Sexual dysfunction in males

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Sexual dysfunction is commonly ascribed to decreased libido, erectile dysfunction, ejaculatory disorder (premature and retrograde ejaculation) and orgasmic dysfunction. Decreased libido and erectile dysfunction are the two most prevalent and studied disorders among men. Where erectile dysfunction (persistent inability to maintain erection during sexual intercourse for satisfactory sexual performance) is mainstay in drug development owing to its widespread prevalence. Prevalence of ED has been reported to be 52% with complete ED ranging from 5 to 15% in men aged 40-70 yrs. However, its prevalence varies from 2% in men aged < 40 yrs to 86% in men aged >80 yrs. There is a lack of data available for the other forms of sexual dysfunction i.e. premature and retrograde ejaculation, loss of libido and orgasmic dysfunction. Since introduction of "Viagra" (sildenafil) in 1999 there has been an overwhelming increase in the prescriptions for medications used to treat erectile dysfunction. Thereafter , over the last decade the market was inundated with herbal treatments for sexual dysfunction. Most of these herbal formulations either lacked the desired efficacy or lacked strong scientific evidence to prove their efficacy. Furthermore several manufacturers of these polyherbal preparations are making huge financial gains by adulterating their herbal products with more efficacious allopathic drugs like sildenafil and tadalafil. A study on this aspect was carried out where some marketed polyherbal aphrodisiac preparations were evaluated for the presence of adulteration of Phosphodiestrase inhibitors i.e. sildenafil and tadalafil. Out of 15 such preparation, 5 were found to be adulterated. Adulteration of polyherbal aphrodisiac preparation posses a life threat to the society for a) Phosphodiestrase inhibitors are contraindicated in cardiac patients stabilised on nitrates b) Erectile dysfunction is commonly observed in geriatric population, moreover, they are the people who are on nitrate therapy making them more vulnerable to risk associated with incompatibility of these polyherbal adulterated preparations with nitrates. It is pertinent to mention that since the launch of sildenafil (Viagra) in 1999 till 2002, 60 deaths were reported where patients were taking sildenafil and were also on medication for cardiovascular complications.