"KORO-A GENITAL RETRACTION SYNDROME EPIDEMIC IN NORTH BENGAL"




DEFINITION & NOMENCLATURE:------

"Koro" is a Genital Retraction Syndrome where a person thinks that his/her external genitilia (Penis/Testicles or Vulva / nipple of Breast ) will shrink, retract and disappear with or without fear of Death.

It occurs more in male than female patients.The earliest Chinese refrence is seen in'Yellow Emperor's classic of Internal Medicine' dated 300 BC,Western reference to the term koro is found in B.F. Matthes' Dictionary of Beginese Language (1874) of South Sulawesi ,Indinesia. The word is also used in Makassarese Language,meaning "to shrink"; the full dialect for it is garring koro. In Malaysian Language,keruk is the probable linguistic link of koro which means "to shrink". The term shuk yang or shook yong or suo yang (Chinese),Jinjina bemar (Assamese,India),Rok-joo(Thai) are coined for this diseas all in regional language, means "the shrinkage of penis".Actual word "KORO"originated from Malaysian word Tortoise (which is another name for "Penis" in slander language)as Tortoise has a habit of retracting their head resembling (like a PENIS)in to body,so people probably used that example to express this disease.

PSYCHOSOCIAL CLASSIFICATION

Koro has been described as"Culture Bound Syndrome"(which means it occurs in person with certain cultures where these cultural beliefs or myths generate and spread this classical form of disease,it is seen endemic with outbreaks or epidemics as in China,South East Asia, Malaysia, Indonesia (migrated people from China with classical )and certain part of Africa,Thailand,Singapore,India (non chinese local peoples as both classical and non cultural form ) and Western countries like Britain,America, France, Canada, Jordan (sporadic non cultural or secondary Koro where only shrinkage without any fear of death associatedwith CNS disorder,drug induced or under another psychiatric diorder) in mental disorder book and has been subgrouped as'Specific Culture-imposed nosophobia'or 'The genital retraction Taxon' or 'Cultural related beliefs as causes of occurrence'.

PREDISPOSING FACTORS & CAUSES

Psychosocial cultural belief which predispose "koro" a punishment of personal guilt of sex with other ladies/prostitutes(than Spouse/Wife),masturbation/Impotence or Sexual inadequacy (many such ancient folk stories are rampant in Chinese culture or theory of loss of yang humor (The Yan & Ying theory)or semen which is condsidered as vital energy,excess loss of this by frequent Ejaculation(depicted in Taosim which strongly inflence chinese medical thought) may lead to death.Witch Craft or evildoers or Fox spirit or ghost stories and folklore novels or KALA JADU (Assam & Bengal) are prevalent in China where it has been described that these spirits cause genitilia to retract in abdomen,making them physically and sexually weak and utimately dead.in South China and in south asian and Africa and even in India where this disease is prevalent,people have strong belief in such stories and play. Mass hysteria that Contaminated pork with swine fever cause epidemic of Koro in singapore in 1967.In Africa,Black magic was behind this and in Nigeria and ghana,there was panic that penis has disappeared by touch of a stranger.

But in isolated 03 cases in America, patients suffering from anxiety and worries about Penis suffered it after smoking Cannabis which may increase worries and anxiety as its side effect.In Britian and other western part it was due to depression resulting from psychological disorder,phobia for AIDS,brain tumor,schizophrenia etc.,but never a social or folk beliefs based on prevalent ancient stories and dramas.Ethnographic psychologist (who study different cultures) consider koro to be closely related to panic attacks caused by either social belief based on prevalent stories or myth or rumors of food poisioning or evil doers or as punishment to evil doing in form of self perceived or believed sexual offence resulting in retraction or shrinkage of genitialia with or without fear of death.Attacks of koro are often set off when men are in situations that would normally cause the male genitals to shrink slightly,such as emotional distress or cold temperatures.as Scrotum and penis more responds for shrinkage on exposure to mental stress and cold temperature they affect more than female.But tensed and psychological disturbed or introverted sexually freezed or tense female may suffer too complaining of retraction of Nipples and of vulva or disappearance of vulva under tight thighes under severe stress and strain.

