On 13th September 2015, Anchored the whole ceremony of felicitation of my best teacher Dr OP kapoor’s release of Family Medical guide Part 2 in marathi int he presence of Chief Guest Padmashri Dr T P Lahane and Bollywood Actress Ms Karishma Kapoor.
An Article was published in Manorama Arogyam May 2015 on Sexual Problems in Diabetes and was written by Dr Shashank R Joshi, Dr Deepak Jumani and Dr A Raveendran.
At the 9th Annual Conference of RSSDI Maharashtra Chapter held at Hotel Westin, Pune last week end, delivered a scintillating talk on Erectile Dysfunction. This mega event was attended by over 1200 physicians from across the country and over 60 faculty members from across India and abroad. The ambiance of the venue was splendid, the food was sumptous, The lectures, orations and keynote addresses were eduinformative. Salutations to to Dr Sanjay Agarwal, Dr Shailaja Kale, Dr Ravindra Kiwalkar, Dr Mohan Magdum, Dr Suresh Erande, Dr Unnikrishnan A G, Dr Narayan Devgaonkar, Dr Sanjiv Indurkar Devyani and all others who gave us a event to cherish for ever. Undoubtedly RSSDI 2015 held at Pune was a La Grand Success
Does Size Matter?
Do Women love it or do men take pride in it ?
In today’s world where everything revolves around big cars, big houses and even big jobs, the question arises whether ‘bigger is always better for everything’? But when it comes to a man’s ability to satisfy a woman, does size actually matter? If you are still wondering just find it out yourself.
Sweet sixteen and that’s when almost 40% of our time is spent in the laughs and giggles with the slightest mention of sex. Catching up with the facts and figure in magazines to a round table conversation with friends, sex is a never ending topic of discussion for people of all ages. In spite of all the reading, don’t you still find bundles of questions toppling in your mind? The older you grow, the more embarrassed you feel to talk about your own sexual concerns. I shall bring to you the most talked about sex myths, the answers of which you have been wondering for years!
It’s a human tendency to believe ‘ bigger is always better’. And it goes without saying that the same has come down across generations as a point of belief when it comes to matters of sex. I once over heard a conversation of a group of girls in their late teens who quite interestingly giggled and discussed how to judge the size of a penis. Is it really important most might ask. But in today’s world where moving in and out of a relationship is not a big deal and a topic of open discussion, a lot goes just for the size. Undoubtedly it is because of the size that there has been many splits amongst couples. However funny it may sound, the length of a penis is a matter of wonder to many. Gaging a size is just next to impossible. To be precise even a man of triceps and 6 packs can break your fantasy.
“Size does not matter. It is not the length of the penis, it is the strength and its function. When it comes to sex it is either a matter of procreation or recreation. The vaginal passage where you insert is 6 inches in length. It is elastic. The outer 1/3 of the vaginal passage contains all the nerve ending and receptive powers which are responsible for the pleasure in a woman including the G spot. So beyond this 1/3 which would be approximately 2 inches and a little more the rest 2/3 area is insensitive. This means the optimal length of the penis in an erect state has to be little more than 2 inches”.
A decent size would also allow you to do good and comfortable oral sex rather than trying to coercing a huge one inside your mouth. But then men are obsessed with the size. Men having a penis size of 5 inches feel that their penis size is small. This is when some real time advices come into action. The point to be noted is women don’t focus on the size until the play is not right. Women focus more on what needs to be done with it.
Frankly speaking women spend more time talking about whether their man washes himself and smells good, rather than how it looks like.
The function of penis is two fold: One is to pass urine for which any length is fine and the second function is procreation or recreation and for this scientifically penile length of 2 inches and above in a non erect state is normal.
A nose is a nose. What difference will it make be it a horse or a pony? Amitabh Bachchan a six footer and Amir Khan a five footer both are best in their work, It is the act of love and affection between you and your partner. The whole purpose of a sexual intercourse is for both of you to enjoy a climax. So long as the functions are taken care, you can plan for a holiday every year. It is hence said that for a archer it is the aim not the length of his arrow that matters.
Early (Premature) Ejaculation is not a disease:
“Man survives earthquakes, epidemics, the horrors of disease, and all the agonies of the soul, but for all time his most tormenting tragedy has been, is, and will be the tragedy of the bedroom” said Leo Tolstoy several decades back and it still wanders the wonders of every man’s bedroom.
The most common sexual dysfunction in men is Premature Ejaculation (PE). In fact it is more common than common cold. I do not consider it to be a disease, because it happens to all men sometime or the other in their life.
