INFERTILITAS

DAN
DISFUNGSI SEKSUAL PADA PRIA
Presented at ASI Congress, Surabaya, August 20 -24, 2006

BAGIAN BIOLOGI KEDOKTERAN DAN ANDROLOGI

KM Arsyad
KMA THE ETIOLOGY OF MI & SD 1
TUJUAN PEMBELAJARAN

 Pada akhir kuliah ini mahasiswa akan

memiliki pengetahuan dan
pemahaman tentang :
1. Pasangan Infertil,
2. Etiologi Infertilitas Pria
3. Fungsi Seksual,
4. Etiologi Dysfungsi seksual pria

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Materi pembelajaran :

1. PENDAHULUAN
2. PASANGAN INGIN ANAK
3. ETIOLOGI INFERTILITAS PADA PRIA
4. TATALAKSANA PRIA INFERTIL
5. FUNGSI SEKSUAL
6. ETIOLOGI DISFUNGSI SEKS PRIA
7. TATALAKSANA DISFUNGSI SEKS PRIA

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1. ANDROLOGi
2. PERAN HUBUNGAN SEKS
3. CABANG ILMU KEDKTERAN TERKAIT PIA

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1.1. ANDROLOGI
 Istilah : andros & logos
 DEFINISI :
 Cabang ilmu Kedokteran mengenai
kesehatan pria umumnya,khusus SRP,
mulai dari masa perkembangan sampai
masa dewasa meliputi masalah
infertilitas, hipogonadism, gangguan
tumbuh kembang organ reproduksi
pria bawaan dan dapatan, disfungsi
seksual pria, Pria lansia dan
kontrasepsi pria

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1.1. DEFINITION

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1.1. DEFINISI ,POKOK BAHASAN

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1.2. PERAN HUBUNGAN SEKS :

PROCREATION PLEASURE
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LOVE 8
1.3. CABANG ILMU KEDOKTERAN TERKAIT PIA

PIA

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KMA THE ETIOLOGY OF MI & SD 10
2.1. REPRODUKSI MANUSIA

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2.1. INFERTILITAS :

 Infertility is defined as the failure of a

couple to achieve pregnancy after
unprotected intercourse,
 Prevalence 8 % (50 – 80 Million population)
 2 Million new Infertile couples each year
 Male infertility has many causes – from
hormonal imbalances, to physical
problems, to psychological and/or
behavioral problems,

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 2.2. Probabilitas PIA
No Treatment
Husband Wife Infertilty
1. FERTILE FERTILE IDIOPATHIC ART/ IMMUNOLOGIC

2. FERTILE SUBFERILE WIFE FACTOR WIFE

3. FERTILE STERILE WIFE FACTOR ADOPTION

4. SUBFERTILE FERTILE HUSBAND FACTOR HUSBAND

5. SUBFERTILE SUBFERTILE BOTH BOTH

6 STERILE FERTILE HUSBAND FACTOR ART/CLONING

7 STERILE SUBFERTILE BOTH ART/CLONING

8. STERILE STERILE BOTH ADOPTION

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 PERTANYAAN
 APA PERSYARATAN SEORANG PRIA
AGAR DAPAT MENGHAMILI ISTRINYA?

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 2.3. PERSYARATAN PRIA UNTUK
TERJADINYA KEHAMILAN

1. The male must produce satisfactory numbers of

normal motile spermatozoa.
2. He must have patent conduits and potency to
ejaculate spermatozoa into the vagina,
3. The spermatozoa must reach to cervix, pass through
the cervical mucus, and ascend through the uterus
and oviduct at an appropriate time to encounter an
ovum,
4. The spermatozoa must be capable of penetrating and
fertilizing ovum,

KMA THE ETIOLOGY OF MI & SD 15

 PERTANYAAN
 APA PERSYARATAN SEORANG WANITA
AGAR DAPAT HAMIL?
 USIA REPRODUKSI TERBAIK
 FREKUENSI DAN TIMING SENGGAMA

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 2.3. PERSYARATAN WANITA UNTUK
TERJADINYA KEHAMILAN

1. The female must release an ovum that has

access to a patent oviduct,
2. The fertilized ovum must move into the
uterus and find an endometrium prepared
for implantation.
3. The embryo must implant, develop
normally, and produce the glycoprotein
gonadotropin (HCG) to rescue the corpus
luteum
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FACTORS AFFECTING REPRODUCTIVE PERFORMANCE :
1. Age of the Wife
2. Age of the Husband
3. Frequency of Intercourse, and
4. Duration of Coital Exposure.

