INFERTILITY

School of nursing bida

What is INFERTILITY IN MEN OR IN WOMEN? AND WHY IS THIS POST VERY IMPORTANT FOR YOU. LET START FROM MEN. WHAT IS ERECTION?

Erectile dysfunction ED. also known as impotence, is a type of sexual dysfunction characterized by the inability to develop or maintain an erection of the penis during sexual activity. ED can have psychological consequences as it can be tied to relationship difficulties and self-help.

Erectile dysfunction or

Other names

Impotence of

Erectile dysfunction.

Is a cross-section of a flaccid penis

Specialty

Urology

A physical cause can be identified in about 80% of cases in men. These include cardiovascular disease, diabetes mellitus, neurological problems such as following prostatectomy, hypogonadism, and drug side effects which many men are into nowadays. Psychological impotence is where erection or penetration fails due to thoughts or feelings i.e. lost of feeling. this is somewhat less frequent, on the order of about 10% of cases. In psychological impotence, there is a strong response to Natural organic treatment . The term erectile dysfunction is not used for other disorders of erection, such as priapism.

Treatment involves addressing the underlying causes, lifestyle modifications, and addressing psychosocial issues. In many cases, a trial of Natural Organic medicine therapy with a organic nutrition inhibitor, such as Oil of magic, can be attempted. But In some cases, treatment can involve inserting prostaglandin pellets into the urethra, injecting smooth muscle relaxants and vasodilators into the penis, a penile implant, a penis pump, or vascular reconstructive surgery that is if you want to follow medical prescription. It is the most common sexual problem in men.

Signs and symptoms

is characterized by the regular or repeated inability to achieve or maintain an erection of sufficient rigidity to accomplish sexual activity. It is defined as the "persistent or recurrent inability to achieve and maintain a penile erection of sufficient rigidity to permit satisfactory sexual activity for at least 3 months.

Psychological impact often has an impact on the emotional well-being of both men and their partners. Many men do not seek treatment due to feelings of embarrassment. About 75% of diagnosed cases of this problem go untreated.

Causes

Causes of or contributors to include the following:

Prescription natural medicine e.g.Oil of magic. As beta blockers, alpha-2 adrenergic receptor agonists, thiazides, hormone modulators, and reductase inhibitors

Neurogenic disorders e.g. diabetic neuropathy, temporal lobe epilepsy, multiple sclerosis, Parkinson's disease, multiple system atrophy

Cavernosal disorders e.g. Peyronie's disease

Hyperprolactinemia e.g., due to a prolactinoma

Psychological causes: performance anxiety, stress, and mental disorders.

Surgery e.g., radical prostatectomy

Aging: It is four times more common in men aged in their 60s than those in their 40s

Kidney failure

Lifestyle habits, particularly smoking, which is a key risk factor for ed, as it promotes arterial narrowing.

Surgical intervention for a number of conditions may remove anatomical structures necessary to erection, damage nerves, or impair blood supply. Ed, is a common complication of treatments for prostate cancer, including prostatectomy and destruction of the prostate by external beam radiation, although the prostate gland itself is not necessary to achieve an erection. As far as inguinal hernia surgery is concerned, in most cases, and in the absence of postoperative complications, the operative repair can lead to a recovery of the sexual life of people with preoperative sexual dysfunction, while, in most cases, it does not affect people with a preoperative normal sexual life.

Ed, can also be associated with bicycling due to both neurological and vascular problems due to compression. The increase risk appears to be about 1.7-fold.

Concerns that use of pornography can cause Ed, have little support in epidemiological studies, according to a 2015 literature review.

Pathophysiology

Diagnosis

In many cases, the diagnosis can be made based on the person's history of symptoms. In other cases, a physical examination and laboratory investigations are done to rule out more serious causes such as hypogonadism or prolactinoma.

One of the first steps is to distinguish between physiological and psychological Ed. Determining whether involuntary erections are present is important in eliminating the possibility of psychogenic causes for Ed, Obtaining full erections occasionally, such as nocturnal penile tumescence when asleep that is, when the mind and psychological issues, if any, are less present, tends to suggest that the physical structures are functionally working. Similarly, performance with manual stimulation, as well as any performance anxiety or acute situational Ed, may indicate a psychogenic component to Ed.

