MANAGEMENT OF SOME COMMON MALE SEXUAL DISORDERS WITH FORTEGE
KAMLESH KUMAR, M.D., D.D., P.0O.M.8.,
Asst. Prof. of Dermatology and Venereology,
Govt. Medical College and Rajindra Hospital, Patiala-147001 (Punjab)
INTRODUCTION:—Sex problems, both in males and females, maybe due to organic, functional, or purely psychological causes. While operative measures are sometimes useful in organic causes, sex problems which are functional and psychological, are aggravated by stress, tension, anxiety, and fatigue, both physical and mental. These factors may be present together to a greater or lesser extent. Constipation is another factor, especially in premature ejaculations, where a little stimulation will trigger ejaculation prematurely. These factors once they are present, aggravate the problems, forming a sort of vicious circle that becomes difficult to break. Loss of confidence in the sex act increases, while actually nothing is wrong; it is reversible with reassurance and corrective measures.
Effective treatment for these conditions is not easy in spite of the vast advances in medical science. Hormones are certainly useful in cases of oligospermia, but in sex problems of functional and psychological etiology, the results of hormones are uncertain and may ever be accompanied by serious side effects and undesirable rebound phenomena on the stoppage of the drug. With this perspective in mind, it was decided to try an ayurvedic preparation, Fortege, because ayurvedic drugs still serve the largely rural population of our country and their efficacy has stood the test of time; they also have a place in the field of health in our country.
Composition of Fortege.—Fortege (Alarsin) is an ayurvedic preparation containing Ashwagandha (Withania Somni-fera), Kapikachchu (Mucuna pruriens), Vridharak (Argyriaspeciosa), Akalakara (Anacyolus pyrethrum), Kamboji (Breynia patens), Jeevanti (Leptadeania reticulate), Chini Kabab (Cubabs Officinalis), J aiphal (Myristica fragrans), etc. The drug is claimed as not only useful in common male sexual disorders which are functional in origin, but also in cases where factors of fatigue, mental stress, anxiety, tensions and loss of confidence form a link creating a Vicious circle. Fortege is said to tone up the neuro-glandular system and act as a rejuvenator for body and gonadal system, giving a sense of freshness and well-being. Sukhtankar (1960), Joshi ( 1965) and Gupta, et al (1975), had reported good results with Fortege and they did not observe any toxic or side effects. This encouraged us to try the drug in this series.
Material and methods.—Fortege was given for 12 weeks. However, each patient was checked every two weeks during the first month, and then once in a month. A final assessment of results was made at the end of the trial period of 12 weeks.
This clinical trial was undertaken during 1974-75 at the Rajindra Hospital, Patiala. Though 70 cases were taken up for trial during this period, only 54 cases that could be followed fully for three months were taken up for the study. The other 16 cases were omitted from the study.
In all those couples with a history of primary sterility, the male partner was subjected to a more detailed examination. The semen was examined. Cases of azoospermia were subjected to testicular biopsy, unilateral, as it was felt to be sufficient.
AGE Groups:—The largest number of patients (viz), 36 (66°7%), came from the age group of 26 to 35 years. The details are given in (Table I).
TABLE I
Showing the Age Group
| Age Group | No of cases | % |
| 17-20 years | 6 | 11.1 |
| 21-25 years | 12 | 22.2 |
| 26-30 years | 16 | 29.7 |
| 31-35 years | 20 | 37.0 |
| Total | 54 | 100 |
Marital status.—There were 45 men (83.3%) who were married and 9 men (16.7%) who were unmarried.
Male sexual disorders.-There 39 cases (72.2%) of male sexual disorders and 15 cases (27.8%) with a history of primary sterility.
Out of 39 cases of male sexual disorders, 21 cases (53.9%) had premature ejaculations, 8 patients (20.5%) had night emissions and 10 patients (25.6%) had sex debility, which was seen in the form of improper erection. (Table II)
TABLE I
Showing Male Sexual Disorder
| Disorder | No.of Cases | % |
| Premature ejaculations | 21 | 53.9 |
| Night Emissions | 8 | 20.5 |
| Sex Debility | 10 | 25.6 |
| Total | 39 | 100 |
TABLE III
Results of semen examination in cases of
primary sterility
| Results | No of cases | % |
| Oligospermia | 3 | 20.0 |
| Sperms of poor motility | 8 | 53.3 |
| Azoospermia | 4 | 26.7 |
| Total | 15 | 100 |
Primary sterility.—There were 15 cases with a history of primary sterility. Semen analysis showed that 3 males had oligospermia, 8 males had sperms of low motility and 4 had azoospermia. All the four cases of azoospermia were subjected to testicular biopsy (unilateral) which confirmed testicular dysfunction; there was no osse of obstructive pathology. (see Table III).
Assessment of results—The result was assessed as good if there was complete reliet or relief of over 75%, as fair if the relief was 50% to 75%, and as slight if the relief was 25% to 50%. It was assessed as poor if the relief was less than 25%.