There were multiple definitions of Premature ejaculations drafted by panel of international sexual health experts and various sexological societies across the world, way back since 1970.; Masters and Johnson, 1970; World Health Organization, 1994. American Psychiatric Association , 2000 Metz and McCarthy, 2003; Montague et al. 2004; McMahon et al. 2004, 2008; and Hatzimouratidis et al. 2010. The first contemporary multivariate evidence-based definition of lifelong Premature Ejaculation was framed by International Society for Sexual Medicine (ISSM), who unanimously agreed that the diagnostic criteria necessary to define PE are time from penetration to ejaculation, inability to delay ejaculation and negative personal consequences from PE. This panel defined lifelong PE as a male sexual dysfunction characterized by ‘ejaculation which always or nearly always occurs prior to or within about one minute of vaginal penetration, the inability to delay ejaculation on all or nearly all vaginal penetrations, and the presence of negative personal consequences, such as distress, bother, frustration and/or the avoidance of sexual intimacy and also considering the frustration of the partner. This definition was also approved as in DSM V (Diagnostic and Statistics Manual) criteria described by American Psychiatric Association, which are followed world over today. Today we also term it as Early or Rapid Ejaculation.
When it comes to sex and the male member, the laws of physics don’t always apply. What goes up sometimes comes down all too quickly, or sometimes stays up all too long. Never-ending stamina–and an always-hard penis– may sound great on paper, but in reality, it’s not true at all times and in fact, it can be awkward or frustrating for both partners.
There are two aspects of this dysfunction in men , one of them and the most common is the psychological perspective which is due to inexperience in sexual activity, fear or performance anxiety, infrequencies of sexual activity and interpersonal disturbances. The other aspect is physiological perspective which is due to Diabetes, mild to moderate inflammation of prostate, urinary tract infection, hypersensitive glans penis and hyper excitability in orgasmic reflexes. Researchers have also uncovered links between P.E. and changes in the way our nervous system works. Specifically, changes in levels of neurotransmitters (the chemical messengers our nervous system relies on to regulate various bodily functions) may be at least partly responsible for P.E. That may explain why certain medications can help. Selective serotonin reuptake inhibitor (SSRI) antidepressants help boost levels of the neurotransmitter serotonin, which can help delay ejaculation.
Most guys can actually only maintain intercourse for an average of about two to five minutes before ejaculating, but for men with Early Ejaculation, that’s an eternity. The sexually normal male has voluntary control over his ejaculatory reflex. Normal voluntary control does not mean being able to bang away at full speed for hours until his partner comes. No man can do that. Adequate ejaculatory control refers to a reasonable degree of voluntary control which allows a man to continue to thrust while he is at a high level of pleasure and arousal, until he chooses to “let go” and come. Sometimes he may want an exciting “quickie” and will enjoy reaching his climax in a minute or two. Other times he may decide to make the pleasure last for 5 or may be 7 minutes or more. Sometimes men may wish to wait until their partners reach orgasm, and other times they may feel like following their own rhythm, perhaps stimulating their lovers to climax before or after intercourse.
Premature ejaculators have not learned this reasonable kind of voluntary control and they have no choice and they ejaculate rapidly and involuntarily as soon as they reach a high state of arousal, whether they want it or not.
Ejaculating rapidly is not a problem for all men but for their partners too. Some men with PE are sensuous skillful lovers who know how to stimulate their partner to orgasm manually or orally, prior to intercourse or after they ejaculate, or before and after, so that their rapid ejaculations do not interfere with their partner’s sexual pleasure.
Many men with early ejaculation lack sexual confidence and they tend to be anxious about their ability to perform. Each time their negative experience convinces them that they are “losers” and this increase their performance anxiety. During anxiety there is a release of adrenalin and nor adrenalin which are our body’s emergency hormones which reach penile circulation in less than a second and instantly constricts the blood vessels reversing the erectile process.
In our society, men often measure their self worth by the hardness of their erection and by their “staying power”. Men who have poor control, especially if they are unsure of themselves in other ways, may end up with a general sense of inadequacy and failure, and may develop additional sexual difficulties.
Early ejaculation is not good for romantic relationships, not because women reject them on account of their PE, but because they develop self –destructive patterns of sexual avoidance and lead a bitter and frustrated life. Many women who complain bitterly about their husband’s PE are really less upset by his rapid climax than by the “wham-bam-thank you, ma’am “syndrome. It is the insensitivity to their feelings, rather than the physical sexual frustration, which is the greatest hurt for these women. Even though there is no reality to the myths that their partner is hostile or that only orgasms produced by penile thrusting are fulfilling, I have seen some emotionally vulnerable women who feel terribly hurt, rejected and depressed about their husband’s lack of control. Naturally, such deep unhappiness on the part of the partner creates pressures which only worsens the couple’s problems.