SIGN & SYMPTOMS: Koro exist in two forms.Classical or True or Primary Koro where patients under a social belif or rumor or myth complains of shrinkage of Penis or testicles or both in Male and of Vulva or Nipples of breast / breast or both in female folowed by retraction of them in abdomen with physical and sexual weakness with or without fear of death.Mostly present as acute attack lasting for hours to maximum duration of 02 days.But some may show symptoms for years as chronic cases or recurrent cases ,some instead of shrinkage of genitilia complain genital shortening,alteration of penis size,loss of muscular strength,genital paraesthesia with no complain of retraction or breast mass in female with altered breast size and hidden or distorted nipples.Feature of sexual dissolution,loss of sexual or physical power,weakness,urinary obstruction,sterility may be seen.Psychologically Pateint suffer from anxiety neurosis may include fear of death,non specific physical danger,impending madness,spirit possession and feeling of being bewithched or under cover of black magic with feeling to sex change to eother female or vice versa or turning Enuch.

But in secondary or unclassical form of Koro as seen in western world only retraction of penis or loss of penile strength is coplained where person has got intense anxiety for penis with a strong psychosocial disease or under any organic brain disease or under influence of drug or intoxication.

While there are no substantiated reports of the condition itself resulting in any physical damage to the individual, many sufferers have unfortunately inflicted harm upon themselves or physical damage in frantic attempts to stretch the penis or Breast to prevent further shrinkage. It is not unusual for those with koro themselves or wthrough their family members and social sympathisers to resort to using devices such as clamps or weights or pegs or by aloop of string for retraction of penis as mechanical traction device.female either herself or ladies around her grab breast,pull nipples out or insert iron pins in nipple so that it cannot go inside.

Chanting of local religious songs and puja or religious celebration to please God/Goddess through local preachers and pandits or programmes for their blessing or correct any unknown mistake conducted in their past celebration or work out by local witch hunters by putting wood fire and smoking to remove bad blessing or evils or black witch from society or beating or killing of socalled wrong or evildoers suspected in society or villages is done.In North bengal people are putting lime water over both ears and nose ,keep Kush grass or pure water of a temple or river to keep these bad evils from them .some also cover their genitilia and breast so much under clothe as nothing happens to these organs.

DIAGNOSIS: it is easily done when epidemics occur as strong social belief or myth or rumor based on past prevalent stories and drama of witch hunt or as a punishment of some sexual wrong doing or intake of contaminated food or prsence of some diseases with typical full blown symptoms of penile/Testicle shrinkage or retraction in abdomen in patient of introversion suffering from anxiety or psychological disorder or under religiuos and social belifs and faith in myths or evil doers with or without sexual and physical weakness and fear of death.Injuries are secondary to measures taken by patients or relatives to prevent injuries.

TREATMENT:---

As the disease involves social beliefs and psychological insult so both Medical and Indigenous treatment should be given otherwise complete eradication may not be possible.As no defect is found in genitilia and breast to nothing is done for this if injuries inflicted by patient or relatives as mechanical manipulation to prevent retraction of genitilia or nipples then local injuries are dealt both surgically and medically.

in Cultural bound cases,lectures should be organised through healers of society by educating them with anatomy and physiology of Genitilia with audio visual or practical demonstration either as alone or to whole society utilising local media,radio /Tv/poster/leaflets and picturing small booklets,Individualy affect person psychosocial analysis is done and therapy for underlying disease is started.Inwestern type sexual conflict is identified and patient treated for any psychological or organic disease diagnosed.

indigenous medicines by local healers may be also advised to win the belief of people,praying to Gods and submitting to socalled social healers and witch hunters may be allowed to control epidemic spread but side to side strong counselling and health education should be provided individually ,by NGO or by Government health agency and social reforming departments.In china people hit gongs or bells to drive out witches .They use chinese a yang or yin augmenting medicine including herbs,animal penises (of tiger,deer,and fur seal )pilose anter(stag of deer) or deer tail.Pepper soup ,ginger soup,Louki or cucumber soup or liquor is also drunk to cure the diesease,in north Bengal people are using lime water application over both ears and nose and kush grass and holy water keeping to keep awya bad evils.

