উত্তেজনা বা যৌন উত্তেজিত হতে সমস্যা (Arousal Disorder)
কাকে বলে?
যখন একজন ব্যক্তি যৌন ইচ্ছা থাকা সত্ত্বেও শারীরিকভাবে যৌন উত্তেজনা তৈরি করতে পারে না বা ধরে রাখতে পারে না, তখন তাকে Sexual Arousal Disorder বলে।
পুরুষদের ক্ষেত্রে
- লিঙ্গ শক্ত না হওয়া
- শক্ত হলেও ধরে রাখতে না পারা
এটিকে Erectile Dysfunction (ED) বলা হয়।
নারীদের ক্ষেত্রে
- যৌন উত্তেজনা না হওয়া
- যোনি ভেজা না হওয়া
- যৌন মিলনে অস্বস্তি
কারণ (Causes)
শারীরিক কারণ
- ডায়াবেটিস
- উচ্চ রক্তচাপ
- হৃদরোগ
- স্থূলতা
- Testosterone কমে যাওয়া
- থাইরয়েড রোগ
- স্নায়ুর রোগ
- ধূমপান
- অ্যালকোহল
মানসিক কারণ
- Anxiety
- Depression
- দাম্পত্য সমস্যা
- অতিরিক্ত টেনশন
- Porn addiction
ওষুধজনিত কারণ
- Antidepressant
- Antihypertensive
- Sedative drug
লক্ষণ (Symptoms)
পুরুষদের ক্ষেত্রে
- লিঙ্গ শক্ত না হওয়া
- যৌন মিলনের সময় erection নষ্ট হয়ে যাওয়া
- যৌন ইচ্ছা কমে যাওয়া
- দ্রুত বীর্যপাত হতে পারে
নারীদের ক্ষেত্রে
- যৌন উত্তেজনা না হওয়া
- যোনি শুষ্কতা
- সহবাসে ব্যথা
- অর্গাজম না হওয়া
Clinical Diagnosis
History
- সমস্যা কতদিন ধরে
- Morning erection আছে কি না
- Diabetes/BP আছে কি না
- মানসিক চাপ আছে কি না
- ওষুধ সেবনের ইতিহাস
Physical Examination
- Blood pressure
- BMI
- Genital examination
- Secondary sexual character
- Peripheral pulse
Investigation
রক্ত পরীক্ষা
- Fasting Blood Sugar / HbA1c
- Serum Testosterone
- Lipid Profile
- Thyroid Function Test
- Serum Prolactin
অন্যান্য পরীক্ষা
- Penile Doppler Ultrasonography
- Nocturnal Penile Tumescence Test
- ECG (cardiac risk assessment)
Differential Diagnosis
- Depression
- Hypogonadism
- Premature ejaculation
- Peyronie disease
- Anxiety disorder
Treatment & Management
১. Lifestyle Modification
- ধূমপান বন্ধ
- অ্যালকোহল বন্ধ
- নিয়মিত ব্যায়াম
- ওজন কমানো
- পর্যাপ্ত ঘুম
- Diabetes/BP control
২. Psychological Therapy
- Sex therapy
- Cognitive Behavioral Therapy (CBT)
- Couple counseling
৩. Pharmacological Treatment
Sildenafil
- Generic: Sildenafil
- Tablet 1.Aggra 50mg/100 mg AS A Sildenafil Citrate AS A Drugs for Erectile Dysfunction.
- Dose:
- 50 mg orally
- যৌন মিলনের ১ ঘণ্টা আগে
- Range: 25–100 mg
Side effects
- মাথাব্যথা
- মুখ লাল হওয়া
- Low BP
Contraindication
- Nitrate drug এর সাথে নিষিদ্ধ
Indications:-
Treatment of men with erectile dysfunction, which is the inability to achieve or maintain a penile erection sufficient for satisfactory sexual performance. In order for Aggra to be effective, sexual stimulation is required. Aggra is also indicated in pulmonary arterial hypertension.