But one ought to understand that it is highly unlikely that the problem of PE will go away by itself. One has also to be aware of the fact that the psychological damage this lack of control is causing to self esteem, sexuality and romantic relationships worsens as time advances. Its better not to wait.
Premature Ejaculation is not a disease, it’s a psycho behavioral issue. All negative emotions such as Anxiety, Worry, Fear, Guilt, Envy, Stress, Impatience, Hurry, Sadness, Doubt, Shame, Suspicion etc, Being Self-Conscious, Self-Critical, Self-Condemning, Self-Doubt can cause Premature ejaculations. All these emotions which repeat off and form an habit and the mind gets conditioned or programmed.
There are no signs or findings on Physical Examination, There are NO Radiological, Pathological, Hormonal, Immunological, Hematological or any Laboratory tests that can Detect, Grade, Rule out or Monitor Premature Ejaculations.
The only way to diagnose is when the individual feels or the partner complains about it.
If a man lasts for say ten minutes he ultimately ends his act with ejaculation, and if a man has PE and lasts for say less than a minute he too ends his act with ejaculations, so in both the instances the sex act is complete. All a man need s to learn the skill to extend the duration of intercourse and these skills can be easily learned.
Anti sexual childhood messages, that sex is disgusting sinful harmful which is transmitted to children by some puritanical families, schools and churches get programmed deeply and damper his sexuality or even parents who have troubled family environment tend to give their children distorted ideas of sex and love. and infact stunt their children’s sexual development.
Some women are calm and supportive while others become upset when a man comes rapidly. Women who take their lover’s rapid ejaculation as a personal rejection or affront, or women who insist that they can be satisfied only with lengthy intercourse, or those who make it clear that they expect their man to hold on until they have their orgasm, create a tense pressuring atmosphere and this does not help.
Many Premature Ejaculators feel too pressured about pleasing their partner. During the sex act their minds are so filled with fears of being criticized or rejected and with checking out their partner’s responses that there is no way they can possibly stay in touch with their own sexual sensations. Some men feel too guilty about masturbation, about having sexual fantasies to allow themselves to register their feelings of pleasure. These overly excited, anxious or guilty men concentrate on their negative feelings and tune out their erotic sensations and avoid prolonged periods of arousal and never experience the natural feelings of intense erotic pleasure which occur just before the sexual climax. In fact they avoid having sexual encounters and the gaps of the acts widen.
Just as PE is not a disease, there are also no quick fixes. What medication can do is slightly increase the duration of intercourse and help him boost his confidence so that he can focus on learning new skills to bring you to orgasm — and that’s the real goal, after all.?Many women don’t understand P.E. and often think that men with the condition are sexually selfish.
My sincere advice to deal with this dysfunction is to use pathways to pleasure outside of intercourse. Help take the pressure off of his penis, and encourage him to provide you with lots of direct clitoral stimulation. Most women don’t orgasm consistently from intercourse alone anyway, so focusing on “outercourse” and extending foreplay into a complete act of love-making is the best way for you both to enjoy sex.?That’s not to say you can’t enjoy intercourse. Let your guy know when you’re close to the point of coming, and then transition into a position like “woman on top” where you can still maintain a lot of direct clitoral stimulation. Even if he ejaculates prior to your orgasm, it will still take a couple of minutes for him to fully lose his erection and, in that window, you have a high likelihood of being able to reach orgasm.
There are several other non pharmacological techniques which have been tried like Seman’s technique (1956), Squeeze technique (1970), Stop-start technique (1983), Surgical cutting of the nerve, Yoga (Vajroli & Ashwini Mudra), Unani approach (interrupting the flow of urine). By modifying the stimulation in masturbatory exercises, a man with premature ejaculation can learn to slow his response. (Studies of masturbation from Love (1911) by Mihaly von Zichy). In some cases we recommend alternating the stop start exercises with Sensate Focus which is a structured sensuous interaction that was devised by Masters and Johnson for the purpose of shifting the couple’s emphasis from performance to mutual exchange of pleasure.
