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Premature Ejaculation
General description:

Premature ejaculation (PE) means 'coming too quickly' is also known as early discharge or quick discharge , early fall, Shighra-patan, rapid ejaculation, rapid climax, premature climax, or early ejaculation) affects 25%-40% of the men.

Premature ejaculation is also defined as the occurrence of ejaculation prior to the wishes of both sexual partners.

Premature ejaculation is one of the most frequent, of sexual disorders in the male and is characterized by sudden ejaculation of the semen, just prior to or immediately after vaginal penetration during intercourse (before one wishes or before he could satisfy the female partner).

It's one of the commonest of all sexual problems. Recently, a survey done of several thousand males, shows that 50 per cent of them 'often' or 'sometimes' had this trouble.

It's commoner in younger men. Men generally get better control as they grow older.

However, various surveys showed that many middle-aged men still have this problem.

This problem makes people unhappy and frustrated and in severe cases PE can threaten or even ruin a marriage - simply because it spoils the sex lives of both partners. Sometimes, the condition is so bad that the man cannot even manage to have intercourse because he invariably ejaculates before he can get into the vagina.

This can be devastating for a man's self-confidence. And it can be hugely frustrating and annoying for his partner, too especially if she wants to get pregnant. One of the major contributor towards this problem is wrong or misadventerous sex practices during early days.

Anxiety too plays a part in many cases of PE. If you're nervous, you're likely to come too quickly. That's why many males have discovered for themselves that a small amount of alcohol eases their nerves and makes them less likely to climax prematurely. But alcohol is not recommend as a treatment !

An estimated 30%-70% of males experience premature ejaculation. The National Health and Social Life Survey (NHSLS) indicates Dr.Kumar’s edit PE 2 approximately 10% to 30% people of all age group suffer with quick semen discharge.

However, various surveys have shown that many men do not report premature ejaculation to their physician, possibly because of embarrassment or a feeling that no treatment is available for the problem.

Premature ejaculation may alter self-esteem, may cause marital dysfunction/divorce, and may be a factor in depression, with its obvious consequences.

This is a very frustrating disorders of male sexual function in which man feels totally helpless. This leads to bitterness in husbands & wife relationships. His pleasure is often decreased by the abrupt early discharge.

When a man is, ejaculating fast, the woman will probably be left unsatisfied. Her frustration will only increase the negative pattern.

As he concentrates on controlling his ejaculation, this concentration may begin to get in the way of maintaining the erection. This then can bring about the loss of erection. After some time this may even completely inhibit the erection from occurring. Often a problem that might begin with premature ejaculation gets joined to a problem of impotence, and then both issue have to be dealt with.

After a time the couple will begin to withdraw from each other, not wanting to enter an experience that is going to end up frustrating them. The man doubts his masculinity, and the wife later experiences a lessening of confidence in her, along with anger toward her partner.

To clarify, a male may reach climax after 8 / 10 minutes of sexual intercourse, but this is not premature ejaculation if his partner regularly climaxes in 5 minutes and both are satisfied with the timing.

Another male might delay his ejaculation for a maximum of 15 minutes, yet he may consider this premature if his partner, even with foreplay, requires 20 minutes of stimulation before reaching climax.

The organ systems directly affected by premature ejaculation include the male reproductive tract (i.e., penis, prostate, seminal vesicles, testicles, and their appendages), the portions of the central and peripheral nervous system controlling the male reproductive tract.

If the premature ejaculation occurs so early that it happens before commencement of sexual intercourse and the couple is attempting pregnancy, then pregnancy is impossible to achieve unless artificial insemination is used.

The genes of a male who ejaculates rapidly (but not so rapidly that ejaculation occurs before intromission) would be more likely to be passed on to succeeding generations.

Premature ejaculation is of two types:

Primary premature ejaculation :- Primary premature ejaculation applies to individuals who have had the condition since they became capable of functioning sexually.
Secondary premature ejaculation means that the condition began in an individual who previously experienced an acceptable level of ejaculatory control, and, for unknown reasons, he began experiencing premature ejaculation later in life.
If the patient has ED that began after the premature ejaculation, then treatment of both conditions may be required.

With regard to premature ejaculation, some type of performance anxiety is often a major factor. Performance pressure (ie, fear of failure to satisfy the partner) can arise from various events. ED is a common precipitating event. If the male is afraid his erection will not last, because of either actual instances of previous ED or imagined failure of his erection, this may precipitate premature ejaculation. The patient may have used the phrase, "Honey, you excited me so much I just could not hold back."

Science of mechanism of ejaculation:

The physical process of ejaculation requires two sequential actions: emission and expulsion.

The emission phase is the first phase. It involves deposition of seminal fluid from the ampullary vas deferens, seminal vesicles, and prostate gland into the posterior urethra. The second phase is the expulsion phase. It involves closure of bladder neck, followed by the rhythmic contractions of the urethra by pelvic-perineal and bulbospongiosus muscle, and intermittent relaxation of external urethral sphincters.

Sympathetic motor neurons control the emission phase of ejaculation reflex, and expulsion phase is executed by somatic and autonomic motor neurons. These motor neurons are located in the thoracolumbar and lumbosacral spinal cord.

Causes of Premature Ejaculation:

Premature ejaculation can be caused by physical or psychological factors. Sometimes, if a man becomes depressed he may experience this issue. Stopping premature ejaculation depends largely on determining why it is happening in the first place.

Thus premature ejaculation causes a man to focus more and more on his own sexual response pattern, thus getting away from the freedom and naturalness of allowing the response to occur by itself. As he concentrates on controlling his ejaculation, this concentration may begin to get in the way of maintaining the erection. This then can bring about the loss of erection. After some time this may even completely inhibit the erection from occurring. Often a problem that might begin with premature ejaculation gets joined to a problem of impotence, and then both issue have to be dealt with.

After a time the couple will begin to withdraw from each other, not wanting to enter an experience that is going to end up frustrating them. The man doubts his masculinity, and the wife later experiences a lessening of confidence in her, along with anger toward her partner.

Possible psychological and environmental factors:

There are number of possible causes of premature ejaculation.
(These causes are diagnosed by detailed history and a thorough physical check-up).

In addition to a general medical history, the history should include details about prior relationships in which premature ejaculation was not a problem.
Does he have an impotence problem? If he has erectile dysfunction (ED), did is begin after the premature ejaculation or before?
Is the patient experiencing premature ejaculation with self-stimulation or just with coitus?
What is the time required for the female partner to reach climax? Can she reach climax with intercourse, or does she require direct clitoral stimulation (oral or manual) to be able to climax?
Was premature ejaculation always a problem or did it start after an initial time frame when coitus was satisfactory to both partners?
1. Hormone disorder.
2. Urogenital Infections.
3. Neurogenic causes.
4. Increased penile sensitivity to touch.
5. Sex Centre disorder i.e. hyper excitability of sex centre.
6. Psychogenic i.e. psychiatric illness.

In following section we'll discuss these causes in detail:

1. Hormone disorder:
In recent studies it have been seen that many hormone disorder directly causes premature ejaculation. Additionally hormone disorder may cause other sexual dysfunction, which may secondarily cause early discharge. These hormones are important for normal control on your ejaculation. Testosterone is thought to play a role in the ejaculatory reflex. Higher testosterone (free and total) levels have been demonstrated in men with premature ejaculation than in men without premature ejaculation. Many men with premature ejaculation have been shown to have low serum levels of prolactin.

