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Gender Specific diseases of AyurvedaW.S.R. to Male Erectile Dysfunction(Klaibya)Dr. K. Shiva Rama PrasadM.D.(KC), C.O.P. (German) M.A, Ph.D (Jyo)doctorksrprasad@sify.comAyurveda & Gender specificityED01♦ Ayurveda with 8 branches did not give special priority to gender♦ The term “Purusha” is used to human in general♦ Women is identified with the special srotases viz. Artava vaha srotas(Yoni) and Sthanya vaha srotas (Breast)♦ The diseases of the female were discussed with reference to that ofPrasooti and Stree roga pertained to female genitalia but not given nayimportance of Sex or pleasure the function of the “Guhya” or “Upasta”as given in case of male♦ Sexual capacity is not an inherent, constant, general property. Capacity to have sexualintercourse with woman differs from person to person and is not constant throughout the lifespan of a person.History & Gender specificity♦ First time in the modern history Dr. William Masters, a gynecologistwith his wife and former assistant Mrs. Virginia Johnson, createdspecial packages of training for various sexual problems♦ Medically speaking, Impotency is defined as the inability to sustain anerection sufficient for intercourse on at least 25% of attempts♦ Anxiety, stress and depression are among the most frequently citedcontributors to psychological impotency.♦ For many reasons, cultural as well as situational anxiety over sexualperformance may provoke an intense fear of failure and self-doubt onthe part of the individual

ED02Erectile dysfunction♦ Sex has got ups and downs in lifetime. A person looking strong in physical growth may beweak in sexual activities and one who looks weak in physique may be sexually strong,potent and possess many offspring.♦ Erectile dysfunction (ED) is both increasingly recognizedand increasing in prevalence with the aging of ourpopulation♦ Erectile dysfunction is a potentially devastating ailment thataffects not only men, but also their sexual partners. TheMassachusetts Male Aging Study revealed that age is thesingle most important variable associated with Erectiledifficulty.♦ Currently, more than 30 million American men suffer somedegree of Erectile dysfunction (ED), with projections that upto 47 million individuals will have treatable Erectiledysfunction by the year 2020.Disease development & Society♦ The people who are living in the townships became lethargicand diseased rapidly. This was the fault under went by them.♦ They attained the symptoms such as mental confusion, loss ofpotency, loss of luster, loss of voice, inconvenience, etc.,♦ All these are conformed only because of “Gramyavasa” i.e.living in the townships.♦ It is clear and evidential that the “Klaibya” is also one suchdisease condition developed only because of “Living City daylights of Concrete Jungle”♦ @ñ¹ÉªÉ: JɱÉÖ EònùÉÊSÉiÉ ÉɱÉÒxÉɪÉɪÉÉ´É®úÉSÉ OÉɨÉÉè¹ÉvªÉɽþÉ®úÉ: ºÉÆiÉ: ºÉÉÆ{ÉÊzÉEòɨÉÆnùSÉä¹]õÉSÉ xÉÉÊiÉEò±ÉɪÉÇ: |ɪÉähÉ ¤É¦ÉÚ´ÉÖ: . iÉä ºÉ´ÉÉǺÉÉʨÉÊiÉ EòiÉÇ´ªÉiÉÉxÉɨɺɨÉlÉÉÇ:ºÉÆiÉÉä - ¨ÉxÉÉäM±ÉÉÊxÉ®ú|ɦÉÉ´Éi´ÉÆ ´É躴ɪÉÈ ´Éè´ÉhªÉÈ SÉ OÉɨªÉ´ÉɺÉEÞòiɨɺÉÖJɨɺÉÖJÉÉxÉÖ¤ÉxvÉÆ SÉOÉɨªÉÉäʽþ ´ÉɺÉÉä ¨ÉڱɨÉɺiÉÉxÉÉÆ - SÉ®úEò ÊSÉÊEòiºÉÉ 1/4/3-4

ED03Purusha – Sukra♦ Pususha are of Srotomayam, Shaturvimshati tatwa yuktam,Shatdhatu yuktam, Tridosha & Sapta dhatu yuktam, etc.♦ Out of the very important factor of reproduction is semen i.e.Sukram.♦ The health of the individual can be estimated through the Ojasand Sukra, which spread all over the body♦ The Sukra formation, ejaculation till to the development ofprogeny one reflects its genes and genetic reflections♦ Klaibya is such a condition where physical, environmental.Psychological, pathological, emotional and many more factorsare involved.Qualities of Sukra♦ Susruta defines the semen as – crystalline whitish luster’s,liquid, soft, sweet taste and equal to that of honey smelled.In further it resembles the Oil or Honey consistency(Su.Sh.2/20).♦ The semen is dominant of “Udaka” with its soft (Sowmya)nature but all the bhutas are interrelated and associated(Su.Sh.3/1)♦ At opine of Charaka the semen is “VishwaroopasyaRoopadravyam” with the qualities of thick (Bahalam),sweet, soft, white and much (Bahu). Such semen is strongto produce offspring.♦ Vagbhata accepts both of the statements (A.H.Sh.1/18)♦ º¡òÊ]õEòɦÉÆ pù´ÉÆ ÎºxÉMvÉÆ ¨ÉvÉÖ®Æú ¨ÉvÉÖMÉÎxvÉSÉ ÉÖGòʨÉSUôÎxiÉ EäòÊSÉkÉÖ iÉè±ÉIÉÉèpùÊxɦÉÆ iÉlÉÉ - ºÉÖÉÞiÉ ÉÉ®úÒ®ú 2/20♦ ºÉÉ訪ÉÆ ÉÖGÆò - (ºÉÉ訪ÉÆ ºÉÉä¨ÉMÉÖhɦÉÚʪɹ]õ¨É - b÷±½þhÉ) ºÉÖÉÞiÉ ÉÉ®úÒ®ú 3/3♦ SÉ®úiÉÉä Ê´É·É°ü{ɺªÉ °ü{Épù´ªÉÆ ªÉnÖùSªÉiÉä ¤É½þ±ÉÆ ¨ÉvÉÖ®Æú κxÉMvɨÉÊ´É»ÉÆ MÉÖ¯û Ê{ÉÎSUô±É¨É ÉÖC±ÉÆ ¤É½Öþ SÉ ªÉSUÖôGÆò ¤É±É´ÉkÉnùºÉÆɪÉÆ- SÉ®úEò ÊSÉÊEòiºÉ 2/4/49♦ ÉÖGÆò ÉÖC±ÉÆ MÉÖ¯ûκxÉMvÉÆ ¤É½Öþ±ÉÆ ¤É½Öþ, PÉÞiɨÉÉÊIÉEòiÉè±ÉɦÉÆ ºÉnÂùMɦÉÉÇªÉ - +¹]õÉÆMÉ ¾þnùªÉ¨É ÉÉ®úÒ®ú 1/18