Along with Psychotherapy, Cognitive Restructuring, numbing creams and sprays, There are lots of anti depressants which have been used in the past but the most recent Seletive Serotonin Reuptake inhibitors have proven to be safe and highly effective. Make sure you express how much you care about him or her and that you are happy with your sex life, but are simply curious about trying out some new positions. Sex should be fun and pleasurable for all of those involved in the sexual event – be sure to communicate openly with your partner about how each position feels for you. Variations on every position can be made to come to a pleasurable compromise and maximize satisfaction for both of you. Women on top is the best position in such situations.
Any man who wants to naturally last longer immediately and for the rest of their life, regardless of the degree of their premature ejaculation, which surely is not a organic disease will benefit with an attentive partner. Learning skills and can enjoy sex life…
We must understand that sex is to be used and not abused and friends sex has no expiry date.
Ageing and Sexual Health in Women
Sex wasn’t God’s mistake, but judging against sex was humanity’s biggest mistake. Pleasure is as divine as any cathedral, temple, mosque or pilgrim.
There are three aspects of sexuality to consider as you get older: physical changes that come with aging, how to adjust to these changes, and how to have safe sex and avoid sexually transmitted diseases.
Ageing is inevitable. Some women are not comfortable with the way their bodies are aging. They may feel that their new wrinkles, grey hairs, or weight gain make them unattractive. This will have an effect on their ability to seek out and enjoy intimacy. If you are struggling with your self-image, remember that your vitality, sensuality and desire to love don’t fade as the years progress. Passion, about yourself and your partner, is still an important part of your life. And passion, about yourself, your partner and your life, begets passion. Being attractive and sensual does not fade with age, it just changes.
There is no age limit on sex for women. Although older women may become aroused more slowly than younger ones, many find that their desire increases when they no longer have to worry about being interrupted by young children or about getting pregnant. Most older women, especially those who remain sexually active, retain the ability to have normal orgasms. But as women age, their bodies change and so do their sexual organs.
The three common issues which affect sexual health of any ageing women are Menopause, Hormone therapies and low desires.
Menopause and Lubrication: After menopause, women’s bodies produce less estrogen (the female hormone). The lower estrogen level creates some physical changes that may affect sexual activity.
Hormone therapy either after Hysterectomy or post menopause produce vaginal dryness.
Decreased desire: Testosterone plays an important role in creating sexual thoughts and arousal in both men and women. Declining levels of testosterone often make your desire for sex less strong. This is normal, but it doesn’t mean that your desire goes away completely. A decrease in desire can also be related to a number of other factors, such as depression, stress, fatigue or the use of some medications (for example some high-blood pressure medications and some anti-depressants). However, a decrease in desire may just mean that you need to find new ways to keep your sex-life fun and exciting. Making it a priority will help keep you and your partner close and connected. However, a decrease in desire may just mean that you need to find new ways to keep your sex-life fun and exciting. Deal with any problems or challenges as they arise and don’t be afraid to experiment. While sex might take a little bit more effort and commitment, from the both of you, that doesn’t mean it’s any less pleasurable.
Focus on your strengths. Be creative in finding ways to make yourself feel more attractive. Take a little extra time with yourself as you get ready in the mornings to greet the day. Makeovers, Wear perfume (if that’s what you like); buy some special lingerie or undergarments. Pamper yourself and your body. Focus on giving and receiving pleasure.
A healthy sex life is an essential part of overall good health, and it’s a myth that sex has to suffer as you get older. If you give sex the attention it deserves, you can maintain a healthy and active sex life throughout your life. Just because you’re getting older doesn’t mean your sexual health needs should suffer. We must learn how to keep your sex life satisfying as you age as I believe Sex is to be used and not abused and wrinkles don’t hurt.
Novel Therapies to treat Male sexual Dysfunctions.
A normal sexual response in men and women begins in the presence of sexually oriented stimulation. When the mood is right, the body responds by releasing a cascade of chemicals that direct the flow of blood into the sexual organs. In women, this leads to engorgement and lubrication of the organs as the body prepares for intercourse. In men, this rush of blood is directed into a pair of pockets, known as the corpus cavernosum, that run inside the shaft of the penis. This inflow of blood is critical to the enlargement and stiffening of the penis.
This engorgement is triggered by a unique neurotransmitter called nitric oxide (NO). Nitric oxide, in turn, stimulates the production of another signaling enzyme called cyclic guanosine monophosphate, or cGMP for short. Under normal circumstances, cGMP signals the smooth muscles surrounding the arteries of the penis to relax and allow blood to flow into the penis. Any condition that interferes with the signaling of these messenger enzymes can quickly lead to the breakdown of the entire process and cause impotence.
