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How to interpret the spermogram?

Infertility is considered a disease of the reproductive system that is found after a period of 12 months of unsuccessful pregnancy attempts, in which the couple had sexual intercourse without the use of any contraceptive method. Currently, it is estimated that infertility affects 10% to 20% of couples of reproductive age, regardless of their ethnic or social origins.

In 30% of couples who are unable to conceive, the man is solely responsible for the cause of infertility, with female causes associated with male causes occurring in 20% of cases. Therefore, it can be said that male problems are present in about 50% of infertile couples. Because male problems are so common, proper investigation of the infertile male is essential.

The spermogram is the main evaluation test, being in most cases the first to be requested in the investigation of infertile men. About 80% of men with difficulty getting their wives pregnant have low sperm concentration associated with decreased motility and/or altered morphology.

The spermogram is a highly variable test, for the same individual, on different collection days, so it is advisable to obtain two semen analyzes before offering an opinion on the patient’s condition. A period of abstinence of 2 or 3 days must be respected. Changes in the period of abstinence may invalidate comparisons between analyses. The exam should be collected in the laboratory or reproduction clinic through masturbation and collected in a special glass or plastic container with a wide opening, avoiding the loss of material.

The analysis methodology and distribution percentiles are described by the World Health Organization, in its 5th edition, revised in 2010, and are represented in the table below.

parameters (5th percentile – 95% CI)
Seminal volume (ml) 1.5 (1.4-1.7)
Total sperm count (10 6 / ejaculate) 39 (33-46)
Sperm concentration (10 6 /ml) 15 (12-16)
total motility 40 (38-42)
Progressive motility (%) 32 (31-34)
Morphology (normal forms, %) 4 (3-4)

Biological proof of male infertility is only possible in cases of complete absence of sperm or complete absence of sperm motility. The interpretation of the values ​​of the seminal parameters defined by the WHO must be carried out with great care and attention. Reference values ​​do not represent the average concentration of sperm in the general population or the minimum values ​​required for spontaneous pregnancy. In addition, patients with seminal parameters outside the normal reference range may be able to get their partners pregnant. Therefore, the sperm analysis should not be seen as a test of male fertility.

Therefore, caution should be exercised in the use of sperm analysis for the diagnosis of male infertility. Men presenting the parameters within the suggested reference as normal, even so, may have difficulty getting their partners pregnant. Although the spermogram is intended to help sexologists in Delhi estimate the relative fertility of a given individual, seminal parameters definitely do not allow the definitive classification of patients as fertile or infertile.

male infertility

Male infertility and omega-3 deficiency

According to a study by University of Illinois staff, omega-3 fatty acids have other health effects in addition to inhibiting the development of cardiovascular disease: they improve male fertility, says sexologist in Delhi.

“In our studies, we used special gene-treated mice that lacked an enzyme that is essential for the production of docosahexaenoic acid (DHA). In the absence of docosahexaenoic acid, male animals were infertile, producing few, and bizarre-shaped sperm that are infertile,” says Manabu Nakura, a nutrition researcher at the University of Illinois.

Omega-3 affects the sperm count of men

However, a DHA-containing diet completely restored fertility. The first study to support the direct importance of DHA for male fertility, despite some previous studies, has suggested that low levels of fatty acids may be associated with low sperm count and reduced mobility.

DHA is an essential ingredient in the omega-3 fatty acid family, including vegetable oils, soybeans, and canola, but is found in the highest amounts in fish oil.

best sexologist in Delhi

The ideal position for a long period of sexual intercourse

Men are more likely to wake up during sex, and when this happens it is more likely that sex will last longer than desired. But it doesn’t have to be this way all the time, you can make sex last longer and satisfy both parties. One of the biggest problems men face is power. If your husband is unable to stay long, he may not be able to satisfy you. While it is not your fault, premature ejaculation affects both of you.  The good news is that you can help them last longer.

Sexual conditions that make you stay longer

Believe it or not, sexual situations affect how long your partner lasts. There are two factors that influence whether sexual orientation is good or bad in order to prolong sex. First is the opinion. There are situations that give great pleasure to men. They feel good, but too many emotions will cause your husband to be confused in front of you.

The second point is work. When your partner is pushing, all the pushing moves increase his or her heart rate. As the blood flows and your heart beats, your body will rush back. Keeping these two points in mind, let us consider what is good and what is bad for a longer period of time.  The worst mistake is the teaching method. This situation combines great ideas with great effort.

Dog behavior is the worst

Doggy mode is the worst-case scenario.  There is something in the way that the curved sex causes excessive emotion. Combining that with the profound and inspiring influence of the view of looking down at a beautiful woman, this situation is only suitable for a quick backpack!

