Panacea Pharmacy & Medic

Men’s Health

 Men’s health

Androgen  insufficiency (  hypogonadism &  andropause).

Erectile dysfunction (ED)

Erectile dysfunction (ED) is the inability to get or maintain an erection firm enough for sexual intercourse. It can be a temporary or chronic condition and may result from a variety of causes, both physical and psychological.

Causes of Erectile Dysfunction

Physical Causes:

  1. Cardiovascular Diseases: Conditions like atherosclerosis (clogged blood vessels), high blood pressure, and high cholesterol can impede blood flow to the penis.
  2. Diabetes: This can damage blood vessels and nerves that control an erection.
  3. Obesity: Excess weight can impact cardiovascular health and hormone levels.
  4. Hormonal Imbalances: Low testosterone levels or other hormonal issues can contribute to ED.
  5. Neurological Disorders: Conditions such as Parkinson’s disease, multiple sclerosis, or spinal cord injuries can affect nerve signals necessary for an erection.
  6. Medications: Some medications can cause ED as a side effect, including antidepressants, antihistamines, and medications for high blood pressure.
  7. Substance Abuse: Alcohol, tobacco, and illicit drugs can impair erectile function.
  8. Peyronie’s Disease: Development of scar tissue inside the penis can cause curved, painful erections.

Psychological Causes:

  1. Stress and Anxiety: High levels of stress or anxiety about sexual performance can lead to ED.
  2. Depression: This can reduce sexual desire and result in ED.
  3. Relationship Problems: Poor communication or other issues within a relationship can lead to ED.

Diagnosis

Diagnosis typically involves a combination of:

  1. Medical History: Understanding symptoms and underlying health conditions.
  2. Physical Examination: Checking for physical causes of ED.
  3. Blood Tests: Measuring hormone levels, cholesterol, and glucose levels.
  4. Urinalysis: Checking for signs of diabetes or other underlying health conditions.
  5. Ultrasound: Assessing blood flow to the penis.
  6. Psychological Examination: Identifying stress, depression, or anxiety.

Treatment Options

  1. Lifestyle Changes: Improving diet, exercise, quitting smoking, and reducing alcohol intake.
  2. Medications: PDE5 inhibitors like sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra).
  3. Therapy: Counseling for anxiety, depression, or relationship problems.
  4. Vacuum Erection Devices: Mechanical pumps to induce an erection
  5. Hormone Therapy: For men with low testosterone levels.
  6. Penile Injections: Medications injected directly into the penis to induce an erection.
  7. Urethral Suppositories: Medicated pellets inserted into the urethra.
  8. Surgery: Penile implants or vascular surgery for severe cases where other treatments are ineffective.

Prevention

While not all cases of ED can be prevented, certain lifestyle choices can reduce the risk:

  1. Regular Exercise: Improves cardiovascular health and blood flow.
  2. Healthy Diet: Supports overall health and can prevent conditions that contribute to ED.
  3. Weight Management: Reduces the risk of diabetes and cardiovascular diseases.
  4. Avoiding Tobacco and Excessive Alcohol: Protects vascular and nervous system health.
  5. Stress Management: Techniques such as mindfulness, meditation, or therapy can reduce stress and anxiety.
  6. Regular Check-ups: Monitoring and managing health conditions that could lead to ED.

When to See a Doctor

If you experience persistent problems with erections, it is essential to consult a healthcare provider. They can help determine the cause and recommend appropriate treatment. Seeking help early can improve the chances of successful treatment and prevent complications.

Mixed Psychogenic and organic ED

Benign prostatic hyperplasia

Treatment

  • Try to find out the reason for ED
  • Try to understand physical and psychological condition
  •  evaluation the testosterone level

If  patient  have enough  testosterone level  and have no spinal cord injuries and no record of BPH.

Check patients  psychological & behavioral activities.

If patient are 

  • Psychological stress
  • Drug addicted
  • Anxiety

Medication 1

 patient should treat

1.1. Antidepressant drug ( eg. fluoxetine,  flupentixol + metifracin combination drug etc.)

 Dose : Twice a day

1.2. Calcium + D3 

 Dose : once a day

1.3. Vitamin E 400 mg

 Dose : Twice a day

In this condition no need phosphodiesterase inhibitor ( PDE5). If patient condition does not improve within two months then added  at  low dose ( eg. Sildenafil, tadalafil or vardenafil).

  • Sildenafil

 Dose : 50- 100 mg  a day 40 minutes before to intercourse for 7 days.

Or 

  • Tadalafi

 Dose : 5mg or 10 mg  twice a week 40 minutes before to intercourse for 1 months.

