Kama, Krodha, Bhaya, Shoka, Moha, Mada, Manoabhighata, Avichara, Irshya, Avisrambha, Utkantha, Udvega etc. are the prime Mano vikaras8 and Manaika Bhava which have got their definite role in the vitiation of general functioning of Mana as well as speculative higher mental and recreational functions i.e. sexual arousal, orgasm by altering the Doshic configuration basically with special reference to Vata Dosha and Rasa and in turn the seventh metabolic discrete Shukra in specific9.

The rule of Chintyanam Atichintana, Achintyanam Chintan, Chintyanam Achintana ascribed to the sexual phenomena will affect the process of sexual response and arousal. The Deha Prakriti, Manaika Prakriti and Satva Bala have been dealt in detail in the texts to explain sexual procreational and recreational capacity of an individual10.

Any of these constitutional defects becomes a susceptible factor to cause sexual dysfunctions in future. Other supportive causes of sexual dysfunctions are viz., the behavior of person towards the female partner, seeing defects in partner, disinterest in partner. When the emaciated person indulges in sex due to excessive sexual drive, ignorance, competitive sex, poor technique etc. leads to sexual dysfunctions. Understanding the instincts mutually is important in sexual arousal for the greater pleasure.

Manasika nidanas

Mind plays an important role in the arousal, desire, erection and ejaculation. So the nidanas which affect the mind will predispose towards Klaibya.The major manasika nidanas explained are Shoka, Bhaya, Krodha, Chinta, Udvega.

Shoka is explained as sorrow or dhukham. 150It is known as depressive behaviour of the patient. The happy state of mind as a pre-requisite for a man’s virility and sexual interest has been mentioned by Charaka .151 Sushruta emphases on a happy state of mind which leads to shukra pravartana.

Therefore shoka being the opposite guna of harsha leads to decrease in sexual desire.152Krodha, Shoka and Bhaya causes pitta prakopa which further leads to the rakta dusti this vidahi rakta and Prakupiat pitta when it gets lodged in Shukravaha srotas causes Shukravaha Sroto dushti and ultimately leads to Klaibya.. 153

Chinta and Udvega distract the mind as a previous failure at sex will increase chinta and Udvega. Interpersonal relationships between the partners i.e lack of coomunication and partner conflicts play a vital role in the development of manasika klaibya.It is mentioned as the causes of Bijopaghataja 154 and Shukra Ksayaja Klaibya .155

Men, who experience a sudden loss of erectile capability often, have a psychological orgin. Just as an erection can result from thinking about sex, negative thoughts can prevent an erection from occurring. Psychological processes such as stress, anxiety and worries can impair erectile functioning by reducing erotic focus. Psychological aspects such as lack of self condidence, lack of communication, lack of sexual knowledge and partner conflicts are important contributing factor for the manifestation of Klaibya.

Some subjects feel anxiety as soon as they have an erection and so lose it then, others are tranquil until the point of penetration but lose the erection at that time; stillothers feel anxiety while they are in the vagina and so become flaccid before they ejaculate. His excessive thinking and worrying prevents adequate sexual performance.

Intrapersonal Difficulties: Due to anxiety, depression, fears, low self-esteem, mild residues of childhood guilt and shame about masturbation and sexual pleasure, feelings of inadequacy or a sense of being undesirable as a partner, moral prohibition, hostile andneurotic association, and man may be unable to express a sexual impulse12.

Interpersonal Difficulties: Due to lack of communication, sexual expectations, sexual expressiveness, marital discord or more serious relationship problem, an inability to trust may lead to impotence.

Post-traumatic stress disorders: When trauma was sexual in nature then there is decreased desire, decreased arousal and aversion to sexuality (e.g. rape or sexual abuse). Sexual conflicts which have their roots in childhood injury and destructive adaptations to these injuries may lead to impotence. Parents negative attitude towards sex also contribute in the development of impotence.

Psychiatric illnesses: Diminution of sexual desire may occur in depression. Anxiety produced by unrealistic sexual expectations of oneself and one’s partner, transient fear of rejection interfere  with sexual  desire. The hidden emotional forces in  a couple’s relationship may produce sexually disruptive anxiety.

Anxiety may interfere with performance, primary arousal. Increased anxiety interferes with normal function of parasympathetic nervous system. Mania classically increases desire or interest. Stress induced by occupation is also a cause for impotence.

The effect of the immediate situation: Fear of damaging the sexual partner or oneself, fear of causing unwanted pregnancy or sexually transmitted disease causes impotence. Some men are impotent with prostitutes; culturally engendered guilt’s etc. is the immediate situation which causes Erectile Dysfunction.

Frigid women: Wife may express her antipathy to sexual intercourse by being completely passive permitting penetration but refusing to stimulate the husband in any way. The lackof emotional response and lack of physiological response in the form of increased vaginal secretion diminish the husband’s desire. Erectile Dysfunction occurs and the wife blames the husband and laugh at him. The repeated failure and the wife’s scornful attitude convince the man of his impotence. Some frigid wives use their ability to allow or to refuse coitus in order to control their husband.

Unconscious psychological causes: Guilt about Homosexuality, a punitive superego, partner is identified with pure sister or mother; severe conscious castration anxiety, etc. may lead to psychological impotence.

