Manasika Klaibya w.s.r erectile dysfunction

understandIng manasika klaibya to erectile dysfunction

1. CONCEPTUAL UNDERSTANDING OF MANASIKA KLAIBYA W.S.R. TO ERECTILE DYSFUNCTION By :- Dr. Gurmel Singh

2. INTRODUCTION Manasika Klaibya may be defined as loss of erection due to inflicted mind. The mind is afflicted with Kama, Krodha , Bhaya , Shoka , Moha , Mada , Manoabhighata , Avichara , Irshya , Avisrambha , Utkantha and Udvega irritability and ultimately causing disturbance in personal, familial and social harmony.

3. Worldwide, E.D. is estimated to affect more than 150 million men. Psychological factors such as Stress, Anxiety, Guilt, Depression, and Low Self – Esteem, and Fear of sexual failure cause 10 – 20% of E.D. cases. Sexual dysfunction may arise from emotional factors, including interpersonal or psychological problems. Interpersonal problems may arise from marital or relationship problems, or from a lack of trust and open communication between partners.

4. Psychological problems may be the result of depression, sexual fears or guilt, past sexual trauma, sexual disorders among others. In case of Klaibya , the treatment of choice is Hetuvipareeta . A positive therapeutic approach should include; 1. Dravya Chikitsa (drug therapy) 2. Adravya-Manasika Chikitsa (included in psychotherapy) 3. Pathyacharana (diet and regimen).

5. SAMPRAPTI Mansika hetu Avara stava Vitiates Rajas↓ and Tamas ↑ Disturbances of Manovishaya Hridaya , shiras Sharirika dosha vitiation Rasa and shukra dusti Manasika and sharirika lakshanas dhvajaanucchraya Sanga in manovaha srotas Further manas vitiation

6. What is the aetiology of ED? INFLAMMATORY Prodtatitis , urethritis MECHANICAL Peyronie disease, chordee PSYCHOLOGICAL Depression, performance anxity , stress, relationship difficulities

7. OCCLUSIVE VASCULAR Art: HYPERTENSION, SMOKING, HYPERLIPIDEMIA,DM, PERIPHERAL VASCULAR DISEASE Ven : venous occlusion due to anatomical or degenerative changes TRAUMA Pelvic fracture, sc inj , penile trauma ENDOCRINE Hypogonadism , hyperprolactinemia , hypo + hyperthyroidism

8. NEUROLOGIC PARKINSONS, MULTIPLE SCLEROSIS, SPINA BIFIDA, PELVIC SURGERY, PERIPHERAL NEUROPATHY CHEMICAL ANTI- HTN, ANTI- ARRHYTHMICS, ANTIDEPRESSANTS, ANXIOLYTICS, ANTI-ANDROGENS, ANTICONVULSANTS, ALCOHOL,MARIJUANA, ANTI-PARKONSON DRUGS, LHRH ANALOGUES EXTRA FACTORS PROSTATECOMY, OLD AGE CRF CIRRHOSIS

9. HOW TO DIAGNOSIS AND EVALUATE ERECTILE DYSFUNCTION HISTORY EXAMINATION INVESTION

10. HISTORY Sexual  Some symptoms suggest psychogenic ED, and others suggest organic disease.  A psychogenic cause is suggested by the sudden onset of ED or the presence of ED under some circumstances but complete erection at other times.  In contrast, gradual deterioration of erectile quality over months or years with preservation of libido suggests organic disease.

11. Psychological Evaluation  Medical Inquiries should be made about: DM, HTN, smoking, hypercholesterolemia, and hyperlipidemia as well as about liver, renal, vascular, neurologic, psychiatric, and endocrine disease.  Surgical History Abdominal, pelvic, perineal  Drug History Androgenic substances are associated with decreased serum testosterone levels and decreased libido.

12. EXAMINATION  Full Physical Body habitus , 2ndry sexual characteristics CVS, abdomen, neurological ( bulbocavernosus reflex is used to assess integrity of S2-4)  External Genitalia Penis: Phimosis , penile lesions Testis: size, consistency DRE

13. INVESTIGATION  LAB: Recommended: Fasting glucose, lipid profile, hormonal profile Others: thyroid, PSA, prolactin  Specialized Evaluations:Indicated for failure of ttt , peyronie’s disease, 1ry ED, history of surgery/trauma, complicated endocrine or neuropsychiatric disorder.

14. A. Vascular Evaluation B. Neurologic Evaluation C. Psychologic Evaluation D. Hormonal Evaluation

15. CHIKITSA The Ayurvedic therapy can be broadly divided into two types- Brimhana and Langhana . Of them Brimhana finds a fair application in Klaibya . In case of Klaibya also the treatment of choice is Hetuvipareeta . Sushruta says- Sadhyanamitaresham Tu Karyo Hetuviparyaya treatments are person specific rather than disorder specific. Thus, the appropriate choice of therapy should be selected considering the causative factors and after a thorough evaluation of the patient.

16. It seems, a positive therapeutic approach should include; 1. Dravya Chikitsa (drug therapy) 2. Adravya-Manasika Chikitsa (included in psychotherapy) 3. Pathyacharana (diet and regimen).

17. Charaka has suitably combined these three in formulating a general line of treatment for Klaibya as shown below: Purification therapy: i . Snehayukta Virechana preceded by Purvakarmas ii . Basti (Asthapana and Anuvasana) B. Vrishya yogas : i . Vrishya Dravyas and ii. Adravya Vrishyas (psychotherapy) Pathyahara - Therapeutic diet.

18. In Manasika Klaibya , Manas is mainly inflicted, so the chikitsa is intended more towards modification of Manovishayas with the Medhya Dravya like Shankhapushpi and psychotherapy in the form of Behavior Therapy.

19. conclusion Sex is not only a dynamic process; it is also an intimate relational bond. Sex problem involves mind, body and intellect of the individual. Mind creates ideas, body tries to execute them and the intellect decides the appropriateness of the action. It deals with psychology as well as physiology and techniques of Sexuality. Thus Sexuality should be studied at all levels- mind, body and intellect of the concerned individual. It is not only psychology but the sexual fitness and behavioral application of the techniques of Sex, which are important in Human Sexuality.