Contraindication:

 Should not use coadministration with Alpha adrenergic blocker drugs ( eg. prazosin ) or Nitroglycerine drugs. 

Medication 2 

If   patient has no BPH  record or  prostatitis or prostate cancer but  testosterone level below than 325 ng/dl. Medication should be testosterone replacement therapy with co- administration with other Drugs. 

 Suggested that –

  1. Administration testosterone replacement therapy-

 It is better to use testosterone intramuscular dose form ( eg. Testosterone cypionate, Testosterone enanthate).

Dose : 50-400 mg two times a month.

Or

A Combination group of testosterone (eg.Testosterone propionate 30 mg + Testosterone Phenylprop 60 mg + Testosterone Isocaproate 60 mg + Testosterone Decanoate 100 mg)

Dose : 1-2 dose a month.

Coadministration Other Drugs

1.1.Vardenafil : 20 mg daily 40 minutes before intercourse for 15 days 

or

1.2.Sildenafil : 50-100 mg daily 40 minutes before intercourse for 15 day.

or

1.3.Tedalafil : 10-20 mg daily 40 minutes before intercourse for 15 day.

2.1. Calcium + Vitamin D3: (500+200 mg) onec daily for 2 months. 

3.1. Vitamin E :  400 mg tow times daily for 2 months.

 

Bening posted hyperplasia (BPH)

Enlargement the prostatic by increasing the adrenergic tone and lead to lower urinary tract symptoms (LUTS) and bladder outflow obstruction (BOO).

Sign and symptoms

  1. Irritative symptoms 
  2. Frequency
  3. Nocturia
  4. Urgency and  urge incontinence 
  • Obstructive symptoms
  • Poor urinary flow
  • Hesitancy in initiation of micturition
  • Post micturation dribble
  • Sensation of incomplete  emptying
  • Occasional acute retention Of urine requiring emergency treatment .

 Others problem maybe

  • Libido
  • Erected dysfunction
  • Ejaculation problem

 Note:  Sever BPH can cause serious problems overtime urinary retention and strain on the bladder which can lead to urinary tract infection, bladder or kidney damage, bladder stones and incontinence.

Evaluation

  • Physical examination by Digital rectal examination ( GRE)
  • Prostatic ultrasound scan por transrectal ultrasonography (TRUS)
  • Post void residual (PVR) –  larger  than 30ml indicate bladder dysfunction

Other major investigation

  • Large prostate – >  30 ml Indicate the prostate dysfunction and initiate BPH
  • Serum posted  specific antigen (PSA) Greater than 1.4 mg per/ml indicated BPH 

Treatment

 Mild or moderate LUTS or BPH Not need any medical or surgical treatment but involed regular active monitoring.

 Medication for moderate BPH

1.1 .  Adrenoreceptor blocking drug ( eg.Tamsulosin) 

Dose: 0.4 mg  tamsulosin once a day.

Or

Combination of tamsulosin + Dutasteride 

Dose : (Tamsulosin  0.4 mg + Dutasteride 0.5 mg) Once a day for 6 months or extend 1 years .

Note : It’s combination help to reduce prostate size. 

 

Medication for advance BPH

  If the posted larger than 40 ml 

1.1.  Finasteride

Dose: 0.5 mg once daily for six months .

1.2. Tamsulosin

Dose : 0.4 mg once daily for six months. 

After 6 months prostate size not reduce then medicine can change.

  it would be combination of Tamsulosin + Dutasteride  for next 1 to 2 years. 

 

 

Prostatitis

Bacterial infection of prostate

 pathogens are

  • Mainly Eschetichia coli

Other agents are

  • Klebsiella spp
  • Pseudomonas SPP
  • Enterococci
  • Staphylococcus  etc 

Symptoms

  • Urinary tract infections (UTI)
  • Dysuria
  • Urinary frequency
  • Urgency
  • Pain of panil lower back or or perennial origin
  • Pyrexia, regors , malaise & myalgia may occur due to systemic infection

Examination and investigation

  • History of recurrent of  relapsing UTIs
  • Microscope and culture of lower  tract urinary secretion ( Urine & Prostetic ) Between  symptomatic period
  • Urine  dipstick and culture reveal  the presence of pathogens and leukocyte
  • Black culture diagnose concomitant bacteria

Medications 1

It is best to use medicine of fluoroquinolones eg. Ciprofloxacin or moxifloxacin. 

More healthful co-administration with Alpha adrenergic receptor antagonist eg. Tamsulosin

Medications 1

1.1 . Ciprofloxacin

Dose: 500 mg twice daily for 2-4 weeks

Or

Moxifloxacin

Dose:  400 mg once daily for 2-4 weeks. 