Sukra as a VegaED04♦ Sukra in one of the 13 non suppressible natural urges♦ If Sukra vega is controlled or suppressed following arewitnessed.1. Pain and oedema in the genital organs2. Uncontrolled excretion of semen3. Distress in the chest4. Fever5. Fatigue and pain all over the body6. Retention of the urine (Sukrashmari)♦ According to Charaka – the man may gradually become impotent apart from the conditiongenerated from the excessive sexual indulgence produced Dhatu kshaya, which eventuallylead to “Yakshma”.♦ ¨ÉäfÅäø ´ÉÞ¹ÉhɪÉÉäÉÚ±ÉÆ +ÆMɨÉnùÉæ ¾þÊnù´ªÉvÉÉ ¦É´Éäi|ÉÊiɽþiÉä ÉÖGäò Ê´É´ÉqÆù ¨ÉÚjɨÉä´ÉSÉ - - SÉ.ºÉÚ. 7/10♦ ÉÖGòÉkÉi»É´ÉhÉÆ MÉÖÁ´ÉänùxÉÉ º´ÉªÉvÉÖV´ÉÇ®ú: ¾þnÂù´ªÉlÉɨÉÚjÉ ºÉÆMÉÉÆMɦÉÆMÉ ´ÉÞnÂùt¨É¹ÉÆb÷iÉÉ: - +.¾þ.ºÉÚ. 4/20♦ ÉÖGòºªÉ nùÉä¹ÉÉiÉ C±É褪ɨɽþ¹ÉÇhɨÉ - SÉ.ºÉÚ. 28/27♦ ®úÉäÊMÉhÉÉÆ C±ÉҤɨɱ{ÉɪÉÖÆ Ê´É°ü{ÉÆ ´ÉÉ |ÉVÉɪÉiÉä xÉ´ÉÉ ºÉÆVÉɪÉiÉä MɦÉÇ: {ÉiÉÊiÉ, |ɻɴÉiªÉÊ{É ÉÖGÆòʽþ nÖù¹]Æõ ºÉÉ{ÉiªÉÆ ºÉnùÉ®úÉÆ ¤ÉÉvÉiÉäxÉ®ú¨É - SÉ.ºÉÚ. 28/27The physiology of sexual intercourse• Sexual intercourse, also known as coitus or copulation, introduces semen into the femalereproductive tract. We shall now consider the process as it affects the reproductive systemsof males and females.• Sex is a harmonious act of two genders with a proper understanding and desire• Sex melts the Male and Female to get in to the action of generating the best of the bestnatures miraculous act of generating the new generations - offspring• Sex doesn’t come easy, it depends upon health and it is not just intercourse, itis all about pleasure.• Sex is achieved by keeping fit, eating well, having a good relationship,proper communication, fine stimulus, proper arousal, perfect erection,good orgasm and timely ejaculation.• The sex act friction generates the flame of Orgasm & the ego burns in inferno

• Apart from all other reasons erection plays an important role.The saga of sex … LAPS with Astanga- MaidhunaED05• Sex starts from the womb by fondling the genitalia• Knowing the sexual anatomy at the adolescence,interest generates to explore• Generating the gender-maps (developmentalrepresentation - gender identity) and Love-maps(idealized Love & Lover - Affair - Program - Sexoeroticactivity projected either imaginary or actual)• Leads to either harmonious matrimonial life or to get into a courtesan (sex worker)• Sukra dhatu, which is, present all over the body with itsderangement either in quality or quantity not only leads to defective fertilization but also tothe mal formation of the foetus.• Mutative age of Sex act – as a child Sukra is subtle like the flavor of a bud. Reproductivecapacity is expressed by the presence of the semen. At old age as natural degenerationtakes place the man loses his sexual urge. Thus the sex act for child under 16 years and oldaged of 70 years are prohibited.• Astanga-Maidhuna - eight Sexes – actsooooooooSmarana - remembering LoverKeertana - singing for / with loverKreeda - conjugal play with loverPrekshanam - dancing with loverGuhyabhashanam - secret seductive talkSankalpa - psycho sex act initiationAdhyavasaya - developing enthusiasm inKriya nivrutti - submissive withdrawal• ªÉlÉɤÉÒVɨÉEòɱÉɨ¤ÉÖ EÞòʨÉEòÒ]õÉÎMxÉnÚùʹÉiɨÉÂ. xÉ Ê´É®úÉä½þÊiÉ ºÉÆnÖù¹]ÆõiÉlÉÉ ÉÖGÆò É®úÒÊ®úhÉɨÉ - SÉ®úEò ÊSÉÊEòiºÉ 30/133• ªÉlÉÉ ¨ÉÖEÖò±É{ÉÖ¹{ɺªÉ ºÉÖMÉÆvÉÉä xÉÉä{ɱɦªÉiÉä ±É¦ªÉiÉä. iÉÊuùEòÉÉÉkÉÖiÉlÉÉ ÉÖGÆò ʽþ näùʽþxÉɨÉÂ.. xÉiÉæ´Éè ¹ÉÉäb÷ÉÉuù¹ÉÉÇiºÉ{iÉiªÉÉ: |ÉiÉÉä xÉSÉ. +ɪÉÖ¹EòÉ+Éä xÉ®ú: ºjÉÒʦÉ: ºÉƪÉÉäMÉÆ EòiÉÖǨɽÇþiÉä.. SÉ®ú EòÊSÉÊEòiºÉ 2-4-39-40