Description:-
Aggra is a selective, reversible inhibitor of cyclic guanosine monophosphate (cGMP)-specific phosphodiesterase type 5 (PDE5). When sexual stimulation causes the local release of nitric oxide; inhibition of PDE5 by Aggra produces increased levels of cGMP in the corpus cavernosum. This results in smooth muscle relaxation and inflow of blood into the penile tissues, thereby producing an erection. Aggra has no effect in the absence of sexual stimulation.
Side Effects:-
Body as a whole: face edema, photosensitivity reaction, shock, asthenia, pain, chills, accidental fall, abdominal pain, allergic reaction, chest pain, accidental injury.
Cardiovascular: angina pectoris, AV block, migraine, syncope, tachycardia, palpitation,hypotension, postural hypotension, myocardial ischemia, cerebral thrombosis, cardiac arrest, heart failure, abnormal electrocardiogram, cardiomyopathy.
Digestive: vomiting, glossitis, colitis, dysphagia, gastritis, gastroenteritis, esophagitis, stomatitis, dry mouth, liver function tests abnormal, rectal hemorrhage, gingivitis.
Hemic and Lymphatic: anemia and leukopenia.
Metabolic and Nutritional: thirst, edema, gout, unstable diabetes, hyperglycemia, peripheral edema, hyperuricemia, hypoglycemic reaction, hypernatremia.
Musculoskeletal: arthritis, arthrosis, myalgia, tendon rupture, tenosynovitis, bone pain,myasthenia, synovitis.
Nervous: ataxia, hypertonia, neuralgia, neuropathy, paresthesia, tremor, vertigo, depression, insomnia, somnolence, abnormal dreams, reflexes decreased, hyperesthesia.
Respiratory: asthma, dyspnea, laryngitis, pharyngitis, sinusitis, bronchitis, sputum increased, cough increased.
Skin and Appendages: urticaria, herpes simplex, pruritus, sweating, skin ulcer, contact dermatitis, exfoliative dermatitis.
Special Senses: sudden decrease or loss of hearing, mydriasis, conjunctivitis, photophobia, tinnitus, eye pain, ear pain, eye hemorrhage, cataract, dry eyes.
Urogenital: cystitis, nocturia, urinary frequency, breast enlargement, urinary incontinence, abnormal ejaculation, genital edema and anorgasmia.
Cardiovascular and cerebrovascular: Serious cardiovascular, cerebrovascular, and vascular events, including myocardial infarction, sudden cardiac death, ventricular arrhythmia, cerebrovascular hemorrhage, transient ischemic attack, hypertension, subarachnoid and intracerebral hemorrhages, and pulmonary hemorrhage have been reported post-marketing in temporal association with the use of Aggra. Most, but not all, of these patients had preexisting cardiovascular risk factors. Many of these events were reported to occur during or shortly after sexual activity, and a few were reported to occur shortly after the use of Aggra without sexual activity. Others were reported to have occurred hours to days after the use of Aggra and sexual activity. It is not possible to determine whether these events are related directly to Aggra, to sexual activity, to the patient’s underlying 23 cardiovascular disease, to a combination of these factors, or to other factors.
Nervous: seizure, seizure recurrence, anxiety, and transient global amnesia.
Urogenital: prolonged erection, priapism and hematuria.
Special Senses: diplopia, temporary vision loss/decreased vision, ocular redness or bloodshot appearance, ocular burning, ocular swelling/pressure, increased intraocular pressure, retinal vascular disease or bleeding, vitreous detachment/traction, paramacular edema and epistaxis.
Tadalafil
- Generic: Tadalafil
- Tablet 1.Intimate 10 mg AS A Tadalafil AS A Drugs for Erectile Dysfunction.