Dosage.—Fortege was given in a dose of 2 tabs. t.ds. for three months (12 weeks). In those 15 cases where semen analysis was made and sperm defects were confirmed, Fortege was given 2 tabs. q.d s. for the first four weeks and later, 2 tabs t.d.s. for two more months, a total of 12 weeks.
Results and discussion— Premature ejaculations:—There were 21 cases of premature ejaculation. The duration of the complaint ranged from 3 months to 6 months in the majority of cases. In some, the duration was about one year. Most of them had complained of fatigue and the majority had constipation. With Fortege, 2 tabs. three times a day, there was improvement every week. At the end of 12 weeks of treatment, the improvement was good in 13 cases (61.9%), fair in 4 cases (19.1%), slight in 2 cases (9.5%) and poor in 2 cases (9.5%).
Night emissions:—There were 8 cases of night emissions. The majority of them were unmarried. The number of nocturnal emissions ranged from 2 to 5 in a week. Improvement was observed in the majority in 4 weeks of treatment with Fortege. At the end of 12 weeks of treatment, the improvement was good in 6 cases, fair in 1 case and slight in 1 case. The majority of these patients had a history of constipation and they had relief from constipation also.
Sex debility:—There were 10 cases of sex debility causing an improper erection. With Fortege treatment of 12 weeks, the improvement was good in 7 patients, fair in 2 patients and slight in 1 case. The duration of sex debility ranged from 6 months to 1 year. Only one case among them had phosphaturia and this also cleared after three months. There was consistent improvement observed at every 4 weeks. The patient could enjoy better sex and he subjectively felt-a sense of rejuvenation, had a feeling of regaining lost strength, had overcome fatigue and experienced a sense of well being.
The over-all response in 39 cases of functional sexual disorders, showed that the improvement was good in 66:7%, fair in 180%, slight in 10.2% and poer in 5.1%.
TABLE IV
Showing results: Functional male sexual disorders
| Disorder | No of cases | Good | % | Fair | % | Slight | % | Poor | % |
| Premature ejaculations | 21 | 13 | 61.9% | 4 | 19.1 | 2 | 9.5 | 2 | 9.5 |
| Night emissions | 8 | 6 | 75.0% | 1 | 12.5 | 1 | 12.5 | – | – |
| Sex Debility | 10 | 7 | 70.0% | 2 | 20.0 | 1 | 10.0 | – | – |
| Total | 39 | 26 | 66.7 | 7 | 18.0 | 4 | 2 | 5.1 |
Results:—Sperm defects.—Cases of primary sterility:— There were 3 cases of oligospermia. They were given Fortege 2 tabs. four times a day for the first four weeks and later 2 tabs three times a day for 8 more weeks. The sperm count ranged from 5.6 million/ cc to 20 million/cc. Repeat semen analysis
after treatment showed that sperm count increased in one case by 15 million/cc. There was a slight improvement in one case and there was no improvement in another case. It was observed that when the sperm count increased, the percentage of motile sperms also increased. A longer course than 12 weeks is necessary for better assessment of results in these cases.
There were 8 cases where motility of sperms was less than 40% and in one case, motility was almost nil. Fortege was given in a dose of 2 tabs. four times a day for the first one month, and later in a dose of 2 tabs. t.d.s. for two more months. Those who improved showed a 50—100% increase in motility on
repeat semen analysis after three months. On the whole, the improvement in motility was good in 2 cases, fair in 3 cases and slight in 3 cases.
There were 4 cases of azoospermia with no obstructive pathology as confirmed by testicular biopsy. These cases were given Fortege, 2 tablets, four times/a day for the first month and later, 2 tabs. t.d.s. for two months. Repeat semen analysis did not show any improvement. However, the men said that their sex performance was better and they felt a sense of freshness and well-being.
TABLE V
Showing results in cases with defects
| Sperm Defects | No of cases | Good | Fair | Slight | Poor |
| Oligospermia | 3 | – | 1 | 1 | 1 |
| Poor Motility of sperms | 8 | 2 | 3 | 1 | – |
| Azoospermia | 4 | – | – | – | 4 |
| Total | 14 | 2 | 4 | 2 | 5 |
Side effects.—No side effects or any adverse effects were observed with the use of Fortege.
Summary.—54 cases of male sexual disorders were treated with Fortege for 12 weeks. Good improvement was observed in 667% of cases who had functional disorders associated with fatigue, anxiety, tensions, and constipation. Among the cases with sperm defects, there was a satisfactory improvement in cases of oligospermia and sperms of poor motility. No improvement was observed in cases of azoospermia, though the patients expressed that their sex performance was better and they felt a sense of freshness and well-being.
Acknowledgement.—I am thankful to the Superintendent, Rajindra Hospital, Patiala, for giving me facilities to undertake this clinical trial. I am also thankful to M/s Alarsin Pharmaceuticals, Bombay-400023, for their co-operation.
REFERENCES :
- Gupta, L.jN., Saluja,” J. 8, *(1975):—Cur. Med. Pract, 19:6; 272.
- 2. Joshi, 8. K. (1965):—Mah. Med. J. 12: 9.
- Sukhthankar, V. R. (1960):—Ind. Pract. 13: 12.