Ejaculation♦ Ejaculation is associated with intensely pleasurable sensations, anexperience known as male orgasm.♦ Several other noteworthy physiological changes occur at this time,including pronounced but temporary increases in heart rate andblood pressure.ED06♦ After ejaculation has been completed, blood begins to leave theErectile tissue, and the erection begins to subside. This subsidence,called detumescence, (The loss of a penile erection) is mediated bythe sympathetic nervous system.♦ Higher centers, including the cerebral cortex, can facilitate or inhibitmany of the important reflexes, thereby modifying the patterns ofsexual function.♦ In summary, arousal, erection, emission, and ejaculation are controlled by a complexinterplay between the sympathetic and parasympathetic divisions of the ANS.Eight ejaculatory factors♦ The most important factor that produces ejaculation of the semen, which is spread all overthe body, is the sexual intercourse. There are eight factors, which initiates the semenejaculation other than that of intercourse. They are -1. Pleasure with intention2. Desire3. Unsuitability of the semen4. Sliminess of the semen5. Heaviness of the semen6. Capacity to pass through the srotas (Anutwa)7. Inherent quality to move out of the body8. Stimulation by Vata♦ Any physical or psychological factor that affects a singlecomponent of the system can result in male sexual dysfunction, also called impotence (Theinability to obtain or maintain an erection) i.e. Klaibya.♦ ºÉ´ÉÇjÉÉxÉÖMÉiÉÆ näù½äþ ÉÖGÆò ºÉƺ{ÉÉÇxÉä iÉlÉÉ. iÉiÉ ºjÉÒ{ÉÖ¯û¹ÉºÉƪÉÉäMÉä SÉä¹]õɺÉÆEò±{É{ÉÒb÷xÉÉiÉÂ. ÉÖGÆò |ÉSªÉ´ÉiÉä ºlÉÉxÉÉVVɱɨÉÉpùÉÇi{É]õÉÊnù´É.. ½þ¹ÉÉÇkɹÉÉÇiºÉ®úi´ÉÉSSÉ {ÉèÎSUô±ªÉÉnÂùMÉÉè®ú´ÉÉnùÊ{É. +hÉÖ|É´ÉhɦÉÉ´ÉÉSSÉpÖùiÉi´ÉÉx¨ÉɯûiɺªÉSÉ. +¹]õɦªÉÉä B¦ªÉÉä ½äþiÉÖ¦ªÉ: ÉÖGÆò näù½þÉiÉ |ÉʺÉSªÉiÉä. SÉ®úEò ÊSÉÊEòiºÉ 2-4/46-48

ED07Premature ejaculation♦ Ejaculation is commonly called premature if a manclimaxes and releases his semen before or within afew minutes after entering his partner's vagina andbefore his partner has an orgasm.♦ Premature ejaculation is a problem only if it prevents acouple from having sexual experiences that aresatisfying for both partners.♦ The human experience of orgasm is a complexinterplay of psychological, physical, and physiologicalfactors.♦ To control the timing of ejaculation a man must learnto exercise some control over these factors.Premature ejaculation is rarely caused by a medicalcondition.♦ Premature ejaculation can occur when a man has nothad sexual intercourse for a long period of time. Other situations in which there is unusuallyheightened sexual arousal and excitement may also promote early ejaculation.♦ Premature ejaculation may happen in a new relationship because the partners have not yetlearned each other's stimulation needs for arousal and orgasm.Gender-map and Love-maps.♦ Ones stimulus, arousal, erection, orgasm and ejaculationdepend upon gender-maps and love-maps. Prof. Dr. JohnMoney of Baltimore, USA, defines the Gender-map and Lovemaps.♦ The Gender-map is defined as a developmentalrepresentation or template synchronously in the mind andbrain depicting the details of one's gender/ identity role.♦ Where as Love-map is depicting the idealized lover, theidealized love affair and the idealized program of sexo-eroticactivity projected in imagery or actually doing sex with lover.

Male Sexual Function♦ Complex neural reflexes that we do not yet understandcompletely coordinate sexual function in males. Thereflex pathways utilize the sympathetic andparasympathetic divisions of the ANS.♦ During arousal, erotic thoughts, the stimulation ofsensory nerves in the genital region, or both leads to anincrease in the parasympathetic outflow over the pelvicnerves, which leads to erection of the penis.♦ The integument covering the glans of the penis containsnumerous sensory receptors, and erection tenses theskin and increases their sensitivity.♦ Subsequent stimulation may initiate the secretion of the bulbourethral glands, lubricating thepenile urethra and the surface of the glans.♦ During intercourse, the sensory receptors of the penis are rhythmically stimulated. Thisstimulation eventually results in the coordinated processes of emission and ejaculation.♦ Emission occurs under sympathetic stimulation. The process begins when the peristalticcontractions of the ampulla push fluid and spermatozoa into the prostatic urethra.♦ The seminal vesicles then begin contracting, and the contractions increase in force andduration over the next few seconds.♦ Peristaltic contractions also appear in the walls of the prostate gland. The combinationmoves the seminal mixture into the membranous and penile portions of the urethra.♦ While the contractions are proceeding, sympathetic commands also cause the contraction ofthe urinary bladder and the internal urethral sphincter. The combination of elevated pressureinside the bladder and the contraction of this sphincter effectively prevent the passage ofsemen into the bladder.♦ Ejaculation occurs as powerful, rhythmic contractions appear in the ischiocavernosus andbulbospongiosus muscles, two superficial skeletal muscles of the pelvic floor. Theischiocavernosus muscles insert along the sides of the penis; their contractions serveprimarily to stiffen that organ.♦ The bulbospongiosus muscle wraps around the base of the penis, and its contractionpushes semen toward the external urethral opening. These contractions are controlled bysomatic motor neurons in the lower lumbar and upper sacral segments of the spinal cord.ED08