Other factors leading to Ed are diabetes mellitus, which is a well-known cause of neuropathy. Ed is also related to generally poor physical health, poor dietary habits, obesity, and most specifically cardiovascular disease, such as coronary artery disease and peripheral vascular disease. Screening for cardiovascular risk factors, such as smoking, dyslipidemia, hypertension, and alcoholism is helpful.

In some particular cases, the simple search for a previously undetected groin hernia can prove useful since it can affect sexual functions in men and is relatively easily curable.

The current diagnostic and statistical manual of mental diseases .DSM-IV. has included a listing for Ed.

Ultrasonography

Transverse ultrasound image, ventral view of the penis. Image obtained after induction of an erection, 15 min after injection of prostaglandin E1, showing dilated sinusoids .arrows.

Penile ultrasonography with doppler can be used to examine the penis in erected state. Most cases of Ed, of organic causes are related to changes in blood flow in the corpora cavernosa, represented by occlusive artery disease, most often of atherosclerotic origin, or due to failure of the veno-occlusive mechanism. Preceding the ultrasound examination with Doppler, the penis should be examined in B mode, in order to identify possible tumors, fibrotic plaques, calcifications, or hematomas, as well as to evaluate the appearance of the cavernous arteries, which can be tortuous or atheromatous.

Erection can be induced by injecting 10-20 of prostaglandin E1, with evaluations of the arterial flow every five minutes for 25-30 min . The use of prostaglandin E1 is contraindicated in patients with a predisposition to priapism .e.g., those with sickle cell anemia. as well as in those with an anatomical deformity of the penis or a penile implant. Phentolamine .2 mg. is often added. Visual and tactile stimulation produces better results. Some authors recommend the use of sildenafil by mouth to replace the injectable drugs in cases of contraindications, although the efficacy of such medication is controversial.

Prior to the injection of the chosen drug, the flow pattern is monophasic, with low systolic velocities and an absence of diastolic flow. After injection, it is expected that systolic and diastolic peak velocities will increase, decreasing progressively with vein occlusion and becoming negative when the penis becomes rigid (see image below. The reference values vary across studies, ranging Values above 35 cm. indicate the absence of arterial disease, values below 25 cm/s indicate arterial insufficiency, and values of 25–35 cm/s are indeterminate because they are less specific . The data obtained should be correlated with the degree of erection observed. If the peak systolic velocities are normal, the final diastolic velocities should be evaluated, those above 5 cm/s being associated with venogenic Ed.

Graphs representing the color Doppler spectrum of the flow pattern of the cavernous arteries during the erection phases. A: Single-phase flow with minimal or absent diastole when the penis is flaccid. B: Increased systolic flow and reverse diastole 25 min after injection of prostaglandin.

Longitudinal, ventral ultrasound of the penis, with pulsed mode and color Doppler. Flow of the cavernous arteries at 5, 15, and 25 min after prostaglandin injection A, B, and C, respectively. Note that the cavernous artery flow remains below the expected levels at least 25–35 cm/s. which indicates Ed due to arterial insufficiency.

Other workup methods

Penile nerves function

Tests such as the bulbocavernosus reflex test are used to determine if there is sufficient nerve sensation in the penis. The physician squeezes the glans head, of the penis, which immediately causes the anus to contract if nerve function is normal. A physician measures the latency between squeeze and contraction by observing the anal sphincter or by feeling it with a gloved finger inserted past the anus.

Nocturnal penile tumescence .NPT.

It is normal for a man to have five to six erections during sleep, especially during rapid eye movement ,REM; Their absence may indicate a problem with nerve function or blood supply in the penis. There are two methods for measuring changes in penile rigidity and circumference during nocturnal erection: snap gauge and strain gauge. A significant proportion of men who have no sexual dysfunction nonetheless do not have regular nocturnal erections.

Penile biothesiometry

This test uses electromagnetic vibration to evaluate sensitivity and nerve function in the glans and shaft of the penis.

Dynamic infusion cavernosometry .DICC.

technique in which fluid is pumped into the penis at a known rate and pressure. It gives a measurement of the vascular pressure in the corpus cavernosum during an erection.

