Sexual dysfunctions: what is it and how to prevent it

“Varicocele is one of the most frequent pathologies affecting young men. It is estimated that its incidence is over 15%. Varicocele is a dilation of the veins surrounding and draining blood from the testicle. It occurs more frequently on the left side, due to anatomical reasons, but it can also be present on the right side or to be bilateral.

This condition can interfere with spermatogenesis, the maturation process of male germ cells, resulting in difficulties in procreation. At one time, this problem was highlighted during the draft visit. Now that this screening visit is no longer performed, it is common to find subjects who have infertility linked to an undiagnosed varicocele”.

Symptoms of varicocele

“Symptoms are often absent or, when present, manifested by discomfort in the testicle in the inguinal region or on the inner side of the thigh. The diagnosis is made with a medical examination and an doppler sonography of the scrotum which is used to confirm the diagnosis.

An examination of the seminal fluid allows to highlight the characteristic alterations and suggest a treatment that can be carried out surgically, with a small access in the inguinal region on the left, or with a laparoscopic approach when we are faced with a bilateral form”, explains Dr. Zani.

Infertility is defined as the failure of a couple to conceive after at least 12 months of regular unprotected intercourse. The World Health Organization estimates that about 15% of couples of childbearing age in Western countries are affected and about 30% of infertile couples recognize a male factor.

“The seminal fluid, both in its liquid and cellular component is subject to many external factors that can compromise its function. One of the most frequent causes of male infertility is varicocele, which we have already talked about, but other diseases can also interfere with normal fertility such as:

• diabetes;
• hemoglobinopathies (genetic disorders of hemoglobin synthesis);
• chronic relapsing prostatitis;
• use of some drugs, such as chemotherapy.

Lifestyle is also very important: smoking, alcohol, diet, low physical activity and obesity can affect spermatogenesis. The environment also seems to play an important role: atmospheric and environmental pollutants and heavy metals can have a great impact,” emphasizes Dr. Zani.

Infertility diagnosis

For a man, in addition to a specialist assessment, it is also required:

• scrotal ultrasound;
• semen examination;
• hormonal balance.

A specialist evaluation in a center which offers assisted fertilization techniques, with a close collaboration between andrologist and gynecologist, can offer couples the best diagnostic therapeutic approach without unnecessary waste of time.

Erectile dysfunction has been defined as the persistent inability to obtain and / or maintain an erection with a rigidity that is suitable for ensuring the performance of a satisfactory sexual act.

“The erection is a complex neurovascular phenomenon under hormonal control and therefore risk factors are in common with cardiovascular disease. Not only that, erectile dysfunction itself is a risk factor for cardiovascular disease”.

Risk factors and diagnosis

 “The known ones are: obesity, smoking, lack of physical activity, hypercholesterolemia and metabolic syndrome. The causes can be vascular, neurogenic, hormonal, pharmacological, psychogenic. The diagnosis is made through an accurate anamnestic collection, an objective examination and the execution of hormonal function investigations. Other, more invasive, tests have selective indications,” specifies Dr. Zani.

Treatments for erectile dysfunction

Treatment primarily involves the removal of risk factors with consequent change in lifestyle, correction of any hormonal imbalances, suspension / change of drug therapy. The latter, through phosphodiesterase 5 inhibitors, represents the first approach together with the use of low-intensity focal shock waves which have the property of regenerating vascular tissue, resulting in an increase in the blood supply to the erectile tissue.

The final result consists in obtaining a satisfactory erection even without the use of drugs. The treatment can be carried out in an outpatient clinic, it is painless, free of side effects and the effectiveness of the treatment lasts over time. Another effective treatment involves the use of intracavernous drug therapy. Finally, in the event that all other treatments have failed, there is the possibility of an implantation of a penile prosthesis.

“Induratio penis plastica is a disease of the connective tissue of the penis characterized by a localized fibrosis in the sheath that covers the corpora cavernosa of the penis. Fibrosis can develop into hard calcified plaque which leads to a bowing of the erect penis.

There are many hypotheses that determine this pathology, but none has ever been ascertained. The diagnosis is simple and is reported by the patient who can often present difficulties, pain, or impossibility of sexual intercourse,” explains Dr. Zani.

How to cure

The goal of the treatment is to reduce symptoms and stem the evolution of the disease. Some supplements, taken systemically, can be useful in the initial stages, when the disease does not preclude the normal sexual act and are designed to avoid worsening the disease.

When the disease is in full swing local injections of the drug can be made to reduce the painful symptoms. Also, in this case, the shock waves can play an important role by causing a rupture of the plaque with consequent symptomatic improvement.

Surgery is reserved in the most serious cases, those in which the curvature compromises sexual activity or when conservative techniques have not been successful.

There is also a congenital penile curvature, that is present from birth and is characterized by an asymmetry in the length of the corpora cavernosa. The problem arises after puberty and can cause pain or difficulty in the relationship. In this case too, surgery is decisive.

“Premature ejaculation consists in the occurrence, persistent or occasional, of ejaculation following minimal sexual stimulation or before, during or shortly after penetration and in any case before the subject wishes. There is no precise criterion, nor precise symptoms, to define when we can speak of real premature ejaculation, because there is no a priori time in which a man should 'last'.

Premature ejaculation can be secondary to organic causes, such as anatomical anomalies of the frenulum, inflammatory states, urethritis, vesiculitis, prostatitis, multiple sclerosis, medullary tumors, stress or hyperthyroidism, but, in most cases, a precise cause is not found if not the psychogenic one,” concludes Dr. Danilo Zani.

Treatment for premature ejaculation

 “Behavioral therapy is aimed and involves a series of exercises to be performed together with the partner in order to gain control.

There is also a drug cure based on serotonergic antidepressant drugs to be taken. The use of local anesthetics for topical use can also improve this disorder. Generally, these therapies must be integrated and it may be useful to also associate a behavioral therapy path with a gradual reduction and suspension of the drug as soon as subject acquires a greater sense of self-control”.

Most health statistical indicators show that men generally live less than women and get sick more. Dr. Danilo Zani explains:

“There are probably many reasons, including undoubtedly a protective action of estrogen, as well as genetic differences. However, the main reason seems to be that men, in general, take less care of themselves. In recent years there has been a greater awareness on the part of men of their health problems and in particular of andrological ones. This phenomenon followed both the awareness campaigns carried out by the various scientific societies of andrology and urology, and the numerous advances obtained in this field both from a pathophysiological and therapeutic point of view”.