Dr.D.R.Nakipuria



09434143550

**Author is a naco trained HIV and sex specialist

DEFINITION & NOMENCLATURE:----
"Koro" is a Genital Retraction Syndrome where a person thinks that his/her external genitilia (Penis/Testicles or Vulva / nipple of Breast ) will shrink, retract and disappear with or without fear of Death.It occurs more in male than female patients.The earliest Chinese refrence is seen in'Yellow Emperor's classic of Internal Medicine' dated 300 BC,Western reference to the term koro is found in B.F. Matthes' Dictionary of Beginese Language (1874) of South Sulawesi ,Indinesia. The word is also used in Makassarese Language,meaning "to shrink"; the full dialect for it is garring koro. In Malaysian Language,keruk is the probable linguistic link of koro which means "to shrink". The term shuk yang or shook yong or suo yang (Chinese),Jinjina bemar (Assamese,India),Rok-joo(Thai) are coined for this diseas all in regional language, means "the shrinkage of penis".Actual word "KORO"originated from Malaysian word Tortoise (which is another name for "Penis" in slander language)as Tortoise has a habit of retracting their head resembling (like a PENIS)in to body,so people probably used that example to express this disease.
PSYCHOSOCIAL CLASSIFICATION
Koro has been described as"Culture Bound Syndrome"(which means it occurs in person with certain cultures where these cultural beliefs or myths generate and spread this classical form of disease,it is seen endemic with outbreaks or epidemics as in China,South East Asia, Malaysia, Indonesia (migrated people from China with classical )and certain part of Africa,Thailand,Singapore,India (non chinese local peoples as both classical and non cultural form ) and Western countries like Britain,America, France, Canada, Jordan (sporadic non cultural or secondary Koro where only shrinkage without any fear of death associatedwith CNS disorder,drug induced or under another psychiatric diorder) in mental disorder book and has been subgrouped as'Specific Culture-imposed nosophobia'or 'The genital retraction Taxon' or 'Cultural related beliefs as causes of occurrence'.
PREDISPOSING FACTORS & CAUSES
Psychosocial cultural belief which predispose "koro" a punishment of personal guilt of sex with other ladies/prostitutes(than Spouse/Wife),masturbation/Impotence or Sexual inadequacy (many such ancient folk stories are rampant in Chinese culture or theory of loss of yang humor (The Yan & Ying theory)or semen which is condsidered as vital energy,excess loss of this by frequent Ejaculation(depicted in Taosim which strongly inflence chinese medical thought) may lead to death.Witch Craft or evildoers or Fox spirit or ghost stories and folklore novels or KALA JADU (Assam & Bengal) are prevalent in China where it has been described that these spirits cause genitilia to retract in abdomen,making them physically and sexually weak and utimately dead.in South China and in south asian and Africa and even in India where this disease is prevalent,people have strong belief in such stories and play. Mass hysteria that Contaminated pork with swine fever cause epidemic of Koro in singapore in 1967.In Africa,Black magic was behind this and in Nigeria and ghana,there was panic that penis has disappeared by touch of a stranger.
But in isolated 03 cases in America, patients suffering from anxiety and worries about Penis suffered it after smoking Cannabis which may increase worries and anxiety as its side effect.In Britian and other western part it was due to depression resulting from psychological disorder,phobia for AIDS,brain tumor,schizophrenia etc.,but never a social or folk beliefs based on prevalent ancient stories and dramas.Ethnographic psychologist (who study different cultures) consider koro to be closely related to panic attacks caused by either social belief based on prevalent stories or myth or rumors of food poisioning or evil doers or as punishment to evil doing in form of self perceived or believed sexual offence resulting in retraction or shrinkage of genitialia with or without fear of death.Attacks of koro are often set off when men are in situations that would normally cause the male genitals to shrink slightly,such as emotional distress or cold temperatures.as Scrotum and penis more responds for shrinkage on exposure to mental stress and cold temperature they affect more than female.But tensed and psychological disturbed or introverted sexually freezed or tense female may suffer too complaining of retraction of Nipples and of vulva or disappearance of vulva under tight thighes under severe stress and strain.
