Common sexual problems in men:
A) Erectile dysfunction
B) Ejaculation disorders
C) Loss or less libido
Causes: Sexual problems can be a result of physical or psychological disorder.
A) Erectile dysfunction or Impotence:
Definition: Inability to attain and or maintain an erection suitable for intercourse.
Causes:- Artherosclerosis [hardening of the arteries] affects blood flow. Nerve disorders / Psychological factors / Stress / Depression / Performance anxiety / Injury to the penis / Chronic illness / Peyronie’s disease[scar tissue in the penis]
B) Ejaculation disorders: There are 4 types of disorders:-
a. Premature ejaculation – It occurs before or soon after penetration
b. Inhibited or retarded ejaculation – Inhibited or retarded ejaculation is delayed &/or slow to occur
c. Retrograde ejaculation – At orgasm the ejaculate is forced back into the bladder rather than through the urethra and out the end of penis.
d. Anejaculation – absence of ejaculation
C) Loss of Libido: Decrease in sexual desire or interest in sexual activity.
Semen analysis is the most important and easy investigation for male partner. You should have abstinence of at least three days before giving semen for examination.
Semen is usually given by masturbation in a sterile semen collection container in laboratory.
Analysis of semen usually includes the following components:
- Sperm volume – is the total amount of semen in a single ejaculation.
- Sperm concentration – is the number of sperms present in one ml of semen.
- Sperm motility – is the ability of sperm to move.
- Morphology – indicates the structure of sperms.
- Minimal requirements for male fertility:
- Semen volume: more than half ml
- Sperm concentration: more than 20 millions/ml
- Total sperm count: more than 40 millions/ml per ejaculate
- Motility : more than 50% sperms having grade 3 to 4 motility( forwardprogression)
- Morphology : more than 30% normal sperms
Evaluation of male hormones:
Testosterone, Follicle stimulating hormone (FSH), Luteinising hormone (LH),
Prolactin (PRL), Dehydroepiandrosterone sulphate (DHEAS), Thyroid hormones (T3, T4, TSH)
Scrotal sonography & Color Doppler: this can diagnose hydrocele, hernia or varicocele.
Testicular biopsy: when semen analysis shows absent sperms in repeated semen samples and testicular size is normal, then testicular biopsy is usually indicated to know the cause of azoospermia. In this small piece of one or both testis is taken for histopathological examination under local or general anesthesia.
Genetic karyotyping: This test is done when some genetic disorder is suspected in male partner or in patients with severe sperm defects. This is also requires before proceeding for IVF or ICSI.
Surgical retrieval of sperms for ICSI: When semen analysis shows absent sperms but testicular biopsy shows production of sperms in testes, then various surgical sperm retrieval techniques are used to retrieve the sperms from testes or the collection system. ICSI treatment is done with these surgically retrieved sperms to achieve the pregnancy.
These techniques are:
- Testicular sperm aspiration (TESA)
- Testicular sperm extraction (TESE)
- Percutaneous epididymal sperm aspiration (PESA)
- Microepididymal sperm aspiration (MESA)
- Vas deferens aspiration (VDA)
- Spermatocele aspiration
Who can be semen donors?
Men with sound medical health and known fertility can donate their semen for IUI, IVF or ICSI procedures after submitting his written consent for the same. They should be between 25 to 45 years of age and should not have had any past history of infectious diseases. They are required to submit their infectious diseases evaluation report, semen analysis and general health analysis report, which should include a complete physical examination done and certified by a registered medical practitioner.
For infectious disease evaluation, the donor is required to be tested negative for Hepatitis B, C antibodies, HIV 1 and 2 antibodies, Trichomonas, Candida, Cytomegalovirus and HTLV-I. Three semen samples of the donor is taken at regular intervals of 3-4 weeks and is tested for volume, pH, count, motility, abnormality, pus cells, agglutination and particulate matter. His semen analysis is required to match with the normal semen parameters of WHO. The donor semen tested should maintain the quality standards in his three trial attempts and only then he is recruited on our lists of semen donors.