and
mental health status. This type of life style
creates tension in the life of the individuals and
physical exercises if not done regularly may
adversely affect his body. Man is surrounded by
various types of diseases as a result of
industrialization and modernization. If these
conditions coupled with disturbed sleep and
habits like cigarette smoking and tobacco
chewing are identified as risk factors for sex
related disorders and unhealthy conditions which
are becoming more and more common now-a-
days. It includes disorders like sexual desire
disorders, sexual arousal disorders or erectile
disorders, orgasm disorders and various sexual
dysfunctions are becoming very common among
people now-a-days.
The common cause which prevents man from
enjoying the act of sexual interplay with his
female partner is referred to as “Klaibya”. A
male suffering from Klaibya is unable to
maintain the sufficient rigid erection during the
lovemaking process required for pleasure or
fertilization therefore Klaibya is creating
problems to males directly and indirectly to
female. It is very humiliating for a person to find
himself ineffective before his female partner
while performing sexual intercourse, since on
the other part the female partner expects the
male partner to give her immense sexual
pleasure and gratification during the full period
of sex. Klaibya can be temporary or permanent
and it can be total or partial too. Generally
Klaibya considered as a disorder of old age but it
can also affect men at any age of puberty. In
such cases Ayurveda is very beneficial because
Ayurved has a hidden treasure to solve the
various sex and infertility related problems of
mankind.
Etymology
The term Klaibya is derived from the root (klibr
adhyastre by applying the sutra ‘lgupadheti’ and
adding the suffix ‘ka’ prsodaraditvad (halayudha
kosha) literary meaning of the word dhyastrye is
discipline, but in the present context the word
dhyastrye means masculine offensive nature,
boldness or arrogance, where ‘a’ is applied as
prefix then it became lack of masculine
offensiveness i.e. The lack of potency for sexual
act. Literally the word Klaibya means to be
impotent, to behave like a eunuch, impotence,
unmanliness, weakness, timidity, cowardice1.
Klaibya is represented by the word impotence.
Impotence is a Latin word, consisting of im and
potence. ‘im’ denotes lack of and ‘potency’
denotes power meaning of which are:
Lack of power.
Specifically lack of copulative power in
the male.
Definition of Klaibya
Klaibya is defined as sexual dysfunction
characterized by the inability of a man to
perform the ‘sexual act’ or incomplete
performance which leaves the female partner
partially or totally dissatisfied. In other words
Klaibya is also defined as inability to attain and
keep sufficient rigid (firm) erection which is
very essential during sexual intercourse for his
sexual needs or the needs of his female partner2.
Chakrapani narrows the definition of Klaibya
which means erectile dysfunction only3.
Common symptoms of Klaibya according to
Acharya Charaka4
A person even on having a strong sexual
desire to perform sexual act with a
beloved, willing and co-operative
partner, he cannot perform coitus with
her due to lack of his penis erection or
lack of penile rigidity.
Even if he manages to have an erection,
his anxiety will cause attacks of
dyspnoea (difficulty during breathing)
and perspiration (excessive sweating),
and his attempts to have sex will result
in a tiredness, frustration and due to
which his attempt will end in a failure.
Bagde A. B., Sawant R.S.: Klaibya (erectile dysfunction) - A bird eye view through Ayurveda and modern science
Journal of Ayurveda and Holistic Medicine | October, 2013 | Vol 1 | Issue 7 15
Absence of morning erections
Semen of this person is thin and
odorless
Erection will not occur at time of the
day or night.
No sexual passion, no erection and even
some time no discharge
Immediate softening of penile erection
after seminal emission
Imperfect or partial erection for a short
time and subsides before the main
sexual act.
premature or early ejaculation)
Types of Klaibya5, 6
Various types of Klaibya are explained in the
classical texts based on their causes. Acharya
Charaka has explained four types of Klaibya;
whereas Sushruta has explained 6 types they are
as follows-
1) Beejopaghaataja Klaibya
2) Dhwajopaghataja Klaibya
3) Shukrakshayaja Klaibya
4) Jarasambhavaj Klaibya
5) Sahaja Klaibya
6) Khara shukra nimittaja
Causes of beejopaghaataja Klaibya7
Regular and excessive consumption of
pungent, sour, hot and salty substances
in diet.