The Common male sexual dysfunctions seen largely are Erectile Dysfunction and Early Ejaculation.
Erectile dysfunction, is defined as the inability to attain or sustain an erection adequate for satisfactory sexual intercourse. Erectile Dysfunction usually has a physical cause, such as disease, injury, or drug side effects. Any disorder that impairs blood flow in the penis has the potential to cause impotence. It occurs as men age: about five percent of men at the age of forty, and between fifteen and twenty five percent of men at the age of sixty-five experience impotence (Fig. 1). Yet impotence is not an inevitable part of aging
Erectile Dysfunction equates Penile Attack. Penile Attack equates Heart attack as there is enough evidence to prove the fact the Erectile Dysfunction or Penis Attack is the earliest marker of Myocardial Infarction. Infact India is the Diabetes Capital of the world, So India is also the Erectile Dysfucntion Capital of the world. We have the expertise and scientific wisdom for the same and so 3.6 millions lives can be saved.
There have been a tremendous breakthrough in managing Erectile Dysfunction.
In 1998 FDA approved Sildenafil a PDE5 inhibitor for treatment of ED and this was the beginning of a new era in the treatment of ED. With three effective and safe phosphodiesterase type 5 (PDE5) inhibitors, today clinicians have multiple choices for treating patients with erectile dysfunction of all severities and etiologies. How ever there are 20-30 percent nonresponders . The possible stratergies to these non responders was a challenge. A proper counselling , switiching over to alternate PDE5inhibitors, chronic use of the PDE5 inhibitors or alternate measures were then adopted. Chronic use of PDE5 inhibitors in low dose proved to be having a favourable pharmacokinetic profile and good therapeutic option with better compliance. A new biomarker platelet cyclic GMP was also used to prove the same. So Chronic therapy with low dose of PDE5 inhibitors was thus a valid choice.
The newer formultations which emerged were oral dispersable Verdanafil, which proved to be more than 44% efficacious, with less side reactions.
Then came the invention of Avanafil and Udenafil which increased the CGMP concentration but due to cost constrains did not have a great acceptabilty.
The other treatment modalities include Injections of Papaverine, Phentolamine, Prostaglandins , as Caverject, Bimix or Trimix given intracorporally with caution and keeping in mind prapism and counselling the patient on this complication and management of the same.
Besides this a novel therapy which is noninvasive also showed promising results i.e. Low Intensity Extracorporal shockwave therapy which increased the penile blood flow and showed imporvement in the IIEF scores.
The other therapies which are still in the research are as follows:
Guanylate Cyclase Activators and Stimulators:It has been also observed that sGC stimulators and sGC activators increase the cellular cGMP concentration via the direct activation of sGC, which results in both vasorelaxation and inhibition of platelet aggregation. The use of these show a promise in the treatment of ED in Diabetics.
Are we really trying to get some breakthrough in treating difficult & stubborn ED ??
A combination of BAY 60-452 along with verdanafil have shown proerectile facilitatory effects in rats whose cavernous nerves were crushed.
One new aspect which was then studied also shows a great deal of promise in the treatment of ED is. Rho-Kinase inhibitors.
Rho-kinase phosphorylates and inhibits the regulatory subunit of myosin phosphatase within smooth muscle cells. This action maintains phosphorylation of myosin filaments and contractile tone within the smooth muscle. So Inhibition of the calcium sensitization pathway with Rho-kinase inhibitors offers a therapeutic option for the treatment of ED that does not involve the direct targeting of the NO/sGC/cGMP pathway.
If pills dont fill we now have low intensity extracorporal shock wave therapy which is non invasive and has shown promising results.
SHH: Sonic Hedgehog using alligned peptide ampiphile nanofibers plays a significant role in peripheral nerve regeneration and has clinical potential to be used as a regenerative therapy for the Cavernous nerve regenerations.
Injections of L Cystine also has shown to produce good erections in rats.
Lastly Gene therapy and stem cell therapy also has been used in treatment of ED in Diabetics, by enhancing the NO production or NO mediated signalling pathways, K + Channel actvity of the SMCC.
Mesenchymal Stem cells along with VEGF injections have also been tried.
While Oral medications have showed good results there are serious Side Effects of PDE5 inhibitors
While Sildenafil is effective for millions of men, the side effects for many —facial flushing, headaches, and indigestion— are too troublesome for continued enjoyment. And, more seriously, soon after its introduction, vision problems began to surface in men taking Sildenafil, leading to warnings for people with retinal eye conditions, such as macular degeneration or retinitis pigmentosa, to use the drug only with caution.