A missionary does not help either

Another dire situation is the missionary. There is a lot of pushy movement that requires a lot of work. Worse still, your husband has to live on his own. It’s like doing push-ups during sex!

sexologist in Delhi

The ideal situation is a cowgirl

The best place for a man to stay in bed longer is a cowgirl as it combines many elements to make sex more enjoyable.

  • The man is lying on his back. This will keep your heart rate slow. You can breathe, relax, sit comfortably, and enjoy the view.
  • There is no small influence for a man. The corner between the sexes is connected so that it can come in and out easily and not have too many impressions.
  • G-spot stimulation and clitoris are very high, a bonus for a woman.
  • You can control the tempo. If you feel like you are pushing too fast and you are getting to the point quickly, you can slow down so that he can breathe.

Another good feature is the front spoon

Another ideal position to take longer is the facial contours. This is where the two of them sleep on their sides, act as if they are hugging, and enjoy the glow of hot sex. This situation is as good as a cowgirl because you can sleep and be quiet. Unlike cowgirl, where you do cardio by riding a penis, spoons also allow you to relax. Stop having intense sex and enjoy the time you spend together.

At the same time, it is a good idea to get involved. You can put your body in the right place so that it gets inside you. More importantly, face and face spoons are a very passionate situation.

For any query call or meet Dr P K Gupta, Best Sexologist in Delhi.

impotence capital of the world

With Hesitation around Sexual Problems, India Has Become Impotence Capital of the World

In the world, India is considered the youngest country because of the population ratio of young people. But now India is also recognized as the Impotence Capital of the World due to the rise of cases of erectile dysfunction. In India talking about sexuality is still taboo and people refrain to discuss it with others.

Erectile dysfunction is a sexual problem in which men do not get sufficient erection in Penis during sex to penetrate or the penis become lump right before sex making it difficult to continue to sexual activities. It leaves both men and women dissatisfied.

Progress in the medical field has made erectile dysfunction treatment available and successful but still, most men avoid consulting sexologists for this problem.

According to statistics, around 30% of men in the age group below 40 years and around 20% of men in the population experience or suffer from erectile dysfunction in India. It is a big number and increasing day by day due to shyness about seeking guidance and treatment of erectile dysfunction.

Erectile dysfunction can happen due to several other health issues like BP, Neurological Problems, Depression, Anxiety, Stress, Cardio-vascular Problems, Prostate Disease, and many more reasons. So early diagnosis can identify the exact cause of erectile dysfunction and can help you recover and regain confidence and erection.

Treatment options for erectile dysfunction include diet changes, exercises, medicines, counseling. These methods help people to overcome erectile dysfunction and enjoy the life ahead.

In my clinic, daily I meet people affected with some sorts of sexual dysfunction and most of the men are facing erectile dysfunction and premature ejaculation. Fortunately, these people are courageous enough to seek help and get treatment before health and family situations get worse.

The author Dr. P K Gupta is a well-renowned sexologist in Delhi, India for counseling and treatment of all sexual problems including erectile dysfunction, premature ejaculation, low sperm count, low libido, STDs. Call 9319436400 to connect with him or Book Appointment

Dr P K Gupta Super Specialty Clinic

1B, 2nd Floor, Metro Tower, Rajinder Nagar
New Delhi, Delhi 110060, India
Phone: 09319436400

Monday 10:00 AM – 8:30 PM
Tuesday 10:00 AM – 8:30 PM
Wednesday 10:00 AM – 8:30 PM
Thursday 10:00 AM – 8:30 PM
Friday 10:00 AM – 8:30 PM
Saturday 10:00 AM – 8:30 PM
Sunday 11:00 AM – 3:30 PM
performance anxiety

Performance Anxiety – Expectation is the killer of mood

There is a perception that a man is always ready for sex. But it is not true. Sometimes men are not able to perform as per the expectation of their partner. It is natural. Performance anxiety is a real thing that forces men and women both to perform well in bed which causes anxiety and leads to failure.

A case I am sharing here is about the same issue: Performance Anxiety.

A couple came to meet me at my clinic with their parents. They were worried about the performance of the men. Men were in a great depression and anxiety due to inability to perform as per the expectation of his wife. The couple got married 2 days before visiting me at my clinic. They both were very tensed. The wife was thinking that his husband has some sexual health issues and cannot perform well during sex. The husband was thinking that before marriage everything was OK but after marriage the first night he was not getting a strong erection and when erected he did not perform well.