Hormones of the Reproductive SystemED09Hormone Source Regulation of Secretion Primary EffectsMales: inhibited bytestosterone andHypothalamuspossibly by inhibinStimulates FSH secretion, LHFemales: GnRH pulsesynthesisfrequency increased byestrogens, decreasedby progestinsGonadotropinreleasinghormone(GnRH)Folliclestimulatinghormone (FSH)Luteinizinghormone (LH)Androgens(primarilytestosteroneanddihydrotestosterone)Estrogens(primarilyestradiol)Progestins(primarilyprogesterone)InhibinAnteriorpituitaryAnteriorpituitaryInterstitial cellsof testesGranulosa andthecal cells ofdevelopingfollicles; corpusluteumGranulosa cellsfrom mid-cyclethroughfunctional life ofcorpus luteumSustentacularcells of testesand granulosacells of ovariesMales: stimulated byGnRH, inhibited byinhibin Females:stimulated by GnRH,inhibited by inhibinMales: stimulated byGnRH Females:production stimulatedby GnRH, secretion bythe combination of highGnRH pulsefrequencies and highestrogen levelsStimulated by LHStimulated by FSHStimulated by LHStimulated by factorsreleased by developingsperm (male) anddeveloping follicles(female)Males: stimulatesspermatogenesis andspermiogenesis through effectson sustentacular cells Females:stimulates follicle development,estrogen production, and oocytematurationMales: stimulates interstitial cellsto secrete testosterone Females:stimulates ovulation, formation ofcorpus luteum, and progestinsecretionEstablish and maintain secondarysex characteristics and sexualbehavior; promote maturation ofspermatozoa; inhibit GnRHsecretionStimulate LH secretion (at highlevels); establish and maintainsecondary sex characteristics andsexual behavior; stimulate repairand growth of endometrium;increase frequency of GnRHpulsesStimulate endometrial growth andglandular secretion;reducefrequency of GnRH pulsesInhibits secretion of FSH (andpossibly of GnRH)

ED10Importance of Women♦ Women are the “Kshetra” for the progeny. (Ch.Chi.2-1-4)♦ Woman is the platform and media for sex and considered alwayspotent in sexual activity but she plays passive role in sex, henceVajikarana is not mandatory for woman.♦ Women with female physique where they are stationed collectively (themultitude sense objects is only in the female body not anywhere else),beautiful, youthful, endowed with auspicious features, submissive andtrained is regarded as the bets aphrodisiac.♦ The women who is being excellent in terms of age, beauty, voice similarpsyche, similar mind, submissive, pleases with partners liking and amorousmovements enters in to heart quickly to fortune and by look it self exhilaratesthe man and arouses the impulse of sexual urge, such women is the bestaphrodisiac. . (Ch.Chi.2-1/8-10)♦ Due to the diversity in liking of the people and fortune of women, the qualities like goodappearance etc. get enhanced on finding a suitable man.♦ ´ÉÉVÉÒEò®úhɨÉOªÉÆ SÉ IÉäjÉÆ ºjÉÒ ªÉÉ |ɽþ̹ÉhÉÒ -

ED11Synonyms of impotency♦ Ayurveda has clearly explained the situation of inactivity of the male in sex act. It has givendifferent words as synonyms to Impotency are -1. Napumsaka - neither female or male2. Kleeba - unable do the sex act and produce offspringÊ´ÉOɽþ{ÉÖι]õ xÉè´ÉätxÉι]õ3. Shanda (both sex) - Hermaphrodite4. Vandhya (both sex) - non-conceived male or female5. Triteeya prakriti - third gender6. Stapatya - who doesn't have "staman" (strength)7. Stapathi - who can not achieve Orgasm (Staputa = ups and downs)8. Kanchuka - male desires to wear ladies garments9. Varshavara - who develops over-hydrosis by thinking sex act (over sweating)10. Sama - equal; neither male or female character dominanceEtiological evaluation of impotency♦ Napumsakata or impotence is going to be bestowed in a child through genetic defect asqualitative or quantitative depletion of semen of father and irregularity in sex postures andpsyche attached to another male or any pyogenic conditions in vagina of mother.♦ Apart from above said causes few dietetic, psychic, exorcists, excessive indulgence in sexact, dhatukshaya, doshavaishamata, sephadosha, etc., causes are also mentioned asetiology of impotency.♦ We want sex badly enough but just can't be bothered. In this age lack of time and energymade sex difficult, once a day or part night (Paksha Shanda). We began to compromise onour sex life and on our relationships. Sex doesn’t come easy, it depends on health and it isnot just intercourse, it is all about pleasure.Classification of Klaibya – (Charaka)♦ Four fold Impotency (Charaka): Charaka classify Klaibya by origin as –1. Beja dosha – due to the defective Pumbeeja (semen)2. Dhwajopaghta – due to the injury to the genital organs3. Jara – due to the old age4. Sukra kshaya – due to the deficiency of semenquantity (Stula Sukra)

ED12Classification of Klaibya – Susruta♦ Six fold Impotency (Susruta) (Su.Chi.26/7-12)1. Manasika or psychological – due to the bitter thoughts / recollection or a forcedintercourse with a disagreeable women who fails to sufficiently rouse up the sexual desire2. Aharaja – due to the excessive intake of Katu, Amla, Lavana rasa and Ushna veeryadravya, which leads to loss of semen3. Ativyavayaja – due to addiction to excessive sexual pleasure with out using aphrodisiacs4. Abhighataja – due to chronic disease of the genitalia (syphilis, gonorrhea, AIDS) ordestruction of a local marma by injury5. Sahaja – (congenital) due to beeja dosha of either mother or father6. Vegavarodhaja – due to voluntary suppression of natural urge – sex desire♦ ¤ÉÒVÉv´ÉVÉÉä{ÉPÉÉiÉɦªÉÉÆ VÉ®úªÉÉ ÉÖGò ºÉÆIɪÉÉiÉ C±É褪ÉÆ ºÉÆ{ÉtiÉä iɺªÉ ÉÞhÉÖ ºÉɨÉÉxªÉ ±ÉIÉhɨÉ - SÉ ÊSÉ 30/154Symptoms of Klaibya – Impotency♦ A person is considered impotent in any one or all of the following symptoms are noted.1) Inability to indulge in sexual act, ever if he desires to with a women who is capable ofrousing his desire2) Dyspnoea and excessive perspiration and fatigue after the act3) Ineffective stimulation of the genitals with complete lack of semen♦ According to Vagbhata –1. Premature ejaculation2. Pelvic Pain (testis, penis, anus)3. Swelling in the lower part of body (testis, penis, anus)4. Fever5. Chest pain6. Obstructive urination7. Testicular swellings8. Urolithiasis (kidney, urethra)9. Shandata – Klaibya♦ ºÉÆEò±{É |É´ÉhÉÉä ÊxÉiªÉ¨É Ê|ɪÉÉÆ ´ÉªÉɺÉÉÊ{É ÎºjɪɨÉ - xɪÉÉÊiÉ Ë±ÉMÉÉèÊlɱªÉÉiEònùÉÊSÉtÉÊiÉ ´ÉɪÉÊnù - ·ÉɺÉÉiÉÇκº´ÉzÉ MÉÉjÉSÉ ¨ÉÉäPÉ ºÉÆEò±{É SÉäι]õiÉ: - ¨±ÉÉxÉ ÊÉxÉSÉÊxɦÉÔVɺºªÉÉnäùiÉi±Eèò¤ªÉ ±ÉIÉhɨÉ - SÉ®úEò ÊSÉÊEòiºÉ 30/155-156♦ ÉÖGòÉkÉi»É´ÉhÉÆ MÉÖÁ´ÉänùxÉɺ´ÉªÉvÉÖV´ÉÇ®ú: ¾þnÂù´ªÉlÉɨÉÚjɺÉÆMÉÉÆMɦÉÆMÉ ´ÉÞnÂùvªÉ¨É¹ÉÆb÷iÉÉ: - +¹]õÉÆMÉ ¾þnùªÉ¨É ºÉÚjÉ 4/20

