Presentation is loading. Please wait.

Presentation is loading. Please wait.

Challenges to Sexual Functioning

Similar presentations


Presentation on theme: "Challenges to Sexual Functioning"— Presentation transcript:

1 Challenges to Sexual Functioning
Dr Ghafghazi

2 Sexual Dysfunctions: Definitions, Causes, and Treatment Strategies
Psychological Factors in Sexual Dysfunction Physical Factors in Sexual Dysfunction Categorizing the Dysfunctions Treating Dysfunctions

3 Sexual Dysfunctions: Definitions, Causes, and Treatment Strategies
The Diagnostic and Statistical Manual (DSM IV-TR) classifies sexual dysfunctions It provides descriptions, diagnoses, treatments, and research findings Note: there is a distinction between Sexual problems vs. sexual dysfunctions Common sexual problems – not enough foreplay, lack of enthusiasm, inability to relax Dysfunction – disturbance in the sexual response that doesn’t go away by itself

4 Psychological Factors in Sexual Dysfunction
Psychological factors can interfere with sexual functioning: fears, stress, anxiety, depression, guilt, anger, partner conflict, dependency, loss of control, time pressures, distractions Performance fear – excessive need to please a partner Spectatoring – acting as an observer or judge of one’s own sexual performance

5 Physical Factors in Sexual Dysfunction
Sexual dysfunction increases with age Disease, disability, illness, and use of prescription and non-prescription drugs can all lead to sexual dysfunctions

6 Categorizing the Dysfunctions
Categorization helps determine appropriate treatment strategies Primary – one that always existed Secondary – one that develops after a period of adequate functioning Situational – occurs during certain sexual activities or with certain partners Global – occurs in every situation

7 Treating Dysfunctions
Medical history and workup are taken first to determine physiological causes Evaluations of past sexual abuse or trauma Plan for treatment is made after causes have been uncovered Treatment may involve several therapy types Highest success rates are 60% for primary erectile disorder, 97% for premature ejaculation, 80% for female orgasmic disorder

8 Sexual Desire Disorders
Hypoactive Sexual Desire Treating Sexual Desire Sexual Aversion

9 Sexual Desire Disorders
Often considered the most difficult sexual dysfunction category to treat Two types: Hypoactive Sexual Desire Sexual Aversion

10 Hypoactive Sexual Desire
Diminished or absent feelings of sexual interest in sexual activity Problem may be due to discrepancy in desire between the partners 33% of women, 16% of men report a lack of interest; increases with age for women Secondary is more common than primary Psychological causes: lack of attraction to partner, fear of intimacy/pregnancy, relationship conflicts, depression, mental disorders, negative body image

11 Hypoactive Sexual Desire
Other causes: anorexia, sexual abuse, and coercion, drug abuse Biological causes: hormonal problems, illness, medication side effects Treatment: sex and marital therapy, cognitive-behavioral therapy, testosterone for those with low levels

12 Sexual Arousal Disorders
Female Sexual Arousal Disorder Male Erectile Disorder

13 Sexual Arousal Disorders
More commonly sexual arousal disorders are secondary They occur even with enough focus, intensity, and duration of sexual stimulation Two types: Female Sexual Arousal Disorder Male Erectile Disorder

14 Female Sexual Arousal Disorder
Inability to lubricate or stay lubricated Increases with age and is common after 50 Physiological factors: lowered blood flow to the vulva Psychological factors: fear, guilt, anxiety, depression Treatment: phytoton cap,afrodit tab, vasoactive agents (pills, creams), herbal drugs, EROS clitoral therapy device, psychological therapy

15 Male Erectile Disorder
Persistent inability to get or keep an erection sufficient for satisfactory sexual performance 30 million men in the U.S.; increases with age Physiological factors: neurological, endocrine, vascular, muscular problems More common in older men (60+) Psychological factors: fear of failure, performance anxiety More common in younger men (20-35)

16 Male Erectile Disorder
Most treatment options of any sexual dysfunction Success rates range from 50-80% Psychological treatment: systematic desensitization, education, sensate focus, communication training, relationship therapy

17 Male Erectile Disorder
Pharmacological treatment: afrodit, pytoton, L Relax penile muscles, dilate penile arteries Erection does not occur without stimulation Must be taken minutes prior to intercourse Erections can last 4-48 hours Many side effects with sildenafil

18 Male Erectile Disorder
Hormonal treatments help those with low testosterone levels Testosterone patch applied to the scrotum, gels & creams to other body parts Intracavernous injections are self-injected into the corpora cavernosa, while the penis is stretched, and causes the vessels to relax Minor pain & possible priapism side effect Prostaglandin pellets put into penile opening

19 Orgasm Disorders Female Orgasmic Disorder Male Orgasmic Disorder
Premature Ejaculation Retarded Ejaculation

20 Female Orgasmic Disorder
Has been referred to as “frigidity” Delay or absence of orgasm following normal sexual excitement A common complaint: 24% of women Those with female orgasmic disorder tend to have more negative attitudes about masturbation, feel more guilt about sex, believe more sexual myths, & have difficulty telling their partner their needs