Their parents were also tensed about the future of the married couples. I listened to their concern very carefully and then explained to him about the performance anxiety which is real in the world. I suggested them to take the lovemaking process slowly and first understand each other’s feeling. After explaining the anatomy of sexual organs and the psychology behind the performance. They left the clinic with satisfaction.

The couple was conscious about the sexual health and performance so without delaying they visited me. But many couples suffer in silence due to performance anxiety. And once someone failed in sexual performance their condition gets worse due to fear of failure.

sexual anxiety

My advice to every couple is to take sexual activities slowly. First, understand each other’s emotions and slowly go further. It is not compulsory to perform first time like a macho man. Slowly you will overcome the fear and anxiety and then will perform well.

The author Dr. P K Gupta is a well-renowned sexologist in Delhi, India for counseling and treatment of all sexual problems including erectile dysfunction, premature ejaculation, low sperm count, low libido, STDs. Call 9319436400 to connect with him or Book Appointment

Dr P K Gupta Super Specialty Clinic

1B, 2nd Floor, Metro Tower, Rajinder Nagar
New Delhi, Delhi 110060, India
Phone: 09319436400

Monday 10:00 AM – 8:30 PM
Tuesday 10:00 AM – 8:30 PM
Wednesday 10:00 AM – 8:30 PM
Thursday 10:00 AM – 8:30 PM
Friday 10:00 AM – 8:30 PM
Saturday 10:00 AM – 8:30 PM
Sunday 11:00 AM – 3:30 PM
Lack of Sexual Desire

Lack of Sexual Desire

Doctor, I don’t feel like having sex with my partner. She is young and attractive but I don’t know what is wrong with me.
I am worried and my partner even more.

These words taken from a query are much more common than it might seem to us and represent a social and couple stigma. In a study conducted in 374 men with a mean age of 48.8 years, 30% had a lack of sexual desire. Of these, 47% also had an erectile dysfunction disorder

What do we understand by lack of desire?

It would be the absence of sexual fantasies and sexual activity that causes great anguish and a disorder in the couple’s relationship; It should not be due to a major mental disorder (except other sexual dysfunction), and it’s not solely due to the effects of a substance or a general medical condition.

The main problem with this definition is that the concept of sexual desire is not yet well defined in the current literature and is based on the traditional model of human sexual response derived from Masters & Johnson and Helen Singer Kaplan.

To begin with, we must be careful to distinguish whether the disorder has always been present, or is recent. If it is presented with any couple or only with one.

Sexual desire is the result of positive interaction between internal cognitive processes (thoughts, fantasy, and imagination), neurophysiological mechanisms (central arousal), and affective components (emotional state), although the biological basis remains almost unknown in humans.

Some hormones such as prolactin, estrogens, cortisol, and in particular testosterone modulate sexual desire, acting on androgen receptors that are present in different areas of the human brain.

The causes of the lack of desire would be determined by biological and psychological factors and relationship problems.

We must emphasize that hypogonadism is a cause of lack of desire, as well as hyperprolactinemia.

Hypothyroidism is another endocrine condition associated with the lack of male desire, in addition to several categories of medications such as Antidepressants, Antipsychotics, Lithium, Antiepileptic, Clonidine, Reserpine, opiates.

What to do in the face of a lack of desire?

The first thing to do is go to a sexologist in Delhi who will conduct a complete medical history in addition to a rigorous physical examination. You will see a possible decrease in testicular and prostate size that makes us suspect hypogonadism. Lack of desire is sometimes the only symptom of a prolactin-secreting pituitary adenoma. Other symptoms such as gynecomastia and galactorrhoea. A hormonal problem must be ruled out, measuring Testosterone, Prolactin, and TSH, or even other tests whenever a systemic disease is suspected.

libido disorder

Libido – Disorders, Reduction, Elevation, Ways To Stimulate

Libido keeps many people awake at night. Is it not disturbed by any chance? What to do to change its level? What factors can influence libido? You will find the answers to all these questions below.

What is libido?

Libido is otherwise known as sex drive. This term was first introduced by Sigmund Freud, who used it to describe life energy understood as sexual energy. Today, in the popular sense, this term is simply a mental sexual arousal aimed at satisfying the body’s needs.

Factors influencing libido

Many myths have arisen about the factors influencing libido. Instead of buying “magic drugs” from the internet, it’s better to find out what actually drives our sex drive. This knowledge will avoid a lot of frustration.

Libido is primarily controlled by endogenous factors. Its regulation takes place mainly in the mesolimbic domapinergic pathway. This means that libido is regulated by the presence of substances in the body such as dopamine, serotonin, acetylcholine, noradrenaline, testosterone, estrogen, progesterone or oxytocin. In other words – libido is in many cases pure chemistry.