In addition to eye problems, both the FDA and the manufacturer began to issue warnings against taking Sildenafil with any nitrate-based cardiac medications (i.e., sublingual nitroglycerin tablets, nitroglycerin patches, etc.). Doctors were warned that heart patients should not be treated with nitroglycerin if the patient had used Sildenafil in the previous twenty-four hours. Additionally, the manufacturer reported several cases where patients who received both drugs died after developing irreversible hypotension (a severe drop in blood pressure).
Tadalafil has backache as its common side effect and also because of its long half life its not a drug which all men like.
A Safe Alternative
As safety issues with PDE5 inhibitors, began to arise, researchers once again began to seek out safer alternatives for treating impotence. Many current pharmaceuticals have evolved from the historical search for herbal compounds to cure or reverse sexual dysfunction. Often, traditional nostrums rely on purely magical (placebo) effects, such as the phallic-influenced belief in the effect of rhinoceros horn—which, in fact, offers no benefit to humans and is fatal for the unfortunate rhino. Conversely, many plant-based traditional treatments, using herbs such as damiana, maca, muira puama, tribulus, and yohimbe, have been explored for their effectiveness in treating sexual dysfunction.
Need of the hour is a safe Neutraceutical which justifies the male sexual response.
Male Sexual Response.
L-Arginine
Viagra works to increase both the levels and activity of nitric oxide, leading to increased cGMP, increased blood flow to the genitals, and more intense sensations. Fortunately, there is a less expensive way to naturally increase the amount of nitric oxide released during sexual stimulation. The key is supplemental L-arginine, the direct precursor of nitric oxide.
In the 1990s, scientists discovered that L-arginine, a non-essential amino acid commonly found in the diet, is an oxidative precursor of nitric oxide (NO). As mentioned previously, nitric oxide is required for achieving and maintaining penile erection. Under conditions in which nitric oxide is produced for a specific physiologic purpose, the concentration of L-arginine (from which it is formed) can be a limiting factor.
A healthy sex life contributes to an improved quality of life and can have profound ramifications on emotional and physical well being. The compounds discussed here have been shown, singly and in combination, to be effective in supporting recovery from sexual dysfunction
Sexual Health at 40.
Is growing older a process of stress and sexual decline or of being stress free and being sexually active? Aging and stress, stress and aging — these two human conditions, when paired, can profoundly affect the quality of life.
Genetic basis of Aging and Neurodegeneration:
When events go awry, molecular processes take place that, over time, can lead to neurodegenerative disease. At the root of the problem is a fundamental process: protein folding. Since proteins are the predominant products of gene expression and provide much of the shape and functionality of the cell, their proper synthesis, folding, assembly, translocation, and clearance are essential for the health of the cell and the organism. When proteins misfold, they can acquire alternative proteotoxic states that seed a cascade of deleterious molecular events resulting in cellular dysfunction. When these events occur in neurons, the consequences can be devastating. Alzheimer’s disease, Parkinson’s disease, amyotrophic lateral sclerosis, Huntington’s disease, and other neuropathies involve the cytopathological appearance of intracellular and extracellular protein aggregates in the brains of affected persons. It is increasingly clear that the relevant event in these neurodegenerative diseases is a toxic gain-of-function mutation associated with the appearance of oligomers and other toxic aggregates consisting of the ?-amyloid peptide, ?-synuclein, superoxide dismutase, and huntingtin, respectively. The way in which these toxic species form, the processes that determine their persistence or clearance, and the molecular basis of their toxicity are critical to the mechanisms of these diseases.
Cohen et all in a land mark study proved that The association between the life span and the cellular stress response is suggested by the insulin-signaling pathway’s requirement for heat-shock factor 1 (HSF-1), the activator of the heat-shock response that induces the expression of molecular chaperones (a large class of proteins that assist in protein folding and thus guard against misfolding) during stress. Consequently, the inhibition of HSF-1 function also increases polyglutamine aggregation, resulting in toxic effects that decrease the life span of C.elegans. Conversely, overexpression of HSF-1 suppresses polyglutamine-mediated toxicity and extends the life span. Collectively, these observations provide support for the hypothesis that graceful aging depends on the cell’s ability to counter the effects of stress by maintaining protein folding, which in turn permits appropriate protein function.
Cohen et al, showed that activation of the insulin-signaling pathway suppresses the toxicity of aggregates Of amyloid ß, a peptide formed in the neuronal tissues.
