Amidst the booming market of treatment pills, powders and supplements aimed at boosting one’s sexual health or well-being, the sheer lack of awareness about the subject often causes problems. Impotence and infertility, two common sexual problems often used interchangeably, have a stark difference between them. While impotence refers to difficulty in getting or maintaining an erection, infertility is defined as the inability to conceive. However, both of these conditions are mostly treatable, with several treatment modalities available for addressing them, says Dr Karthikeyan VS, microsurgical andrologist and urologist, Apollo Hospitals, Chennai.
What is impotence?
Impotence — currently referred to as erectile dysfunction — is defined as the failure to achieve or maintain an erection suitable for satisfactory sexual intercourse. “This can make it difficult for a couple to consummate their relationship. Although there’s no recognized time limit for it to be considered a condition, some have suggested that it needs to persist for six months or more,” says Dr Shashidhar B, senior consultant, andrology, Manipal Hospital, Bangalore.
Additionally, Dr Rajan Bhonsle, professor and HOD, sexual medicine, KEM Hospital & Seth GS Medical College, Mumbai, explains that the term erectile dysfunction is often used in a derogatory manner. This stems from a lack of knowledge. According to him, reproductive issues can be broadly divided into two categories: the inability to perform a sexual act due to problems with erection or ejaculation and a low sperm count despite adequate ejaculation of semen. Less than 15 million sperm per milliliter of semen is categorized as a low sperm count.
Diagnosing and treating impotence
According to Dr Karthikeyan, besides analyzing one’s medical history, it’s important to understand what they mean by impotence – whether they’re facing problems with erection or experiencing delayed ejaculation. In addition, questionnaires and an erection hardness score (EHS) can also help diagnose the condition. “We perform detailed lab investigations based on the individual’s queries, age, comorbid conditions, lifestyle and BMI. We also conduct semen analysis whenever required. Furthermore, the andrologist can also conduct an erection test instead of using a penile Doppler test — a scan for assessing the penile blood flow,” he explains.
The condition can be reversed by a healthy diet, lifestyle changes and medication. “In extreme cases, we use injections or perform surgeries in the form of penile prosthesis implantation. We also have newer treatments like shockwave therapy and stem cell therapy, but they’re experimental at this point in time,” says Dr Karthikeyan.
What is infertility?
According to the World Health Organization (WHO), infertility, a complication of the male or female reproductive system, is defined as the failure to achieve a pregnancy after having regular, unprotected sexual intercourse for a period of 12 months or more.
Explaining how it’s caused, Dr Shashidhar says that infertility in males can result from several factors, ranging from problems with ejaculation, low sperm count or azoospermia (absence of sperm) to abnormal sperm morphology and motility. The scrotum, which contains the testicles, has a temperature that’s one or two degrees lower than that of the body, says Dr Bhonsle, who’s also the co-author of the book ‘What the FUQ? – Frequently Unanswered Questions about Sex.’ “The testes require lower temperatures to produce an adequate number of sperm. If a man wears tight undergarments, pants or both, takes long hot baths, regularly visits the sauna and keeps laptops above the genital area, among others, the scrotum gets pressed on the warm body. This can lead to a low sperm count, also referred to as oligospermia,” he explains. In case of females, infertility may result from abnormalities of the ovaries, uterus, fallopian tubes or endocrine system, among others.
Diagnosing and treating infertility
Infertility can result from problems with the male, female or, at times, both. Sometimes, the couple might not experience any complications as well, says Dr Karthikeyan. “For identifying male factors, we assess their history, examine the testicular size and check for varicose veins, infections or inflammation in the seminal passage. We also check if the seminal passage is fully developed,” he explains.
Apart from these tests, the doctors also conduct semen analysis and other investigations (like blood tests) to assess the capacity of the testes to produce sperm. “Further, we also conduct a Doppler ultrasound of the scrotum to confirm for varicocele,” notes Dr Karthikeyan.
According to him, treatment modalities for males include a healthy diet, lifestyle changes, abstaining from tobacco, specific medications, antioxidant supplements, injections like human chorionic gonadotropin (also known as hCG, which stimulates testosterone production) and human menopausal gonadotropin (also known as hMG, which stimulates sperm production) as well as correction of varicocele by microsurgical treatment. Dr Shashidhar says infertility in females can be treated with medication, surgery, intrauterine insemination and assisted reproductive technologies like IVF (in vitro fertilization).
Other factors affecting men’s reproductive health
According to experts, several factors can affect the reproductive health of males, which include:
- Testicular disorders
- Prostate cancer
- Loss of libido
- Sexually transmitted diseases
- Penile disorders
- Swelling of the penis
- Painful or premature ejaculation
- Genital ulcers
- Urethral discharge
- Testicular torsion (twisting of the spermatic cord due to the rotation of a testicle)
- Testicular injuries
- Mumps infection
- Impotence refers to the inability to get or maintain an erection. Infertility, on the other hand, is defined as the inability to conceive after trying for a year or more.
- Analysis of one’s medical history and tests based on factors like age, BMI, comorbid conditions, etc., can help diagnose impotence.
- Infertility in males can result from certain habits like wearing tight undergarments, taking long hot baths and keeping laptops above the genital area. In females, it can be caused by abnormalities of the ovaries, uterus, fallopian tubes or endocrine system.
- A healthy diet, an active lifestyle, laying off tobacco and certain medications can help reverse impotence and infertility. However, specific surgical interventions are required in extreme cases.