21 Female Orgasmic Disorder
Psychological factors: lack of sex education, fear, anxiety, personality disorders Physical factors: chronic illness & disorders, diabetes, neurological problems, hormone deficiencies, prescription drugs, alcoholism Treatments: homework assignments, sex education, communication skills, cognitive restructuring, desensitization

22 Male Orgasmic Disorder
Delay or absence of orgasm following normal sexual excitement phase 8% of men Psychotropic medications may be a cause Treatment: psychotherapy, changing medications

23 Premature Ejaculation
A man reaching orgasm just prior to, or immediately after, penetration Not viewed as a problem in cultures where only male pleasure is considered important Frequency: 30% of men in a given year Related factors: depression, drug/alcohol abuse, personality disorders

24 Retarded Ejaculation A man may not reach orgasm during certain sexual activities or may only ejaculate after prolonged (30-45 minutes) stimulation Physical factors: diseases, injuries, drugs Psychological factors: strict religious upbringing, unique masturbation patterns, sexual orientation ambivalence Situational factors Difficult to treat; often use psychotherapy

25 Illness, Disability, and Sexual Functioning
Cardiovascular Problems Cancer Chronic Illness & Chronic Pain Diabetes Multiple Sclerosis Alcoholism Spinal Cord Injuries AIDS & HIV Mental Illness & Retardation

26 Illness, Disability, and Sexual Functioning
Physical illness can interfere with sexual functioning due to physiological changes, as well as psychological changes & relational changes Disabled women have more difficulties, however, research has focused on men Illnesses and disabilities: Cardiovascular Problems Cancer

27 Illness, Disability, and Sexual Functioning
…Continued Chronic Illness and Chronic Pain Chronic Obstructive Pulmonary Disease Diabetes Multiple Sclerosis Alcoholism Spinal Cord Injuries AIDS and HIV Mental Illness and Retardation

28 Cardiovascular Problems: Heart Disease and Stroke
Heart disease is the primary cause of death in the U.S. A person can return to normal sex about 4-8 weeks after recovery, however, intercourse tends to decrease Reasons for the decrease: fear, erectile difficulties, depression, feelings of inadequacy, loss of attractiveness, partner becomes the caretaker

29 Cardiovascular Problems: Heart Disease and Stroke
Stroke – blood is cut off from part of the brain Can create memory, perceptual, & cognitive problems, but usually not affect sexual functioning Problems stem from: fear, worries about attractiveness, stress, anxiety, some erections may be crooked, jerking motions, reduced sensation, communication problems May cause hypersexuality or hyposexuality

30 Breast Pelvic Prostate Testicular
Cancer Breast Pelvic Prostate Testicular

31 Cancer Cancer produces feelings of shock, depression, numbness, & fear
Partners may change roles Cancer can decrease sexual activity, even if it does not affect sexual organs Ostomies can be hard for many to accept Scars, loss of body parts, changes in skin & hair, nausea, weight change, and bloatedness can all inhibit sexual relations

32 Breast Cancer Much of a woman’s self-image can be invested in her breasts Removal of all or part of a breast or both can alter a woman’s self-image and sexual identity Many women may wear a prosthesis, undergo breast reconstruction, or have implants

33 Pelvic Cancer and Hysterectomies
Cancer of the vagina, cervix, uterus, & ovaries can affect a woman’s sexual response She may undergo a hysterectomy, which is currently the most common medical procedure in the U.S. The surgery may cause nerve damage It may also improve sexual functioning

34 Pelvic Cancer and Hysterectomies
Removal of ovaries will create a hormonal imbalance that can reduce lubrication, cause mood swings, other bodily changes Removal of the uterus may decrease pleasure during orgasm that was obtained through contractions of the uterus If the vagina is shortened, it may make intercourse more painful Some may mourn the loss of a body part, female identity, or the ability to have kids

35 Prostate Cancer Most men will have enlargement of the prostate gland as they age Prostate cancer is one of the most common in men over 50 Prostatectomy may be performed May cause incontinence and necessitate a catheter May cause erectile dysfunction

36 Testicular Cancer A testicle may be removed (orchiectomy), which can make a man feel that he has lost part of his manhood and become concerned about the appearance of his scrotum Prosthesis may take the place of the missing testicle Penectomy may occur in rare cases of cancer of the penis

37 Chronic Illness and Chronic Pain
Arthritis, migraine headaches, & lower back pain can make intercourse difficult or impossible

38 Diabetes Pancreas cannot make insulin or the body cannot use the insulin that is produced Insulin processes blood sugar into energy Often creates many sexual difficulties Erection difficulties, vaginitis, yeast infections Many diabetic men receive penile prostheses Both physiological and psychological problems often play a part

39 Multiple Sclerosis Breakdown of the myelin sheath that surrounds & protects nerve fibers Symptoms: dizziness, blurred vision, muscle spasms, loss of control of muscles, weakness 60-80% of men with MS experience ED Women with MS may lack vaginal lubrication, have difficulty attaining orgasm Many may be hypersensitive to touch Treatments: therapy, prostheses, lubrication