These investigations showed that in suppressing the toxicity of aggregates, the insulin-signaling pathway activates two
downstream pathways, both of which affect the fate of an aggregation-prone protein. Each pathway is triggered by a transcription factor: HSF-1 or abnormal dauer formation 16 (DAF-16). The authors showed that HSF-1 promotes disaggregation by elevating the levels of protective molecular chaperones, whereas DAF-16 enhances the formation of
large, inert aggregates from toxic oligomers.
A Model of Age-Related Protection against Proteotoxicity.
The insulin-signaling pathway is triggered in C. elegans by a receptor called DAF-2. It has a profound effect on aging — a mutation of daf2 can result in a doubling of the life span of this organism, and similar results have been observed in mice. DAF-2 represses two downstream pathways: one is commandeered by the transcription factor HSF-1 and the other by the
Transcription factor DAF-16. (Transcription factors are proteins that “turn on” specific genes.) A recent study by Cohen et al. shows that both HSF-1 and DAF-16 provide protection against proteotoxicity of the amyloid ß peptide, an aggregation-prone peptide that can spontaneously form small toxic aggregates. The default pathway, regulated by HSF-1, identifies and breaks apart toxic aggregates. When the HSF-1 machinery is overloaded, however, a molecular apparatus regulated by DAF-16 grinds into gear, resulting in the formation of less toxic high-molecular-weight aggregates.
Psychological impact of Aging and Sexual Health
Masters and Johnson proved that the loss of sexuality is not an inevitable aspect of aging, and the majority of healthy people remain sexually active on a regular basis until advanced old age. However, the aging process does bring with it certain changes in the physiology of the male and the female sexual response, and these along with a number of medical problems that become more prevalent in the mature years, play a significant role in the pathogenesis of the sexual disorders of the elderly. The typical patient over 40 has only a partial degree of biological impairment, which has, however, been escalated into a total sexual disability by a variety of cultural, intrapsychic, and relationship stressors. Fortunately, these problems are frequently amenable to an integrated psychodynamically oriented sex therapy approach that emphasizes the improvement of the couple’s intimacy, and the expansion of their sexual flexibility
Endogenous Sex Hormones and Metabolic Syndrome
in Aging Men a landmark study done by Majon Muller, Diederick E. Grobbee, Isolde den Tonkelaar, Steven W. J. Lamberts, and Yvonne T. van der Schouw proved that Sex hormone levels in men change during aging. These changes may be associated with insulin sensitivity and the metabolic syndrome.
THE METABOLIC SYNDROME represents a constellation of lipid and non lipid risk factors of metabolic origin and is closely linked to a generalized metabolic disorder called insulin resistance in which the normal actions of insulin are impaired . The syndrome is most important because of its association with subsequent development of type 2 diabetes mellitus and cardiovascular disease. The pathogenesis of the syndrome is multifactorial, but obesity and sedentary lifestyle and factors in concert with diet and still largely unknown genetic factors interact in the occurrence of the syndrome.
Androgen Deficiency, Aging and Male Sexual Health
Decline of both testicular and adrenal function with aging causes a decrease in androgen concentrations in men . Epidemiological evidence has shown that sex steroid hormones are related to type 2 diabetes and CVD in men. Although the mechanisms underlying the association between endogenous sex hormone levels and both diabetes and CVD are not entirely understood, it has been postulated that low levels of total testosterone, bioavailable testosterone, SHBG, and dehydroepi- androsterone sulfate (DHEA-S) are associated with unfavourable levels of several strong CVD risk factors, such as lipids and blood pressure, which are components of the metabolic syndrome, and insulin levels. It is proven beyond doubt that endogenous sex hormones and metabolic syndrome are linked as proven by a large-scale cross-sectional study which was done to investigate the relation of endogenous testosterone, SHBG, DHEA-S, and estradiol (E2) with metabolic syndrome, as defined by the National Cholesterol Education Program (NCEP), in middle-aged and elderly men.
Testosterone acts on the male brain to promote sexual desire and arousal. With increasing age there is a varying degree in reduction of Free Testosterone which is the bioavailable male hormone, and this is why the possible responsiveness of neurones in the relevant areas of the brain, such as locus ceruleus, the brain stem-centre for testosterone dependent arousal mechanism. These changes contribute to the age related decrease in sexual interest and to some extent erectile function. There are age related changes in the various aspects vascular and smooth muscle tissues related to erectile process, including a increased sensitivity to inhibitory (ie contractile ) signals in the erectile smooth muscle.
