Sexual and reproductive health is a subject that is not much appreciated for an open discussion in our country even when sexually transmitted infections continue to be one of the major public health concerns. Medicircle which is a dedicated healthcare media portal is conducting a series on sexual and reproductive health awareness. We aim to raise awareness and educate society to reduce the spread of sexually transmitted infections and improve one’s overall health by taking care of one’s sexual health.

Dr. Vilvapathy S Karthikeyan is Consultant Lead - Andrology, Men's Health and Urologist, Department of Urology, Sri Narayani Hospital and Research Centre. He helps patients who are suffering from male infertility (inability to father children), erectile dysfunction (impotence), disorders of ejaculation, testosterone deficiency(hypogonadism), premarital check, and men’s health evaluation.

Sri Narayani Hospital and Research Centre is situated in Thirumalaikodi, which is about 9 kilometres from Vellore. Its prime objective since inception is to provide quality medical service to the less privileged rural population at a level on par with hospitals of metropolitan cities.

How do Andrologists Help Males

Dr. Karthikeyan explains, “Andrology is a subspecialty of urology that deals specifically with sexual health and reproductive health. It mainly deals with erectile dysfunction, premature ejaculation, male infertility, and some other related issues like testosterone deficiency, etc. There are two broad categories of male sexual health - erectile dysfunction and premature ejaculation. Andrologists find underlying reasons by having lengthy discussions with patients so that they could study patient's minds and behavioural patterns as well and accordingly come with a solution or treatment plan. In this age of the Internet, males visit andrologists after already researching their problems on the internet. But they might not be correct in identifying their problem and might be making assumptions for e.g.: they might think they are suffering from premature ejaculation but after talking to them with focus on checklists of several factors, andrologists might find out that what the patient is experiencing is not premature ejaculation, rather erectile dysfunction. Thus, andrologists help males to understand their actual sexual health problems and use remedies to reduce or remove such problems. The remedies do not always revolve around medications or surgeries but can be in the form of change of behavioral patterns as well,” says Dr. Karthikeyan.

Common Problems for Which Men visit Andrologists

Dr. Karthikeyan lists down the following reasons:

Body's inability to sustain an erection - the inability to stay inside the female's vagina for a long time, patients come and say that they are not able to satisfy their female partners. They want more intravaginal time  Body’s inability to ejaculate – patients say that they can self-stimulate and masturbate but they are not able to ejaculate inside the female partner  Non-consummation of marriage - Newlywed couples, who have not been able to have successful intercourse even for one time,” informs Dr. Karthikeyan. 

Sexual Health and Reproductive Health are Markers of General Well-Being

Dr. Karthikeyan emphasizes, “Sperm health and sexual health is a marker of overall health. Sexual health is having a good erection, and being able to sustain it for a long time, and then being able to ejaculate at convenience. This may not be possible in every man. But the basic thing to be understood is, that the penis has arteries inside which blood flows. When there is a problem in the blood flow of the arteries of the penis leading to erectile dysfunction, this arteriogenic cause might affect the heart and the brain as well,” says Dr. Karthikeyan.

Treatment of Sexual Health is Aimed at Reducing the Chances of Heart Disease

Dr. Karthikeyan mentions, “Just like blood flows in the arteries of the heart, it flows in the arteries of the penis as well. Treatment of sexual health would ultimately help to reduce heart ailments. There are four basic pillars of men’s health:

Diet Lifestyle Exercise The Need to de-stress oneself

These four factors would help in improving the male sexual and reproductive health, thereby helping in keeping other body organs like heart healthy,” advises Dr. Karthikeyan.

Erectile Dysfunction Causes 

Dr. Karthikeyan talks about some major causes of erectile dysfunction:

“Inadequate blood flow in the arteries of the penis  Venous Leakage  Anxiety  Stress Ailments like diabetes  Advancement in Age Other Family issues etc.

The main job of the andrologist is to talk to the patients and identify what is there in his mind. It is not like just checking the blood sugar and giving treatment for diabetes etc. The main thing is to go into the patient's mind and identify what exactly is causing this problem,” explains Dr. Karthikeyan. 

Intercourse Quality is Important too

Dr. Karthikeyan informs that people often come for infertility treatments. This is a significant area related to the consummation of the marriage. However, there is one more aspect related to the consummation of marriage which people do not generally talk about and that is whether the couple can have a good quality of intercourse or not. This is a significant factor to find a solution from the andrology perspective and couples should meet the andrologist for these issues as well because there are methods to identify and treat these important issues.

No Fixed Benchmark of Timing for Premature Ejaculation

 Dr. Karthikeyan points out that “there is no clear-cut definition of premature ejaculation. It's not that if there is ejaculation after five minutes or more, then it is normal. And if one ejaculates within three minutes, then it is abnormal. The main point is whether the male is getting the pleasure and whether the female partner can sustain it. If the male is not able to stay inside the vagina even for one minute, then that is something that has to be looked into. It’s called primary premature ejaculation. That is something that andrologists work upon to improve. It can be improved with medications and some counselling. Also, we have to go into depth and identify what the male and the female want. So, based on that, we have to tailor our treatment. There are many tools in clinics of andrologists that help identify the time of erection and ejaculation and determine whether it is the problem or not," explains Dr. Karthikeyan.

Some significant factors that Andrologists consider while finding a solution:

Dr. Karthikeyan informs that since patients come with their own assumptions, andrologists help them to correctly understand their problems through a checklist of factors concerning their sexual life which has questions like the following:

How much time does one take for getting an erection?  Has one seen a decrease in erection compared to the past? Has one taken self-medication before, which generally people try to hide? If there is abstinence from sex or a gap of 10 to 12 days, then is the erection better?  Is there any mental stress?  If one is indulging in sex every day in an attempt to have a child, is there a problem with erection then only? Etc.”

Females Provide Good Clues to Doctors to Work on the Underlying Causes

Dr. Karthikeyan points out, “Sexual dysfunction in a man is not only about him. Nobody thinks about the pleasure quotient of the women. Female partners provide good clues to the andrologists to find the underlying cause of the problem. Hence not just male and andrologist interaction, rather couple interaction with andrologist is very important in the treatment of sexual dysfunction.” 

Solutions to Improve sexual performance

Dr. Karthikeyan lists down following solutions to have improved sex-life:

“Lifestyle changes, diet patterns, exercises like brisk walking for at least 150 mins a day Behavioural therapies  Some techniques to increase the duration of sexual timing e.g start-stop technique, squeeze technique, etc.  Pelvic Floor Exercises Counselling with Andrologists And if highly required, then medication and surgery”

Premarital Check-ups

Dr. Karthikeyan advises that if there has already been a failed marriage of either of the partners before or if the male partner’s age is about 35 or the female partner is around more than 30-31 in age, then it is wise to take a premarital health check-up because this is the age when problems start creeping in. It would be easier for the couple to begin the conjugal life with more confidence and have a good marital life subsequently.

(Edited by Amrita Priya)