2. Urogenital Infections:
Any infection of urethra, prostate, epidididymis, seminal vesicle, Orchitis, epididimo-orchitis etc. Leads to irritability of sacro-coccigeal nerves, which govern the function of all these sex organs. This irritability leads to lowers threshold for ejaculation. Thus infections are one of the significant causes of early orgasm.

3. Neurogenic causes:
Among nervous system disorder, any disorder involving sex centre area in brain as multiple sclerosis, hyper-excitable focus or any organic lesion will lead to very fast semen discharge. Any lesion of conus medullaris of spinal cord leads to premature ejaculation.

4. Increased penile sensitivity to touch:
There is excess of certain neurotransmitters in the penile skin which makes it highly erogenous at time of sexual excitation leading to reaching peak of excitation & climax fast. In various studies it has been found that bulbo-cvernous reflex is hyperactive.

5. Sex Centre disorder:
There are certain conditions in which sex centre, which is situated in brain, becomes hyper excitable so that peak of orgasmic threshold reaches very quickly, which occurs due to various reasons. Sex centre is a part of brain, which is situated in hippocampal part of forebrain. It controls the time taken for orgasm i.e. ejaculatory discharge during sexual activity.

In early orgasm disorders the sex centre is extremely sensitive to sexual stimulation so that sex centre reaches peak of excitation within few moments after penetration in vagina so that the orgasmic threshold reaches within seconds of sexual intercourse or even before coitus.

Sex centre also controls the other component of sex cycle namely desire & erection. Thus beside premature ejaculation, patient may also suffer with low desire or erectile dysfunction.

6. Psychogenic:
Psychological factors commonly contribute to premature ejaculation. While men sometimes underestimate the relationship between sexual performance and emotional well-being, premature ejaculation can be caused by temporary depression, stress over financial matters, unrealistic expectations about performance, a history of sexual repression, or an overall lack of confidence, many psychiatric illnesses as anxiety, anxiety neurosis, schizophrenia, Performance Anxity leads to early climax.

Deficiency of neuro-transmitters as serotonin & others have been found to be one of the significant causes of early semen fall.

Research published in an andrology journal showed that semen from men with premature ejaculation contained significantly less acid phosphatase and alpha-glucosidase than did the semen of controls. These researchers concluded that these may reflect dysfunction of the prostate and epididymis, possibly contributing to premature ejaculation.

According to Dr. A. Kumar – who heads the Kayakalp International Sex & Health Clinic, Mumbai, India ---

I have found from my 23 years of experience that those males who have less sperm counts in their semen (like oligospernia & Azoospermia) suffers from premature ejaculation.

Diagnosis of Cause:

We take detail history:

Detailed general & systemic examination.
Investigation & Diagnostic tests.
Complete Male Hormone Profile tests.
Biochemistry tests.
Urine is tested for pus cells.
Scrotum, epididydmus, prostate is examined for infection.
Semen is examined for pus & semen culture sensitivity.
Ultrasonography of scrotum & prostate may be required.


Treatment may involve the clinician simply explaining why premature ejaculation occurs, assuring the person or couple that it is a normal part of the male sexual response, and providing techniques that may assist the man in learning to delay ejaculation.

Such techniques (Sex Therapy) may include :

1. The "stop and start" method:
This involves sexual stimulation until the man recognizes that he is about to ejaculate, the stimulation is then stopped for about thirty seconds and then may be resumed. The sequence is repeated until ejaculation is desired, the final time allowing the stimulation to continue until ejaculation occurs.

2. The "squeeze" method popularized by Masters & Johnson:
This involves sexual stimulation until the man recognizes that he is about to ejaculate, at that point, the man or his partner gently squeezes the end of the penis (where the glans meets the shaft) for several seconds whilst withholding further sexual stimulation for about 30 seconds, and then resuming stimulation. The sequence may be repeated by the person or couple until ejaculation is desired, the final time allowing the stimulation to continue until ejaculation occurs.

Stopping premature ejaculation is a major goal of any man who suffers from it. It can be one of the most embarrassing and frustrating sexual problems that a man can deal with, and there is a lot of advice out there about how to put it to an end. Men who find themselves grappling with this issue are likely to try practically anything to make it stop. Men may try many different techniques in order to stop premature ejaculation; they range from medication to therapy to specific methods in bed. Trying many different things is the best idea, though.

There are dozens of different hints and tips for stopping premature ejaculation; in some cases, sexual therapy is the best method. Other men find that the best way to stop premature ejaculation is by trying medication.

3. Kegel exercise:
First published in 1948 by Dr. Arnold Kegel, a pelvic floor exercise, more commonly called a Kegel exercise, consists of repeatedly contracting and relaxing the muscles that form part of the pelvic floor. Exercises are usually done to reduce premature ejaculatory occurrences in men, as well as to increase the size and intensity of erections.

The aim of Kegel exercises is to improve muscle tone by strengthening the pubococcygeus (PC) muscles of the pelvic floor.

Kegel exercises can help men achieve stronger erections, maintain healthy hips, and gain greater control over ejaculation.

PC muscles control the flow of semen and urine, the firmness of your penis during erection and the shooting power of your ejaculation. The great thing about Kegel exercises for men is that you can do them anywhere, anytime -- and nobody will know the difference.

You will be able to have better sex by being able to better control your orgasms and ejaculations, and last for longer.

4. Delay Creams And Gels:
One of the most common treatments for stopping premature ejaculation are topical creams, gels and other ointments. These products usually work to numb up a man's penis, making it less sensitive and prolonging sexual encounters and some men claim that they are the most effective means of stopping premature ejaculation. However, other men have little success with them. As mentioned previously, stopping premature ejaculation differs from man to man; trying out different kinds of creams and gels is just another way of trying to achieve success against this embarrassing problem.

5. Some men try to distract themselves by thinking non-sexual thoughts (such as naming baseball players and records) to avoid getting excited too fast.

In Korea and other areas of the Far East, SS cream (a combination of 9 ingredients, mainly herbal; SS stands for Super Secret) has been shown to desensitize the penis, decrease the vibratory threshold, and help men with premature ejaculation to significantly delay their ejaculatory response.

Unfortunately, SS Cream is not yet approved by the US Food and Drug Administration (FDA).

6. Using of Condoms:
Using one or two condom during intercourse also delay the ejaculation time, as the condom reduces the touch sensation.

Some therapists advise young men to masturbate (or have their partner stimulate them rapidly to climax) 1-2 hours before sexual relations are planned.

7. Oral Medicines:
After the finding out the cause of premature ejaculation. Various drugs to treat sex centre & other causes are prescribed along with sex therapy.

Hormone pills are given when hormone disorder are found.
Medicines to cure the urogenital infections when infection as the cause is confirmed.
In recent years, Doctors are trying to treat premature ejaculation with antidepressant drugs. That may seem a little odd, but the reason is that certain antidepressants are well known for the side-effect of delaying male climax. For most men, that side effect is unwanted. But for guys with premature ejaculation, it's quite desirable.
8. Surgical Care:
No recommended surgical treatment exists for premature ejaculation.