Sorrow
Worry and Anxiety
Excessive intercourse at premature age
Excessive heavy exercise
Excessive sexual activities
Lack of confidence in female partner
Black magic
Anuloma and viloma kshaya of all
rasadi dhatus
Sex with a woman who is having lack of
sex interest
Prolonged abstinence from sexual act
Due to above causes aggravated vata dosha
vitiated the shukra dhatu and diminished in
quantity which causes beejopaghaataja Klaibya.
Symptoms of beejopaghaataja Klaibya8
The person suffering from this type of Klaibya is
paleness, weak, low in vitality, less excitement
with women, hridya roga (heart diseases),
tamaka shawasa (asthma), kamla roga
(jaundice), klama (exhaustion), vaman
(vomiting), atisara (loose motion), shool (colic
pain) and fever.
Causes of dhwajopaghataja Klaibya9
This type of Klaibya is caused by
excessive consumption of sour & salty
products
Viruddhanna (incompatible food)
Severe emaciation caused by chronic
diseases
Intercourse with wife of enemies.
Due to lack of personal hygiene
Sexual intercourse with very young girls
Trauma caused by teeth and nails
Injury to genital organ or nerve
Sexual intercourse with a menstruating
woman
Sexual intercourse with a woman who is
suffering from chronic disease
Lack of sex interest in the sexual partner
Finding fault with partner
Intercourse with animals like
Intercourse with women who is in
menstrual cycle
Intercourse with female who is having
infected vagina
Excessive use of shuka prayoga (a
procedure which is used to increase
length of penis)
Bagde A. B., Sawant R.S.: Klaibya (erectile dysfunction) - A bird eye view through Ayurveda and modern science
Journal of Ayurveda and Holistic Medicine | October, 2013 | Vol 1 | Issue 7 16
Intercourse with female who is not
maintaining proper cleanliness of her
sex organs.
Ayonigamana9 (other than vagina e.g.
Anal sex, oral sex and masturbation)
Symptoms of dhwajopaghataja Klaibya10
Swelling of penis
Ulceration on penis with severe pain.
The ulcers start oozing with a red or
turbid colored discharge.
Suppuration discharge resembling rice-
water having aruna or shyava varna.
The penis becomes hard and rounded.
Other symptoms like fever, thirst,
vomiting etc. are found.
There is a burning sensation in the
urinary bladder, scrotum and groin.
The ulcers on the penis sometimes emit
foul smelling with whitish and viscous
discharge.
Sometimes ulcers will heal quickly and
sometimes persist for a long time and
will be infested with maggots and
worms.
Causes of shukrakshayaja Klaibya11
Daily intake of dry foods and drink
Consumption of food which is not
suitable for body
Worry, sorrow, anger
Sever emaciation due to chronic
diseases
Controlling semen at the time of
ejaculation12
Suppression of natural urges
fasting for long period
Due to this the rasa dhatu which is located in the
heart becomes depleted. Due to the decrease of
rasa, the subsequent tissues from rakta and
mamsa till shukra will get depleted. Even after
the decrease of shukra, if the person still
indulges more in sexual acts in parlance with his
strength without taking vajikarana preparations
(aphrodisiac drug) his shukra will quickly get
exhausted and he falls prey to serious disease
and even may prove fatal. Therefore abstinence
or regulated sex should be maintained till the
lost shukra regains its normal capacity.
Jarasambhavaj Klaibya13
This type of Klaibya occurs naturally in old age.
Because in old age, all the rasadi dhatus under
gone the dhatu kshaya (process of depletion).
Moreover, there is depletion of shukra dhatu
also and ultimately it resulted in shukra-kashya.
During this period if that person does not
consume any vrishya aahara (aphrodisiac diet) in
his daily routine diet, then there will no
nourishment of shukra dhatu. It results in
balakshaya (weakness), veeryakshaya and
indriya balakshaya (loss of strength of the sense
organs). In this state if he is performing strenous
activity & fast, which will cause jarajanya
Klaibya. The person becomes despicable and
looks malnourished and also loses its
complexion.
Sadhyaasadhyata (prognosis) of Klaibya14
Acharya Charaka has mentioned that Klaibya
occurred due to dhwajabhanga, janmjat and
kshayajanya Klaibya are asadhya (incurable).
