In younger age groups, masturbation and nocturnal emissions (night discharge) are common problems and in older patients, impotence is a common complaint. It’s a pity that many GPs cannot guide boys and young men regarding masturbation and nocturnal emissions. These problems are so commonly seen because of the lack of sex education. The common impression carried by the Indian public is that loss of semen leads to weakness. This is not correct. These patients, thus carry a guilt feeling.
Normally, as the boys mature, they start having nocturnal emissions. Depending on their social class, cultural activities and surroundings, the frequency may be once a day or once a month. Loss of weight, weakness and other symptoms are due to fear and guilt feelings. Masturbation is absolutely normal, especially in our Indian society. In foreign countries, boys over fifteen years start enjoying their regular sexual intercourse, so that there is no need for them to masturbate. Regarding the normal frequency of masturbation, as there is no rule of medicine, how often a husband should visit his wife, similarly there is no rule, how often a young man or boy should masturbate. There is a wide range of normal variation. Of course tranquilizers would reduce their urge and symptoms. Tranquilizers should be given after adequate explanation to the patients and his parents who themselves did not get any sex education and are therefore responsible partly for giving this complex to their children.
Regarding impotence, most of the doctors treat it with hormone injections. This is again not right. Diabetes and syphilis are two uncommon causes of organic impotence and should always be excluded. Drugs used for hypertension may be responsible for impotence. However, the most important type and commonest type of impotence seen in general practice is functional in origin. These patients may complain of poor erection and premature ejaculation.
Poor erection is due to fear, anxiety, tension of day to day life, business worries etc. Treatment is an adequate explanation, encouragement, a holiday with wife and without children away from town. Tranquilizers should not be prescribed. Nowadays, Sildinaphil (Viagra) can be prescribed for these young patients specially to generate confidence in them.
For premature ejaculation, the treatment is 1) encouragement, 2) a tranquilizer tablet and 3) Xylocaine can be applied locally to the glans penis, a few minutes before sexual intercourse.
These patients usually have fear and inferiority complex. They should also be advised to play with female partner for a few minutes before the sexual intercourse.
Excess of premarital and extramarital sex may occasionally lead to impotence.