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Sexually Transmitted Diseases
General Discription

Sexually Transmitted Diseases (STDs) or Sexually Transmitted Infection (STI) or Venereal Disease (VD) are diseases that are mainly passed from one person to another (that is transmitted) during sex. There are at least 25 different sexually transmitted diseases (Like 1) Syphilis, 2) Gonorrhea, 3) Chancroid, 4) Genital Herpes, 5) HIV/AIDS, 6) Human Papillomavirus (HPV), 7) Lymphogranuloma Venereum (LGV), 8) Bacterial Vaginosis, 9) Chlamydia, 10) Trichomoniasis, 11) Hepatitis B & 12) Hepatitis C) with a range of different symptoms. These diseases may be spread through vaginal, anal and oral sex.

Most sexually transmitted diseases will only affect you if you have sexual contact with someone who has an STD. However there are some infections, for example scabies, which are referred to as STDs because they are most commonly transmitted sexually, but which can also be passed on in other ways.

With STDs And viruses spreading like wildfire across the world we must all take steps to protect ourselves. The estimated total number of people living in the US with STD is over 65 million. There are literally millions of new STD cases each year creating an extremely dangerous environment for all of us.

Most at risk of contracting an STD or STI are people from ages 16 to 26 Young people tend to be more promiscuous and by having more partners increase their risk in contracting an STD or virus. There has also been a steady STD increase in college students because of drug and alcohol use.

There are many types of sexually transmitted diseases and viruses out there which can be easily treated or can be become terminal (deadly). But all of them are dangerous. We all have unanswered questions about STD's and viruses, and being properly informed is without a doubt our best defense to preventing, contracting, and/or spreading these harmful disease's and bacteria's.

Many sexually transmitted diseases can be easily cured, but if left untreated, they may cause unpleasant symptoms and could lead to long-term damage such as infertility. Some STDs can be transmitted from a pregnant woman to her unborn child. It is important that anyone diagnosed with an STD informs everyone they have had sex with within the past year (or everyone following the partner they believe may have infected them).
Common signs / symptoms of STD / STI / VD:

STD symptoms vary, but the most common are:

Itching around the vagina and/or discharge from the vagina for women.
Discharge from the penis for men.
Pain during sex or when urinating.
Pain in the pelvic area.
Sore throats in people who have oral sex.
Pain in or around the anus for people who have anal sex.
Chancre sores (painless red sores) on the genital area, anus, tongue and/or throat.
A scaly rash on the palms of your hands and the soles of your feet.
Dark urine with bad smell, loose, light-colored stools, and yellow eyes and skin.
Small blisters that turn into scabs on the genital area.
Swollen glands, fever and body aches.
Unusual infections, unexplained fatigue, night sweats and weight loss.
Soft, flesh-colored warts around the genital area.

If you are experiencing any of these STD symptoms you should see a medical professional immediately. Some STD's and STI's can be cleared up quickly if treated early so time is a factor.

Others may be quite dangerous and must be treated immediately before it becomes worse.

Many STDs are (more easily) transmitted through the mucous membranes of the penis, vulva, rectum, urinary tract and (less often—depending on type of infection)[citation needed] the mouth, throat, respiratory tract. The visible membrane covering the head of the penis is a mucous membrane, though it produces no mucus (similar to the lips of the mouth). Pathogens are also able to pass through breaks or abrasions of the skin, even minute ones. The shaft of the penis is particularly susceptible due to the friction caused during penetrative sex.

This is one reason that the probability of transmitting many infections is far higher from sex than by more casual means of transmission, such as non-sexual contact—touching, hugging, shaking hands.

Although mucous membranes exist in the mouth as in the genitals, many STIs seem to be easier to transmit through oral sex than through deep kissing. According to a safe sex chart, many infections that are easily transmitted from the mouth to the genitals or from the genitals to the mouth, are much harder to transmit from one mouth to another.

Depending on the STD, a person may still be able to spread the infection if no signs of disease are present. For example, a person is much more likely to spread herpes infection when blisters are present (STD) than when they are absent (STI). However, a person can spread HIV infection (STI) at any time, even if he/she has not developed symptoms of AIDS (STD).

All sexual behaviors that involve contact with the bodily fluids of another person should be considered to contain some risk of transmission of sexually transmitted diseases. Most attention has focused on controlling HIV, which causes AIDS, but each STD presents a different situation.

It is not possible to catch any sexually transmitted disease from a sexual activity with a person who is not carrying a disease. Some STDs such as HIV can be transmitted from mother to child either during pregnancy or breastfeeding.
Prevention of STD / STI / VD:

The most effective way to prevent sexual transmission of STIs is to avoid contact of body parts or fluids which can lead to transfer with an infected partner.

Proper use of condoms reduces contact and risk.

Although a condom is effective in limiting exposure, some disease transmission may occur even with a condom.

Ideally, both partners should get tested for STIs before initiating sexual contact, or before resuming contact if a partner engaged in contact with someone else.

Many infections are not detectable immediately after exposure, so enough time must be allowed between possible exposures and testing for the tests to be accurate.

Taking safety precautions is essential to not catching an STD. The best method of protecting yourself from catching an STD is through abstinence and not having any contact with your partners genitals.

It's also important to have an STD tests done regularly, particularly if you are sexually active.

Condoms only provide protection when used properly as a barrier, and only to and from the area that it covers. Uncovered areas are still susceptible to many STDs.

Proper usage entails:

Wearing a condom too loose can defeat the barrier.
Avoiding condoms made of substances other than latex or polyurethane, as they don't protect against HIV.

However, no protective method is 100 percent effective, and condom use cannot guarantee absolute protection against any STD.

In order to achieve the protective effect of condoms, they must be used correctly and consistently. Incorrect use can lead to condom slippage or breakage, thus diminishing their protective effect.

Inconsistent use, e.g., failure to use condoms with every act of intercourse, can lead to STD transmission because transmission can occur with a single act of intercourse.

In order to best protect oneself and the partner from STIs, the old condom and its contents should be assumed to be still infectious. Therefore the old condom must be properly disposed of. A new condom should be used for each act of intercourse, as multiple usage increases the chance of breakage, defeating the primary purpose as a barrier.

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Male Infertility (Childlessness)

In our Indian society, the objective of marriage is propagation, having children to carry forward the family name. The name & achievements of a childless person are forgotten with his or her Death. Childless couples do not get due respect in the society. They are considered to be handicapped. They have to bear the taunts from people. Sometimes the taunts become so unbearable that the women commit suicide or have extra marital affairs to have children because it is the woman who is held responsible for having no children. Some times, pressurized by the family members, the husbands give divorce to the wives.

Q - Dr. A Kumar, please tell us the real meaning of infertility.
A - If you are married and you want a child. You are having intercourse regularly, without using any contraceptives (condom, copper T or contraceptive pills). After doing all this, if the wife does not conceive for A YEAR, it is called infertility.

Q - The woman is held responsible for having no Children, is it a fact?
A - No. Not at all. The fact is, in 30 % cases, the man is at fault for having no children. In 30 % cases, the woman is at fault. In 30 % cases, both the man and woman are at fault and in remaining 10 % cases, the reason is unknown. For having a healthy baby, the outer and inner sex organs of the man and woman need to be normal. Any disease or abnormality in these organs will make it difficult to conceive.

Q - What are the reasons of male infertility?
A - When the man is at fault for not having a baby, there is some problem in his semen. Normally, when the sperms in the semen are not normal, the man cannot have a baby. There may be no sperms at all (Azoospermia) or the number of sperms may be very small (Oligospermia) or the sperms may be less mobile (Nil Motility -Asthenospermia). In some cases, the Quantity of semen is very small because sufficient semen is not produced in the testes. In some cases, Antisperm antibodies are found in the semen.