Age Mean Conception Age Conception in less

Of wife delay in months of husband than 6 months(%)
16 12 <25 75
17 10 25 – 29 48
18 9 39 - 34 38
19 8 35 - 39 25
20 7 40 / > 23
21-23 6 Weekly freq. Conceptions in under
24 5 of intercourse 6 months (%)
25 6 <1 17
26 8 once 32
twice 46
three 51
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KMA THE ETIOLOGY OF MI & SD 19
3. ETIOLOGI INFERTILITAS PRIA :

1. Hormonal
Imbalances,
2. Physical
Problems,
3. Psychological
Problems,
4. Behavioral
Problems,

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3.1.HORMONAL IMBALANCES :

 Disorders on the
hypothalamus-pituitary
– testis axis,
 Hyperprolactinemia,
 Hypogonadotropic
Hypopitutarism,
 Panhypopituitafism,
 Hypothyroidism,
 Congenital Adrenal
Hyperplasia.

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3.2. PHYISICAL PROBLEMS :
 Varicocele,
 Damaged Sperm
Ducts :
congenital, or
acquired,
 Infection and
Diseases,
 Retrograde
Ejaculation,
 Torsion.
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3.2.1. INFECTION and DISEASES :

1. Sexual transmitted diseases.

2. Orchitis,
3. Accessory glands infection,
4. Diseases with high fever,
5. TBC
6. Diabetes Mellitus
7. Others systemic diseases affected to
Liver or Kidney function,

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3.3.PSYCHOLOGICAL PROBLEMS :

 The term mental illness covers a

broad range of disorders cause
psychological, personality or
behavioral symptoms,
 Neuroses, stress, depression
 Psychoses,
 Sexual deviation.
 Drug uses for mental therapy
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3.4. BEHAVIORAL PROBLEMS :

 Occupational diseases,
 Lifestyle (Alcoholism, Smoking,
Drug addiction, etc)
 Tight underwear
 Pollution (air, water and food)

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ETIOLOGIC FACTORS INFLUENCES SPERM

FREE RADICAL

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KMA THE ETIOLOGY OF MI & SD 27
4. TATALAKSANA INFERTILITAS PRIA

Pemeriksaan Andrologi.
Treatment ?
Anamnesa
Pemeriksaan fisik :
Diagnosa Kausatif ?
1. Umum
2. Khusus / Kualitas Sperma
Reproduksi

Uji sperma khusus

Analisis Semen Pemeriksaan Penunjang
Rutin lainnya
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 ANAMNESA
 PERKEMBANGAN ORP
 RIWAYAT PENYAKIT UROGENITAL
 INTERVENSI BEDAH
 INTERVENSI MEDIK
 POLA HIDUP
 PEKERJAAN
 RESPON SEKSUAL
 ??
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PEMERIKSAAN FISIK UMUM
 VITAL SIGN
 BB DAN TB
 CIRI CIRI SEKS SEKUNDER
 LIPAT PAHA
 REFLEKS CREMASTER?

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 2.2. ORGAN REPRODUKSI PRIA
PEMERIKSAAN FISIK KHUSUS

3
2

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PEMERIKSAAN FISIK KHUSUS

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KMA THE ETIOLOGY OF MI & SD 33
 Laboratory Assays for
Evaluation of Human Semen
No Lab Test Parameters
1. Routine Seminal fluid volume, Sperm count, motility,
Evaluation Morphology, Viability, Leukocytes in semen,
Sperm antibodies
2. Specialized Membrane integrity, Sperm-cervical mucus
Sperm interaction, CASA, Capacitation, Acrosome reaction,
Zona pellucida binding, Zona pellucida penetration,
Function Oocyte-sperm fusion

3. Sperm HOST, Postcoital test, SPA, Acrosome reaction

Function tests, , HemiZona Assay, IVF

Assays

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ANALISIS SEMEN RUTIN

1. Persyaratan Sample :
Abstinensia seksualis,
wadah,waktu transfer
2. Pemeriksaan Makroskopis :
warna, bau, likuefaksi, volume,
viskositas, pH.
3. Pemeriksaan Mikroskopis:
motilitas,jumlah.Morfologi sperma,
elemen seluler bukan sperma,
agglutinasi, viabilitas dan lekosit