Klaibya occurred due to amputation of penis or
testicles are also considered as incurable.
Modern view
Erectile dysfunction (impotence) occurs when a
man can no longer get or keep an erection firm
enough for sexual intercourse. Having erection
trouble from time to time isn't necessarily a
cause for concern. But if erectile dysfunction is
an ongoing problem, it may cause stress, cause
relationship problems or affect your self-
confidence.15
Even though it may seem awkward to talk with
your doctor about erectile dysfunction, go in for
an evaluation. Problems getting or keeping an
erection can be a sign of a health condition that
Bagde A. B., Sawant R.S.: Klaibya (erectile dysfunction) - A bird eye view through Ayurveda and modern science
Journal of Ayurveda and Holistic Medicine | October, 2013 | Vol 1 | Issue 7 17
needs treatment, such as heart disease or poorly
controlled diabetes. Treating an underlying
problem may be enough to reverse your erectile
dysfunction.
If treating an underlying condition doesn't help
your erectile dysfunction, medications or other
direct treatments may work.
Causes
Male sexual arousal is a complex process that
involves the brain, hormones, emotions, nerves,
muscles and blood vessels. Erectile dysfunction
can result from a problem with any of these.
Likewise, stress and mental health problems can
cause or worsen erectile dysfunction. Sometimes
a combination of physical and psychological
issues causes erectile dysfunction. For instance,
a minor physical problem that slows your sexual
response may cause anxiety about maintaining
an erection. The resulting anxiety can lead to or
worsen erectile dysfunction.
Physical causes of erectile dysfunction 15
In most cases, erectile dysfunction is caused
by something physical. Common causes include
Heart disease
Clogged blood vessels (atherosclerosis)
High cholesterol
High blood pressure
Diabetes
Obesity
Metabolic syndrome, a condition
involving increased blood pressure, high
insulin levels, body fat around the waist
and high cholesterol
Parkinson's disease
Multiple sclerosis
Low testosterone
Peyronie's disease, development of scar
tissue inside the penis
Certain prescription medications
Tobacco use
Alcoholism and other forms of
substance abuse
Treatments for prostate cancer or
enlarged prostate
Surgeries or injuries that affect the
pelvic area or spinal cord
Psychological causes of erectile dysfunction
The brain plays a key role in triggering the series
of physical events that cause an erection, starting
with feelings of sexual excitement. A number of
things can interfere with sexual feelings and
cause or worsen erectile dysfunction. These
include
Depression, anxiety or other mental
health conditions
Stress
Relationship problems due to stress,
poor communication or other concerns
Risk factors
A variety of risk factors can contribute to
erectile dysfunction. 16 They include:
Medical conditions, particularly
diabetes or heart problems.
Using tobacco, which restricts blood
flow to veins and arteries. Over time
tobacco use can cause chronic health
problems that lead to erectile
dysfunction.
Being overweight, especially if you're
very overweight (obese).
Certain medical treatments, such as
prostate surgery or radiation treatment
for cancer.
Injuries, particularly if they damage the
nerves that control erections.
Medications, including antidepressants,
antihistamines and medications to treat
high blood pressure, pain or prostate
cancer.
Psychological conditions, such as
stress, anxiety or depression.
Bagde A. B., Sawant R.S.: Klaibya (erectile dysfunction) - A bird eye view through Ayurveda and modern science
Journal of Ayurveda and Holistic Medicine | October, 2013 | Vol 1 | Issue 7 18
Drug and alcohol use, especially if
you're a long-term drug user or heavy
drinker.
Prolonged bicycling, which may
compress nerves and affect blood flow
to the penis, can lead to temporary
erectile dysfunction.
Complications
Complications resulting from erectile
dysfunction can include 17
An unsatisfactory sex life
Stress or anxiety
Embarrassment or low self-esteem
Marital or relationship problems
The inability to get your partner
pregnant
Diagnostic techniques/tools
Subjective techniques
International index of erectile function (IIEF) 18
DSM-IV TR diagnostic criteria for ED 19
Objective techniques
Audio-visual reaction time (AVRT) 20, 21
Galvanic skin resistance (GSR) 22, 23
Duplex USG 24, 25, 26
Penile nerve function 27
Dynamic infusion Cavernosometry 24, 26, 28
Penile biothesiometry 24, 26, 27, 28
Nocturnal penile tumescence [NPT] testing 24, 26,
28
Discussion:
Sex is the means by which a person achieves
maximum pleasure, which no other costly thing
can provide him. Successful intercourse relives a
person from all day tensions and helps him to
relax physically and mentally. But when a man
suffers from inefficiency of having normal sex,
the tensions generated tend to increase not only
in himself but also in his partner.