In some cases, The Laboratory reports show that the sperm count and sperm mobility is Normal. But still there is problem in conceiving. In such cases, the sperms are very weak. They die before reaching the egg or cannot break the outer layer (cover) of the egg. This condition is also deterrent for conceiving.

Apart from semen related problems, surgery around penis, vericocele, (painful and swollen testicles), hydrocele (increased size of and hanging testicles), some diseases like Syphilis, Gonorrhea, Mumps, T.B. etc..

Apart from these reasons, there are other reasons too, responsible for male infertility. These are Low sex power, Erectile Dysfunction, Premature Ejaculation etc. Sometimes, the man cannot have sexual intercourse. These are the main reasons of male infertility. When proper intercourse is not possible, conception is also not possible.

The reasons for female infertility are obstructions or swelling in the fallopian tubes, problems in the uterus, acidic discharge from the vagina, surgery around vagina, STD, inconsistent periods, underdeveloped uterus, ovulation problems etc.

Q - What would you like to tell the Childless couples?
A - Most of the couples resort to the means like worshipping gods, pooja-paath, mantra-tantra, black magic etc. This is nothing but waste of time, energy and money. Many years after the marriage, they come to the doctor. I would like to urge them that they should not waste time and money in these things and visit good sexologist / Gyaenecologist / Infertility Specialist in time so they can find the exact reason of male or female infertility and treat it accordingly. Sometimes wasting time may make the disease Incurable.

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Delayed / Absent Ejaculation

Delayed ejaculation or Retarded ejaculation is the medical condition in which a male has inability to ejaculate or experience climax inside the vagina.

Normally a man can achieve orgasm within 2–4 minutes of active sexual intercourse, whereas a man with delayed ejaculation either does not have orgasms at all or can't have an orgasm until after

prolonged intercourse which might last for 30–45 minutes or more.

In most cases delayed ejaculation presents the condition in which the man can experience climax and ejaculate only during masturbation, but not during sexual intercourse.

Because of Delayed Ejaculation, the man undergoes considerable distress, anxiety and loss of sexual confidence. It often has a damaging effect on a couple's relationship, particularly if the woman wants to have children.

It is the third most common male sexual disorder after impotence (erectile dysfunction) and premature ejaculation. However, it is nothing like as common as the other two.

Psychological causes of delayed ejaculation

Psychological causes of delayed ejaculation might include numerous factors that prevent a man from achieving orgasm during sexual intercourse. Among those factors are:

Fear of causing pregnancy.
Fear that the vagina is dirty.
Over-strict religious upbringing.
Latent homosexuality.
Traumatic events (such as being discovered in masturbation or illicit sex, or learning one's partner is having an affair).
Certain psychological conditions such as depression or anxiety.
Fear that he may get V.D. / S.T.D. like Aids etc.
Stressful situations, such as financial difficulty, problems at work or the recent loss of a loved one.
Insufficient sleep.
Lack of attraction for a partner.
Distraction from worry.
Distraction from the environment.
Anxiety about pleasing his partner and anxiety about relationship problems.

Physical causes:

One of the main causes of delayed ejaculation is adaptation to a certain masturbatory technique. The sensations a man feels when masturbating may be different to the sensations he experiences during intercourse.

Factors such as pressure, angle and grip during masturbation can make for an experience so different from sex with a partner that the ability to ejaculate is reduced or eliminated.

The Physical causes may also include:

Surgeries: Prostate surgery, or prostate removal, Pelvic Surgery, Heart surgery may cause Delayed ejaculation.
Infections: Prostate or urinary tract infection may cause Delayed ejaculation.
Diseases and conditions: Some diseases and conditions affect a man's ability to achieve orgasm. These include many neurological (for example stroke or damage to the back or spinal cord) and diabetes, prostate problems, some allergies and high blood pressure.

Some men report a lack of sensation in the nerves of the glans penis, which may or may not be related to external factors, including a history of circumcision.
Medications: Delayed ejaculation might be a side effect of some medications, usually of some antidepressants, antipsychotics and antihypertensives.

Opiate based medications (dope dick) and recreational drugs can prevent or delay ejaculation as they paralyze or slow all involuntary muscles.
Alcholol: Another reason for delayed ejaculation is excessive use of alcohol (sometimes termed "whiskey dick").
Older age: as men become old, it's normal for ejaculation to take longer.
Erection problems: Erectile dysfunction may also cause delayed ejaculation.
Certain birth defects affecting the male reproductive system may cause Delayed ejaculation.
Ejaculation will also take longer if the man has recently ejaculated.

Examinations and Tests:

Stimulation of the penis with a vibrator or other stimulatory device may determine if an underlying physical problem exists.

Self-treatment of this problem will probably be unsuccessful in most cases. Treatment of delayed ejaculation depends on severity of the disorder and on its causes.

If a man has never had ejaculation through any kind of sexual stimulation (such as vaginal or anal intercourse, oral sex, masturbation, wet dreams etc) then he should consult a urologist in order to find out whether there is a physical abnormality and then get necessary treatment.
Sex therapy:

If the disorder is not so severe and a man can ejaculate through some form of stimulation like masturbation, oral or Anal Sex, he should apply to a sex therapist / Sexologist.

Commonly the couple is advised to go through three stages.

At the first stage a man masturbates in the presence of his partner. Sometimes this is not an easy matter as a man might be used to having orgasms alone. After a man learns to ejaculate in the presence of his partner, the couple gets to another stage where the man's hand is replaced with the hand of his partner. Step by step a man learns to ejaculate closer and closer to the desired orifice (Vagina).

In the final stage the receptive partner inserts the insertive partner's penis into the partner's vagina, anus or mouth as soon as the ejaculation is felt to be imminent. Thus a man gradually learns to ejaculate inside the desired orifice (Vagina).

Some Sexologists recommend sex toys to train the patient to respond to vaginal or anal stimulation. This is especially effective in cases where the masturbatory technique is the source of the problem.

In cases where there is a problematic relationship or an inhibition of sexual desire between the couple, therapy to enhance the relationship and emotional intimacy may be required as a preliminary step.

In some cases hypnosis can help with the problem, especially if a partner does not want to participate in therapy.

Naturally, if delayed ejaculation is caused by a disease, the disease is first of all treated.

In those cases when delayed ejaculation is a side effect of medication the man's physician is to review other medication options.

In the case of alcohol addiction a man should get necessary treatment intended to help treat his addiction.

For many people it has proven to be the case that overly frequent masturbation on the part of the man is the root cause of his delayed vaginal ejaculation. Ceasing masturbation for a few days is often an effective and easy way to achieve more rapid orgasm during intercourse.

Our ancient Medicinal system, Ayurveda also describes this condition in detail. It gives prime importance to the Psychological aspect.

"The Desired women” itself works as the best aphrodisiac (increasing the desire of sex). Shukravardhak or Vajikaran medicines are usually helpful in this condition. Almond milk is a well known and easy household remedy, alongwith it Ashwagandha, Jatiphala, Bala, Vidari are some herbs used since ancient times. Medicines like Dhatupaushtik churna, Ashwagandhadi churna, vanari gutika etc. are also administered under guidance. These medicines are admistered as to increase the amount and quality of semen, and other type cures physiological conditions. If any other aliment as the cause, then ayurveda believes that it needs to be cured first.