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NILAI NORMAL SPERMIOGRAM

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 NOMENKLATUR SPERMIOGRAM
1. NORMOZOOSPERMIA = Ejakulat normal sesuai
sesuai nilai baku,
2. OLIGOZOOSPERMIA = Konsentrasi sperma kurang
dari nilai baku,
3. ASTHENOZOOSPERMIA = Motilitas sperma kurang
dari nilai baku,
4. TERATOZOOSPERMIA = Morfologi sperma kurang
dari nilai baku,
5. OLIGOASTHENOTERATO ZOOSPERMIA = Ketiga
variabel baku abnormal,
6. AZOOSPERMIA = tidak adanya sperma di dalam
ejakulat,
7. ASPERMIA = tidak ada ejakulat.
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 MANFAAT ANALISIS SEMEN

1. DIKETAHUINYA FUNGSI TESTIS, KELENJAR ASESORIS

DAN SALURAN PENGELUARAN ORGAN REPRODUKSI PRIA

2. FUNGSI SEKSUAL PRIA, KARENA JIKA TERJADI EJAKULASI

MAKA TAHAPAN RESPON SEKSUAL PRIA ADA,

3. MERUPAKAN INFORMASI UNTUK PENANGANAN

INFERTILITAS PASUTRI SELANJUTNYA, BAIK ITU
ANALISIS SEMEN OPTIONAL, ATAU LANJUTAN ATAU
PEMERIKSAAN LABORATORIUM LAINNYA BAIK
UNTUK SUAMI MAUPUN ISTRI,

4. DAPAT DIBERIKAN TERAPI AWAL BERDASARKAN HASIL

ANALISIS SEMEN RUTIN.

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 TERAPI SUAMI DAN PASANGAN
(PIA)

FAKTOR PRIA I ST R I
BISA DIOBATI NORMAL GAG A L

T E R A PI :
I ST R I
1) EMPIRIK ABNORMAL
TERAPI
2) KAUSATIF

GAG A L T R B / ART
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KMA THE ETIOLOGY OF MI & SD 40
 5.1. SIKLUS RESPON SEKS

4 Fase :
1. Excitement
2. Plateau
3. Orgasmic
4. Resolution
Keempat rentetan siklus reaksi
seksual diatas merupakan satu siklus yang lengkap

Orgasmic
Plateau phase
phase
Penetrasi Resolution
Phase
(Fore play )
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ALUR SYARAF YANG MEMPENGARUHI
RESPON SEKS

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 Gangguan Respon seks pada Pria

Disorder of Functions*
No

Syndrome
Pathology
Inhibited sexual desire ,Low sexual interest
1) Disorder of interest or libido

2) Disorder of excitement or
Erectile dysfunction
arousal

3) Anorgasmia, Premature ejaculation, Delayed ejaculation

Disorder of orgasm

4) Ejaculatory pain, Erectile dysfunction

5) Pain related disorder
(performance anxiety)
Fear/anxiety related disorder
sexual phobia
Kok Lee Peng, Psychosexual Counseling.1999

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5.2. DISFUNGSI SEKS PRIA :

 Male sexual dysfunction is a problem with 1 of

the 4 main components of male sexual
function (libido, erection, ejaculation, orgasm)
that interferes with interest in or ability to
engage in sexual relations.

 Disfungsi seks pria :

1. Dysfunction of Libido,
2. Erectile Dysfunction,
3. Ejaculatory Dysfunction,
4. Orgasmic Dysfunction

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5.2.1. DiSFUNGSI LIBIDO :

 Hormonal imbalance :
eq :Hypogonadism, Hyperprolactinemia,
 Physical Problems :
eq : Diabetes, Anemia, etc
 Psychological Problems :
eq Stress, Sexual deviation, etc

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5.2.2. DISFUNGSI EREKSI
 A man who is unable to develop or sustain an
erection sufficient for penetrative sexual
intercourse is usually or traditionally labeled
“impotent”- a word that not only has pejorative
implication, but also takes little account of the
complex process of male sexual function.