In women, libido is closely related to the menstrual cycle. Women experience the greatest sex drive a few days before ovulation, which is when they are most fertile. It is also natural to reduce libido as a result of menopause, because the level of estrogen in a woman’s body drops drastically.

Psychological and social factors are also important. Childhood trauma can cause permanent libido disorders. However, it should be remembered that depression or even short-term stress can also result in the loss of sex drive.

Lifestyle also has a huge impact on libido. Research shows that low physical activity, alcohol consumption and smoking significantly reduce libido. Some pharmaceuticals, including hormonal contraception, have a similar effect. Some diseases, such as anemia, can also cause a decrease in libido.

Libido disorders

Libido disorders can manifest themselves in both increased and decreased sex drive. In the first case, we are talking about hypersexuality (nymphomania and satirism), and in the second – about hypolibidemia. These disorders are difficult to diagnose because libido standards cannot be clearly defined.

How to increase libido?

If we have the impression that our libido is unnaturally low, sexologist in Delhi recommend finding the cause of this condition first. Lowered libido is often the result of stress, exhaustion and insufficient sleep. If you take care of these factors, eliminate stimulants, take care of a proper diet and physical activity. Also check that the drugs you are taking do not lower your libido. If, despite these efforts, the drive does not change, it is worth consulting a sex specialist in Delhi to look for the cause in the body. You may be suffering from a hormonal imbalance, anemia, or some other illness.

premature ejaculation

How to Extend Intercourse?

Wondering how to prolong your intercourse could mean you are dealing with premature ejaculation. It is a common condition of men at different stages of life, but it is reassuring – you can fight it effectively.

Premature ejaculation is the most common male sexual disorder – according to the available data, 28% suffer from it. Premature ejaculation occurs when ejaculation occurs within the first two minutes of intercourse. The causes of this ailment may be different. In adolescence, it results mainly from a hormonal storm, in adulthood it is most often caused by health problems. So, both hypertension, prostate diseases, prostatitis, too frequent masturbation, as well as prolonged sexual abstinence, can result in premature ejaculation.

Risk factors are also: smoking, alcohol or other intoxicating substances, stress and feeling insecure. According to the best sexologist in Delhi, ejaculation is present in over 90 percent. from the psyche, therefore, in premature ejaculation treatment in Delhi, great emphasis is placed on a positive attitude.

How to extend intercourse?

There are many ways to deal with premature ejaculation in the forum, but it’s good to be vigilant. To avoid the use of often dangerous methods, below you can find some proven, effective and safe solutions.

APE method

One of the most popular exercise methods recently to prolong intercourse is APE – a set of exercises and tips based on natural behavior. When deciding on this method, you need to remember about regular, preferably daily, at least half an hour of exercise.

The three finger technique

Another helpful method is the perineal compression technique, also known as the three-finger technique, known for over 5,000 years. To do it correctly, you need to press three fingers on the point between the testicles and the anus (in the central part of the perineum) and wait for the excitement to fall – using this method can extend the intercourse by up to several minutes.

Kegel exercises

Regular Kegel training is another highly effective method. Strongly trained, these muscles allow a man to control his reactions and thus prolong intercourse. To achieve the desired effect, you need to perform 30 series of quick contractions and relaxation of the pelvic floor, and then perform several series of long, minimum 10-second contractions. Such exercises should be repeated in the morning and evening, and their duration should be extended every week.

STOP and GO method

Another popular technique is the STOP and GO method recommended mainly by sexologist doctor in Delhi. It is characterized by simplicity of implementation and high efficiency and consists in stopping penetration a moment before orgasm to take care of the partner. Simply put, it is an interweaving of intercourse with other forms of sex that can extend your penetration time up to two times. According to this technique, sexual intercourse can only be resumed after the erection has slightly subsided.

9 thrust technique

To properly perform this prolonged intercourse exercise, the partner should count the cycles of shallow and deep thrusts performed without leaving the partner. Please adhere to the following rule:

  1. 9 shallow vs. 1 deep thrusts
  2. 8 shallow to 2 deep thrusts
  3. 7 shallow to 3 deep and so on from 1 shallow to 9 deep.

Shallow thrusts should be done at a moderate pace and deep thrusts quickly and decisively. After the first series, you can take a break (without interrupting the penetration, however) and then move on to the next one.

Pills to prolong intercourse

The above manual methods are very effective, but if they are not enough, it is worth getting pharmacological agents. Tablets for prolonging the intercourse available in pharmacies (it is better to avoid agents from uncertain sources) should be treated as a last resort.