Outpatient treatment commonly requires about 3 – 4 months with an average success rate in the range of 70 - 80%.

First of all a man should have a healthy attitude towards sexuality and his sexual response. He should be fully aware of the fact that anxiety and fears cannot contribute to a normal and satisfying sexual experience.

A man who wants to avoid ejaculation problems should concentrate on the pleasure he gets rather than worrying about when and whether his ejaculation is going to occur. The partner should also be tactful and should not put pressure on the man by asking him whether he has ejaculated or not.

Delayed ejaculation can cause a variety of complications, both for men who suffer from it, as well as for their partners.

Delayed ejaculation become annoying for both partners when the man suffering from delayed reaction cannot, in spite of all efforts, achieve orgasm.

Overall, the situation can worsen: both partners can choose to avoid sexual contact which does not result in orgasm. Consequently, both partners suffer from sexual dissatisfaction, becoming likely to lose sexual desire.

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Retrograde Ejaculation
Retrograde ejaculation or Dry Orgasm

Retrograde ejaculation refers to the entry of semen into the bladder instead of going out through the urethra during ejaculation.

Retrograde ejaculation is not life threatening but is one cause of male infertility.

Retrograde ejaculation may cause a couple to experience problems, including infertility, as most sperm fail to enter the partner's vagina, lowering the chances of conception. To induce pregnancy, the male's urine may be centrifuged and the isolated sperm injected directly into the woman.

Taoists and Indian Yogis and some fields of alternative medicine recommend and teach deliberate retrograde ejaculation as a way of "conserving the body's energy". One manner of achieving this is by applying pressure to the perineum during orgasm. It was believed that doing this caused the sperm to travel into the head and nourish the brain, or that energy is conserved physically by keeping the sperm (and thereby, the "intelligence" that created it) in the body.

Although you still reach sexual climax,

Retrograde ejaculation doesn't affect your ability to get an erection or have an orgasm — but when you climax, semen goes into your bladder instead of coming out of your penis. Retrograde ejaculation signs and symptoms include:

During a male orgasm, sperm is released from each of the testicles. From each testicle, sperm then travels through a tube called the vas deferens. The vas deferens leads into the prostate, where sperm mixes with semen. The muscle at the opening of the bladder (bladder neck) tightens to prevent semen from entering the bladder as it passes into the tube inside the penis (urethra).

This is the same muscle that holds urine in your bladder until you urinate. With retrograde ejaculation, the bladder neck muscles don't tighten properly. As a result, sperm can enter the bladder instead of being ejected out of your body through the penis.


• Retrograde ejaculation is a common side effect of medications, such as tamsulosin, that are used to relax the muscles of the urinary tract, treating conditions such as benign prostatic hyperplasia. By relaxing the bladder sphincter muscle, the likelihood of retrograde ejaculation is increased.
The medications that mostly cause it are antidepressant and antipsychotic medication; patients experiencing this phenomenon tend to quit the medications.
• Retrograde ejaculation may be caused by prior prostate or urethral surgery, diabetes, some medications, including some drugs used to treat hypertension (high blood pressure) and some mood-altering drugs. The main reason is that the bladder neck does not close off so semen goes backwards into the bladder rather than forward out of the penis.
The condition is relatively uncommon and may occur either partially or completely. The presence of semen in the bladder is harmless. It mixes with the urine and leaves the body with normal urination. Men with diabetes and those who have had genitourinary tract surgery are at increased risk of developing the condition.
• Retrograde ejaculation can be caused by medications, health conditions or surgeries that affect the nerves or muscles that control the bladder opening.
Several conditions can cause problems with the muscle that closes the bladder during ejaculation. These include:

Surgery such as bladder neck surgery or prostate surgery.
Side effect of certain medications used to treat high blood pressure, prostate enlargement and mood disorders.

Nerve damage caused by a medical condition such as diabetes, multiple sclerosis or a spinal cord injury
A dry orgasm is the primary sign of retrograde ejaculation. But dry orgasm — the ejaculation of little or no semen — can also be caused by other conditions, including:

Surgical removal of the prostate (prostatectomy)
Surgical removal of the bladder (cystectomy)
Radiation therapy to treat cancer in the pelvic area

Risk factors

You're at increased risk of retrograde ejaculation if:

You have diabetes or multiple sclerosis
You've had prostate or bladder surgery
You take certain drugs for high blood pressure or a mood disorder
You had a spinal cord injury

Causes of Retrograde Ejaculation

The following medical conditions are some of the possible causes of Retrograde Ejaculation. There are likely to be other possible causes, so ask your doctor about your symptoms.

• Previous surgery to the prostate
• Diabetes mellitus
• Multiple sclerosis
• Blood pressure medication
• Abdominal, pelvic or genital surgery (see Abdominal symptoms)
• Antidepressant drugs
• Previous radiation for treatment of prostate cancer


• Little or no semen discharged from the urethra during the male sexual climax (during ejaculation)
• Possible infertility
• Cloudy urine after sexual climax

Exams and Tests

A urinalysis performed on a urine specimen that is obtained shortly after ejaculation will reveal a large amount of sperm in the urine.


Medications do not help retrograde ejaculation if there has been permanent damage to the prostate or the testes from radiation. Medications also do not help if prostate surgery has resulted in damage to the muscles or nerves. Medications only work if there has been mild nerve damage caused by diabetes, multiple sclerosis or mild spinal cord injury.

If retrograde ejaculation is caused by drugs, your doctor may recommend that you stop taking such drug. This can make the problem go away.
Retrograde ejaculation caused by diabetes or after genitourinary tract surgery may be treated with epinephrine-like drugs (such as pseudoephedrine or imipramine).

If retrograde ejaculation is caused by medications, discontinuation of the medication often restores normal ejaculation. If retrograde ejaculation is caused by surgery or diabetes, it is often not correctable.

Maintaining good blood sugar control may help prevent this condition in men who have diabetes. Avoiding drugs that cause retrograde ejaculation will also prevent this condition.

Medications used to treat retrograde ejaculation include

• Tricyclic antidepressants.
• Antihistamines.
• Decongestants..

These medications tighten the bladder neck muscles and prevent semen from going backwards into the bladder. However, the medications do have many side effects and they have to be taken at least 1–2 hours prior to sexual intercourse.

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A varicocele is an enlargement of the veins within the scrotum, (the loose bag of skin that holds the testicles).

Varicoceles are a common cause of low sperm production and decreased sperm quality, which can cause infertility. However, not all varicoceles affect sperm production. Varicoceles can also cause testicles to shrink.

Most varicoceles develop over time. With time, varicoceles may enlarge and become more noticeable. Fortunately, most varicoceles are easy to diagnose and many don't need treatment. If a varicocele causes symptoms, it often can be repaired surgically.


A varicocele often produces no signs or symptoms. Rarely, it may cause pain, Atrophy (Shrinking) of the Testicles. The pain may : Vary from dull discomfort or light or dual pain or a feeling of heaviness or to sharp pain.

• Pain Increase with sitting, standing or physical exertion, especially over
long periods.
• Pain Increase over the course of a day or during long weeks or running.
• Be relieved when you lie on your back.
• Low Testosterone level in blood.

Because a varicocele usually causes no symptoms, it often requires no treatment. Varicoceles may be discovered during a fertility evaluation or a routine physical exam.
However, if you experience pain or swelling in your scrotum or you discover a mass on your scrotum, contact your doctor. A number of conditions can cause a scrotal mass or testicular pain, some of which require immediate treatment.