- Dose:
- 10 mg before intercourse
- অথবা 2.5–5 mg daily
Indications:-
Intimate is indicated in-
- Erectile Dysfunction (ED)
- Benign Prostatic Hyperplasia (BPH)
- Both Erectile Dysfunction and signs and symptoms of Benign Prostatic Hyperplasia
- Side Effects:-
- Headache, Dyspepsia, Back pain, Myalgia, Nasal pharyngitis, Nasal congestion are common side effects. Change in Color Vision, Sudden vision loss, Hearing loss, Stevens-Johnson Syndrome, Exfoliative dermatitis, Angina, Stroke, Myocardial infarction, Severe hypotension, Tachycardia may also occur rar
Contraindications:-
- Use of Nitrates (for example, Nitroglycerine, Isosorbide): may increase hypotensive effects of Nitrates
- Hypersensitivity reactions to Tadalafil
সুবিধা
- দীর্ঘ সময় কাজ করে (36 ঘণ্টা পর্যন্ত)
Vardenafil
- Generic: Vardenafil
- Tablet 1.Valenty 10 mg AS A Vardenafil AS A Drugs for Erectile Dysfunction.
- Dose:
- 10 mg orally before intercourse
Indications:-
Valenty is used to treat erectile dysfunction (ED).
Pharmacology:-
Vardenafil is a selective inhibitor of cyclic guanosine monophosphate (cGMP) specific phosphodiesterase type 5 (PDE5). Penile erection is a hemodynamic process initiated by the relaxation of smooth muscle in the corpus cavernosum and its associated arterioles. During sexual stimulation, nitric oxide is released in the corpus cavernosum & activates the enzyme guanylate cyclase resulting in increased synthesis of cyclic guanosine monophosphate (cGMP) in the smooth muscle cells of the corpus cavernosum. The cGMP in turn triggers smooth muscle relaxation, allowing increased blood flow into the penis, resulting in an erection. Inhibition of PDE5 enhances erectile function by increasing the amount of cGMP. Because sexual stimulation is required to initiate the local release of nitric oxide, the inhibition of PDE5 has no effect in the absence of sexual stimulation.
Interaction:-
Valenty can potentiate the blood pressure lowering effect of antihypertensive agents. In clinical studies, single doses of Valenty 20 mg caused a mean decrease in blood pressure of 7 mmHg systolic and 8 mmHg diastolic. Caution should be taken when co-administered with other vasodilators including alpha blockers. Valenty does not potentiate the hypotensive effect of alcohol. CYP3A4 inhibitors (ketoconazole, indinavir, ritonavir and erythromycin) may reduce Valenty excretion from body
Side Effects:-
The most common side effects with Valenty are headache, flushing, stuffy or runny nose, indigestion, upset stomach, dizziness or back pain.
Avanafil
- Generic: Avanafil
- Tablet 1.Aventy 50 mg AS A Avanafil AS A Drugs for Erectile Dysfunction.
- Dose:
100 mg orally before intercourse
- Indications:-
- Aventy is a phosphodiesterase 5 (PDE5) inhibitor indicated for the treatment of erectile dysfunction.
Pharmacology:-
Avanafil is a selective phosphodiesterase 5 (PDE5) enzyme inhibitor used for the treatment of erectile dysfunction caused by diabetes, age induced oxidative stress or other complications. Avanafil inhibits the cGMP specific phosphodiesterase 5 (PDE5) which is responsible for degradation of cGMP in the corpus cavernosum located around the penis. Penis erection during sexual stimulation is caused by increased penis blood flow resulting from the relaxation of penis arteries and corpus cavernosal smooth muscle. This response is mediated by the release of nitric oxide (NO) from nerve terminals and endothelial cells, which stimulates the synthesis of cGMP in smooth muscle cells. Cyclic GMP causes smooth muscle relaxation and increased blood flow into the corpus cavernosum. The inhibition of phosphodiesterase 5 (PDE5) by avanafil enhances erectile function by increasing the amount of cGMP.