Both exercises and pills help to prolong intercourse, so everyone can find the best method for themselves to deal with this embarrassing but common problem.

erectile dysfunction treatment in Delhi

ED: Provoke The Occasion

Erectile dysfunction (ED) occurs when a man has difficulty getting or maintaining an erection sufficient to have sex. About thirty million Indians suffer from ED. It may affect self-esteem and put the love relationship to the test.

If you have ED, you may wonder, “Why me?” ED is often caused by physiological problems. An erection requires both blood vessels and a healthy nervous system. Heart disease, diabetes, blood clots are all likely to damage blood vessels and cause ED. Surgery, diabetes, a spinal cord injury, multiple sclerosis, or a stroke can damage nerves and decrease erection ability. Low testosterone can also cause erectile dysfunction, possibly due to a lack of sexual appetite, which would explain why drugs to treat erectile dysfunction such as sildenafil (Viagra®), tadafil (Cialis®), and vardenafil (Levitra®) are not effective for some men. In a study of 75 men between the ages of 18 and 80 who had low testosterone levels and for whom sildenafil had no effect, testosterone replacement therapy significantly improved their erectile dysfunction.

ED is sometimes caused by psychological factors such as anxiety, depression, performance anxiety or guilt. In other cases, it is the side effect of a medication. Antidepressants, lithium, digoxin, cimetidine, and antipsychotics are all likely to cause ED. Smoking is also linked to the risks of erectile dysfunction.

Most ED cases can be treated. Treatment options include:

  • Oral medications, including sildenafil (Viagra), tadafil (Cialis) and vardenafil (Levitra). They are practical, but they are not suitable for all men (for example those with low blood pressure or those who take nitrates). They can also cause headaches, dizziness, hot flashes, vision problems, and priapism (a prolonged painful erection that lasts for hours, even without stimulation) which can damage the penis.
  • Medicines injected into the penis (injection of alprostadil [Caverject ® ]), or inserted into the urethra (pellets of alprostadil [MUSE ® ]). It is an option for men who cannot take oral medication. They can also cause priapism.
  • Devices (such as vacuum pumps). These devices create a vacuum that draws blood into the penis, causing an erection. A constriction device (compression ring) is placed at the base of the penis to hold blood in the penis. Constrictors are used with or without a vacuum pump, but should not be left in position for more than 30 minutes. These devices offer an alternative to men who do not tolerate any medication.
  • Surgery to insert a prosthesis (a rigid or inflatable rod that causes an erection). Because of the risks of surgery (including infection, hemorrhage, and reactions to anesthesia) this procedure is reserved for cases where no other treatment has been found to be effective.

If ED is caused by low testosterone, testosterone replacement therapy may help. Testosterone is available in patches, gel, injections, and tablets. For more information, see the section “When you lose your sexual appetite”. If your ED is caused by the side effects of a medication, sexologist in Delhi will probably suggest that you replace it with another that is less likely to cause this effect.

stress and sex

How does stress influence your sex life?

We all know that excessive stress does not do us any good, since its impact is manifested not only in our mind but also physically. It can affect different systems of our body, such as the immune system and, therefore, our body is more prone to any disease.

Since stress affects us physically, emotionally, and relationally, what does it have to do with sex life then? During periods of stress, our body adopts a “survival mode”, increasing blood flow and heart rate, while decreasing other non-priority functions at that time, such as sex. When we talk about stress, it is also important to note that our body produces more cortisol – in response to it – which can decrease libido. In addition, in women, it can cause an imbalance in the menstrual cycle, which, in turn, can result in mood instability.

Dr. P K Gupta, best sexologist in Delhi, says that our biggest sexual organ is the brain, that is, if we have a “busy mind” and if we get distracted during sex, it will be more difficult to focus on arousal, sensations pleasurable or in orgasm. On the other hand, when we are under stress, our metabolism can change and cause changes in weight. So, if you are not feeling well with the changes in your body, you will be less likely to want to be sexually involved.

As we know, stress can also lead to depression and anxiety, which interferes with healthy sex life. Fortunately, we can do something to deal with this issue: it is important to have an escape from stress, such as practicing yoga, exercising, or receiving a massage. Take time to take care of yourself. Yes, we all have stress in our daily lives, however, if you can identify the factors that cause the greatest stress in your life, it can help you understand how you can minimize or eliminate them.

Having an intimate relationship with your partner can help reduce stress, so try to prioritize some time during the day, even when you feel exhausted. It is important to bear in mind that the feelings produced by sex are natural defenses against stress, such as closeness, attachment, and the feeling of calm, so making time and space for physical intimacy is by no means fruitless, even if the stress levels are high.

However, even if you have already done everything you could to control your stress levels, but it still affects your life, it may be time to seek help.