Male reproductive system

Your spermatic cord carries blood to and from the testicles. It's not certain what causes varicoceles, but many experts believe a varicocele forms when the valves inside the veins in the cord prevent your blood from flowing properly. The resulting backup causes the veins to widen (dilate).

Varicoceles often form during puberty. They are most frequently diagnosed when a patient is 15-30 years of age, and rarely develop after the age of 40. They occur in 15–20% of all males, and it is the main cause of male infertility.

98% of idiopathic varicoceles occur on the left side, apparently because the left testicular vein connects to the renal vein (and does so at a 90-degree angle). However, a varicocele in one testicle can affect sperm production in both testicles.

There don't appear to be any significant risk factors for developing a varicocele. However, some research suggests that being overweight may increase your risk.


A varicocele may cause:

• Shrinkage of the affected testicle (atrophy). The bulk of the testicle comprises sperm-producing tubules. When damaged, as from varicocele, the testicle shrinks and softens. It's not clear what causes the testicle to shrink, but the malfunctioning valves allow blood to pool in the veins, which can result in increased pressure in the veins and exposure to toxins in the blood that may cause testicular damage.

• Infertility. It's not clear how varicoceles affect fertility. The testicular veins cool blood in the testicular artery, helping to maintain the proper temperature for optimal sperm production. By blocking blood flow, a varicocele may keep the local temperature too high, affecting sperm formation and movement (motility).

If the pain is sharp & you are not able to see your Doctor then u can use over-the-counter pain reliever and wear an athletic supporter to relieve pressure.

Tests and diagnosis

Your doctor will conduct a physical exam, which may reveal a twisted, nontender mass above your testicle that may feel like what's been described as a bag of worms. If it's large enough, your doctor will be able to feel it. If you have a smaller varicocele, your doctor may ask you to stand, take a deep breath and hold it while you bear down (Valsalva maneuver). This helps your doctor detect abnormal enlargement of the veins.

If the physical exam is inconclusive, your doctor may order a scrotal ultrasound. To ensure there isn't another reason for your symptoms. One such condition is a tumor that compresses the spermatic vein.

Treatments and drugs

Varicocele treatment may not be necessary. However, if your varicocele causes pain, testicular atrophy or infertility, you may want to undergo varicocele repair. The purpose of surgery is to seal off the affected vein to redirect the blood flow into normal veins. However, the effect of varicocele repair on fertility is unclear.

Although varicoceles typically develop in adolescence, it's less clear whether you should have varicocele repair at that time. Indications for repairing a varicocele in adolescence include progressive testicular atrophy, pain or abnormal semen analysis results.

Varicocele repair presents relatively few risks, which may include:

• Buildup of fluid around the testicles (hydrocele)
• Recurrence of varicoceles
• Damage to an artery
Repair methods include:
• Open surgery. This treatment usually is done on an outpatient basis, using general anesthetic or local anesthetic. Commonly, your surgeon will approach the vein through your groin (transinguinal), but it's also possible to make an incision in your abdomen or below your groin.

Advances in varicocele repair have led to a reduction of post-surgical complications. One advance is the use of the surgical microscope, which enables the surgeon to see the treatment area better during surgery. Another is the use of Doppler ultrasound, which helps guide the procedure.

You may be able to return to normal, nonstrenous activities after two days. As long as you're not uncomfortable, you may return to more strenuous activity, such as exercising, after two weeks.

Pain from this surgery generally is mild. Doctor may prescribe pain medication for the first two days after surgery. After that, your doctor may advise you to take over-the-counter (OTC) painkillers, to relieve discomfort or pain.

Doctor may advise you not to have sex for one to two weeks. You'll have to wait three or four months after surgery to get a semen analysis to determine whether the varicocele repair was successful in restoring your fertility.

• Laparoscopic surgery. Your surgeon makes a small incision in your abdomen and passes a tiny instrument through the incision to see and to repair the varicocele. This procedure requires general anesthesia.

• Percutaneous embolization. A radiologist inserts a tube into a vein in your groin or neck through which instruments can be passed. Viewing your enlarged veins on a monitor, the doctor releases coils or a solution that causes scarring to create a blockage in the testicular veins, which interrupts the blood flow and repairs the varicocele. This procedure is done with local anesthesia on an outpatient basis. This procedure isn't as widely used as surgery.

Lifestyle and home remedies

If you have a varicocele that causes you minor discomfort but doesn't affect your fertility, you might try the following for pain relief:

• Take over-the-counter painkillers, such as Paracetamol etc.
• Wear an athletic supporter or Langot to relieve pressure.

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A hydrocele is a fluid-filled sac surrounding a testicle that results in swelling of the scrotum, the loose bag of skin underneath the penis. Older boys and adult men can develop a hydrocele due to inflammation or injury within the scrotum.

A hydrocele usually isn't painful. Typically not harmful, a hydrocele may not need any treatment. However, if you have scrotal swelling, see your doctor to rule out other causes.

They are common in newborns, but most hydroceles disappear without treatment within the first year of life. However, if your baby's hydrocele doesn't disappear after a year or if it enlarges, you should make another appointment for your child's doctor to examine the hydrocele again.


Usually the only indication of a hydrocele is a painless swelling of one or both testicles. Adult men with a hydrocele may experience discomfort from the heaviness of a swollen scrotum. Sometimes, the swollen testicle may be smaller in the morning and larger later in the day.

See your doctor if you experience scrotal swelling. It's important to rule out other possible causes for the swelling. Sometimes a hydrocele is associated with an inguinal hernia, in which a weak point in the abdominal wall allows a loop of intestine to extend into the scrotum and which may require treatment.


In older males, a hydrocele can develop as a result of inflammation or injury within the scrotum. Inflammation may be the result of infection of the small coiled tube at the back of each testicle (epididymitis) or of the testicle.

A hydrocele typically isn't dangerous and usually doesn't affect fertility. However, it may be associated with an underlying testicular condition that may cause serious complications:

• Infection or tumor. Either may reduce sperm production or function.
• Inguinal hernia. A loop of intestine could become trapped in the weak point in the abdominal wall (strangulated), a life-threatening condition.

Get immediate medical treatment if you develops sudden, severe scrotal pain or swelling, especially within several hours of an injury to the scrotum. These signs and symptoms can occur with a number of conditions, including hydrocele. These signs and symptoms may also be caused by a condition called testicular torsion. Testicular torsion is an emergency medical condition that occurs when a testicle becomes so twisted that blood flow is blocked. The testicle can only be saved if this condition is treated within hours of when symptoms began.

If you have painless scrotal swelling, meet your doctor.

Tests and diagnosis

Your doctor will do a physical exam. The exam may reveal an enlarged scrotum that isn't tender to the touch. Pressure to the abdomen or scrotum may enlarge or shrink the fluid-filled sac, which may indicate an associated inguinal hernia.

Because the fluid in a hydrocele usually is clear, the doctor may shine a light through the scrotum (transillumination). With a hydrocele, the light will outline the testicle, indicating that clear fluid surrounds it.

If your doctor suspects your hydrocele is caused by inflammation, blood and urine tests may help determine whether you have an infection, such as epididymitis.

The fluid surrounding the testicle may keep the testicle from being felt. In that case, you may need an ultrasound imaging test, can rule out a hernia, testicular tumor or other cause of scrotal swelling.