40 Alcoholism Alcohol is a nervous system depressant with long & short term effects on sexual operations May impair spinal reflexes, decrease testosterone, lead to erectile dysfunction In men may cause feminization, gynecomastia, testicular atrophy, sterility, ED In women may cause decreased menstrual flow, ovarian atrophy, loss of vaginal membranes, miscarriages, infertility

41 Spinal Cord Injuries Damage can cut off impulses in areas served by nerves below the damaged section Depending on where the injury occurred, & the extent of the damage, a man may still be able to have an erection through a reflex action responding to stimulation, however, he is not likely to orgasm or ejaculate Likely to make a person dependent on his/her partner or caretaker

42 Spinal Cord Injuries Women can remain fertile and bear children
Women may also lose sensation & ability to lubricate Spinal cord injuries may create new erogenous zones Typically, sexual activity decreases after the injury Preferred sexual activities tend to change to kissing, hugging, & touching

43 Spinal Cord Injuries Couples can still use their mouths & possibly hands to pleasure their partner “Stuffing” may also be used Treatment methods include prosthesis implantation, vacuum erection devices, injection of vasoactive drugs, & Viagra™

44 AIDS and HIV Those infected often fear infecting others, are shamed, and may stop all sexual activity Other may limit their sexual activity to hugging, kissing, & touching Care needs to be taken to avoid exchanging bodily fluids & keeping clean Sexual relations can still occur while remaining safe

45 Mental Illness and Retardation
Those with psychiatric disorders have been treated as asexual or as perverts Those institutionalized are discouraged from masturbating, though each institution differs Special sexuality education programs are designed for those with mental retardation & those that are developmentally disabled Denying sexuality in these cases is needless Sexual exploitation can also occur

46 Sexual Dysfunction DO YOU HAVE ANY OF THESE SYMPTOMS?
                Decrease in sexual performance is the number one biomarker of aging. Low sexual performance may even relates to some hidden diseases and in many cases has low energy level. Sexual dysfunction is a health problem that over looked by many people. Sexual dysfunction always related to cardiovascular circulation and nutrition problems.                 DO YOU HAVE ANY OF THESE SYMPTOMS?    Decrease in sex drive      Lack of energy    Decrease in strength and or endurance    Decreased "enjoyment of life"    Sad and or grumpy    Erections less strong    Deterioration in sports ability    Falling asleep after dinner meal    Decreased work performance    Mood swings    .

47 Aphrodit tablet, drop Contains dry extracts of tribulus terrestric,zingiber,cinammom,and saffron

48 Phytoton cap Contains ginseng, ginkgobiloba extrcats

49 Tribulus terrestris T. terrestris is a flowering plant in the family Zygophyllaceae, native to warm temperate and tropical regions of the Old World in southern Europe, southern Asia, throughout Africa, and in northern Australia. It can thrive even in desert climates and poor soil. It increases testosterone by increasing gonadotropin-releasing hormone (GnRH) which in turn stimulates the production of LH and follicle-stimulating hormone (FSH). Testosterone, besides its role in muscle-building and raising fertility and libido, is also known to have a positive effect on bone marrow activity (for red blood cell production) and the immune system.

50 What is Tribulus? Other Names: Puncture vine Tribulus terrestris is a herb that has been used in the traditional medicine of China and India for centuries. In the mid-1990s, tribulus terrestris became known in North America after Eastern European Olympic athletes said that taking tribulus helped their performance. The active compounds in tribulus are called steroidal saponins. Two types, called furostanol glycosides and spirostanol glycosides, appear to be involved with the effects of tribulus. These saponins are found primarily in the leaf. Why Do People Use Tribulus? Tribulus is most often used for infertility, erectile dysfunction, and low libido. In the last decade, it has become popular to improve sports performance. Tribulus has been marketed these conditions because research performed in Bulgaria and Russia indicates that tribulus increases levels of the hormones testosterone (by increasing luteinizing hormone), DHEA, and estrogen. The design of these research studies, however, has been questioned.

51 Other Tribulus health benefits include: reduction in cholesterol, reduction in high blood pressure, inhibition of stress-induced clumping of blood platelets, increases in strength of contraction of the heart muscle, reductions in sodium and fluid retention,  prevention of kidney stones, improvement of the profile of red and white blood cells, and strong anti-bacterial, anti-malarial, and anti-fungal properties, anti-inflammatory activity and action.

52 Tribulus terrestris is a very effective testosterone and libido enhancer, and as a treatment to increase sperm quality and quantity.        In one study, Tribulus terrestris increased spermatogenesis and sexual activity in laboratory animals. Tribulus terrestris appears to raise/turn on natural testosterone production in men via the activation of hormone secretion and estradiol

53 Another study  noted that Tribulus restores and improves libido sexualis in men, improves and prolongs the duration of erection, and also that Tribulus exerts a stimulating influence on spermatogenesis by increasing the number of spermatozoa and their mobility, and that it increases the level of testosterone.  In addition, Tribulus helps reduce some symptoms associated with male menopause and aging. 

54 Clinical studies in Bulgaria have shown Tribulus terrestris to increase the sex hormones LH (luteinizing hormone) level by 72% and the body's own free testosterone level by 41% in healthy adult males in only five days. LH regulates the testosterone production in the testes and high levels of LH coincide with high testosterone levels. 