1.2. Tamsulosin

Dose: 0.4 mg Once daily. 

 

Medications 2 

2.1. 3rd Generation cephalosporin eg. Cefixime 

Dose:  400 mg twice daily for 2-4 weeks. 

Note:  Oral administration are less effective . Try to select IV or IM formulation. 

1.2. Tamsulosin

Dose: 0.4 mg Once daily. 

 

 

 premature ejaculation (PE)

 premature ejaculation means leave the men semen from the body (ejaculate)  sooner than wanted during sex.

It is mainly  ejaculate within 1 to 3 minutes of penetration. Almost complaint 1 out of 3 people about this problem.

Symptoms

Ejaculation occurs   within 1 to 3 minutes  or  less than 1 minute  after penetration during intercourse. 

 

 Classification

 Premature ejaculation categorized two types

  1. Lifelong ( primary):  It means this  experience  always or  almost always since first sexual experience. 
  1. Acquired ( secondary) :  it means at longer lasting ejaculation in life but have developed PE.

 

Causes

 Both  psychological and biological factors  involved PE . 

 

Psychological factors

  • Depression
  • Stress
  • Sexual abuse
  • Poor body image 
  • Early sexual experience
  • Worry about premature ejaculation
  • Guilty feeling that can cause to rush through sex
  •  Relationship problems
  •  Sexual inexperience
  • Over excitement

 

 Biological factors

  • Irregular hormones level 

( eg. Decrease Oxytocin level,  

 -Decrease luteinizing hormone (LH), 

 -Decrease prolactin,

 -Increase thyroid stimulating hormone (TSH ),

 

  • Irregular levels of brain chemicals 

            (e g. Decrease serotonin or dopamine level )

  • Swelling and infection of the prostate or urethra
  • Inherited traits

 Biologicall factors are  relevant by medical cause such as

 

  •  Diabetics
  •  Multiple sclerosis
  •  Prostate disease
  •  Thyroid problems
  •  Illicit drug use
  •  Excessive alcohol consumption

 

 Treatment

 Treatment may classified by two type  by using medicine or without medicine.

Note:  more than one type of treatment may be used at the same time.

 

 Treatment without medicine

 It involves two types-

  1. Psychological therapy 
  • It needs counseling about sex of both partners
  • About sexual relationship
  • Try to decrease stress, depression, anxiety etc 

2.Behavioral therapy

 It involves  exercise and self-train of body away from PE. It may be-

 2.1. The  squeeze method

According to this method  stimulate the  penis until close to ejaculation when close squeeze the penis so erection partly goes away. It leads to become aware of the sensation leading to climax and gives better control and delay climax.

2.2. The stop-start method 

According this method stimulate the penis until just before ejaculation near to climax stop stimulating. After resting stimulating about 1 minutes then again stimulating the penis. This process is repeated 3   times and  ejaculate on the fourth time. You repeat the method three times a week until gained more control. 

2.3. Pelvic floor exercise

 Pelvic floor exercise can help men delaying ejaculation. To perform pelvic floor exercise- 

  1. Find the right muscles by stopping mid-stream while peeing or tightening the muscle  that stop you from passing gas.
  2. While lying down contact pelvic floor muscle for three seconds. Do this at least 10 time in a row. Repeated  at least three times a day. Gradually Increase the number of seconds and time and muscle become strong. 

Others technique include

  • Masturbating 1 to 2 hours before having sex
  • Using the thick condom
  • Having sex with your partner on top 

Treatment with Medicine

Oral medication
  1. Antidepressant  drugs

 A side effect of this drug delayed orgasm. Antidepressant drugs are maybe

 

1.1. Serotonin receptor inhibitors (SSRIs).

  1. Dapoxetine, sertraline,  escitalopram etc. 

Dapoxetine use first line treatment. Medication usually takes 2 to 3 weeks as a single dose.  It should take 1 to 3 hours before sex.

1.2. Tricyclic antidepressant drugs

  1. Clomipramine

Medication usually takes 2 to 3 weeks as a single dose.  it should take 1 to 3 hours before sex.

 

  1. Pain reliever      

       eg.Tramadol

As a single dose 100 mg take 1 to 3 hours before sex.

Or combine with SSRI

 

  1. Phosphodiesterase-5 inhibitors

             eg .Sildenafil, tadalafil etc

             It should take 1 hour before sex.

 

From this three types of medicine you can choose only one medicine as a primary level. 

 

Topical medication

 Cream, gels and sprays that contain a numbing  agent such as Benzocaine, lidocaine or prilocaine.

Use this agent 10 to 15 minutes before sex into penis glans.