Sukra & Sukra vaha srotas in KlaibyaED13♦ The Sukra or semen (the complete testicular secretions i.e., Semen + Androgens) hassynonyms of Retas, Beejam, Varam, Veeryam, Harshajam, Snehu, Powrusham, Suklamand Pradhana dhatu.♦ The Sukra flows in sukravaha srotas, which are spread all over the body. Shukra is the thingbelonging to man, product of 4 proto-elements (Ap, Agni, Pruthvi and Vayu), composed ofall six tastes, when deposited in the womb of a woman brings about conception (Cha.Sa2/3)♦ Retas, the ejaculate (Rupadravya) comes out during intense coital pleasure. (Ca. Ci.2/4/48-50, Su. Sa. 2/11). Praharsha (Excitement, Erotic), Dhairya (daring activeness), Priti(Love), Cyavana (to come out), Bala (Energy) and Garbhotpatti (Fertilization) are thefunctions of Sukra related to sexuality (A.H.Su. 1 1/4, Su. Su. 15/5, Ca. Ci. 15/6).♦ Any defect in Shukra thus leads to infertility and sexual dysfunction (Ca. Ci. 30/153, Ca. Ci.30/139-144, Su. Sa. 2/3). Therefore in man Sukra is responsible for all-reproductivephenomena and relative psycho-sexo-neuro-endrocrinal dysfunction too (A.S.U. 50/7).♦ When these are at failure two types of Impotency develops.1) Sukra vaha sroto dusti with sukra dusti, where erection is possible but unable toproduce offspring.2) Erection is not possible because of local lesion in penis or retovaha sira/srotas.The causes of Sukra vaha srotas dusti are – (cha.chi.30/135-138)1. Indulging in the several sex act at a time when the person is nor roused with desire2. Indulging in sex act with animals3. Withholding the sexual indulgence4. Excessive sexual indulgence5. Injury due to the instruments, Kshara and Agni kriya6. Ahara – Asatmaya and non computable7. Vihara – masturbation, excess sex actsEight defects of semen (cha.chi.30/139)1. Phenila5. Pooti2. Tanu6. Pichchila3. Rooksha7. Anya dhatu samslishtata4. Vivarna8. Avasadi

ED14Klaibya reemphasized as NapumsakaSHANDA: - (Nara/nari Shanda) A child born of an act of fecundation foolishly or ignorantlyeffected during the menaces of its mother by its progenitor by holding her on his bosom duringthe act is called a Shanda and invariably exhibits effeminate traits in his character. A daughterborn of a woman riding on her husband during the act of sexual intercourse will developmasculine traits in her character. Here Klinefelter's and Turner syndrome are applicable, whichare said to be the beeja dosha or chromosomal anomalies.ASEKYA: - A child born of scanty paternal sperm becomesan Asekya and feels no sex desire with out previouslydrinking the semen of another man.SOUGANDHIKA: - A child begotten in a sordid vagina iscalled a Sougandhika, whose organ does not respond tothe sexual desire without smelling the genitals of others.KUMBHIKA: - The man who first becomes a passivemember of an act of sodomy and able to act as man withgood erection is called as Kumbhika.IRSHAYAKA: - The man who can not copulate with awomen without previously seeing the sexual intercourse ofanother is called as Irshaka (Voyeurism).KLEEBA: - Kleeba is defined as a person with ED undervarious etiological factors.Napumsaka (Klaibya) reclassifiedNapumsaka are classified as under.1. Asukra Napumsakai) Beeja dowrbalya or beeja doshaa) sukra dosha - nara shanda ; Klinefelter's syndromeb) artava dosha - nari shanda ; Turner syndromeii) Garbha dosha - pseudohermaphroditismiii) sukra dhatu vaha sroto doshaiv) Retovaha sira dosha or soshav) retovaha sroto dosha

ED152. Sasukra NapumsakaA) Sukra and Sukravaha sroto dustii) Impotency - unable to produce offspringAzospermiaOligospermiaDefective morphology of semenii) 8 varietiesVata, pitta, kapha,Kunapa gandhi, Grandhi, KsheenaPootipooya, Mutrapureesha gandhiB) Retovaha (Seminal duct) sroto and sira dustii) temporary ED or emotional EDii) Semi permanent ED or kleebaBeejopaghata - non production of semen leading to EDOrganic - Heart problemsMetabolic - DiabetisJara - geriatric EDLoss of vigourloss of strengthSukra kshaya - loss of semen leading to EDDwaja bhanga - EDKrimija - infective EDPootigandha - Fungal Infections leading to EDViseerya mani - wound at glansViseerya medhra - injury to shaftViseerya mushka - wound at testisiii) Paraphilic ED or napumsakaAsekya - Mukha yoni - Erection after Swallow of semenSougandhika - Nasa yoni - Erection after smellingothers geneteliaKumbheeka - catamite; Erection after anal penetrationErshayaka - Drig yoni - Erection after Voyerism