55 What does it do and what scientific studies give evidence to support this? Tribulus Terrestris is a testosterone enhancer. Studies show that it works very well when stacked with DHEA. It increases testosterone levels in a different way then either DHEA or Andro. Instead of being a "testosterone precursor", it leads to the production of the luteinizing hormone (aka LH). When LH levels are increased, the natural production of testosterone also increases. LH is a hormone that also deals with sex drive. It has also been used to increase fertility and help with impotence. Laboratory animal studies found that Tribulus Terrestris increased sperm count as well as motility levels after taking it for 30 days.

56 Phytochemicals and the breakthrough of traditional herbs in the management of sexual dysfunctions. :
Protodioscin is a phytochemical agent derived from Tribulus terrestris L plant, which has been clinically proven to improve sexual desire and enhance erection via the conversion of protodioscine to DHEA (De-Hydro-Epi-Androsterone). Preliminary observations suggest that Tribulus terrestris L grown on different soils does not consistently produce the active component Protodioscin.

57 The causes of erectile dysfunction are still unknown
The causes of erectile dysfunction are still unknown. Psychological or physical changes in the body can prevent blood from flowing properly to the penis, making a satisfying erection impossible. There are a few approaches for ED, but not all of them are effective. There are three FDA-approved prescription drugs to treat ED (sildenafil), however they are all expensive and may have serious side-effects such as flushing, headache, painful urination, diarrhea, vision problems and blindness, and a painful, prolonged erection (priapism).

58 Today millions of men, young and
old, suffer from Erectile Dysfunction (ED) due to: (1) High levels of synthetic Hormones (known as Xenoestrogens) in our Diet / Environment; (2) Nutritional Imbalanced Diet resulting from poor quality of produce; and (3) Extremely low levels of Testosterone

59 Eggs and Meats that we eat;
Xenoestrogens have now entered the food chain and affect our Body through: 1. The grains – wheat Eggs and Meats that we eat; 2. The Petrochemical products like Herbicides, Pesticides and Fungicides; Mosquito and Cockroach sprays; 3. The Pollution we breathe; and 4. The Contraceptive pills, Hormone Replacement Therapy (HRT) and Testosterone Replacement Therapy (TRT) being used

60 This Hormonal Pollution has approximately affected
Ø 25% males in the age group of 20 to 35 years; Ø 50% males in the age group 36 to 50 years; and Ø 75% males in the age group 51 to 75 years. In short, Erectile Dysfunction (ED) has reached Epidemic Proportions.

61 These 25 year olds suffer from the following symptoms:
Ø Mood swings / Depression Ø Inability to loose weight Ø Anger / Irritability Ø Foggy thinking Ø Memory Loss Ø Reduced Muscular strength Ø Lower Libido Ø Lack of interest in Sex Ø Hair Loss Ø Insomnia Ø Lack of Sex drive Ø Inability to perform as Executives

62 Ø Difficulty Passing Urine Ø Burning sensation passing urine
Left undiagnosed / unattended, these symptoms further evolve in later life to Ø Swollen feet / ankles Ø Low Blood Sugar Ø Enlarged Prostate Ø Difficulty Passing Urine Ø Burning sensation passing urine Ø Incontinence Ø Prostate Inflammation Ø Prostate Cancer Ø Osteoporosis Ø Diabetes

63 Tribulus Terrestris is ecologically pure.
It strengthens the reproductive systems of both males and females. It helps to treat impotency in men and sterility in women. It helps to control excessive bleeding during menstruation or in pregnant women threatened by an abortion. It calms the mind, promotes mental clarity and is used in the treatment of diabetes and to tone the heart. It is used as a safe natural diuretic and as an aphrodisiac.

64 Tribulus Research Studies have shown positive benefits of
supplementing Tribulus Terrestris, and almost no adverse effects since it is from a natural plant source. Ø A study done with healthy individuals taking 750mg of Tribulus per day showed a 72% LH increase, and a 41% increase in testosterone. Ø In a study conducted with 20 males and females, 75% of the participants had increases endurance, 80% had increased libido and sexual performance, and 95% of the females reported no pms symptoms no PMS symptoms.

65 A study conducted with 200 males suffering from impotence showed increase in LH and testosterone levels after supplementing Tribulus. The study also found an increase in sperm production. Tribulus Terrestris Formulations Because Tribulus Terrestris is such a neutral and beneficial supplement, it’s often formulated with other Herbal Supplements like Winter Cherry which is known to help increase growth hormone secretion in the body, and other herbs which help enhance its performance. In the modernization of Herbal / Ayruvedic Medicine, herbs are now a days often combined with other nutritional supplements. This has resulted in a new subject called Modern Ayurveda or Modern Medicine where herbs are used from all over the world rather than be restricted to one continent alone as was done in the old Ayurveda. Tribulus Side Effects Tribulus has been used for thousands of years, and no studies have found any adverse side effects of Tribulus. The only adverse side effect experienced by a small percentage of users is, an upset stomach, which can be eliminated by taking Tribulus with food

