Sex problems are one of the major problems encountered in general medical practice. Some of them are associated with anxiety. Patients are often reluctant to discuss them freely and frankly. Some of these complaints are psychosomatic. There exist wrong beliefs and notions regarding sex in our young and general population. As talking about sex or discussing it in open is a taboo, this leads to needless worry about complaints like weakness, tiredness and so-called nervous exhaustion. Sex education would help to remove the common misconceptions and prevent a great deal of mental agony and silent suffering. In adolescence, majority of the problems are psychological which respond to sex education and reassurance. If these problems are neglected, they would in their wake bring psychological strain.

In day to day practice, there are a few common sexual disorders like premature ejaculation, functional impotence, lack of sexual desire, unsatisfactory penile erection, sexual weakness in the elderly, depressed libido and unsatisfactory sex performance, apart from masturbation, nocturnal emissions and/or spermatorrhoea. This group of patients either seek medical advice on their own or are brought to the clinic by their friends, relatives or parents.

Masturbation is mostly occasional but later on, it may become a compulsive habit. This often leads to a guilt complex leading at times to personality changes in many a young adult. He may have a feeling of weakness, tiredness and exhaustion perhaps due to a mistaken belief in spontaneous loss of vigour. He may sometimes become sick or negligent in his duties for a long time. He may also have sex neurosis with depressed moods, elevated emotions and anxiety. He may complain of fatigue, loss of memory, palpitation, dizziness and frequency of micturition.

Young adult males have quite often anxiety over masturbation, nocturnal emissions or spermatorrhoea. Excess of masturbation in young adults may lead to involuntary nocturnal emissions producing psychosomatic manifestations like deterioration in educational performance, sleeplessness, irritative moods and lack of concentration.

Masturbation and/or spermatorrhoea or frequent night emissions are quite a common complaint. These may in their wake bring a state of anxiety or a feeling of weakness, tiredness or exhaustion. They may even bring about a feeling of sexual inferiority complex contributing to the early difficulties of married life, if not treated with determination.

The 12 patients in the present study belonged to two distinct groups. The patients in both the groups presented with the complaint of spermatorrhoea and/or nocturnal emissions and there was a history of masturbation in some cases. Group I consisted of young unmarried youths with mild or moderate types and Group II of married patients with the severe types. Psychotherapy was not effective in both the groups and hence Speman tablets were tried in Group I and Confido (Speman forte) in Group II cases after initial poor response to Speman tablets.

In each group, age, socio-economic condition, educational and occupational background and history of sex life were elicited. History of present and past illness was taken in detail and thorough physical examination was carried out and the assessment of psychological behaviour was noted. All were also examined for organic and serious psychiatric disturbance. Other factors such as use of tobacco, alcohol and drugs, diabetes mellitus, obesity, mental state, environments, physical health, dietary deficiency were also noted. Both the groups were advised to avoid rich, stimulating diet, have open air exercise, bathe the genital region at night with cold water. They were given general sex education and reassurance. No supplementary medicines were used in either group.

In Group I, the age varied from 20 to 27 years and most of the patients complained of spermatorrhoea and a few gave history of frequent nocturnal emission. There was history of earlier masturbation in some. All the patients were from lower and middle socio-economic group and were unmarried young adults. None had any physical defect or serious organic disorder.

In the mild type, the complaint was found to be recent and in the moderate type, the complaint was of much longer duration. Speman tablets 1 t.i.d. were given for one week in mild cases and 1 t.i.d. for two weeks in moderate cases and if necessary, such course was repeated after three months.

In the severe group the age varied from 22 to 40 years and there were married as well as unmarried males. Some of them were not well-built physically and to a certain extent, mentally. There was past history of pulmonary tuberculosis, jaundice, hypotension, amoebic hepatitis and eosinophilia and supplementary therapy for the specific disease was given simultaneously when necessary. Most of the married persons gave a history of a happy married life.