The Impact of Aging on Sexual Function and Sexual Dysfunction in Women: A Review of Population-Based Studies By Richard Hayes and Lorraine Dennerstein proved that the role of hormones in the effects of aging in women’s sexuality is less clear and has not been extensively studied. The effect of menopause is complex involving not only physiological changes eg( reduced vaginal lubrication due to reduced estrogen levels), but also an end to women’s fertility, social attitudes about the role of post menopausal women, that vary across cultures and a transitional phase with increased vulnerability to depression. Most Indian women do not express their concerns and most of the diabetic women are all depressed. The levels of testosterone in women also decrease with aging and this also affects their sexual functions.
Scientific interest in the impact of aging on women’s sexual function and dysfunction has increased in the half century since Sir Alfred Kinsey described age-related changes in women’s sexual activities. However, a range of methodological issues limit the conclusions that can be drawn from many published studies in this area.
Aging encompasses a range of processes that have the potential to affect a woman’s sexual function. Hormonal and physiological changes take place throughout a woman’s life. These changes are particularly pronounced during puberty, menstrual cycles, pregnancy, postpartum, and the menopausal transition. Relationship factors including the presence of a partner, the partner’s age and sexual function, the length of the relationship, and a woman’s feelings for her partner may change as a woman ages. The importance of sex in her life and level of distress she feels if she suffers from sexual dysfunction may also differ as a consequence of her age. Given that so many changes take place in a woman’s life as she ages, it can be challenging to separate out which factors affect which aspects of her sexual function and to what degree. One of the major deficiencies in the literature is that many of the relevant determinants of sexual function are not measured or analyzed to separate out their effects.
New definitions of sexual dysfunctions have been developed which include personal distress as part of the definitions for vaginismus, desire, arousal, and orgasmic disorders. Sexual inactivity increases with age, but it may also be a response to sexual difficulties.
John H.J. Bancroft, M.D. in his editorial on Sex and Aging states that, As compared to studies in men studies in women have emphasized the effect of relationship factors and mental health which increasingly are proven to be more important predictors of sexual well being than the physiological factors of sexual arousal and response. For many women, being in a relationship, the quality of the relationship, and their partner’s sexual problems are more important than their sexual responsiveness. Women also differ from what they find rewarding after having sex. Some are motivated principally by the desire of intimacy, whereas for others the desire for sexual pleasure and orgasm is equally important. This different motivational patterns may be affected in different ways by aging.
Despite of high prevalence of sexual problems at aging, a fact remains at most patients don’t talk about it nor do their physicians ask about it. A simple question which I advise to the physicians to ask all their patients above forty is this :Do you have problems in making love ? .. This shall open a pandora’s box.
Given the age-related decline in sexual function, one might expect that sexual difficulties or dysfunctions would increase with age. This does not appear to be the case. The prevalence of most sexual difficulties or dysfunctions changes very little with advancing age, and sexual pain disorders appear to decline. An age-related decline in sexually related personal distress might help explain this. Certainly, the importance of sex does appear to decline with age.
At present day scenario, a man of 40 is not at all considered old. The life expectancy has increased by many fold and unless one is in his late 60s, no one considers himself old. Infact Life begins at 40. This is a universal fact that men hardly feel themselves aged unlike women. As after 40 the graph of life is all descending, men become conscious of this and starts acting more like a man in his twenties.
In my opinion, we are all aware that sex and pleasure is a state of mind and not present in genitalias, so visualise yourself as a sexual being and feel good about your body Dress sexily for each other, try out newer things in bed to enhance your libido, bring in variety in every initiation of your sexual act, go on dates and trips with your partner, show spontaneity, never take your spouse for granted, give your spouse time not gifts, never criticise, complain or compare your partner and never make him have any pressure to perform and always say yes to sex.
As we get older, the way in which media portrays one could be forgiven for thinking that sex is the province of the young. This is not true. The Menopause, The controversial Andropause are not a matter of concern , infact its a liberation time, because for women, its now the time of their life when they need not worry about contraception, unwanted pregnancy etc and men by balancing their metabolic syndrome, regular exercise, balanced diet, erotic intelligence and undying passion and romance can be sexually confident.
Sex is not a activity, it’s an IDEA. If we have complicated ideas we tend to complicate Sex. Whatever be your age, weight, these are just numbers and Sex has no expiry date. Aging is graceful in a monogamous relationship, which is like a garden and polygamous relationship is like a jungle. To remain Sexually healthy one must learn to cultivate his/her garden. Truly Rishi Vatsayana in Kamsutra said that Sex is to be used and not abused.