SIGN & SYMPTOMS: Koro exist in two forms.Classical or True or Primary Koro where patients under a social belif or rumor or myth complains of shrinkage of Penis or testicles or both in Male and of Vulva or Nipples of breast / breast or both in female folowed by retraction of them in abdomen with physical and sexual weakness with or without fear of death.Mostly present as acute attack lasting for hours to maximum duration of 02 days.But some may show symptoms for years as chronic cases or recurrent cases ,some instead of shrinkage of genitilia complain genital shortening,alteration of penis size,loss of muscular strength,genital paraesthesia with no complain of retraction or breast mass in female with altered breast size and hidden or distorted nipples.Feature of sexual dissolution,loss of sexual or physical power,weakness,urinary obstruction,sterility may be seen.Psychologically Pateint suffer from anxiety neurosis may include fear of death,non specific physical danger,impending madness,spirit possession and feeling of being bewithched or under cover of black magic with feeling to sex change to eother female or vice versa or turning Enuch.
But in secondary or unclassical form of Koro as seen in western world only retraction of penis or loss of penile strength is coplained where person has got intense anxiety for penis with a strong psychosocial disease or under any organic brain disease or under influence of drug or intoxication.
While there are no substantiated reports of the condition itself resulting in any physical damage to the individual, many sufferers have unfortunately inflicted harm upon themselves or physical damage in frantic attempts to stretch the penis or Breast to prevent further shrinkage. It is not unusual for those with koro themselves or wthrough their family members and social sympathisers to resort to using devices such as clamps or weights or pegs or by aloop of string for retraction of penis as mechanical traction device.female either herself or ladies around her grab breast,pull nipples out or insert iron pins in nipple so that it cannot go inside.
Chanting of local religious songs and puja or religious celebration to please God/Goddess through local preachers and pandits or programmes for their blessing or correct any unknown mistake conducted in their past celebration or work out by local witch hunters by putting wood fire and smoking to remove bad blessing or evils or black witch from society or beating or killing of socalled wrong or evildoers suspected in society or villages is done.In North bengal people are putting lime water over both ears and nose ,keep Kush grass or pure water of a temple or river to keep these bad evils from them .some also cover their genitilia and breast so much under clothe as nothing happens to these organs.
DIAGNOSIS: it is easily done when epidemics occur as strong social belief or myth or rumor based on past prevalent stories and drama of witch hunt or as a punishment of some sexual wrong doing or intake of contaminated food or prsence of some diseases with typical full blown symptoms of penile/Testicle shrinkage or retraction in abdomen in patient of introversion suffering from anxiety or psychological disorder or under religiuos and social belifs and faith in myths or evil doers with or without sexual and physical weakness and fear of death.Injuries are secondary to measures taken by patients or relatives to prevent injuries.
TREATMENT:---
As the disease involves social beliefs and psychological insult so both Medical and Indigenous treatment should be given otherwise complete eradication may not be possible.As no defect is found in genitilia and breast to nothing is done for this if injuries inflicted by patient or relatives as mechanical manipulation to prevent retraction of genitilia or nipples then local injuries are dealt both surgically and medically.
in Cultural bound cases,lectures should be organised through healers of society by educating them with anatomy and physiology of Genitilia with audio visual or practical demonstration either as alone or to whole society utilising local media,radio /Tv/poster/leaflets and picturing small booklets,Individualy affect person psychosocial analysis is done and therapy for underlying disease is started.Inwestern type sexual conflict is identified and patient treated for any psychological or organic disease diagnosed.
indigenous medicines by local healers may be also advised to win the belief of people,praying to Gods and submitting to socalled social healers and witch hunters may be allowed to control epidemic spread but side to side strong counselling and health education should be provided individually ,by NGO or by Government health agency and social reforming departments.In china people hit gongs or bells to drive out witches .They use chinese a yang or yin augmenting medicine including herbs,animal penises (of tiger,deer,and fur seal )pilose anter(stag of deer) or deer tail.Pepper soup ,ginger soup,Louki or cucumber soup or liquor is also drunk to cure the diesease,in north Bengal people are using lime water application over both ears and nose and kush grass and holy water keeping to keep awya bad evils.
PROGNOSIS:prognosis is seen in patient having an acute attack with short history having uncomplicated sexual life,low freauency of attack with previous functional personality.
Dr.D.R.Nakipuria