66 Good Reasons to Try Herbal Alternatives for ED
Viagra might have been the king of the ED treatment market, but there are also men who are looking for alternatives for treating ED, due to reasons of side effects, costs and failure of product efficacy in certain specific conditions of the user. It is known for a fact that herbal preparations are without any side effect as they are natural and most often organic. Thus men looking for herbal alternatives for the treatment of ED can not come as a surprise

67 1: It is widely known that most drugs used from treating ED, including the top brands are filled with various side effects ranging from headaches, flushing, dizziness, sneezing, dyspepsia and blurriness and loss of vision to priapism (painful and harmful condition that happens when the erect penis does not come back to its flaccid state), abnormally low blood pressure, heart attacks, stroke and even sudden death.  It is also widely known that one of the most common reasons for people to look for herbal alternatives is the side effect profile of these drugs. Herbal alternatives on the other hand, has no side effects. Incredible as it may sound, these side effect free preparations are made from individually tried and tested ingredients which are of natural and organic origin

68 How erection takes place
The penis contains two chambers called the corpora cavernosa, which are almost equal to the length of the organ. The spongy tissue fills these chambers. The corpora cavernosa are surrounded by a membrane, called the tunica albuginea. The spongy tissue contains smooth muscles, fibrous tissues, spaces, veins, and arteries. The urethra, which is the channel for urine and ejaculate, runs along the underside of the corpora cavernosa and is surrounded by the corpus spongiosum.

69 Factors Affecting Erection
Smoking, being overweight, and avoiding exercise are also the possible causes of ED. These are the lifestyle diseases which contribute to heart disease and vascular problems also raise the risk of erectile dysfunction. Surgery sometimes, can lead to ED by harming nerves, especially radical prostate and bladder surgery for cancer. This can injure nerves and arteries near the penis, causing ED. Injury to the penis, spinal cord, prostate, bladder, and pelvis , smooth muscles, arteries, and fibrous tissues of the corpora cavernosa. Many common medicines—blood pressure drugs, antihistamines, antidepressants, tranquilizers, appetite suppressants, and cimetidine—can produce ED as a side effect.

70 Stress, anxiety, guilt, depression, low self-esteem, and fear of sexual failure cause 10 to 20 percent of ED cases. Men with a physical cause for ED may also generally suffer from psychological reactions (stress, anxiety, guilt, depression). Other possible causes are smoking, which affects blood flow in veins and arteries, and hormonal abnormalities, like low levels of testosternone hormone. Herbs like Tribulus terrestris helps a lot in this naturally.

71 Clinical Studies on Tribulus terrestris Protodioscin in Women with Endocrine Infertility or Menopausal Syndrome The opinion of the research team, based on the experience from treatment of more than 150 women with natural or postoperative menopause, is that Tribulus can successfully be used for treatment of the menopausal syndrome in women. Tribulus treatment resulted in the complete or almost complete disappearance of all or most of the menopausal syndrome symptoms were found in 49 from 50 treated patients (98%). 

72 It increases the level of testosterone.
The therapeutic effect of Tribulus terrestris' protodioscin on the endocrine function of women was studied by the team in the last few years. The first clinical trials were carried out on women with the dysovulatory syndrome and infertility and later they were redirected to the premenopausal and menopausal syndrome. Women with postoperative castration-induced menopause were included in a separate group

73 Action: . It improves libido sexualis in women, exerts a slight stimulating ovulation effect, it has a favorable influence on vasomotory manifestation during natural and post-castration climacterium, as well as on subjective complains such as insomnia, general tenseness, irritability or apathy, etc.

74 Treatment of sexual dysfunction in diabetes mellitus subjects using orally administered protodioscin and injection of vasoactive compounds Diabetes mellitus is a systemic metabolic disease which results in the destruction or weakening of many tissues and cell types. Here we conducted a preliminary clinical study to determine the level of dehydroepiandrosterone-sulphate (DHEA-S) in 15 diabetic males and 15 healthy controls. This study shows that the DHEA-S levels in healthy people are significantly higher than that found in diabetic subjects. A further study conducted with 30 male subjects with diabetes shows that those also suffering from erectile dysfunction (ED) have even lower DHEA-S levels than those without the dysfunction.

75 Treatment of diabetic subjects with protodioscin in the form of tablets of Tribulus terrestris L extract (Libilov, 250 mg at 3 x 1 tablet daily for ten days) results in the increase of DHEA-S levels of these subjects, with the most gain experienced by those who also suffer from ED. Moreover, in this study we notice a significant increase (> 60%) in the frequency of successful sexual intercourse, as well as increased libido or sex drive in the diabetic male subjects. In this clinical study, we find no unwanted side-effects of administration of Libilov as examined by laboratory blood tests, as well as kidney and liver function tests.