However any of accidental outbreaks of sexual impairment due to other factor can in turn inhibit the further process of stimulation or loss of self-determination so Mana here is acting as a cause or as an effect in genesis of Manasika klaibya.18 Mana is minute, shifts from one to another very fast within very negligible period of time, so anything that hits the nature and functioning aspects of Mana, specially the causes aimed at sexual physiology within no time of contact, intactness, working motto and continuity of sexual arousal and process is checked and the shift of the same into another aspect of thoughts of fear, aversion or disinterest in sexual act appears. The vice versa of the same is also possible i.e. any of incapability to perform sex even at normal mental capacity will certainly, immediately affects the Manaika Bhava leading to the same shift phenomenon. Hence the Mana act again as a cause and effect in causing Manasika Klaibya.19

Mana is an internal instrument, part and parcel of Prakriti without which one cannot understand the facts or follow the same. The Manovikara are the deviators from self. It is also hindering factor for attainment of self or knowledge or both. The Manovikara like Iccha, Moha etc. when act strongly against the context and conduct of sex in particular the ongoing feelings and arousal and further continuation of sexual phenomenon etc. are sodisturbed to maintain the internal instrument and avoiding the Manovikara is required for integrity of sexual act otherwise the covering of the same is happening and the further sexual thoughts20, process and interest are lost. Indriya are those entities made up of Prana and are Chetanavan, do not depend upon Mana for existence but astonishingly depend for functioning. The control over Indriyas is indirect phenomenon. During sexual congress due to any of the exogenous or endogenous triggers, ifMana loses its control over Indriyas, any of the excessive lack or pervasive or indiscriminate sexual attitudes will develop leading to sexual dysfunctions. It tunes the sensory systems to give much perfection and again the disturbance in tuning process will certainly disturb the dos and don’ts in sexual congress. The property of Mana to become introverted leads to detachment from sensory activities. This leads to lack or absence of perception from psycho sexual responses, the effect being sexual problems21.

The functions of Mana like, to think, to predict, to move, to motivate, to decide, etc. when predict in relation to sexual response, i.e. to think about the sexual acts and aboutpartner the decisions regarding the sexual congress and other matter related topsychosexual and behavioral aspects when get disturbed due to the different etiological factors, the result will be disturbed sexual attitude and disinterest or aversion or lack of sexual potency. So the dysfunctions of Mana will be the cause for sexual dysfunction22. If the analysis of sexual instincts or stimuli are carried through senses with the help of Mana and then assessed in the light of Buddhi and its subtypes the proper cognition is possible. Any defects in this channel will disturb the sexual perceptions, feelings, arousal and even orgasm. The inability of a person to understand and perceive the sexuality of partner or women is also due to defective cognitive functions or affective functions, the Mana being the effective factor23.

partner, the thoughts of the partner, hearing to sexual word of the partner, the touch and sensation of the female partner and the exciting condition and excitement derived from all these and the pleasant mind are the factors that bring to cause the ejaculation of Retas29.

This is also equated with the expulsion of breast milk due to the sensation, thought, touch of baby and intactness of Sankalpa. The definition of Vrishya itself contains the property of Mana- Harshana of Mana (Pleasing of Mana) without which no drug can become virilific. So the impairment or lack of this Harshana also leads to the sexual dysfunctions. Fearlessness, daily habituations to copulation are the qualities of Mana and behavioral attitude helping for virility.

Sexual dysfunctions are caused mainly due to the lack of moral support and confidence. The erection and ejaculation are achieved by physiological force mediated by the strong psychological determination and the exhilaration or sexual drive from higher to lower region so the defect or lack of these will certainly lead to sexual dysfunctions viz., ejaculatory incompetence, lack of satisfactory erections etc. Prasanna Mana (pleasant mind) and Harsha are essential for ejaculation; even though the person is copulating with the partner this again shows the role and significance of Mana in sexuality and sexual dysfunctions30.

Hence, in a nutshell the role of Mana in the pathogenesis of Klaibya or in total sexual dysfunction can be summarized as the intact, healthy and effective functioning of Mana viz. Sankalpa, Nirbhayata, Harsha, Tarsha, pleasure, pleasantness, love enjoying, exciting, cheerfulness, Pravara Satvabala, SauManaya, Avyakulata, Prasanna Mana, normalcy of ManoVishayas and Arthas and also Vrittis can bring the normal sexual erections and ejaculation. At the same time any defect in the above said Manovyaparas and Chittavrittis 31will certainly hamper the capacity to get erections and ejaculation and the sustenance and activity in sexual congress resulting in satisfactory sexual acts or dysfunctions the Mana is the causative factor here.

Body and mind are relatively working in all aspects and sexuality is not away from this. The rule for manifestation of disease is Mana affecting the body and body affecting the Mana. There are various reference explained in Hetu Skandha in favour of Mana affected due to disturbed physiological conditions leading to sexual disturbances like certain food substance dominant with Rajas and Tamas properties, food incompatibilities and misconducts and Prajnaparadha will lead to physiological disturbance in turn affecting the psychological disturbances.

The fear, insanity, guilt, ignorance, negative experience, external injuries to genitals leading to sexual problems in turn definitely affect the Mana which become frightened or disturbed once again deeply. Lastly it is clear from ongoing discussion that Krodha, Shoka, Bhaya, Ajnana, Moha, Udvega etc. are the Manovikaras and Alpa Satva or Avara Satvabala are theManaika causes in the genesis of Manasika Klaibya32. Therefore the role of Mana in Samprapti of Klaibya is established as a cause or effect or both.

C. Pathyahara: Therapeutic

In Manasika Klaibya, Mana 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.

Sadhyasadhyatva

Manasika Klaibya is curable36but the success depends upon the nature of causative factor. If a sexual partner is not cooperative then management of Manasika Klaibya is difficult. Fruitful outcome of therapy is always depends upon the self-esteem of the person.Those with low self-esteem may take more time to overcome the problem.

Conclusion

Erectile dysfunction is a prevalent problem that can affect, and can be affected by, psychosocial aspects of a man's life. Medical or pharmacological interventions are often appropriate to treat ED, but the psychosocial aspects should not be ignored. 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. Sex is an instinctual expression involving a physical relation, and is technical and not mechanical.

References