Treatments and drugs

For adult males as well, hydroceles often go away on their own within six months. A hydrocele requires treatment only if it gets large enough to cause discomfort or disfigurement. Then it may need to be removed.

Treatment approaches include:

• Surgical excision (hydrocelectomy). Removal of a hydrocele may be performed on an outpatient basis using general or spinal anesthesia. The surgeon may make an incision in the scrotum or lower abdomen to remove the hydrocele. If a hydrocele is discovered during surgery to repair an inguinal hernia, your doctor may remove it even if it's causing you no discomfort.

A hydrocelectomy may require you to have a drainage tube and wear a bulky dressing over the site of the incision for a few days after surgery. Also, you may be advised to wear a scrotal support for a time after surgery. Ice packs applied to the scrotal area after surgery may help reduce swelling. Surgical risks include blood clots, infection or injury to the scrotum.

• Needle aspiration. Another option is to remove the fluid in the scrotum with a needle. The injection of a thickening or hardening (sclerosing) drug after the aspiration may help prevent the fluid from reaccumulating. Aspiration and injection may be an option for men who have risk factors that make surgery more dangerous. Risks of this procedure include infection and scrotal pain.
Sometimes, a hydrocele may recur after treatment.

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Erectile Dysfunction and Diabetes
Coming Soon

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Gonorrhea (also gonorrhoea) is a common sexually transmitted infection caused by the bacterium Neisseria gonorrhoeae (also called Gonococcus, which is often abbreviated as "GC" by clinicians).

In both men and women if gonorrhea is left untreated, it may spread throughout the body, affecting joints and even heart valves.

Signs and symptoms

The infection is transmitted from one person to another through vaginal, oral, or anal sexual relations.

The incubation period is 2 to 30 days with most symptoms occurring between 4–6 days after being infected. A small number of people may be asymptomatic for a lifetime.

In males, symptoms include a yellowish discharge from the penis, associated with painful, and sometimes frequent, urination. Symptoms can develop from two to thirty days after infection. A few percent of infected men have no symptoms. The infection may move into the prostate, seminal vesicles, and epididymis, causing pain and fever. Untreated, gonorrhea can lead to sterility.

Men may complain of pain on urinating and thick, copious, urethral pus discharge (also known as gleet) is the most common presentation. Examination may show a reddened external urethral meatus. Ascending infection may involve the epididymis, testicles, or prostate gland, causing symptoms such as scrotal pain or swelling.

Women may complain of vaginal discharge, difficulty urinating (dysuria), projectile urination, off-cycle menstrual bleeding, or bleeding after sexual intercourse.

The cervix may appear anywhere from normal to the extreme of marked cervical inflammation with pus. Early symptoms may include a discharge from the vagina, discomfort in the lower abdomen, irritation of the genitals, pain or burning during urination and abnormal bleeding. Symptoms, which may indicate development of pelvic inflammatory disease (PID), include cramps and pain, bleeding between menstrual periods, vomiting, or fever.

Women who leave these symptoms untreated may develop severe complications. The infection will usually spread to the uterus, fallopian tubes, and ovaries, causing Pelvic Inflammatory Disease (PID).

Infection of the urethra (urethritis) causes little dysuria or pus.

The combination of urethritis and cervicitis on examination strongly supports a gonorrhea diagnosis, as both sites are infected in most gonorrhea patients. Gonorrhea infection can also be present as septic arthritis.

An infected mother may transmit gonorrhea to her newborn during childbirth, a condition known as ophthalmia neonatorum.


There are many Antibiotics that may be used to treat gonorrhea.

It is important to refer all sexual partners to be checked for gonorrhea to prevent spread of the disease and to prevent the patient from becoming re-infected with gonorrhea. Patients should also be offered screening for other sexually transmitted infections. In areas where co-infection with chlamydia is common, doctors may prescribe a combination of antibiotics.

The patient must be rechecked by throat swab 72 hours or more after being given treatment, and then retreated if the throat swab is still positive.

In men, inflammation of the epididymis (epididymitis); prostate gland (prostatitis) and urethral structure (urethritis) can result from untreated gonorrhea


The exact time of onset of gonorrhea as prevalent disease or epidemic cannot be accurately determined from the historical record.

It has been suggested that mercury was used as a treatment for gonorrhea.

Silver nitrate was one of the widely used drugs in the 19th century. The silver-based treatment was used until the first antibiotics came into use in the 1940s.

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Human Immunodeficiency Virus (HIV) is a lentivirus (a member of the retrovirus family) that causes acquired immunodeficiency syndrome (AIDS), a condition in humans in which the immune system begins to fail, leading to life-threatening opportunistic infections.

Infection with HIV occurs by the transfer of blood, semen, vaginal fluid, pre-ejaculate, or breast milk. Within these bodily fluids.

The four major routes of transmission are unsafe sex, contaminated needles, breast milk, and transmission from an infected mother to her baby at birth (vertical transmission).

HIV infection in humans is considered pandemic by the World Health Organization (WHO).

From its discovery in 1981 to 2006, AIDS killed more than 25 million people. A third of these deaths are occurring in Sub-Saharan Africa, retarding economic growth and increasing poverty. According to current estimates, HIV is set to infect 90 million people in Africa, resulting in a minimum estimate of 18 million orphans.

HIV infects primarily vital cells in the human immune system such as helper T cells (to be specific, CD4+ T cells.

HIV infection leads to low levels of CD4+ T cells. When CD4+ T cell numbers decline below a critical level, cell-mediated immunity is lost, and the body becomes progressively more susceptible to opportunistic infections.

Most untreated people infected with HIV-1 eventually develop AIDS. These individuals mostly die from opportunistic infections or malignancies associated with the progressive failure of the immune system.

HIV progresses to AIDS at a variable rate affected by viral, host, and environmental factors; most will progress to AIDS within 10 years of HIV infection: some will have progressed much sooner, and some will take much longer.Treatment with anti-retrovirals increases the life expectancy of people infected with HIV.

Three main transmission routes for HIV have been identified. HIV-2 is transmitted much less frequently by the mother-to-child and sexual route than HIV-1.

UNAIDS and the WHO estimate that AIDS has killed more than 25 million people since it was first recognized in 1981, making it one of the most destructive pandemics in recorded history. .

Sub-Saharan Africa remains by far the worst-affected region, with an estimated 21.6 to 27.4 million people currently living with HIV.

South & South East Asia are second-worst affected with 15% of the total. AIDS accounts for the deaths of 500,000 children in this region. South Africa has the largest number of HIV patients in the world followed by Nigeria.

Countries such as Uganda are attempting to curb the epidemic by offering VCT (voluntary counselling and testing), PMTCT (prevention of mother-to-child transmission) and ANC (ante-natal care) services, which include the distribution of antiretroviral therapy.


There are two species of HIV known to exist: HIV-1 and HIV-2. HIV-1 is the virus that was initially discovered. It is more virulent, more infective, and is the cause of the majority of HIV infections globally. The lower infectivity of HIV-2 relatively poor capacity for transmission, HIV-2 is largely confined to West Africa.
Comparison Of HIV Species
Species Virulence Infectivity Prevalence Inferred Origin
HIV - 1 High High Global Common Chimpanzee
HIV - 2 Lower Low West Africa Sooty Mangabey

Signs & Symptoms

Infection with HIV-1 is associated with a progressive decrease of the CD4+ T cell count and an increase in viral load. The stage of infection can be determined by measuring the patient's CD4+ T cell count, and the level of HIV in the blood.