76 MECHANISM OF REGULATION OF CONTRACTION OF SMOOTH PENILE MUSCLES
It is medically accepted that relaxation of the corpus cavernosum smooth muscle results in penile erection. First, the relaxation of the smooth muscle causes arterial blood to flow to tiny pool-shaped blood vessels called cavernous sinuses. The veins surrounding these tissues then are compressed shut by the pressure of the erectile tissues. The blood that pooled in the vessels are unable to flow out, thus resulting in penis rigidity. Destruction of the endothelium cells can directly result in ED

77 For example, endothelium derived relaxing factor (EDRF) produced by these cells results in increased level of nitric oxide in the penis smooth muscles, which then results in tissue relaxation. In addition to EDRF, these endothelium cells also produce endothelin hormones, one of which is a strong vasoconstrictor. Furthermore, these endothelin hormones are similar to growth factors, in that they cause endothelium, fibroblast and smooth muscle cell production and development. By this mechanism, endothelin controls not only the structural development of blood vessels and smooth muscle tissues, but also that of the endothelium cells as well. Hyperglycemia and hypercholesterolemia associated with diabetes mellitus are two main causes of endothelial cell destructions.,

78 OTHER VASOACTIVE ENDOTHELIN
Prostaglandins are eicosanoids produced in corpus cavernosum which function in controlling smooth muscle contraction and tone. For example, PGF-2a, PGI-2 and thromboxane are prostaglandins that result in smooth muscle contraction, whereas PGE-1 results in smooth muscle relaxation. Indeed, injection of PGE-1 has been used as treatment for ED caused by diabetes mellitus. With well regulated diabetes management, injection of PGE-1 or other vasoactive chemicals such as papaverin and fentolamin can result in temporary erection. This palliative approach of injecting non-physiological vasoactive compounds, however, does not treat the underlying disease. Without injection, subjects will always experience ED.

79 CAN PROTODIOSCIN REPAIR DAMAGED CELLS?
Protodioscin is the active ingredient in Tribulus terrestris L plant extracts. Tribulus is known as effective herbal medication for sexual dysfunctions in central European and Asian countries. Protodioscin's chemical structure is close to that of dihydroepiandrosterone (DHEA), a precursor to testosterone which circulates in the bloodstream as DHEA-sulphate (DHEA-S). DHEA-S has been shown to significantly activate the immune system. As diabetes mellitus is a systemic metabolic disease which results in the destruction or weakening of many tissues and cell types, we conducted a preliminary clinical study to determine the level of DHEA-S in 15 diabetes subjects and 15 healthy controls. Subjects suffering from diabetes were found to have an average of 50 mg/dl of DHEA-S, whereas healthy men had an average of 77.6 mg/dl (p < 0.01

80 Moreover, from this study we notice a significant increase of more than 60% in the frequency of successful sexual intercourse, as well as increased sexual libido or sex drive in these male subjects. It is possible that the increased DHEA-S levels in these subjects promote healing of the membrane integrity of the endothelium, corpus cavernosum and cells in other penile tissues, as well as improved performance of the body's circulatory system. This hypothesis is well supported by previous findings that Tribulus supplements improve spermatozoa morphologies of infertile men, resulting in greater frequency of conception. Significant among the morphology improvements is the increased efficiency of enzymatic reaction of the acrosome.

81 in all these clinical studies, including ours, there was no unwanted side-effects of administration of Tribulus extract as examined by laboratory blood, kidney function, and liver function tests. In exception of the desirable increase in DHEA-S level as mentioned above, we found no changes in the concentration of other hormones in the circulatory system.

82 We found that this treatment successfully increased DHEA-S levels in these subjects by over 61% to 19.2 mg/dl. Treatment of diabetes subjects without erectile dysfunction with similar Tribulus dosage resulted in the increase of nearly 30% of their average DHEA-S level to 41.8 mg/dl (p < 0.005). Therefore, treatment with Tribulus extract can successfully increase the level of DHEA-S in diabetes subjects, with the most gain experienced by those who also suffered from erectile dysfunction.

83 This showed that the DHEA-S levels in healthy people were significantly higher than that found in subjects with diabetes mellitus. With this result, we conducted a larger study composed of 30 diabetes subjects that also suffered from sexual dysfunction. We found that these subjects had even lower level of DHEA-S of 11.9 mg/dl compared to 15 diabetes subjects that had no erectile dysfunction with DHEA-S level of 32.2 mg/dl (p < 0.05). To the diabetes subjects with erectile dysfunction, treatment with protodioscin in form of tablets of Tribulus terrestris L extracts (250 mg) was administered in form of one tablet three times daily for ten days

84 Animal models of this form of diabetes show that hyperglycemia or abnormally high concentration of blood sugar can result in lowered androgen production, and lowered amounts of Leydig cells and Luteinizing hormone (LH) receptors. At first, insulin can successfully treat these deficiencies, suggesting that the lack of insulin is responsible for the sexual dysfunction of male diabetes mellitus subjects. This turns out not to be true, as later research revealed that insulin cannot successfully treat ED in these subjects.

85 Erection begins with sensory or mental stimulation, or both
Erection begins with sensory or mental stimulation, or both. Impulses from the brain and local nerves cause the muscles of the corpora cavernosa to relax, allowing blood to flow in and fill the spaces. The blood creates pressure in the corpora cavernosa, making the penis expand. The tunica albuginea helps trap the blood in the corpora cavernosa, thereby sustaining erection. When muscles in the penis contract to stop the inflow of blood and open outflow channels, erection is reversed.