Classification of sexual disordersED16The following people are said to be suffering from 'Sexual Disorders'♦ Those individuals who are unable to participate in a sexual relationship and carry out thesexual activity to their and their partners' satisfaction♦ Those who lack interest in the heterosexual act and fail to have normal psycho-physiologicalresponses necessary for sexual interaction♦ Fail to experience orgasm♦ These disorders are:1) Sexual dysfunction:a) Lack or loss of sexual desire – In women it is known as 'Frigidity'.b) Sexual aversion and lack of sexual enjoymentc) Failure of genital response;In men: Erectile dysfunction difficulty in developing and maintaining an erectionrequired for coitusIn female: Vaginal dryness.d) Orgasmic Dysfunctione) Premature ejaculation: Inability tocontrol ejaculation.f) Vaginismus: Spasm of the musclessurrounding the vagina leading to difficultyin the coitus.g) Dyspareunia: Pain during sexualintercourseh) Excessive Sexual desire2) Gender identity disordersa) Trans-sexualism: Desire to live and beaccepted as a member of opposite sex.They ask for 'Sex change operation'.b) Transvestism: Wearing of clothes of opposite sex and enjoy being the member of oppositesex for short periods.

IV. Dhat Syndrome (Culture Bound Syndrome)♦ Dhat Syndrome is specific to Indian subcontinent.3) Disorders of sexual preference:a) Fetishism: Getting sexual arousal and satisfactionwith articles like clothes, shoes of the opposite sex.b) Exhibitionism: Exposing genitalia to the membersof opposite sex and getting sexual satisfaction.c) Voyeurism: Getting sexual satisfaction by lookingat people engaging in sexual act.d) Paedophilia: Sexual preference for childrene) Sadomasochism: Sexual preference for inflictionof pain during sexual activity.f) Homosexuality: Preference for member of thesame sex for sexual activity and gratification.♦ As people wrongly believe that masturbation is bad and leads to sexual weakness, loss ofsemen leads to sexual weakness as well as sterility;♦ They start worrying about masturbation and semen loss.♦ They develop multiple somatic complaints like general weakness, easy fatigability,decreased concentration, memory, black rings around the eyes, loss of hairs or graying ofhairs, premature ejaculation, Erectile dysfunction, fear of being sterile and attribute thesesymptoms to -1. Masturbation2. Nocturnal emission3. Sexual fantasies4. Passing semen in urine5. Frequent sexual intercourseThey have to be reassured and educated to removethese beliefs.ED17

ED18INTERVENTION OF AGNI IN IMPOTENCY♦ Dhatwagni influences two types of Dhatwagnipaka, prasada and kitta where transformationof nourishing material and waste products takes place respectively.♦ The specific functions of dhatwagni are synthesis of particular dhatu and continuousreplenishment by nutrients.♦ The main dhatwagni vyapara of Sukra is stated by some Acharyas as production of Ojasand Vagbhata considers it as mala of Sukra.♦ Function of Sukra is said as reproduction. It not only means perpetuating the progeny butalso cell division in the body.♦ The stula sukra (semen) and Sukradhatu are different entities. Sukra gata Kusta, where♦Sukradhatu and sukragni are involved in pathogenesis influences the repair and healingprocess or a loss of regeneration, and more over it carries to the offspring.A non-regenerative cell media leads to an individual depressed and physically week bodystates, resulting into a temporary or permanent Impotency.The Male Climacteric in Aging♦ Changes in the male reproductive system occur more gradually than do those in the femalereproductive system. The period of change is known as the male climacteric (The agerelatedcessation of gametogenesis in males due to reduced sex hormone production).♦ Levels of circulating testosterone begin to decline between ages 50 and 60, and levels ofcirculating FSH and LH increase.♦ Although sperm production continues (men well in to their eighties can father children), thereis a gradual reduction in sexual activity in older men.♦ This decrease may be linked to declining testosterone levels (Sukradhatu in the body). Some clinicians are now tentatively suggesting theuse of testosterone replacement therapy to enhance libido (sexual drive)in elderly men.♦ The inability to contract the ischiocavernosus and bulbospongiosusmuscles would interfere with a male's ability to ejaculate and to experienceorgasm.♦ As the result of parasympathetic stimulation in females during sexualarousal, there is engorgement of the Erectile tissues of the clitoris, increasedsecretion of cervical and vaginal glands, increased blood flow to the walls ofthe vagina, and engorgement of the blood vessels in the nipples.

Physiology of erection -The penis and Erectile functionED19♦ The penis is composed of the corpus cavernosum, two parallel spongy columns of Erectiletissue, and the corpus spongiosum♦ Erectile tissue is rich in tiny pool-shaped blood vessels (cavernous sinuses), surrounded bysmooth muscles and supported by elastic fibrous tissue composed of collagen.♦ In the flaccid, or un-erect, state of the normal penis, the small arteries leading to thecavernous sinuses contract, reducing the in flow of blood.♦ The smooth muscles of the many tiny blood vessels within the penis are also contracted,and the blood they contain leaks out of the surrounding spongy tissue, when a manbecomes aroused, his central nervous system stimulates the release of a number ofchemicals, including acetylcholine and nitric oxide, that relax the smooth muscles in thepenis, allowing blood to flow into the tiny pool-like sinuses and flood the penis.♦ The spongy chambers almost double in diameter due to the increase in blood flow.♦ The veins surrounding the corpus cavernosum and corpus spongiosum are squeezedalmost completely shut by the pressure of the Erectile tissue♦ They are unable to drain blood, causing the penis to become rigid.♦ Oxygen-rich blood is critical for Erectile health.♦ Oxygen itself affects two substances that are important in achieving erection; it suppressestransforming growth factor beta I(TGF-BI) and enhances prostaglandin E1.♦ The smooth muscles produce TGF-B1, a component of the immune system, its role is toproduce collagen.♦ Collagen contributes not only to structural tissue in thebody but is also the material that comprises scar tissue.♦ Prostagladin E1 is produced during erection by the musclecells in the penis; it activates and enzyme that results incalcium release by the smooth muscle cells, which in turn,relaxes them and allows blood flow.♦ Prostaglandin E1 also suppresses collagen production.Oxygen levels vary widely from reduced levels in theflaccid state very high in the erect state.♦ During sleep, for instance, oxygen levels are high and aman can normally have three to five erections per night,each one lasting from 20 to 40 minutes.