 Erectile Dysfunction (ED) is the inability to

achieve or maintain a hard, erect penis sufficient
for sexual intercourse.

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 5.2.2.1. PREVALENCE AND RISK OF
ERECTILE DYSFUNCTION
 Prevalence :
 5% among 40 years olds
 10% among 60 years olds
 15% among 70 years olds
 Risk Factors :
 Diabetes Mellitus, Hypertension,
Hyperlipidaemia, Depression, Smoking,
Hypothyroidism, Chronic Renal Failure,
Hypogonadism and Hyperprolactinemia.
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5.2.2. PENYEBAB DE :

1. Psychogenic,
2. Psychiatric
3. Neurogenic,
4. Endocrine,
5. Arteriogenic,
6. Venous,
7. Drugs

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5.2.2.1.CAUSES OF PSYCHOGENIC ED

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5.2.2. CAUSES OF ARTERIOGENIC ED :

1. Hypertension,
2. Smoking,
3. Diabetes Mellitus,
4. Hyperlipidemia,
5. Peripheral vascular disease,

 CAUSES OF VENOUS ED :
1. Functional impairment of the veno-
occlusive mechanism

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5.2.2.3. CAUSES OF ENDOCRINE ED :

1. Hormonal deficiency –
low testosterone
2. Raised SHBG,
3. High Prolactin

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5.2.2.4. CAUSES OF NEUROGENIC ED :

1. Trauma,
2. Myelodysplasia,
3. Intervertebral disc lesion,
4. Multiple Sclerosis,
5. Diabetes mellitus,
6. Alcohol,
7. Pelvic Surgery.

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5.2.2. 5. CAUSES OF DRUG ED :
1. Major tranquilizer,
2. Anticholinergics,
3. LH-RH analogues
4. Anti Androgen
5. Antihypertension,
6. Antidepressant
7. Anxioloytic,
8. Psychotropic drugs.

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5.3. DISFUNGS EJAKULASI :

 Unejaculation
 Retrograde ejaculation
 Damaged ducts :
Congenital Duct and Accessory glands Agenesis
Acquired duct obstruction
 Premature ejaculation :
Short Frenulum

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5.4. DISFUNGSI ORGASMUS :

 Physical Problems:
 Anatomical anomaly
(Hypo/epispadia),
 Psychological Problems

 Behavioral Problems (Lifestyle)

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6.TATALAKSANA DSP :
 History ( to confirm that the patient is
suffering from SD, to assess the severity of
the condition, to identify a possible underlying
aetiology)
 Physical examination (secondary sexual
characteristics, blood pressure, abdominal
aneurysm, external genitalia and prostate,
lower limb pulses).
 Clinical investigation ( urine, serum glucose,
serum testosterone,SHBG, probating,
creatinine, thyroid hormones, fasting lipid
profile, PSA)
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. DIAGRAM GOAL ORIENTED TREATMENT OPTION

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KESIMPULAN :
 Infertilitas adalah ketidakmampuan pria
untuk menghamili istrinya,
 Penyebab infertilitas mungkin dapat
mempengaruhi fungsi seks pria dan juga
peranan hubungan seks,
 Anamanesis dan pemeriksaan fisik yang
menyeluruh dapat membantu mengatasi
masalah infertiltas dan disfugsi seks pada
pria,

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 RUJUKAN :
1. Biology, 5th Ed. Campbell,NA,Reece,JB, Mitchel,LG,
Addison Wesley Longman, Inc., New York 1999.
page. 913 - 935
2. Richardson,D Overview:What do we tell our patient?,
dalam: The Assessment and Treatment of Erectile
Impotence, editors :Stricker,P.,Richardson,D. Excerpta
Medica,Australia, 1992
3. Nieschlag, E., Behre,H.M., Andrology, Male
Reproductive Health and Dysfunction,
Springer.Berlin,2000.
4. Kok Lee Peng Psychosexual Counseling, 7th
Workshop & Seminar on Male & Female Sexual
Dysfunction, Singapore, 20-21 March 1999.
5. Carani,C.,Granata,ARM.,Faustini,M.,and Marrama,P.
Prolactine and Testosterone : their role in male sexual
function, Int. J. of Andrology, 19: 48 – 54,1996.

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Prof David de Kretser

King and Queen

Seatle, Washingon, USA

Brisbane, Australia
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