CONCEPTUAL UNDERSTANDING OF MANASIKA KLAIBYA W.S.R. TO ERECTILE DYSFUNCTION

1. CONCEPTUAL UNDERSTANDING OF
MANASIKA KLAIBYA
W.S.R. TO ERECTILE DYSFUNCTION

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:
A.Purification therapy:
B. i. Snehayukta Virechana preceded by Purvakarmas
ii. Basti (Asthapana and Anuvasana)
B. Vrishya yogas: i. Vrishya Dravyas and ii. Adravya
Vrishyas (psychotherapy)
C.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.