ED20Pathophysiology of Erectile dysfunction (impotence)♦ Impotence or Erectile dysfunction is the inability to achieve or maintainan erection sufficiently rigid for intercourse, ejaculation or both.♦ It does not affect sexual drive or the ability to have an orgasm.♦ Rarely does Erectile dysfunction signify a chronic problem.♦ When a consistent pattern of sexual dysfunction extends over aprolonged period of time.♦ However, a physical or serious emotional disorder may be indicated.Impotence is not new in the medical texts or in human experience.♦ It is not easily or openly discussed, however.♦ Our cultural expectations of male to sexuality have forced many men torefrain from seeking help for a disorder that can, in most cases, benefitfrom medical treatment.Mechanism of impotency♦ It is being observed the erection is under the Neurovascular control as emotional control,where chemicals are released and physically filling the vessels of penis and making hardwith proper erection.♦ So the neuro-vascular control in normal man stress when sexually aroused. The brainactivates and releases Nitric oxide in the spongy tissues. It activates the enzyme Guanylatecyclase that produces cyclic guanosina mono phosphase (cGMP).♦ The cGMP relaxes the spongy tissues and increases the blood flow to the penis.♦ The penis stiffens as the auteries and the spongy tissues dilate and squeeze the vein shunt.♦ It withstands till the venous drain leakage takes place. Otherwise erection flags whenanother enzyme called phospho diesterase type 5 (PDE5) neutralises the cGMP. Thespongy tissues compress and blood drains out through vein.♦ Usually anxiety or fear leads to the situational impotency. A temporary impotency mostlyachieved by verious leakage or any metabolic disorders such as stoulya (obesity). Out of thevarious groups of impotency beejadosha janya or sukra dhatu gata mapumsakata can notbe treated. We can make a prophylactic treatment for father and mother before conceptionthere by they want give birth to child of impotency. The other group, temporary impotencyare situational impotency can be treated best out of Ayurveda.

How Is Impotence Diagnosed? Medical and personal history♦ There are several tests available to assist physicians in diagnosing impotence and itscauses.♦ The first step is, of course, talking openly the patient must be as frank as possible in order toassist his physician in making a diagnosis.♦ In addition to reporting any past and present medical problems, the patient should reportany medications or drugs he is taking and any history of psychological problems, includingstress, anxiety, or depression.♦ The physician also requires a sexual history. This should include the nature of the onsetof the dysfunction, and the frequency, quality, and duration of- any erections, and whetherthey occur at night or in the morning.♦ The physician might also ask about the specific circumstances when Erectile dysfunctionoccurred, details of technique, the man's motivation for and expectations of treatment, andwhether problems exist in the current relationship.♦ The man should not interpret these questions as intrusive or too personal if he expects toobtain help; they are very relevant and important for determining the properapproach to the problem.♦ If appropriate, the physician might also interview the sexual partner.♦ Apart from this a Physician may use battery of tests, bothlaboratory and invasive along with a detailedexamination to diagnose impotence.ED21Management of ED (Klaibya- IMPOPENCY)♦ Impotency is of Neuro-vascular disorder, needs of counseling reassurance and correction.♦ The counseling includes taking information of situation and careful & perfect analysis♦ Second step is reassurance the patient and correcting the problem.♦ Venous leak correction or penile prosthesis, etc. treated with surgical interventions.♦ Erectile dysfunction due to metabolic disorders, emotional or attention deficit disorders(ADD) are considered specifically or minimal brain dysfunction also leads one to developImpotency.♦ Apanavata – Vyanavata – Sadhakapitta – Manas – axis leads to Sukra dusti & ED to beregulated along with general health maintenance

Medicinal classification used in EDED22♦ Many medicines are told for the ED, apart from surgical, instrumental and exercises♦ The non drug therapy are of psychological – out of the best is “A perfect Female”♦ Drug therapy includes –1. Sukra janaka – which increases the semen quantity to rouse the person – eg. Sukra jananavarga - Mudgaparni, Mashaparni, Shatavari, Jatamamsi, Karkata srungi, Dugdha, Masha,Amalaki, Bhallataka majja, etc,2. Sukrala or Sukra utpattikara – generates semen – Aswagandha, Sharkara, Musali, etc.3. Sukra pravartaka or Sukra rechaka – surges the semen – Bruhati, Kantakari, Bhallataki, etc.4. Sukra janaka pravartaka – increases the quality and quantity and surges semen well in time– Ksheera, Masha, Amalaki, etc.5. Sukra shodhaka – eliminates the seminal problems – Sukra shodhaka gana – Kusta,Elavaluka, Katphala, Samudra phena, Kadamba niryasa, Ikshu, Kandekshu, Ikshurakam,Vasuka, Usheera, Saireyaka, Gunja, etc.6. Sukra stambhaka – retards the ejaculation and enhances the longevity of intercourse –Jatiphala, Ahiphena, Udakeerya, Vatsanabhi, Koshamra, Poogeephala, Tinduka, Vakula,Babboola, Akarakarabha, etc.♦ Apart from these – we have many drugs which can act at their pharmacological propertieswith specific alkaloids present in them as – Vajeekara, Sukrala, Vrushya, Dhatu pustikara,Kamottejaka, etc. are – eg. Kapikacchu, Gokshura, Kakamachi (DM), Taalaphala,Mocharasa, Kumari (for female), Palasha, Kharjura, Kushmanda, Eranda, Sariba,Tamboola, Bakuchi, Latakasturi, Twaka, Shireesha, etc.♦ Our of Rasa dhatu – Swarna, Abhraka, Parada, Swarna makshika, Vajra bhasma, etc.♦ Vrushya varga – Madhura rasa, Snigdha Guru Guna, Brumhana, Jeevaneeya dravya andManollasakara vihara always useful to rectify EDSome Vajikarana Yoagas are used at EDAkarakarabhadi vati (Bh.Pr.Ut)Rativardhana Yoga (Bh.Pr.Ut)Bruhatchagalyadighruta (Bh.Rt.74/312-336) Shatavari Ghruta (Ch.chi.2-3/18)Brumhani Guti (Ch.chi.2-1/24-33)Vajikarana ghruta (Ch.chi.2-1/33-37)Kameswara modaka (Bh.Pr.Ut)Vanariguti (Bh.Pr.Ut)Mamsa Guti (Ch.chi.2-4/11-14)Vidaryadi churna (A.H. Ut.40/21-22)Narasimha choorna (Chakradatta)Vrushya Ghruta (Ch.chi.2-2/21-23)Poogapaaka (Bh.Pr.Ut)Vrushya Guti (Ch.chi.2-4/30-32)

