Sexual and

reproductive health
in men
Dr. Rahmawati Thamrin Sp.And
Male reproductive system
• Many male reproductive system
problems could be perceived as
being embarrassing, which may
be one of the reasons that they
are often not identified in
general practice.
Male Hypogonadism
(Testosterone
Deficiency ) • Male hypogonadism is associated with
decreased testicular function, with
decreased production of androgens
and/or impaired sperm production .
This is caused by impaired testicular function or as a result of
inadequate stimulation of the testes by the hypothalamic-pituitary
axis. Several congenital or acquired disorders causing impaired
action of androgens are also described .
• Hypogonadism may adversely affect multiple
organ functions and quality of life (QoL).
• Late-onset hypogonadism (LOH) is a clinical
condition in ageing men, which, by definition,
must comprise both persistent specific
symptoms and biochemical evidence of
testosterone deficiency .
• Late-onset hypogonadism is frequently
diagnosed in the absence of an identifiable
classical cause of hypogonadism, which
becomes more prevalent with age, usually
occurring, but not exclusively, in men aged >
40 years.
 Role of testosterone in male • During the first trimester, the testes drive the
virilisation of internal and external genitalia through
sexual and reproductive placental human chorionic gonadotropin (hCG)-
health• Sexual development stimulated androgen secretion by Leydig cells.
• During puberty, reactivation of the hypothalamus–
and maturation pituitary-gonadal (HPG) axis allows the
development of secondary sexual characteristics,
spermatogenesis maturation and, along with the
contribution of other hormonal axes, completion of
• Testosterone production in the foetal testis starts the adolescent growth spurt .
between the eighth and ninth week of gestation after
the expression of the SRY gene, which regulates
organisation of the undifferentiated gonadal ridge into
the testis .
Sexual RIMBERIO

function
Testosterone is involved in the regulation of all steps of the male sexual

response. Sexual thoughts and motivations are universally accepted as the

most testosterone-dependent aspects of male sexual behaviour

• The European Male Aging Study (EMAS), a population-based survey

including 3,369 subjects aged 40-79 years from eight European
countries, showed that sexual symptoms, particularly impairment of
sexual desire, ED and decreased frequency of morning erections, were
the most specific symptoms associated with age-depended decline of
testosterone .
Specific symptoms associated with LOH
 RIMBERIO
Loss of libido is a not uncommon
presenting symptom in general
practice and can be affected by many
factors including:

• fatigue – such as from long or irregular working hours

• stressors – from any source, but potentially related to work, finances,
health or relationships
• lack of psychological wellbeing – such as depression, anxiety or low self
esteem
• relationship problems – such as conflict, poor intimacy or sexual
incompatibility.
 EPIDEMIOLOGY AND PREVALENCE OF SEXUAL DYSFUNCTION
AND DISORDERS OF MALE REPRODUCTIVE HEALTH :
Erectile Dysfunction
Epidemiological data have shown a high prevalence and incidence
Illustration by Smart-Servier Medical Art

of ED worldwide . Among others, the Massachusetts Male Aging

Study (MMAS) reported an overall prevalence of 52% ED in non-
institutionalised men aged 40-70 years in the Boston area; specific
prevalence for minimal, moderate, and complete ED was 17.2%,
25.2%, and 9.6%, respectively.

In a cross-sectional real-life study among men seeking first medical

help for new-onset ED, one in four patients was younger than 40
years, with almost 50% of the young men complaining of severe ED.
Differences among these studies can be explained by differences in
methodology, ages, and socio-economic and cultural status of the
populations studied.
 A symptom or a disease?

● The importance of ED being identified is that in the

majority of men, ED is not a disease in itself, but rather an
early symptom of cerebro-cardio-vascular disease.

● Arterial narrowing initially manifests itself in the small

arteries (such as the penile arteries) before narrowing of
larger arteries (such as the coronary and cerebral arteries)
declares itself in the form of symptoms such as angina and
transient ischaemic attacks (TIAs).
TREATMEN RIMBERIO

T
Among the medications available at the primary care level for efficaciously

treating the symptom of ED in most affected males are PDE inhibitors (eg.

sildenafil, tadalafil, vardenafil).

• Contraindications should be noted, in particular the concomitant use of long and

short acting nitrates and nitrate-like medications.
• Guidelines exploring the use of PDE5 inhibitors highlight the importance of in-
consultation brief education and counselling before use, so that both the male patient
and their partner have a realistic idea of what to expect from treatment.
Premature ejaculation
Premature ejaculation (PE) is a common and highly sensitive
matter and most men avoid broaching the problem .When raised
(either by the GP or the patient), a frank and supportive approach
goes a long way to opening up conversation and working toward a
more satisfying sex life for both the patient and their partner.
ASSESSME
• Lifelong (primary) or acquired (secondary) PE is typically diagnosed
via a sexual, medical and psychological history:

NT  Sexual history: onset and duration, ejaculatory latency time,

perceived control over ejaculation, frequency of occurrence,
past sexual relationships and functioning
 Medical history: general history, medications, past or current
infections, past traumas
 Psychological history: guilt, inhibitions or misinformation about
sex, negative sexual experiences, anxiety, depression, and the
impact of PE on the patient and their partner.
 A brief physical examination of the vascular, endocrine and
neurologic systems may be undertaken if the patient’s history
suggests an underlying medical condition, such as chronic
illness, genitourinary infection, Peyronie disease,
endocrinopathy or autonomic neuropathy.4
Treatment
the off-label use of daily selective serotonin reuptake inhibitor (SSRI) therapy.
The recommended dosages are
paroxetine (20–40 mg/day),
sertraline (25–200 mg/day), or
 fluoxetine (10–60 mg/day)
the application of topical anaesthetic to reduce penile sensitivity, eg. lidocaine-
prilocaine cream (5%) applied 20–30 minutes before sexual activity.
(Note: A condom must be used to avoid causing numbness in the partner).
Premature Ejaculation
Second line treatments include behavioural and cognitive
techniques.
‘Stop-start’ techniques
Behavioural techniques focus on reducing sexual stimulation
by exploring sexual activities or positions that may be less
stimulating or arousing.
using double condoms to decrease penile sensitivity, or
cognitive distractions to reduce arousal.
Illustration by Smart-Servier Medical Art

Male Infertility
LIFESTYLE
Hasil Analisis Sperma
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