Sexually Transmitted Diseases - I. I. Mavrov 2005

Climacteric
Male Climacteric

The Climacteric (climacteric period, or male menopause) is a period of life during which the generative function ceases against the Background of general age-related bodily changes. The onset of the climacteric is predetermined by the genetic Aging program as an essential mechanism for preserving the Qualitative and quantitative forms of species existence by reducing reproductive function at the corresponding life stage.

The climacteric period and its associated physiological and morphological changes occur in both women and men, although the decline in generative function takes place at different times. A distinction is made between the physiological climacteric period, the early climacteric period (which develops in men before the age of 50 and in women before 45), and the pathological climacteric period, which is accompanied by endocrine, autonomic, and psychological disorders known as the climacteric syndrome.

Physiological menopause is caused by age-related disturbances in hormonal and general METABOLISM, and primarily by the age-related decline in gonadal function. It occurs between the ages of 50 and 60 and presents with less pronounced manifestations than in women. The aging mechanism is not strictly specific; therefore, the signs of the climacteric—the precursor to old age—can be observed at various ages and with differing degrees of severity.

The primary mechanism underlying the decline in sexual function during the climacteric is undoubtedly considered to be alterations in the Hypothalamus-pituitary-gonad axis resulting from decreased incretory function of the Gonads. This system is correlatively linked with the neural and humoral regulatory pathways of other body systems. Consequently, pronounced or uncoordinated Changes in the functional state of the hypothalamus-pituitary-gonad axis can lead to various somatic disorders.

Involutional processes during the climacteric period primarily affect the incretory function of the Testes. However, a normal plasma testosterone concentration is frequently observed even in men aged 70–80. They retain their libido and a certain level of potency, enabling episodic sexual intercourse. Thus, physiological aging involves a coordinated restructuring of various levels of sexual regulation, leading to a uniform downregulation of all components that support sexual function at a relatively stable physiological level, which largely depends on individual characteristics. When this process occurs unevenly, the coherence of regulatory mechanisms is disrupted, resulting in the clinical picture of pathological menopause.

The clinical manifestations of pathological menopause in men can be generalized or predominantly affect specific body systems, such as the nervous, cardiovascular, gastrointestinal, or urogenital systems. The pathological course of the climacteric is largely determined by a chain of events, with gonadal dysfunction serving as a crucial link.

The primary Complaints include headache, palpitations, cardiac pain unrelated to physical exertion, Hypertension, shortness of breath, hot flashes to the HEAD, and sudden flushing of the face, neck, and upper torso. Cardiovascular dysfunction is noted in 60% of patients, and nearly 40% of men with pathological climacteric symptoms suffer from Diabetes Mellitus.

The climacteric state is frequently accompanied by depression, manifested by a loss of interest in work, family, and past hobbies, a sense of doom and uselessness, hypochondria, tearfulness, groundless jealousy, cancerophobia, etc. Sexual disorders in the form of decreased libido and potency are observed in 80% of patients with pathological menopause. The main complaints in this regard boil down to weakened erection, premature ejaculation, and blurred orgasm.

Age-related changes in the functional state of the gonads are primarily manifested by dysfunction of Leydig Cells, which produce the male sex hormone testosterone. As early as age 30–40, proliferation of Fibrous Connective Tissue in the testes—characteristic of the aging Organism—is observed (I. I. Mavrov, 1978). This suggests that age-dependent changes in the gonads are evidently regular and may occur earlier than previously assumed. The exclusion of Sex Hormones from the body's humoral environment significantly affects its Functions. The activity of the central and autonomic nervous systems is impaired, leading to dysregulation of neurohumoral control; visceral organ functions suffer, metabolism changes, and the Synthesis and Secretion of hormones, mediators, etc., are disrupted.

Vascular System disorders in pathological menopause depend on age-related changes and the functional state of the Prostate Gland (proliferation of connective tissue within it, altered secretory function), as well as a reduced release into the body's humoral environment of its secretion, which possesses a pronounced vasodilating effect, particularly on the Vessels of the Penis.

B. A. Vartapetov and A. N. Demchenko (1975) established that with aging, the Temperature of the Scrotum increases while the temperature of the glans penis decreases, resulting in a convergence of these parameters. For instance, while the temperature difference is about 5 °C at ages 20–30, by age 45 it averages 1.5 °C, and in individuals over 55, it becomes negligible. The observed age-related decrease in the temperature of the glans penis is presumably explained by changes in its vascular Blood filling.

In patients with pathological menopause, the scrotal temperature is higher and the penile temperature is lower than in practically healthy individuals of the corresponding age. This indicates that more pronounced vascular disorders occur in the genitals during climacteric syndrome than during the normal (physiological) course of the climacteric. Such patients exhibit high blood pressure (180–200/100–140 mm Hg) with angiospastic crises, frequent (paroxysmal) severe facial hot flashes, and a complete lack of potency.