Uttravasti in ED and orgasmic problems - ultimate management♦ Modern medicine has hardly any drugs or therapy to benefit patients with InhibitedSexual Desire (ISD)♦ Uttaravasti with vatahara and sukradoshahara dravyas either in the form of taila or kashayato be introduced per urethra at the quantity of 10 to 15 ml according to the procedure. Itrelieves the diseased state and normal equilibrated state is introduced in the body humorsand tissues.ED – Other Managements (Select patient either for Drug Therapy or Drugless)1. It is best to maintain general health to regulate under the stipulations of Dinacharya andRutucharya as a prophylactic measure.2. Erection frequenter technique – repeatedly exciting erection withdrawal technique3. Kegel Exercise – is simple used at urinary incontinence – inhibiting the urinary reflex andtightening and releasing pelvic muscles at least 10 –15 times at each episode4. Reducing causative medication - such as ACE inhibitors5. Psychotherapy and Behavioral therapy - it is a part of counseling and reassurance6. Injections – Alprostadil or Prostaglandin E1 urethral injections, Papvarine injections in tospongy tissue7. Oral Drug Therapy – Sildenafil – acts over PDE5, cGMP, effective with in 20 –30 minutes8. Other experimental oral drugs - Phentolamine, Apomorphine, Pentoxifylline (for richOxygen delivery), Naltrexone, etc.9. Hormone Replacements – Testosterone therapy10. Tropical medicine – Aerosol spray of Minoxidil, SS cream (Herbal), etc.11. Vacuum devices – plastic cylinder emptiness at penis creates more blood rush12. Penile implants – surgical procedures implants “Hydralic implant” or “Prosthesis” – a semirigid bendable rod resembles erect penis13. Vascular surgery – bypass or revascularisation with venous legation14. Folklore / Herbal medicines – Yohimbine, Ginkgo, Ginseng,15. Ayurvedic Aphrodisiacs - Patient medicines for ED or ISD from Ayurveda (I tried)Actiforte (Anuja)Afrol (Solumics)Amber Forte (Anuja)Confido (Himalaya)Desirex (Anuja)Himcolin (Himalaya)Mustong (TTK)Neo (Charak)Rathi (Capro)Senzine (J&J)Spy (Yogi)Tentex Forte (Himalaya)Vigorex (Zandu)Vimfix (Sandu)ED23

ConclusionsED241. Sex act is equal responsibility, sharing and inter personalcommunication of partners. Both of sex partners are equallyresponsible for the ED development2. Sex disturbances are common and need not be always a psychopathology3. Mother is responsible for genesis of impotency in child by her psyche,dietetics, behavioral or genetically intervention4. Growth (proper cell division) is directly proportional to Libido / sexarousal5. Apart from many symptoms nervousness, over sweating and pseudoanasarca are predominate symptoms of Erectile dysfunction6. The situational or temporary ED can be treated effectively with Vatahara, Sukra shodhaka modalities of management and any structuralimparities are well managed with surgical procedures7. Uttara vasti is a best shodhaka and also shamaka management in ED8. Vajikarana is a management told in samhita much times misinterpreted as Sexology, whichcan not be accepted9. Vajikarana is intended to facilitate potent offspring is a Male dominate and meant for Maleseither to relieve penile problems or to initiate sex even to get abundant semen for eneratingthe healthy successive generation other wise it is “Eugenics” I.e. improvement of thequalities of a race by control of inherited characteristics10. Vajikarana (Aphrodisiacs) is that which potentates a man to traffic in to women like a horseand also sustenance in the same mainly the animal relationship example are –♦ Chataka - (Sparrow) multiple short span conjugation with small amount of semen♦ Gaja - (Elephant) once in a while long time conjugation with abundant semen discharge♦ Vrusha - (Buffalo) regular stable seasonal conjugation with more quantity sperm (Semen)♦ Ashwa - (Horse) regular forceful dynamic conjugation with less qualitative semen♦ Vajikarana is Long lasting since the descend of Ayurveda it needs initial purification of thebody cleansing through “Panchakarma Shodhana” “Temptations” towards female and thereby a chemical reaction occurs in the body through the buffered “Vajikarana Dravya” theprobable action is a - psycho-neuro-motor activity enhances the blood flow to the Malegenitalia, so it erects and ejaculates well to produce a child

♦ Sexology is ... A science which is based on mutual consent, gratification, seduction andconjugal satisfaction of either gender where birth of child is not essential♦ Sex is other wise a materialistic pleasure of either gender, some times it is of the samegender initiated by PDE5, cGMP & NO and lacks of it gives rise to ED♦ A patient of ED or Perfect Sex of an individual is assessed by –1. MSP - my sexual persona,2. GRISS - Golombok-Rust Inventory of sexual satisfaction3. GRIMS - Golombok-Rust Inventory of Marital state4. HARDS (HAR) - Hospital A&D score & Stress score5. Libido score6. Frequency of NPT7. Penile Erection score8. Penile Rigidity score9. Semen Ejaculation score10. Orgasm score11. Androgen deficiency score♦ Woman is the platform and media for sex and considered always potent in sexual activitybut she plays passive role in sex, hence Vajikarana is not mandatory for woman is astatement of ancient.♦ Not only Vaginismus, Dyspareunia, Sexual fantasies, masturbation and Prematureejaculation and/or orgasm problems are becoming common in female.♦ At present many occasions it is found and researches are going on with the “Female sexualdysfunction” and Female ED.ED25Next topic of interest is “Female sexual dysfunction”From the Desk of Dr. K. Shiva Rama Prasad, M.D.(KC), C.O.P. (German) M.A, Ph.D (Jyo)