09434143550
**Author is a naco trained HIV and sex specialist

Gradually as we are more educated by Media,internet,print media,films, social interactions, books,our day to day exposure in family,friends,society to sex from our childhood till Adult period or even we are middle aged or old,Sex either comes spontaneously or otherwise due to above reasons becomes a very need of our life like Anger,fear,Greediness,Love,Hunger,Thirst,Sex is important involuntary demand of our body.
But as becomes more informed on this matter either by family /society or our exposure to different above mentioned information channels,we start asking ourselves as we are competent enough to perform Sex properly and completely qualitively and quantitavely perfect.Mostly A person or his/her are experiencing it ,that is why if partner complains (which is mostly not seen in our Indian society) a person is ofeten left to himself whether he is performing normally or not and he becomes more questening whe he reads or sees videos /stories of betters performing persons who are doing sex for much time ,much frequently and in different postures and styles ,satisfying partner with more satisfications in form of penetrations, cries,return behaviours and demands.But most of such behavioural changes are wrong as Sex performance never means deep or forceful penetrations, excessive strong rigid,fatty and thickened tight Penis or Fatty full Labia with prominent Clitoris or with excessive discharge of Male or Female before or after Coitus or making partner more demanding sex or behaving in abnormal styles,fashions and positions.If these comes in our sexual behaviour these are excess above Normal Sexual behaviour,whether this is pervertion or not is questionable but not a certainly normal behaviour.A normal sex apathy cannot be said at all if these are absent,only need is of a normal sex desire at a proper time,place with a normal partner with or without a fore play and after desire a normal erection with normal penetration,coitus , normal holding,exercise for 1-5minutes and normal discharge inside or outside of few ML of fluid only.Iind arousal may come immediately or may not come for hours it never means less strength or apathy or a partner not interested for second after first in short time.But beside this there are some gray areas where a person in normal condition without under any influence of medicine,addiction or psycho social or organic body diseases never gets sexual desire even after proper stimulation by partner or by books / stories or video and remain apathetic to sex ,these persons whether Male or Female are called Apathetic to Sex or we can say Less desire/Drive/Interst for Sex is seen among them,Mostly it is assumed that Male suffers it most and it is reflected more as Male is Active Partner in Sex but it is not true a freezed Female can damp a normally (not Hyperactive) Male too or a stimulated Female can boost up a borderline or less performing Male too also,so Importance of Both Partners exist and one can supplement and correct other by Physical or Psychosocial stimulation,some time change of partner,time,place,orientation,external stimulation,visualisation and exhibition of Normal Sex and psychosocial support corrects this Low desire so well that in most of cases mere psychosocial correction and support yields very good result needing no medicines .
That is why this article will provide us correct knowledge of Less Desire/ Drive in sex. Mostly we assume that wife is a bit concerned, but it doesn?t bother you too much because she doesn?t speak about it or mentions it. However, deep within, you want to understand how and why you have transitioned from a once energetic young chap who could satisfy his newly-wedded wife in a matter of minutes to a man who no longer yearns to play the game. Deep inside, you also realize that the longer things go on like this, the farther apart you and your wife will drift. However, time and time again, you brush the issue under the carpet.Men often don?t express their personal problems, especially those involved with relationships or sexual in nature, and, therefore, find it difficult to seek help. This eventually leads to breakdown of their relationships and causes stress, which further aggravates the problem.
What is low sex drive?