86 Performance Erectile Dysfunction Preliminary animal studies found that tribulus heightened sexual behavior and increased intracavernous pressure. This was attributed to increases in testosterone. There haven't been any well-designed human studies to confirm these early findings. Body Composition and Exercise Performance Although tribulus has become popular as a sports performance aid, one small but well-designed study found it has no effect on body composition or exercise performance. Fifteen subjects were randomly assigned to tribulus (3.21 mg per kg body weight daily) or a placebo. After eight weeks with resistance training, there were no changes in body weight, percentage fat, dietary intake, or mood in either group. What was surprising was that muscle endurance actually improved more in the placebo group. Muscle endurance (determined by the maximum number of repetitions at 100 to 200% of body weight) increased for the bench and leg presses in the placebo group. The tribulus group experienced an increase in leg press strength only. Dosage Tribulus terrestris is often taken at a dose between 85 to 250 mg three times daily, with meals.

87 Osteoporosis- some improvement in women over 70 but not in younger (Baulieu et al. PNAS 2000;97: ) Adrenal insufficiency: some improvement Improving sexual functioning in women over 70 (but not younger women or men); another study showed increased sexual arousal in postmenopausal women (J Womens Health Gender Based Med 2002;11:155-62) Improving erectile dysfunction: N=40 Reiter et al. Urology 1999;53: Benefit in small controlled study Athletic performance: mostly negative results Risks unknown; stimulates hormone responsive breast tissue in vitro. Stimulates prostate cancer cell growth in vitro. Adverse effects on cholesterol pattern, acne and hirsutism increased

88 Ginger Zingiber officinale History-long used for food and medicine
Pharmacology digestive aid flavor nausea and vomiting treatment-effect is on the stomach not on the CNS For pain Chemistry volatile compounds non volatile compounds gingerol shogaol

89

90 studies are not in agreement on efficacy
Ginger Efficacy Studies post operative nausea studies are not in agreement on efficacy motion sickness most studies “in the field” show benefit but those in a spinning chair are equivocal

91 Ginger Summary possibly worthwhile in preventing motion sickness
possibly worthwhile in treating and preventing nausea must weigh risk vs. benefit in treating nausea of pregnancy products and doses 0.5-1g one hour before travel 2g/d in divided doses for nausea dried powdered ginger capsules are OK

92 Ginseng Is anyone using ginseng?
I found an article by JADA in 2002 that ginseng was the most frequently used supplements among university students. I thought it’s interesting.

93 What is Ginseng? “Low-growing, shade-loving perennial herb of the Aralianceae family” (http://www.bccancer.bc.ca/PPI/UnconventionalTherapies/Ginseng.htm) Latin name= Panax The scientific names Panax Ginseng Derived from the Greek word for cure-all, related to the word Panacea.

94 Types of Ginseng (Panax Quinquefolium) (Panax Ginseng) True Ginseng:
American Ginseng (Panax Quinquefolium) Korean, Chinese or Japanese Ginseng (Panax Ginseng) American Ginseng -- (Panax Quinquefolium) an indigenous wild plant found in Canada and the eastern area of the United States. Korean or Japanese Ginseng -- Panax Ginseng which is used widely in the Orient and Russia as folk medicine. The Chinese words jen (man) and she (root) are the roots of "Ginseng" derived from the shape of the root. There are a number of other perennial herbs in the ginseng grouping including Panax Pseudoginseng.      

95 History Ginseng root has been used for over 2000 years
Has traditionally used for treatment of a number of disorders in China and Korea Crossed to Western by the eighteenth century US expoted $20.9 million worth of ginseng last year (NYtimes, 2005) Has traditionally used for treatment of a number of disorders in China and Korea (1). Ginseng root has been used for over 2000 years (1, 4,). Crossed to Western by the eighteenth century (4). Earliest report about ginseng is in1274 by Marco Polo, and it began to get attention by European in the 17th century. An article mentioned about ginseng history in America. Since the “ginseng rush” happened in 1859, ginseng farming became the economic base of Marathon County in Minnesota. (A) A famous person related to Ginseng is Paul Hsu, a Taiwanese born in Wisconsin. He was working as a social worker and spent the early 1970’s learning the ginseng business at night while mediating domestic disputes by day. And in 1994, his company’s sales topped $18 million by selling ginseng. (A) Now ginseng business is big in the state, and NY times noted that US farmers and dealers exported $20.9 million worth of ginseng mostly to Asia last year. (A)

96 Active Components Ginsenosides or Panaxosides Panaxans Ginsenans
Major ginsenosides: Rg1, Re, Rf, Rb1, Rc, Rg2, Rb2, Rb Panaxans Ginsenans Ginsenosides/ panaxosides 6-8 major ginsenosides: Rg1, Re, Rf, Rb1, Rc, Rg2, Rb2, Rb Panaxans (peptidoglycan in ginseng. may role to help stabilize blood sugar) Ginsenans (which is known as polysaccharide in ginseng)

97 Clinical efficacy of Korean red ginseng for erectile dysfunctionClinical efficacy of Korean red ginseng for erectile dysfunction To investigate the efficacy in treating erectile dysfunction and to develop a natural drug without complications, the results of ginseng treatments are compared to placebo and other drug. A total of 90 patients with 30 patients in each group were closely followed.