Side Effects:-
Most common adverse reactions (greater than or equal to 2%) include headache, flushing, nasal congestion, nasopharyngitis, and back pain.
Testosterone Therapy
যাদের Testosterone কম
Testosterone Enanthate
Capsule1.Androcap 40 mg AS A Male Sex hormones (Androgens).
- 100–200 mg IM every 2–4 weeks
- Injection 1.Testanon IM 250MG/ML 1ml Ampoule AS A Testosterone Decanoate Male Sex hormones (Androgens).
অথবা
Testosterone Gel
- 50 mg topical daily
সতর্কতা
- Prostate cancer থাকলে ব্যবহার করা যাবে না
নারীদের Management:-
Vaginal Lubricant
- Water-based lubricant
- Gel 1.K-Y Jelly Gel 50gm jelly AS A Glycerol AS A Miscellaneous topical agents.
- K-Y Jelly কাকে বলে?
- এটি একটি Water-based lubricant যা যোনিপথের শুষ্কতা কমাতে এবং যৌন মিলনের সময় ঘর্ষণ ও ব্যথা কমাতে ব্যবহার করা হয়।
- কীভাবে ব্যবহার করবেন (Step by Step)
- ব্যবহারের আগে
- হাত ভালোভাবে ধুয়ে নিন
- যোনি ও genital area পরিষ্কার রাখুন
- ব্যবহার পদ্ধতি
- Step 1
- টিউব থেকে অল্প পরিমাণ Jelly বের করুন
(প্রথমে ১–২ চা চামচ সমপরিমাণ) - Step 2
- নিচের যেকোনো স্থানে লাগাতে পারেন:
- যোনির মুখে
- লিঙ্গে
- Condom এর বাইরের দিকে
- Step 3
- আস্তে করে ছড়িয়ে দিন
- Step 4
- তারপর যৌন মিলন করুন
- কখন ব্যবহার করবেন?
- যৌন মিলনের ঠিক আগে
- যোনি শুষ্কতা থাকলে
- Menopause পর
- সহবাসে ব্যথা হলে
- কতবার ব্যবহার করা যাবে?
- প্রয়োজন অনুযায়ী ব্যবহার করা যায়
- অতিরিক্ত শুষ্কতা থাকলে আবার লাগানো যায়
- সুবিধা
- ব্যথা কমায়
- friction কমায়
- Condom safe
- সহজে ধুয়ে যায়
- Side Effects
- কখনো কখনো:
- জ্বালাপোড়া
- অ্যালার্জি
- irritation
- এসব হলে ব্যবহার বন্ধ করুন।
- গুরুত্বপূর্ণ সতর্কতা
- Oil-based cream (যেমন Vaseline) condom এর সাথে ব্যবহার করবেন না
- Infection থাকলে ডাক্তারের পরামর্শ নিন
- শুধুমাত্র বাহ্যিক ব্যবহারের জন্য
- Indications
- This Jelly is indicated to enhance the comfort and ease of intimate activity with or without latex condoms. This personal lubricant can be safely applied directly to a genital body orifice or a latex condom. The product can be used inside condoms to facilitate application or outside for lubrication during intercourses.
- Dosage & Administration
- Apply the desired amount of lubricant to your intimate areas. Reapply as needed. This Jelly is not applicable for pediatric Use.
- Side Effects:-
- No common side effects have been reported with K-Y Jelly. Few allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); new or worsening skin irritation may occur.
Estrogen Cream
Generic: Estradiol vaginal cream
Vaginal Cream 1.Prepose 0.0625% 15gm tube AS A Conjugated Estrogen Female Sex hormones.
- Dose:
- 0.5–2 g intravaginally daily initially
- Indications:-
- Prepose cream is indicated in the following indications-
- Moderate-to-severe vasomotor symptoms associated with estrogen deficiency.
- Prevention and management of osteoporosis associated with estrogen deficiency.
- Atrophic vaginitis and Kraurosis Vulvae.
