Transcript Sexuality After 50

By
DR SAATIISH JHUNTRRAA
MBBS,DPM,FIPS,MCSEPI
Diplomate,American Board of Sexology
Sexologist & Psychiatrist
Vivan Hospital for Sexual Health
 Took me 3 years in planning & execution of this




project
Jaipur as the city because of viniita ‘s support group,
capital city of Rajasthan and my own experience of
friendly nature of people of Jaipur
Emphasis on keeping the information totally secure
and private, yet assessable to the patient . This is done
by creating such environment in hospital and emr
We have around 7800 sq.ft. area divided in 3 floors
Emphasis on creating awareness in our colleagues and
public so we have a modern conference hall for 25
persons
Facilities in Vivan Hospital
 Consultation for all sex problems
 Diagnostic facilities like
- Pathology Lab
- Computer Assisted Semen Analysis
- Psychometry for Psychogenic factors
- Vascular Doppler for PPI
- CIS
Vasculogenic
- Rigidometry
Causes
Facilities at Vivan Hospital
 SSEP and SEP for
neurological causes
 NPT to differentiate
Psychogenic from
physical impotence
Facilities at Vivan Hospital
 Counseling – individual





and couples
Medicines
Intrapenile injections for
ED
VED
Penile Implant
Vibrator therapy for
anorgasmia,
anejaculation
Male Sexual Dysfunction Management
System
 It helps in mild to
moderate ED
 Has the option of
treatment for
anejaculation ,delayed
ejaculation
Facilities at Vivan Hospital
 Multidisciplinary Approach
- Psychiatrist
- Gynecologist
- Andrologist
- Urologist
- Plastic Surgeon
- Endocrinologist
- Dermatologist/ Sonologist (Vacant)
I have added 2 causes of ED
(Demand and Supply)
 A 40 yr male, working in police, came for ED, increase in
penile size and increase of sex power. He had BMI 26, Abd,
Girth 38 inches, normo tensive ,non diabetic, non smoker
but occasional alcohol abuser . Stress level was moderate as
per his profession . Wife claimed he was perfectly fine in
sex . It turned out that he had Par. Sch. So took very
frequent leaves from office to make sure she is sexually
satisfied and does not go outside for sex.
- Actually he has no ED
- Will not accept treatment for mental problem
What to do?( Demand and Supply)
 60yr man, businessman, married for 36 years, came
with reduced desire & ED. He was a non diabetic, occ
alcoholic, hypertensive (on beta blocker),non
smoker,BMI 24 , highly stressed , good masturbation,
watched porn movies but ED with wife ( as per her
demand, he could perform once per day but the
demand was many times . She wanted to make sure
that he is milked everyday to the extent he can have no
other affair.
 In Jaipur, the situation seems to be
much better
 People are willing to discuss their
problem , they want to hide from
their partners ( mostly wives) so we
are formulating counseling by proxy
though I can’t comment on
effectiveness
Sexuality after 50
 Ageing is a normal and eternal truth every one has to




pass through, whether one likes it or not
There are changes in physical, mental,social,spritual
,occupational ,economical and sexual health.
Many keep on harping on their past prowess, esp. in
sexuality which leads to frustration and sex problems
WHO celebrated 7th April ,2012 with the themeAgeing and health with the slogan- good health adds
life to years
Life expectancy at birth in Europe is 72 years in males
and 80 years in females
Sexuality after 50
 So they have a fair part of life after retirement left
 They have every right to lead a healthy, purposeful and
satisfactory life after retirement.
 Sexual health is a good indicator of the health and well
being in old age
 This recognition is very important to change negative
stereotypes and barriers to participation of older
people in sexual health care services.
 Status of sexual healthcare services are scarce,
fragmented and inadequate globally , esp. in India
Myths about sexuality after 50
 Sexual Difficulties are normal part of ageing
 Sexual difficulties don’t cause distress
 Sexual difficulties may not be serious
 In time, they will resolve
 People are not sexually active after
retirement
SEXUALITY AFTER 50
(Problems in males)
 Loss of desire
- Hypogonadism
- Depression
- Other stressors like negative life events
Increased Desire
- They have more time ,experience
and willing to experiment
- Recent change may be due to DAT
Problems in Males
 ED- 70% AFTER 70 HAVE ED . Incidence of physical
cause increase as age advance , esp. vascular cause but
psychological causes are under reported and often
ignored – causing poor response to treatment
 Inability to maintain erection is common – may be due
to poor veno -occlusive mechanism or psychogenic
cause
 Delayed ejaculation /An ejaculation is common , -due
to Prostate enlargement or psychogenic factors
 TUR may cause retrograde ejaculation
Sex Problems in Females after 50
 HSDD- reduced desire due to stress,
exhaustion, depression, low
testosterone, secondary to pain during
sex due to dry vagina
 Vaginal Infections
 Pain during sex
Physical problems contributing to sex problem












Arthritis
Ch. Pain
Dementia
Diabetes
Cardiac Problem
Incontinence of urine – esp. in females
Stroke
Depression
Hysterectomy
TUR
Medications
Alcohol
Psychosocial Factors
 Retirement
 Financial/Family Support
 Loneliness
 Physical /Mental Abuse
 Psychiatric problems like Depression
 May face grief of near and dear ones
Management
 Emphasis should be on overall improvement
of physical and mental health so
encouragement for healthy life style, and
controlling contributing factors is a must
 For women- Vaginal dryness should be
treated by HRT/ KY jelly or counseling
encouraging to explore sexuality
Treatment of Sexual Dysfunction in Men
 Every male with sex problem after 50 should
be checked for free testosterone level at 8
AM . If it is found to be reduced- HRT may
be started
 Counseling for safe sex is important
 PDE-5 inhibitors- Sildenafil, Tadalafil,
Udenafil AND Avanafil in India .
Verdenafil is not available right now
 Intrapenile injections are very effective
Management of Erectile Dysfunctions
 Vacuum Erection
Device
Management of Erectile Dysfunction
 Penile Prosthesis-
It is a inflatable 3
pc. Device , placed
inside the penis in
place of corpora
cavernosa