Sex education programme helped to remove misconceptions and thorough interest in the complaint and reassurance were helpful. Patients were advised to abstain from reading erotic literature and seeing sexually exciting pictures and avoid sex stimulating dialogues and company during the period of therapy.

Speman/Confido (Speman forte) tablets (The Himalaya Drug Company) have been very favourably reported by a large number of clinicians and research workers. They contain indigenous ingredients of ancient reputed herbal drugs having salutary pharmacological action in spermatorrhoea, nocturnal emissions, masturbation and allied sex disorders. The constituents of Speman tablets bring about powerful contraction of the seminal vesicle cutting up the afferent stimuli from the seminal vesicle and thus relieve spermatorrhoea. It tones up the system and improves the general vitality and acts as a restorative nervine tonic. It is not just a sedative and it does not diminish desire or sex interest as bromides, valerian and other tranquillisers usually do.

Confido (Speman forte) was used in severe type of cases. These were cases in married or unmarried young adults complaining of these disorders for much longer duration and were almost resistant to other therapy. Most of the patients were put on Speman tablets 2 b.i.d. for one week but the response was poor and they were later on switched to Confido (Speman forte) tablets one t.i.d. for 2 weeks which was sufficient to control their ailment. Such a course may be repeated after 3 months. Confido (Speman forte) tablets are equally effective to control spermatorrhoea and nocturnal emissions of resistant types. It is a hypothalmic tranquilliser and does not allow many provocative stimuli to pass down to lower sex centres and thereby Confido (Speman forte) checks hyper-irritability of the higher and lower centres with its potent action. Whatever the mechanism of action may be, the fact is that clinicians concede that it is an effective remedy in slowing down seminal discharges. We have detected no toxicity or untoward side-effects in either Speman or Confido (Speman forte) tablets in any case. There have also been no case of intolerance, allergy or sensitivity to the drug. These drugs have been favourably reported after clinical research and studies by N.C. Bhargava, M.D. Vidya, S.N. Ranade and N. Banerjee in various sex disorders.

The results of Speman tablet therapy in cases of mild and moderate cases of spermatorrhoea and/or night emissions with a background of masturbation in some cases gave 80% good results at the end of one week and 100% good results at the end of two weeks in all the cases where earlier therapy, reassurance and psychotherapy had failed.

The results in severe cases were not very satisfactory with Speman tablets alone for one week but with Confido (Speman forte) tablets 2 t.i.d. for 2 weeks there were 100% good and satisfactory results. There was no recurrence, even one year after the complete cure. Once the patient is cured of the symptom, and sexual activity is resorted, most of the patients gain self-confidence and maintain normal sex life even after discontinuing the drug and repetition of therapy is not at all required.

Modern medicine offers no satisfactory remedy for the treatment of these sex complaints. The problems of sex and allied disorders do not find their legitimate place in medical or clinical teachings of modern medicine. They form bulk of the problems a family doctor tries to treat and sometimes is frustrated in the process of follow-up or cure. It is only very recently that the attention is focused on sex education and scientific aspects and implications of the problems connected with sexual life.

1. Speman tablets 1 t.i.d. were tried in cases of spermatorrhoea and/or night emissions with or without a history of earlier masturbation.
   
   
2. Earlier therapy with other drugs, reassurance or psychotherapy were of no avail.
   
   
3. Speman tablets 1 t.i.d. gave 80% good results at the end of the first week and 100% excellent results at the end of two weeks in mild and moderate cases.
   
   
4. Confido (Speman forte) tablets 1 t.i.d. were given for 2 weeks after no response with Speman 1 tablet t.i.d. for one week, in severe cases. All the severe cases responded excellently (100%) to Confido (Speman forte).
   
   
5. There was no recurrence of symptoms in cases in the two groups at the end of one year.
   
   
6. There were no toxic, allergic or sensitivity reactions or intolerance in any case.
   
   
7. The drugs are completely safe and give excellent results – (100% cure rate).