Klaibya or male sexual dysfunction, denoting
the inability of a man to achieve a satisfactory
sexual relationship, may involve inadequacy of
erection or problems with emission, ejaculation;
retarded ejaculation and retrograde ejaculation.
These a wide range of disorders pertaining to the
male sexual response ultimately converts into
male sterility also.
In Ayurveda explains these disorders under the
heading of Klaibya. The capacity to have sexual
intercourse with a woman is not constant
throughout life. It differs from man to man and
also in the same individual at different times and
phases of life. Some men can have repeated
sexual acts, some men have less number of
sexual acts, and same men are virile by nature.
Ayurveda recognizes this aspect of sexuality and
explains it by giving examples of deferent
animals like the horse, sparrow, bull, elephant
etc. Sexual potency and attitudes vary from
person to person. A person looking strong in
physical growth may be weak in sexual activities
and one who looks weak by physique may be
sexually strong, potent and possess many
offspring.
According to modern, the erectile impotence is
defined when a person has a problem to achieve
and maintain a firm erection, consistently over a
6 month period and in more than 50% of his
coitus attempts.
Klaibya is also found as an associated condition
in many diseases, which can be taken as
nidanarthkara diseases for Klaibya. e.g. Grahani
(~Sprue), Arsha (~Piles), Halimaka (a type of
jaundice), etc. which will lead to problems of
sexual performance and person suffers from
alpa-maithuna and Klaibya. Even improper
sleeps, lack of sleep also cause of general
deterioration in sexual performance and potency.
Acharya Charaka says that virility of a man
depends much or proper sleep & lack of proper
sleep will lead to impotence. Ayurveda explains
clearly the role of mind in the sexual response of
man. So it is natural that Ayurveda considers the
Bagde A. B., Sawant R.S.: Klaibya (erectile dysfunction) - A bird eye view through Ayurveda and modern science
Journal of Ayurveda and Holistic Medicine | October, 2013 | Vol 1 | Issue 7 19
mental factors as one of the prime etiologies of
Klaibya.
Ayurveda texts explains about Jarasambhavaja
Klaibya which can be established by a recent
study. Chandra Nikhil et al shown in his study
that male Sexual dysfunctions are the most
common of the psychosexual disorders in
clinical practice. The incidence of sexual
dysfunctions increases with age. About 5% of 40
year old men and between 15% and 25% of 60
year old men experience sexual dysfunctions.29
Many studies have been conducted to treat
Klaibya and its associated conditions.
Manhunatha et al has discussed about role of
Gokshuradi Yoga in the management of Klaibya
(~ED). It was revealed that there is improvement
of patients of Klaibya with said preparation.30
Mishra Amit Kumar et al concluded in his
review that if we see the etiology behind the
Klaibya or erectile dysfunction, we find that the
causes of Klaibya are of various kinds viz.
psychological, organic, metabolic etc. Based on
the causes the different investigative / diagnostic
techniques are developed; although their clinical
use may be limited on certain instances; but it
helps a lot to know the inherent cause of the
disease and to plan the appropriate management
accordingly.31
Kulkarni H et al in his study on drug Putranjiva
roxburghii has found highly significant effect
upon all the Sexual Parameters. The sexual
desire, penile erection, penile rigidity,
ejaculation, orgasm, frequency of coitus, and
duration of coitus all were found to increase at a
highly significant level in the trial drug
administered group. The placebo administered
group showed a significant increase in all the
parameters except orgasmic score and sexual
desire. However no significant changes in the
biochemical and hematological values were
recorded.32
Bhatted Santosh et al in his study concluded that
Akarakarabhadi Yapana Basti is highly useful in
reducing symptoms of Klaibya such as lack of
erection & lack of rigidity, desire, ejaculation
disorder, post act exhaustion. In other group
with Akarkarabhadi churna administered orally,
shows moderately significant changes than basti
group. The placebo group has shown
insignificant results. The study denotes Basti is
imperative in treatment of disorders caused by
Apana Vayu such as Klaibya.33
In another study, it was found that patients of
erectile dysfunction (klaibya) along with
diabetes when treated with powder of F.