A man with decreased libido thinks less about sex, loses interest in sexual fantasy and in sexual activity. Even sexual provocation by sights, words, or touches, may fail to induce interest. The man, however, often retains the capacity to have sex. Some men, despite having no desire for sex, continue to engage in sexual activity in order to satisfy their partners. In such cases, women may find the excitement completely lacking and might start feeling that their partners are no longer interested in them.Different men have different levels of libidos. This may range from one extreme, (such as wanting sex everyday) to the other extreme (having sex only once, twice or thrice a month/year). Men also have varying levels of satisfaction with their own sex drives. Therefore, there is no normal range of sexual activity for a coupleProblems may arise when the husband?s libido is persistently low, which causes the wife to remain sexually dissatisfied or unfulfilled or when the man seems to be dissatisfied with his own level of sex drive. Compatibility between spouses, including sexual compatibility and sex drive, is essential to maintain healthy sexual life. While libido may be decreased temporarily by conditions such as fatigue or anxiety, some men experience low levels of sexual desire all their lives.
Medical causes
Low libido may be caused by many different medical conditions. One of the most frequent is low levels of testosterone in the body. Apart from erectile dysfunction and premature ejaculation, which may induce anxiety and as a result, decrease your sexual drive, other unrelated conditions (such as Physical weakness Diabetes,TB,anemia, chronic Disease of Liver,Kidney, Lung,Neurological,spinal Gi Tract,cardiovascular disease, Genitourinary diseases pain due to Bony,Skeletal or Muscular diseases,Hormonal diseases) may also lower your libido.Try to rule out all physical or organic disease possibilities for your reduced sex drive. If you have any condition that might be associated with a low libido, see your doctor. You could have a medical condition that can be easily remedied or controlled. Treating the underlying medical condition may help in improving your sex drive.
Stress
Chronic stress can interfere with the hormones involved in the sexual response. This may result in low libido. Stress may be induced due to a variety of factors such as financial, personal, work?related and so on.if by counselling or psychosocial support or some time by psychiatrist using some medicines to cut depression,fear,mania oranger,anxiety, sleeplessness and once these are corrected a normal drives come,but in most of cases of absent such diseases Less Drive is mostly due to our thinking due to our experience or influence by some incidence or videos or exposures and as these are better explained and cleared Drive comes gradually.In Female,a very orthodox bringing a belief of severe pain,bleeding,tear or shock or loss of virginity or of pregnancy create so much nervousness as she never allows any penetration or sometime even any physical exposure or stimulation,They need support from senior members or friends in Family or Partner or some time psychological counselling or medicines.sometime presence of excessive pain due to infection in Genitourinary system causes them Freezed,a proper control of infection by medicines by a good gynaecologist or Urologist or Family Physician corrects it.In amle,except for presence of infections in genitilia or urinary system mostly corrected by good psychological counselling and support ,medicines have got a little role except to correct infection or psysical diseases. Reduce stress and manage it more effectively. This can range from employing stress-relieving techniques such as prayers, meditation and yoga to delegating more responsibilities to your colleagues and peers, depending upon the cause of stress. Alternatively, have sex to reduce stress! It is a well-known fact that sex is a wonderful stress-buster.
No time for sex
Commonly seen now a days! because of our urge to be more and more busy,to earn more and more and in this race we forget our selves,some basic need of our body as we start less eating,gradually it becomes our diet ,same way no time for sex in early days lead to no sex drive in future leading to complete loss of our social and familial life .Juggling multiple responsibilities of earning and providing to your family, parenting, keeping the household afloat and discharging social responsibilities?whew! You find yourself constantly busy. Having packed schedules daily drains your energy and leaves no time for sex. A busy schedule also means a busy mind ? and having a lot on your mind makes it difficult for you to relax and "get in the mood?. Sex, may, therefore, take a backseat and feel like just one more thing on your extremely-long "to-do list." All of these factors contribute to a lower libido.Remember that sex is an important part of an adult relationship. Just as we need to find time for ourselves, we also need to find time for our partners. Designate a night or two a week to spend quality, romantic time with your wife. You can make it more interesting by bringing something new to the bedroom occasionally.
Emotional causes