Corpus cavernosometry

Cavernosography measurement of the vascular pressure in the corpus cavernosum. Saline is infused under pressure into the corpus cavernosum with a butterfly needle, and the flow rate needed to maintain an erection indicates the degree of venous leakage. The leaking veins responsible may be visualized by infusing a mixture of saline and x-ray contrast medium and performing a cavernosogram. In Digital Subtraction Angiography .DSA, the images are acquired digitally.

Magnetic resonance angiography .MRA.

This is similar to magnetic resonance imaging. Magnetic resonance angiography uses magnetic fields and radio waves to provide detailed images of the blood vessels. Doctors may inject a "contrast agent" into the person's bloodstream that causes vascular tissues to stand out against other tissues. The contrast agent provides for enhanced information regarding blood supply and vascular anomalies.

Treatment

One ad from 1897 claims to restore "perfect manhood. Failure is impossible with our method". Another "will quickly cure you of all nervous or diseases of the generative organs, such as Lost Manhood, Insomnia, Pains in the Back, Seminal Emissions, Nervous Debility, Pimples, Unfitness to Marry, Exhausting Drains, Varicocele and Constipation" The U.S. Federal Trade Commission warns that "phony cures" exist even today.

Treatment depends on the underlying cause. In general, exercise, particularly of the aerobic type, is effective for preventing Ed during midlife., 18–19 Counseling can be used if the underlying cause is psychological, including how to lower stress or anxiety related to sex. Medications by mouth and vacuum erection devices are first-line treatments,. 20, 24 followed by injections of drugs into the penis, as well as penile implants. :25–26 Vascular reconstructive surgeries are beneficial in certain groups. Treatments, other than surgery, do not fix the underlying physiological problem, but are used as needed before sex.

Medications

The PDE5 inhibitors sildenafil Viagra, vardenafil .Levitra, and tadalafil .Cialis. are prescription drugs which are taken by mouth.; 20–21 As of 2018, sildenafil is available in the UK without a prescription. Additionally, a cream combining alprostadil with the permeation enhancer, has been approved in Canada as a first line treatment for Ed. Penile injections, on the other hand, can involve one of the following medications: papaverine, phentolamine, and prostaglandin E1, also known as alprostadil. In addition to injections, there is an alprostadil suppository that can be inserted into the urethra. Once inserted, an erection can begin within 10 minutes and last up to an hour. Medications to treat Ed may cause a side effect called priapism.

Testosterone

Men with low levels of testosterone can experience Ed. Taking testosterone may help maintain an erection. Men with type 2 diabetes are twice as likely to have lower levels of testosterone, and are three times more likely to experience Ed than non-diabetic men.

Pumps

Main article: penis pump

A vacuum erection device helps draw blood into the penis by applying negative pressure. This type of device is sometimes referred to as penis pump and may be used just prior to sexual intercourse. Several types of FDA approved vacuum therapy devices are available under prescription. When pharmacological methods fail, a purpose-designed external vacuum pump can be used to attain erection, with a separate compression ring fitted to the base of the penis to maintain it. These pumps should be distinguished from other penis pumps supplied without compression rings, which, rather than being used for temporary treatment of impotence, are claimed to increase penis length if used frequently, or vibrate as an aid to masturbation. More drastically, inflatable or rigid penile implants may be fitted surgically.

Surgery

Main article: Penile implant

Often, as a last resort if other treatments have failed, the most common procedure is prosthetic implants which involves the insertion of artificial rods into the penis :26 Some sources show that vascular reconstructive surgeries are viable options for some people.

Alternative medicine

The Food and Drug Administration .FDA. does not recommend alternative therapies to treat sexual dysfunction. Many products are advertised as "herbal viagra" or "natural" sexual enhancement products, but no clinical trials or scientific studies support the effectiveness of these products for the treatment of Ed, and synthetic chemical compounds similar to sildenafil have been found as adulterants in many of these products. The FDA has warned consumers that any sexual enhancement product that claims to work as well as prescription products is likely to contain such a contaminant.

Erection

Physiological phenomenon in which penis becomes firm

Clitoral erection

physiological phenomenon where the clitoris becomes enlarged and firm, as result of a complex interaction of psychological, neural, vascular and endocrine factors, usually though not exclusively associated with sexual arousar

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This article needs more medical references or our Organic doctors for verification or relies too heavily on primary sources.