Sexual dysfunction during the climacteric is characterized by polygenesis. It is promoted by alterations in the integrating role of the Central Nervous system and hormonal regulation. In pathological menopause, The breakdown of sexual function often occurs suddenly against the background of an adequate sex life, which generally exacerbates the already pronounced neurotic manifestations characteristic of this condition.

During physiological menopause, a normal, age-appropriate frequency of sexual intercourse is observed in the vast majority of men, whereas in pathological menopause it occurs in only 3.9% of cases (B. A. Vartapetov, A. N. Demchenko, 1975). Impotence is frequently caused by impairments in erectile and ejaculatory functions.

Inadequate erection during physiological menopause is typically combined with difficulty in ejaculation, whereas in pathological menopause it is associated with premature ejaculation.

Two MAIN TYPES OF sexual disorders are distinguished in pathological menopause. The first is primarily caused by a disturbance in cortical neurodynamics and manifests as the so-called irritable weakness syndrome. In this case, due to rapidly ensuing ejaculation, the sexual act cannot be completed in full. In the second type (against the background of neurological disorders), hormonal disturbances come to the foreground, contributing to the impairment of erectile and ejaculatory functions; complete impotence is frequently observed.

The Diagnosis of pathological menopause in men is based on identifying characteristic complaints, detecting androgen deficiency, and recognizing hormonal dyscoordination. Radioimmunoassay is the most precise METHOD FOR DETERMINING hormone levels in Blood Plasma. When evaluating men's complaints regarding sexual disorders, it is necessary to assess their objectivity, taking into account the natural age-related process of declining sexual potency.

Since symptoms of pathological menopause can overlap with those of various conditions typical of older age (atherosclerosis, coronary cardiosclerosis, cerebrovascular sclerosis, etc.), a comprehensive examination of patients by a general practitioner, endocrinologist, neurologist, psychiatrist, urologist, venereologist, and other specialists is required.

Only pathological menopause requires Treatment. Therapy must be comprehensive, including etiological, pathogenetic, and symptomatic treatment.

First and foremost, the age parameters of men entering the climacteric period must be taken into account. At the same time, consideration should be given to certain endogenous and exogenous Factors influencing the onset of menopause: traumatic, chemical, pharmacological, or radiation exposures, cases of castration, previous Inflammatory Diseases of the Reproductive System and Organs involved in sex hormone metabolism, bilateral cryptorchidism with androgen deficiency, diabetes mellitus, alcohol abuse, and other chronic intoxications.

In the treatment of male pathological menopause, special attention is paid to measures related to psychotherapy, daily routine, and diet. Hormone therapy is of major importance. Once androgen deficiency is established, treatment begins with testosterone preparations. Positive results were obtained by B. A. Vartapetov (1975) using the three-component drug testobromlecithine. Methyltestosterone tablets are also recommended (5 mg 2–3 times daily sublingually for 1–2 months). To achieve a faster therapeutic effect, testosterone propionate is prescribed; a 1% solution is administered intramuscularly (daily or every other day) at 1 ml for 2–3 weeks. In cases of prolonged treatment, it is advisable to use Sustanon-250 (Omnadren), administered at 1 ml intramuscularly once a month for 3–6 months. These androgenic drugs and their analogues increase the reactivity of the spinal centers of erection and ejaculation, promote the activation of prostate function, restore libido, enhance erection, exert a positive overall effect on the body (due to an anabolic effect), increase mental and physical performance, improve cardiovascular activity, enhance Blood supply to the genitals and accessory sex glands, and strengthen the contractile capacity of the detrusor (to normalize urination when obstructed).

Patients exhibiting emotional tension, fear, and autonomic instability are prescribed trioxazine, a medication that does not suppress Spinal Cord excitability and is therefore optimal when potency is reduced.

For a tonic effect, herbal remedies can be used in the form of tinctures of Aralia, Eleutherococcus senticosus (Zamanicha), Schisandra chinensis, ginseng, etc. Symptomatic therapy includes antispasmodics, ganglion blockers, cardiotonics, and antihypertensive agents, which are used as part of comprehensive treatment depending on the specific manifestations of pathological menopause.

Of great importance in the treatment of sexual disorders associated with the climacteric are the restoration of a regular sex life, psychotherapy, The Use of low doses of psychotropic drugs, physiotherapy, an optimal pace of sexual activity, and the preservation of marital harmony. Structure/149.html">The problem of preventing early pathological menopause is closely linked to general gerontological tasks aimed at preventing premature aging.