Saturday, November 5, 2011
Clinical experience: association of sexually transmitted infections with sexual dysfunctions
Sexual dysfunctions in the form of Erectile Dysfunction (ED), Premature Ejaculation (PD), Nocturnal Emission (NE), Dhat Syndrome (DS) are not uncommon in clinical practice. These disorders predominantly affect the male community of different age groups. Many times sexual dysfunctions arise from excessive stress, sustained depression, sexual boredom though physical reasons like long standing diabetes, hypertension, excessive smoking, chronic alcoholism, trauma, neurological disorders should be always screened among the cases of sexual dysfunctions through detailed history, proper clinical examination and appropriate investigations.
Sexually Transmitted Infections in males are most of the time symptomatic (unlike females). I have had the opportunity to treat around 3000 cases of sexually transmitted infections (both males and females) during my tenure in Sonagachi Sexual Health Project (1999 – 2002) as a clinical healthcare provider of the STI & HIV clinics of the project. The project also gave me ample scope to treat a number of male cases with sexual dysfunctions; many of them finally landed into the project clinics after seeking treatment at a number of places including road side quacks, pharmacists and qualified sexologists (though the number of qualified sexologists are very few in the city like Kolkata).
Approximately 10% cases of sexual dysfunctions was detected with sexually transmitted lesions during clinical examination, either in the form of genital ulcer or urethral discharge, which were never revealed by the patients during the history taking. The key need of all those patients was primarily to regain their sexual potency, not to get the co-existing sexually transmitted infections treated and cured.
I am still not able to find scientific studies that match with my own clinical experience.
Sexually Transmitted Infections generate considerable concern and stress in the patients which may easily lead to temporary loss of sexual activities. But as a general phenomenon, STI cases are seen to remain sexually active during the course of the disease and that’s what makes it an absolute necessity for them to practise safe sex with their partners/spouses correctly and consistently.
But my experiences with the sexual dysfunction cases explored the other side of the coin.
When they lost their sexual desire and potency (partially or completely) they left no stone unturned to regain their vigour which ranged from witchcraft treatment to visiting a sex worker.
Once, a boy around 17-18 years came to my clinic complaining of discharge of semen on the slightest sexual excitement and frequent nocturnal emission. He was often teased by his friends and also intimidated that he can never satisfy his wife after marriage because these are the symptoms of losing one’s sexual potency. The poor boy, who had been working in a local factory was looking severely tense and going through lot of mental agony and distress.
When examining the boy, I found he was running temperature. I examined his genitalia and found discharge of thick purulent pus on gentle urethral milking. After further interrogation he admitted associated symptoms like urinary burning and fever which started after he had visited a local brothel with one of his friends. The friend advised him to have sex with a sex worker to know correctly if he had actually lost his sexual potency or not. The poor boy would like to prove to himself that he is sexually healthy but he just didn’t bother to use a condom.
All my patients suffering from sexual dysfunction strongly opined that condoms further kill their desire and performance, so they did not use them during sex with a stranger or a sex worker.
Another of my patient, a man in his early forty, who complained of lack of sexual desire after reaching his fifteenth year of married life, was found to nest an incompletely healed genital ulcer which, after a detailed history, was found to be acquired from unprotected sexual contacts again with sex workers. The man didn’t bother about the painless lesion which was healing gradually, because his mind was completely pre-occupied with the growing concern over his decreasing sexual desire and potency.
I do feel these are important observation. A man primarily with sexual dysfunction lands finally into STIs while experimenting on his own sexual performance and potency but without caring about safe sex knowingly or unknowingly.
I didn’t have the records of their syphilis or HIV screening tests and results. But they were all treated for bacterial STIs, cured and given thorough education on STIs, HIV/AIDS and correct & consistent condom use. They were also counselled for the dysfunction part with varied outcome. Some of them were referred to the psychiatrists and lost to follow up.
But the experiences were invaluable to me because they taught me to screen all cases of sexual dysfunction for the presence of STI lesions through detailed history taking and meticulous physical examination and promptly treating the STIs with adequate and appropriate health education.