Rod of Asclepius.

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This additional citations for verification.

Hyperprolactinaemia is the presence of abnormally high levels of prolactin in the blood. Normal levels are less than 500 mIU/L (milli-international units per litre, for women, and less than 450 mI U/ for men, medical citation needed.

Hyperprolactinaemia

Other names

Hyperprolactinemia

PRL structure.

Prolactin

Specialty

Endocrinology

Prolactin is a peptide hormone produced by the anterior pituitary gland that is primarily associated with lactation and plays a vital role in breast development during pregnancy. Hyperprolactinaemia may cause galactorrhea (production and spontaneous flow of breast milk, infertility, and disruptions in the normal menstrual period in women; and hypogonadism, infertility and erectile dysfunction in men.

Hyperprolactinaemia can also be a part of normal body changes during pregnancy and breastfeeding. It can also be caused by diseases affecting the hypothalamus and pituitary gland. It can also be caused by disruption of the normal regulation of prolactin levels by drugs, medicinal herbs and heavy metals inside the body. Hyperprolactinaemia may also be the result of disease of other organs such as the liver, kidneys, ovaries and thyroid.

Signs and symptoms Edit

In women, a high blood level of prolactin often causes hypoestrogenism with anovulatory infertility and a decrease in menstruation. In some women, menstruation may disappear altogether amenorrhoea. In others, menstruation may become irregular or menstrual flow may change. Women who are not pregnant or nursing may begin producing breast milk galactorrhoea. Some women may experience a loss of libido interest in making love, and breast pain, especially when prolactin levels begin to rise for the first time, as the hormone promotes tissue changes in the breast. Intercourse may become difficult or painful because of vagi.. dryness. medical citation needed.

In men, the most common symptoms of hyperprolactinaemia are decreased libido, sexual dysfunction in both men and women, erectile dysfunction, infertility, and gynecomastia. Because men have no reliable indicator such as menstruation to signal a problem, many men with hyperprolactinaemia being caused by a pituitary adenoma may delay going to the doctor until they have headaches or eye problems caused by the enlarged pituitary pressing against the adjacent optic chiasm. They may not recognize a gradual loss of sexual function or libido. Only after treatment do some men realize they had a problem with sexual function.[medical citation needed

Because of hypoestrogenism and hypoandrogenism, hyperprolactinaemia can lead to osteoporosis. medical citation needed.

Causes Editor.

Hyperprolactinaemia may be caused by either disinhibition e.g., compression of the pituitary stalk or reduced dopamine levels, or excess production from a prolactinoma a type of pituitary adenoma). A blood serum prolactin level.

Hyperprolactinemia inhibits the secretion of gonadotropin-releasing hormone (GnRH) from the hypothalamus, which in turn inhibits the release of follicle-stimulating hormone FSH and luteinizing hormone LH from the pituitary gland and results in diminished gonadal sex hormone production termed hypogonadism, This is the cause of many of the symptoms described below.

In many people, elevated prolactin levels remain unexplained and may represent a form of hypothalamic–pituitary–adrenal axis dysregulation.

Causes of hyperprolactinemia

Physiologic hypersecretion

Pregnancy

Lactation

Chest wall stimulation

Sleep

Stress

Hypothalamic-pituitary stalk damage

Tumors

Craniopharyngioma

Suprasellar pituitary mass

Meningioma

Dysgerminoma

Metastases

Empty sella

Lymphocytic hypophysitis

Adenoma with stalk compression

Granulomas

Irradiation

Trauma

Pituitary stalk section

Suprasellar surgery

Pituitary hypersecretion

Prolactinoma

Acromegaly

Laron syndrome

Systemic disorders

Chronic kidney failure

Hypothyroidism

Cirrhosis

Pseudocyesis

Epileptic seizures

Drug-induced hypersecretion

Dopamine receptor blockers

Atypical antipsychotics: risperidone

Phenothiazines: chlorpromazine, perphenazine

Butyrophenones: haloperidol

Thioxanthenes

Metoclopramide

Dopamine synthesis inhibitors

α-Methyldopa

Catecholamine depletors

Reserpine

Opiates

H2 antagonists

Cimetidine, ranitidine

Tricyclic antidepressants

Amitriptyline, amoxapine

Selective serotonin reuptake inhibitors

Fluoxetine

Calcium channel blockers

Verapamil

Hormones

Estrogens

TRH

Physiological causes Edit

Physiological i.e., non-pathological, causes include: pregnancy, breastfeeding, and mental stress.