HIV infection has basically four stages : 1) Incubation period, 2) Acute infection, 3) Latency stage and 4) AIDS.

The initial incubation period upon infection is asymptomatic and usually lasts between two and four weeks. The second stage, acute infection, lasts an average of 28 days and can include symptoms such as fever, lymphadenopathy (swollen lymph nodes), pharyngitis (sore throat), rash, myalgia (muscle pain), malaise, and mouth and esophageal sores.

The Latency stage, which occurs third, shows few or no symptoms and can last anywhere from two weeks to twenty years and beyond. AIDS, the fourth and final stage of HIV infection shows as symptoms of various opportunistic infections.

Main symptoms of acute HIV infection.

The initial infection with HIV generally occurs after transfer of body fluids from an infected person to an uninfected one. The first stage of infection, the primary, or acute infection, is a period of rapid viral replication that immediately follows the individual's exposure to HIV leading to an abundance of virus in the peripheral blood with levels of HIV commonly approaching several million viruses per mL.

This response is accompanied by a marked drop in the numbers of circulating CD4+ T cells. This acute viremia is associated in virtually all patients with the activation of CD8+ T cells, which kill HIV-infected cells.

The CD8+ T cell response is thought to be important in controlling virus levels, which peak and then decline, as the CD4+ T cell counts rebound. A good CD8+ T cell response has been linked to slower disease progression and a better prognosis, though it does not eliminate the virus.

During this period (usually 2–4 weeks post-exposure) most individuals (80 to 90%) develop an influenza, the most common symptoms of which may include fever, lymphadenopathy, pharyngitis, rash, myalgia, malaise, mouth and esophageal sores, and may also include, but less commonly, headache, nausea and vomiting, enlarged liver/spleen, weight loss, thrush, and neurological symptoms. Infected individuals may experience all, some, or none of these symptoms. The duration of symptoms varies, averaging 28 days and usually lasting at least a week.

Because of the nonspecific nature of these symptoms, they are often not recognized as signs of HIV infection. Even if patients go to their doctors or a hospital, they will often be misdiagnosed as having one of the more common infectious diseases with the same symptoms. As a consequence, these primary symptoms are not used to diagnose HIV infection, as they do not develop in all cases and because many are caused by other more common diseases. However, recognizing the syndrome can be important because the patient is much more infectious during this period.

Latency stage

A strong immune defense reduces the number of viral particles in the blood stream, marking the start of the infection's clinical latency stage. Clinical latency can vary between two weeks and 20 years. During this early phase of infection, HIV is active within lymphoid organs, where large amounts of virus become trapped in the follicular dendritic cells (FDC) network.

The surrounding tissues that are rich in CD4+ T cells may also become infected, and viral particles accumulate both in infected cells and as free virus. Individuals who are in this phase are still infectious. During this time, CD4+ CD45RO+ T cells carry most of the proviral load.


When CD4+ T cell numbers decline below a critical level of 200 cells per ΅L, cell-mediated immunity is lost, and infections with a variety of opportunistic microbes appear.

The first symptoms often include moderate and unexplained weight loss, recurring respiratory tract infections (such as sinusitis, bronchitis, otitis media, pharyngitis), prostatitis, skin rashes, and oral ulcerations.

Common opportunistic infections and tumors, most of which are normally controlled by robust CD4+ T cell-mediated immunity then start to affect the patient. Typically, resistance is lost early on to oral Candida species and to Mycobacterium tuberculosis, which leads to an increased susceptibility to oral candidiasis (thrush) and tuberculosis.

Later, reactivation of latent herpes viruses may cause worsening recurrences of herpes simplex eruptions.

Pneumonia caused by the fungus Pneumocystis jirovecii is common and often fatal. In the final stages of AIDS, infection with cytomegalovirus (another herpes virus) or Mycobacterium avium complex is more prominent. Not all patients with AIDS get all these infections or tumors, and there are other tumors and infections that are less prominent but still significant.

The majority of HIV infections are acquired through unprotected sexual relations. Sexual transmission can occur when infected sexual secretions of one partner come into contact with the genital, oral, or rectal mucous membranes of another.

The correct and consistent use of latex condoms reduces the risk of sexual transmission of HIV by about 85%.

In general, if infected blood comes into contact with any open wound, HIV may be transmitted. This transmission route can account for infections in intravenous drug users.

Since transmission of HIV by blood became known medical personnel are required to protect themselves from contact with blood by the use of universal precautions. People who give and receive tattoos, piercings, and scarification procedures can also be at risk of infection.

HIV has been found at low concentrations in the saliva, tears and urine of infected individuals, but there are no recorded cases of infection by these secretions and the potential risk of transmission is negligible..It is not possible for mosquitoes to transmit HIV.


The transmission of the virus from the mother to the child can occur in utero (during pregnancy), intrapartum (at childbirth), or via breast feeding. In the absence of treatment, the transmission rate up to birth between the mother and child is around 25%.[31] However, where combination antiretroviral drug treatment and Cesarian section are available, this risk can be reduced to as low as one percent.

Postnatal mother-to-child transmission may be largely prevented by complete avoidance of breast feeding.


Many HIV-positive people are unaware that they are infected with the virus.

HIV-1 testing consists of initial screening with an enzyme-linked immunosorbent assay (ELISA) to detect antibodies to HIV-1.

Specimens with a reactive ELISA result are retested. If retest is reactive, the specimen is reported as repeatedly reactive and undergoes confirmatory testing with a more specific supplemental test (e.g., Western blot. Specimens that are repeatedly reactive by ELISA and reactive by Western blot are considered HIV-positive and indicative of HIV infection.

Modern HIV testing is extremely accurate.


There is currently no publicly available vaccine or cure for HIV or AIDS. However, a vaccine that is a combination of two previously unsuccessful vaccine candidates was reported in September 2009 to have resulted in a 30% reduction in infections in a trial conducted in Thailand. Additionally, a course of antiretroviral treatment administered immediately after exposure, referred to as post-exposure prophylaxis, is believed to reduce the risk of infection if begun as quickly as possible.

Current treatment for HIV infection consists of highly active antiretroviral therapy, or HAART. This has been highly beneficial to many HIV-infected individuals since its introduction in 1996, when the protease inhibitor-based HAART initially became available.

Current HAART options are combinations (or "cocktails") consisting of at least three drugs belonging to at least two types, or "classes," of antiretroviral agents.

In developed countries where HAART is available, doctors assess their patients thoroughly: measuring the viral load, how fast CD4 declines, and patient readiness. They then decide when to recommend starting treatment.

HAART neither cures the patient nor does it uniformly remove all symptoms; high levels of HIV-1, often HAART resistant, return if treatment is stopped. Moreover, it would take more than a lifetime for HIV infection to be cleared using HAART.

Despite this, many HIV-infected individuals have experienced remarkable improvements in their general health and quality of life.

The development of HAART as effective therapy for HIV infection has substantially reduced the death rate from this disease in those areas where these drugs are widely available.


Without treatment, the net median survival time after infection with HIV is estimated to be 9 to 11 years.

In areas where it is widely available, the development of HAART as effective therapy for HIV infection and AIDS reduced the death rate from this disease by 80%, and raised the life expectancy for a newly diagnosed HIV-infected person to 20–50 years.

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