religiosa Linn. shown moderate significant
results where as highly significant results in non
diabetic subjects. Which clearly indicates DM
plays major role in pathology of erectile
dysfunction which interfere in its management.34
Conclusion:
From this review article it can be concluded that
root causes of Klaibya is the hectic and stressful
life schedule of present times. General health
considerations like sleep, appetite, mental
tension, worry; excessive exercise and fatigue
affect the sexual performance and desire (libido)
of a healthy man. Impotence (male sexual
dysfunction) is mainly discussed under the
heading Klaibya with some scattered references
relating to the symptoms in Sukragata Vata,
Sukravrita Vata, Sukrakshaya etc. Bijophagataja
Klaibya is due to abnormality in the sperms.
Dhvajabhangaja Klaibya is due to inflammatory
disease of the penis. Sukrakshayaja Klaibya is
due diminution of semen as a result of various
Aaharaja, Viharaja and Manasika factors. Jaraja
Klaibya is due to decreased levels of serum
testosterone in old age.
For having good quality of sexual intercourse,
erection plays an important role, and erection
depends upon physical, emotional and mental
health. Real and everlasting success of married
life is hidden in the sexual harmony of the
couple. Therefore any woman can never love a
person who is suffering from Klaibyata. This
type of person is not regarded by any woman
even though he is very strong in body built,
handsome and affluent in wealth. A woman is
happier and more contented with a poor and
Bagde A. B., Sawant R.S.: Klaibya (erectile dysfunction) - A bird eye view through Ayurveda and modern science
Journal of Ayurveda and Holistic Medicine | October, 2013 | Vol 1 | Issue 7 20
ugly man who is potent and virile than a man
devoid of sexual power.
Lack of sexual knowledge, fear and anxiety are
most common factors of Klaibya. Majority of
the patients did not have a reliable source for
sexual education and having many
misconceptions regarding normal sexual
response. Before to start any type of treatment
the best approach is to counseling the couples
rather than drug therapy. Sex education and
reassurance may also be beneficial in the patient
of Klaibya.
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Cite this article as: Bagde A. B., Sawant R.S., klaibya
(erectile dysfunction) - a bird eye view through
ayurveda and modern science, Journal of Ayurveda
and Holistic Medicine; 2013;1(7): 13-21.
Source of support: Nil, Conflict of interest: None Declared.
ResearchGate has not been able to resolve any citations for this publication.
Article
Full-text available
Klaibya or Erectile dysfunction (ED) is a very common male sexual dysfunction which affects majority of men sometimes in their lives. It has been reported to affect as many as 152 million men worldwide. There are so many etiological factors producing the abnormality which include-physical, chemical, biological, psychosocial causes etc.; to diagnose the cause there are several subjective and objective tools available viz.-DSM-IV-TR, diagnostic criteria for ED, IIEF,
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Duplex ultrasound is used commonly to evaluate vascular function in impotent men. There is evidence, however, that some men with normal vascular function may have falsely abnormal duplex ultrasound results because of suppression of response to pharmacological stimulation due to anxiety. We performed a prospective blinded study of 40 impotent men comparing duplex ultrasound to a formal nocturnal penile tumescence evaluation. Duplex ultrasound was done with a standard 10 MHz. color Doppler unit after intracorporeal pharmacological stimulation. Nocturnal penile tumescence was performed at a sleep laboratory, and included measurements of penile circumference, axial rigidity, arterial pulsations, and direct patient and observer evaluation of erections.