Medications Edit

Prolactin secretion in the pituitary is normally suppressed by the brain chemical dopamine. Drugs that block the effects of dopamine at the pituitary or deplete dopamine stores in the brain may cause the pituitary to secrete prolactin. These drugs include the typical antipsychotics: phenothiazines such as chlorpromazine Thorazine, and butyrophenones such as haloperidol .Haldol, atypical antipsychotics such as risperidone (Risperdal) and paliperidone (Invega) gastroprokinetic drugs used to treat gastro-oesophageal reflux and medication-induced nausea (such as that from chemotherapy. metoclopramide (Reglan) and domperidone; less often, alpha-methyldopa and reserpine, used to control hypertension; and also estrogens and TRH. The sleep drug ramelteon (Rozerem) also increases the risk of hyperprolactinaemia. A benzodiazepine analog, etizolam, can also increase the risk of hyperprolactinaemia.[medical citation needed] In particular, the dopamine antagonists metoclopramide and domperidone are both powerful prolactin stimulators and have been used to stimulate breast milk secretion for decades. However, since prolactin is antagonized by dopamine and the body depends on the two being in balance, the risk of prolactin stimulation is generally present with all drugs that deplete dopamine, either directly or as a rebound effect.

Specific diseases Edit

Prolactinoma or other tumours arising in or near the pituitary — such as those that cause acromegaly may block the flow of dopamine from the brain to the prolactin-secreting cells, likewise, division of the pituitary stalk or hypothalamic disease. Other causes include chronic kidney failure, hypothyroidism, bronchogenic carcinoma and sarcoidosis. Some women with polycystic ovary syndrome may have mildly-elevated prolactin levels.

Nonpuerperal mastitis may induce transient hyperprolactinemia neurogenic hyperprolactinemia .of about three weeks' duration; conversely, hyperprolactinemia may contribute to nonpuerperal mastitis.

Apart from diagnosing hyperprolactinaemia and hypopituitarism, prolactin levels are often checked by physicians in patients that have suffered a seizure, when there is doubt as to whether they have had an epileptic seizure or a non-epileptic seizure. Shortly after epileptic seizures, prolactin levels often rise, whereas they are normal in non-epileptic seizures.

Diagnosis Editor.

A doctor will test for prolactin blood levels in women with unexplained milk secretion (galactorrhea) or irregular menses or infertility, and in men with impaired sexual function and milk secretion. If prolactin is high, a doctor will test thyroid function and ask first about other conditions and medications known to raise prolactin secretion. While a plain X-ray of the bones surrounding the pituitary may reveal the presence of a large macro-adenoma, the small micro-adenoma will not be apparent. Magnetic resonance imaging (MRI) is the most sensitive test for detecting pituitary tumours and determining their size. MRI scans may be repeated periodically to assess tumour progression and the effects of therapy. Computed Tomography (CT scan) also gives an image of the pituitary, but it is less sensitive than the MRI.

In addition to assessing the size of the pituitary tumour, doctors also look for damage to surrounding tissues, and perform tests to assess whether production of other pituitary hormones is normal. Depending on the size of the tumour, the doctor may request an eye exam with measurement of visual fields.

The hormone prolactin is downregulated by dopamine and is upregulated by oestrogen. A falsely-high measurement may occur due to the presence of the biologically-inactive macroprolactin in the serum. This can show up as high prolactin in some types of tests, but is asymptomatic.

Treatment Editor

Treatment is usually medication with dopamine agonists such as cabergoline, bromocriptine .often preferred when pregnancy is possible. and less frequently lisuride. A new drug in use is norprolac. with the active ingredient quinagolide. Terguride is also used.

Vitex agnus-castus extract can be tried in cases of mild hyperprolactinaemia.

Historical names

See also

References

Prolactinoma

adenoma of the pituitary gland producing prolactin

Cabergoline

chemical compound

Prolactin modulator

drug class. Thanks for your time.