- Female hypoestrogenism.
- Treatment of moderate to severe Dyspareunia.
- Description:-
- Preposes for vaginal administration is a mixture of estrogens, obtained exclusively from natural sources, blended to represent the average composition of material derived from pregnant mares’ urine. It contains the sodium salts of water-soluble sulfate esters of estrone, equilin, and 17 alpha-dihydroequilin, together with smaller amounts of 17 alpha-estradiol, equilenin, 17 alpha-dihydroequilenin, 17 beta-dihydroequilin, 17 beta-dihydroequilenin, 17 beta-estradiol, and delta 8,9-dehydroestrone.
Side Effects:-
The most serious adverse reactions associated with the use of estrogen are indicated under Warnings and Precautions. The following additional adverse reactions have been reported with estrogenic therapy.
- Genitourinary System: Breakthrough bleeding, spotting, change in menstrual flow, amenorrhea.
- Breasts: Tenderness, enlargement, secretion.
- Gastrointestinal: Nausea, vomiting, abdominal cramps, bloating, cholestatic jaundice.
- Skin: Chloasma or melasma which may persist when drug is discontinued, alopecia, rash.
- Eyes: Steepening of the corneal curvature; intolerance to contact lenses.
- Central Nervous System: Headache, migraine, dizziness; chorea.
- Miscellaneous: Increase or decrease in weight; edema; changes in libido, aggravation of porphyria.
Common side effects include Headache, Breast pain, Irregular vaginal bleeding or spotting, stomach or abdominal cramps, bloating, Nausea and vomiting, Hair loss, Fluid retention, Vaginal yeast infection, Reactions from inserting Prepose Vaginal Cream, such as vaginal burning, irritation and itching.
Uncommon side Effects Heart attack, Stroke, Blood clots, Dementia, Breast cancer, Cancer of the lining of the uterus (womb), Cancer of the ovary, High blood pressure, High blood sugar, Gallbladder disease, Enlargement of benign tumors of the uterus
(fibroids), Severe allergic reaction.
Complications
- Depression
- Relationship problem
- Infertility
- Low self-esteem
Prognosis
সঠিক কারণ নির্ণয় ও চিকিৎসা করলে অধিকাংশ রোগী ভালো হয়ে যায়।
Overview / Summary
Sexual Arousal Disorder হলো যৌন উত্তেজনা তৈরি বা ধরে রাখতে সমস্যা। এটি শারীরিক, মানসিক ও হরমোনজনিত কারণে হতে পারে। Erectile Dysfunction পুরুষদের সবচেয়ে সাধারণ সমস্যা। সঠিক history, investigation এবং guideline-based treatment অত্যন্ত গুরুত্বপূর্ণ।
Actionable Plan
- Blood sugar ও Testosterone পরীক্ষা করুন
- Smoking বন্ধ করুন
- মানসিক চাপ কমান
- PDE-5 inhibitor (যেমন Sildenafil) প্রয়োজনে ব্যবহার
- দীর্ঘমেয়াদি সমস্যা হলে Urologist/Sex specialist দেখান
References
Textbooks
- Harrison’s Principles of Internal Medicine, 21st Edition
- Davidson’s Principles and Practice of Medicine, 24th Edition
- Campbell-Walsh Urology, 12th Edition
Guidelines
- American Urological Association (AUA) Erectile Dysfunction Guideline, 2018
- European Association of Urology (EAU) Sexual & Reproductive Health Guideline, 2024
Journals
- Goldstein I et al. Oral Sildenafil in the Treatment of Erectile Dysfunction. NEJM. DOI: 10.1056/NEJM199805143382001
- Hatzimouratidis K et al. Guidelines on Male Sexual Dysfunction. European Urology. DOI: 10.1016/j.eururo.2010.12.048
Md.Rafiqul Islam Lipu Date:-09-05-2026 Saturday Time:-10-13-39 pm