Men generally overlook emotional causes of decreased libido such as fear, anxiety and depression. When we are afraid, anxious or depressed, sex is usually the last thing on our minds. Anxiety, fear and depression may stem from a variety of causes, be they work dilemmas, relationship issues, family woes, or money problems, but emotional experiences greatly impact our sex drive. On the contrary, fear and anxiety may occur due to sex itself. This includes the fear of contracting an STD, of making your partner pregnant or of not being able to make her conceive.
All these emotional experiences dampen our sex drive and hamper our chances of having a pleasurable sexual experience. Improving your health and immunity are the primary factors that can ensure that you are able to tackle these emotional experiences. You can manage anxiety, fear and depression by meditating, doing yoga, talking to friends or playing with your kids. When your mind is healthy, there are fewer chances of problems intruding into your bedroom. However, if you feel that these emotional experiences are overwhelming you and you cannot cope with them, seek professional help.
Boredom
After being married for few years, some couples can hardly find any sexual excitement left in their lives. You might also lose interest if your mate doesn?t take care of her looks, body and behavior.
Experiment! Bring back the excitement by trying out stuff that you had been fantasizing about for some time. Gift your wife sexy dresses, which will help bring in some spontaneity to the experience. Talk to your partner about her idea of improving the sexual relationship.

Relationship issues
Having relationship issues with your partner such as unresolved conflicts, resentment or unexpressed anger can dampen your sexual desire. You need to deal with relationship issues with your partner if you want to enjoy sex again.
Communicate. Identify the problem and try to find the solution together before issues explode into huge conflicts. If talking to each other doesn't work, seek help from a therapist.

Body Image
Some people feel unhappy about their bodies and are shy to expose them to their partners. Though, we all love and hate some aspects of our bodies, the key here is to learn to be happy with what you have and feel sexy about it.We can do away with the negative feelings by thinking about the positive aspects that you have. Even if you are overweight, you can try out ways to feel sexy by enhancing your other valuable body aspects. If you are obese, try to shed some weight by seeking professional help.
Aging
With age, men produce less testosterone, which reduces their sex drive. Other concomitant factors that may play a role in reduced libidos are age-associated fear, anxiety, and depression. Testosterone levels may be increased by taking testosterone supplements, but this should be subsequent to consultation with your doctor. Additionally, the dosage of testosterone must be carefully monitored, as high levels of this Hormone can cause depression or other side effects like prostatic or testicular cancers. Long-term safety of testosterone supplements, especially in elderly men, has also not been established. Other temporary alternatives can be the use of Viagra (Sildenafil citrate).But it corrects only erectile dysfunction not libido so it is not very useul here works or work as psycological boosting agent However, prior to initiating any medicine to boost your sex drive, it?s essential to consult your doctor.
Sexual Abuse
If you have been a victim of sexual abuse, you may find it difficult to have normal physical relations. By taking your own time to heal, being patient and getting help of friends and counselors, you can overcome this past issue and resume a normal and healthy sex life. The key here is not to pressurize yourself or get pressured from others to have sex until you are completely healed and ready.
Medication
Some common medicines such as those for high blood pressure, depression, or relieving anxiety can reduce sex drive. Depression can also lower your sex drive and so can the medicines you take to relieve it. Additionally, antidepressants can cause sexual dysfunction, such as delay in orgasm, inability to achieve orgasm or erection or ejaculation. Any of these conditions can have an adverse affect on your level of desire. Before taking any new medicine, talk to your doctor about the possible side effects on sexual activity. Also, make a list of all the medicines that you take and get to know about their side-effects. Talk to your doctor and seek alternatives to the medicines which seem to be the cause of low sex drive or sexual dysfunction. Other options may include taking drug holidays, reducing the dosage or taking antidotes. Some people may benefit from taking supplements such as Gingko biloba or switching to a different medicine. The most important thing to remember here is that you should not stop taking any medicine without first talking to your doctor.
The best approach to this problem is to try and identify the cause of low sex drive .Once we are able to do so, try to eliminate the cause or seek professional help. Remember, putting in the effort and resolving problems now will go a long way in living a sexually-fulfilling and blissful life! But most of time our belief in Less Drive/Desire is not correct as either our mental level has raises or we are under above mentioned physical or psychosocial stress and oce we get corrected it,normal desire comes but it is most true that a normal Sex must be perfomed by partners at regular interval as it increases our cohesiveness and adherance to each other and normally shapes our family and society. Neither we should be overactive or more demanding destroying our social fabrics nor we should be so much busy or shameful of performing Sex inspite of our time, space,place, age,religion,enviornment or any other social factor.
DR.D.R.NAKIPURIA
SILIGURI
09434143550
NACO TRAINED EXPERT ON HIV,SEX & VENERAL DISEASES