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To develop a brief, reliable, self-administered measure of erectile function that is cross-culturally valid and psychometrically sound, with the sensitivity and specificity for detecting treatment-related changes in patients with erectile dysfunction. Relevant domains of sexual function across various cultures were identified via a literature search of existing questionnaires and interviews of male patients with erectile dysfunction and of their partners. An initial questionnaire was administered to patients with erectile dysfunction, with results reviewed by an international panel of experts. Following linguistic validation in 10 languages, the final 15-item questionnaire, the international index of Erectile Function (IIEF), was examined for sensitivity, specificity, reliability (internal consistency and test-retest repeatability), and construct (concurrent, convergent, and discriminant) validity. A principal components analysis identified five factors (that is, erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction) with eigenvalues greater than 1.0. A high degree of internal consistency was observed for each of the five domains and for the total scale (Cronbach's alpha values of 0.73 and higher and 0.91 and higher, respectively) in the populations studied. Test-retest repeatability correlation coefficients for the five domain scores were highly significant. The IIEF demonstrated adequate construct validity, and all five domains showed a high degree of sensitivity and specificity to the effects of treatment. Significant (P values = 0.0001) changes between baseline and post-treatment scores were observed across all five domains in the treatment responder cohort, but not in the treatment nonresponder cohort. The IIEF addresses the relevant domains of male sexual function (that is, erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction), is psychometrically sound, and has been linguistically validated in 10 languages. This questionnaire is readily self-administered in research or clinical settings. The IIEF demonstrates the sensitivity and specificity for detecting treatment-related changes in patients with erectile dysfunction.
Article
Do we need impotence testing? Yes, it is the clinician's obligation to establish the etiology of impotence: end organ vascular failure vs neurologic dysfunction vs psychosexual dysfunction, classify the severity of that dysfunction, and select a therapy that is not only acceptable to the patient but also addresses his pathology. The most commonly utilized diagnostic tests for erectile dysfunction are outlined in this monograph. Nocturnal erections are evaluated by tests commonly known as nocturnal penile tumescence (NPT) studies. NPT has been measured by each of the following methods: stamp test, Snap Gauges, strain gauges, NPTR (Rigiscan, Osbon Medical Systems), and sleep lab NPTR. Normal Nocturnal Penile Tumescence and Rigidity (NPTR) depends on both the integrity of the corticospinal efferents to the penis and vascular responsiveness of the penile tissues to those nerve signals. When nocturnal erections are of appropriate duration and strength the central and peripheral neuroeffectors and intra-corporal regulators of penile hemodynamics are intact. Unfortunately, abnormal NPTR is of little value in determining the etiology or classifying the severity of vascular impotence; the most prevalent kind of end organ failure. The sacral reflex arc of erection consists of somatosensory afferents via the dorsal and pudendal nerves and autonomic efferents via the pelvic and cavernous nerves. These afferents have been measured indirectly by somatosensory evoked potentials (SSEP) and bulbocavernosus reflex latency (BCR). Penile EMG's have recently been recorded, corporal cavernosal smooth muscle electrical activity: CC-EMG. This technology is far from standardized; computer-assisted interpretations of penile electrical potentials may eventually differentiate afferent nerve pathologies so long inferred in: diabetes, spinal cord injury and following radical pelvic surgery. Numerous diagnostic tests have been employed to evaluate penile hemodynamics: penile plethysmography, penile blood pressures, penile brachial index, selective internal pudendal pharmacoangiography, Doppler sonography, dynamic infusion cavernosometry/cavernosography, nuclear washout radiography, and color duplex Doppler ultrasound. Insufficient corporal veno-occlusion is implicated in up to 50% of patients. The diagnosis and demonstration of venous leakage requires complete smooth muscle relaxation. Veno-occlusive dysfunction is associated with poorly sustained erections; this pathology has traditionally been evaluated with Dynamic Infusion Cavernosometry and Cavernosography. DICC is an invasive test, and is now primarily reserved for patients considering the option of vascular reconstructive procedure. Pharmacotesting consists of intracavernous injection and visual rating of the subsequent erection; the test is the most commonly used office procedure for diagnosing erectile dysfunction. It is simple, minimally invasive, and performed without monitoring equipment. Hemodynamic investigations suggest that a positive injection test is associated with normal veno-occlusion, but not necessarily with normal arterial function. When the penile response to pharmacotesting is suboptimal or equivocal, diagnostic testing with duplex Doppler assessment should be performed. The penile blood flow study (PBFS) provides an objective, minimally invasive evaluation of a suboptimal/equivocal erectile response.
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This article outlines the typical phases in the development and maintenance of healthy female sexual functioning, and highlights the problems related to sexual functioning that women may present in a primary care practice. The author discusses an approach to the sexual problems of women subjected to trauma and those with certain psychiatric illnesses, and the effect of psychotropic medications on sexual functioning.
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