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ANDROLOGY

Erectile Dysfunction (ED)

Erectile Dysfunction is the inability to achieve or maintain an erection firm enough for sexual intercourse.
It is very common—affects nearly 40% of men by age 40 and 70% by age 70.
ED is not a sign of weakness. It is a medical condition that can be successfully treated.

Common Causes Of Erectile Dysfunction (ED)

ED can occur due to one or more of the following:

1. Physical / Medical Causes

  • Diabetes
  • High blood pressure
  • High cholesterol
  • Heart disease
  • Obesity
  • Hormonal imbalance (low testosterone)
  • Nerve injuries (pelvic surgeries, spine issues)
  • Prostate surgery side effects
  • Smoking or alcohol excess

2. Psychological Causes

  • Stress
  • Anxiety
  • Performance anxiety
  • Depression
  • Relationship issues

3. Lifestyle Causes

  • Lack of sleep
  • Sedentary lifestyle
  • Poor diet
  • Use of recreational drugs

Symptoms

  • Difficulty in achieving erection
  • Difficulty in maintaining erection
  • Reduced sexual desire
  • Erections not firm enough for penetration.

Evaluation at Our Clinic

We follow a stepwise, scientific approach:

  • Detailed medical history
  • Physical examination
  • Blood tests (testosterone, sugar levels, lipids, thyroid)
  • Penile Doppler ultrasound (assesses blood flow)
  • Psychological assessment (if needed

Treatment Options for Erectile Dysfunction

1. Lifestyle & Medical Optimization

  • Weight loss
  • Exercise
  • Sleep improvement
  • Reduce alcohol/smoking
  • Optimize sugar/BP control

2. Oral Medications

First-line and highly effective:

  • Sildenafil
  • Tadalafil
  • Vardenafil

These increase blood flow to the penis. Safe when used under doctor supervision.

3. Testosterone Therapy

  • Given only if patient has clinically low testosterone levels.

4. Vacuum Erection Device (VED)

  • Creates vacuum to maintain erection.
  • Useful for men who cannot take medications.

5. Penile Injection Therapy (ICI)

  • Self-injection before intercourse using vasodilator medications.
  • Effective when tablets fail.

6. Shockwave Therapy (Low-Intensity ESWT)

  • Non-invasive, painless treatment to improve penile blood circulation.
  • Helpful for mild-to-moderate ED.

7. Penile Implants (Prosthesis Surgery)

For severe ED or when all other treatments fail.
Types:

  • Malleable (Semi-rigid)
  • Inflatable 3-Piece Implant (most natural erection) 
  • High satisfaction rates (90–95%).

Premature Ejaculation (PE)

PE occurs when ejaculation happens sooner than desired, often within
• 1 minute of penetration (lifelong PE), or
• Earlier than expected due to stress, anxiety, or medical issues (acquired PE).
It is the most common sexual problem in men, often causing frustration, stress, and reduced
confidence.

Causes Of Premature Ejaculation (PE)

1. Psychological Factors

  • Performance anxiety
  • Stress
  • Depression
  • Relationship issues

2. Physical Factors

  • Nerve hypersensitivity
  • Thyroid disorders
  • Prostatitis
  • Erectile dysfunction
  • Serotonin imbalance in the brain

Symptoms

  • Ejaculation with minimal stimulation
  • Ejaculation before or immediately after penetration
  • Feeling unable to control ejaculation
  • Reduced sexual satisfaction

Evaluation at Our Clinic

  • Sexual history
  • Assessment for associated ED (very common combination)
  • Hormonal tests (if needed)
  • Prostate examination in selected patients

Treatment Options for Premature Ejaculation

1. Behavioural Therapy

Proven effective techniques taught in clinic:

  • Start–Stop technique
  • Squeeze technique
  • Breathing and relaxation exercises
  • Sensate-focus therapy

These help improve control and reduce anxiety.

 

2. Topical Anesthetic Sprays or Creams
Reduce penile sensitivity:

  • Lidocaine
  • Prilocaine
  • Combination sprays

Used 10–15 minutes before intercourse.

3. Oral Medications

Most effective option for persistent PE:

  • SSRIs (e.g., Dapoxetine) — on-demand tablet
  • Sertraline / Paroxetine — daily treatment for chronic cases

These increase serotonin levels and improve control.

 

4. Treat Associated Erectile Dysfunction

If ED is present:

  • PDE5 inhibitors (Tadalafil, Sildenafil)
  • Improving erection often automatically improves PE.

5. Counseling / Psychotherapy

  • Helpful when anxiety or relationship issues contribute to PE.

6. Pelvic Floor Exercises

Strengthen the muscles that control ejaculation.

When to See a Urologist?

You should consult a specialist if:

  • ED lasts more than 3 months
  • PE causes distress or affects relationship
  • ED coexists with diabetes or heart disease
  • Low libido or hormonal symptoms present

Male Infertility Evaluation

Male infertility is treatable in many cases. Causes include lifestyle, varicocele, hormonal
imbalance, infections, or blockage

Treatment Options:

•  Semen analysis

•  Hormonal correction

•  Varicocelectomy

•  Treating infections

•  Sperm retrieval techniques

•  Lifestyle improvement plans

Varicocele

Enlarged veins in the scrotum that affect sperm quality and can cause pain.

Treatment Options:

  • Microsurgical Varicocelectomy —  gold standard.
  • Laparoscopic varicocele ligation
  • Pain management

TESE / Micro-TESE for Sperm Retrieval

Used when there is azoospermia (no sperm in semen).

  • TESE — small biopsies to find sperm
  • Micro TESE — microscope-guided,       highest success rates.

Treatment Options:

• Frozen sperm storage

• Coordinated IVF/ICSI treatment

• Hormonal treatment for select       cases

Non-Scalpel Vasectomy

A safe, stitch-less male sterilization procedure. Fast recovery, very low risk, and minimal discomfort.

Treatment Options:

  • Day care procedure 
  • Anaesthesia not required in majority of cases.
  • Need to use contraception post procedure till repeat semen analysis shows no sperms in semen.