98 The overall therapeutic efficacies on erectile dysfunction were 60% for ginseng group and 30% for placebo and trazodone treated groups, statistically confirming the effect of ginseng (p < 0.05). No complete remission of erectile dysfunction was noted, but partial responses were reported.

99 Dosage usually provide 100mg to 400mg of dried extract
(equivalent to 0.5g to 2g of ginseng root.) Dosage products usually provide 100mg to 400mg of dried extract, which equivalent to 0.5g to 2g of ginseng root.

100 Marketing Claims “Heart tonic” “Energy and mood booster”
“Healthy glucose metabolism formula” “Helps normalize imbalances in the body’s energy in different disease status” “Sex drive” “Immune support” “Stress management” “Menopausal control” When I googled ginseng and looked over some ginseng products, Main market claims were: “heart tonic” “energy and mood booster” “helps normalize imbalances in the body’s energy in different disease status” “sex drive” Immune support” “Stress management” “Menopausal control

101 Traditional and modern uses
Improving the health of people recovering form illness Increasing a sense of well-being and stamina, and improving both mental and physical performance.

102 Current Research Area Ginseng vs. Exercise performance
Mood and cognitive function Cardiovascular disease Sexual function Diabetes Obesity Cancer Current research areas are: (read) (So seems like ginseng is known to do a lot of good stuff to your body. When I was going over the claims, I was interested in the statement of relation ship between ginseng and blood glucose. I remember when I was doing my field experience in a Db clinic in a hospital last summer, a lot of patients asked to my supervisor about the effectiveness of using herbs to their treatment. So I thought this topic, ginseng vs. Db, might be useful information when we become RD and I chose to research the effectiveness.)

103 Diabetes vs. Ginseng Historically used to treat type-2 diabetes.
No. 6th commonly suggested herbal medicine to improve glycemic control by Italian herbalists Many studies support its antihyperglycemic activity. This is info about Db vs. Ginseng. Ginseng has historically used to treat type-2 diabetes (mostly in Asia) Ginseng is the #6th commonly suggested herbal medicine to improve glycemic control in hyperglycemic subjects with or without a medical diagnosis of IGT or Db by italian herbalists (Acta Diabetologica, 2004) Many studies support of its antihyperglycemic activity and believe in lowering blood glucose.

104 Theoretical Basis Ginsenosides alter blood glucose levels by
stimulating the biosynthesis of insulin by the pancreas inducing the production of a glucose transporter in the liver The polysaccharides in ginseng lower blood glucose by either decreasing the production of glucose by the liver increasing the use of glucose by tissues But number of invitro studies reported that Ginsenoside alter blood glucose levels by stimulating the biosynthesis of insulin by the pancreas and inducint the production of a glucose transporter in the liver And The polysaccharidesin ginseng ( which is known as Ginsenance) lower blood glucose by either decreasing the production of glucose by the liver or increasing the use of glucose by tissues.

105 THE MARKET FOR MALE SEXUAL HEALTH PRODUCTS IS EXTREMELY CROWDED …
THE MARKET FOR MALE SEXUAL HEALTH PRODUCTS IS EXTREMELY CROWDED ….WITH MOST PRODUCTS NOT MEETING EXPECTATIONS A majority of products are not clinically proven or the studies are not conducted by qualified professionals They do not address all the main components of male sexual function (libido, erection, ejaculation, orgasm) Drugs like Sildenafil though very widely used are beneficial only in Erectile Dysfunction. They are contraindicated in patients with cardiac disorders & also cause other side effects such as headache, flushing & dyspepsia One has to be exceptionally cautious of formulations that do not have sufficient scientific backup , are unethical , do not match quality standards & may cause untoward side effects In contrast… Carefully selected phytoconstituents with proven activity offer multiple actions & are not only useful in treating the problem of male sexual dysfunction but also address other health conditions that might otherwise inhibit sex eg. problems of impotence, prostate problems , andropause , arthritis , diabetes , lack of energy

106 Cinnamomum zeylanicum (cinnamon)
Parts used- oil & bark Evergreen tree native to India & Sri Lanka; in Laurel family Properties- Astringent, stimulant, anti-infective, anti-fungal, digestive aid One of the oldest and most valuable spices Related spice, called cassia, from C. cassia.

107 Crocus sativus (saffron)
Member of “Iris” family From ‘zafaran’ in Arabic From 3-parted Stigma of flower Dried by slow roasting Imparts delicate & distinct taste & color Used in French, Spanish, Middle Eastern & Indian cooking Each saffron crocus flower has 3 stigmas Ca. 80,000 flowers (240,000) stigmas to make a pound of saffron 12 days to pick cost is > $250 per ounce (so most costly spice) 1444: any merchant caught selling adulterated saffron in Bavaria was burned alive


Download ppt "Challenges to Sexual Functioning"

Similar presentations


Ads by Google