Effective Treatments for Erectile Dysfunction

Mental Impotence Healer Program

Mike Millers Mental Impotence Healer is an eBook that utilizes guided imagery to help you to cure your psychological impotence. In guided imagery, you will be guided into imagining a scenario which will help you overcome psychological and physical issues. It commonly uses descriptive language and instructions that have direct affects on the brain. Because the mind greatly influences your body, this system will help you have rock-hard erections whenever you need them most. Simply listen to The Mental Impotence Healer Program for 60 days and completely annihilate your sexual fears and in next to little time you will definitely make yourself a brand new You! Recharged with sexual energy, bursting with self-confidence, rock solid on command, and conditioned to believe that your times of Psychological Impotence have dissapeared, permanently! The Mental Impotence Healer Program provides you with your confidence back and will maximize your self-esteem to amazing new heights. Listen to the beautiful, calm and relaxing Guided Imagery session and it definitely will totally transform your sex life. You will obtain control over your erections without taking any harmful medication or dangerous pills. Grab a set of headphones and the recordings will go to work while you relax. The carefully mastered binaural beats and subliminal messages will reprogram your subconscious mind to a radically altered state of heightened sexual awareness and desire! Read more...

Mental Impotence Healer Program Summary

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Author: Mike Miller
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Female Sexual Function After RPIPAA

Many studies examined sexual function after RP-IPAA and particularly sexual satisfaction, desire, ability to experience orgasm and coital frequency 40, 43, 45, 46 . Results were satisfactory, as most of these aspects are influenced very little by surgery. However, a percentage of patients, ranging from 3 to 18 , were afraid of having stool leaks during intercourse. In contrast, especially in those with postoperatively unchanged or increased coital frequency from 82 to 100 , the appearance of dys-pareunia was a rather frequent complication. Incidence varied considerably, from 0 to 38 41, 42 , stabilising in most works at 25 . Moreover, Farouk found that the incidence of this complication after surgery seems to increase over time 47 .

Can Impotence Be Due To The Drugs Patients Are Taking

Almost any drug, or just knowing that you have a heart condition that necessitates taking a drug, may cause or contribute to impotence. Some groups of drugs given to either prevent or treat patients with coronary heart disease are particularly likely to cause impotence. These are

Are These The Viagra Tablets

The new group of drugs, called phosphodiesterase type-5 inhibitors (PDE-5-drugs ending in tadalafil ), of which sildenafil (or Viagra) was the first, may help. Others (tadalfil, vardenafil) are available. They are safe and useful in most men with impotence. Depending on what other conditions the man has, for example, diabetes, his internist or cardiologist may be able to

The Human Sexual Response

Vaginal Vasocongestion

The sexual response, similar in both sexes, is often divided into four phases excitation, plateau, orgasm, and resolution. The excitation phase, also known as arousal, is characterized by myo-tonia (increased muscle tone) and vasocongestion (the engorgement of a sexual organ with blood). This results in erection of the nipples in both sexes, although the effect is more intense and evident in females than in males. The clitoris swells (analogous to erection of the penis), and the labia minora swell to more than twice their previous size. Vasocongestion of the vagina leads to secretion of fluid, producing vaginal lubrication. Vasocongestion also causes considerable enlargement of the uterus, and in women who have not breast-fed a baby the breasts may enlarge as well. (pigmented areas surrounding the nipples). Pronounced engorgement of the outer third of the vagina produces what Masters and Johnson, two scientists who performed pioneering studies of the human sexual response, called the...

Central Mechanisms Of Penile Erection And Flaccidity

And genital sensations but does not lead to penile erection. Conversely, stimulation of cortical-subcortical areas linked to the limbic system elicit penile erections in response to stimulation, as demonstrated in monkeys (5,171-173). Direct study of the human brain is limited to observations made during neurosurgical procedures. Conversely, stimulation of the amygdala (a limbic structure) can induce erotic emotions similar to those experienced during intercourse. Analogous observations have been made by comparing the experiences of patients suffering from epilepsy with parietal lobe foci to those with mediobasal temporal foci. Animal experiments have shown that damage to the fornix and prefornical area also injures the paraventricular nucleus (PVN) outflow to the MFB, possibly accounting for the impotence associated with these operations. The current hypothesis of the inhibitory role of the cortex is supported by the findings of hypersexuality and penile erection in the Kluver-Bucy...

Modes Of Penile Erection

Penile erections are elicited by local sensory stimulation ofthe frenulum, glans penis, and perigenital skin (reflexic erections) as well as by central stimuli received by, or generated within, the brain (psychogenic erections). Both types of erectile mechanisms likely act in a synergistic manner and are controlled by the autonomic nervous system (see Fig. 6 Table 7).

Herbal Alert Ginseng

Ginseng has been called the king of herbs because of its wide use and the benefits attributed to the herb. In early times in China, ginseng was valued as high as gold. Hundreds of ginseng products (eg, gum, teas, chewing gum, juices) are sold throughout the US. Ginseng is the fourth best selling herb in the US. The primary use ofginseng is to improve energy and mental performance. The benefits of ginseng include improving endurance during exercise, reducing fatigue, boosting stamina and reaction times, and increasing feelings of well-being. Adverse reactions are rare, but sleeplessness, nervousness, and diarrhea have been reported in individuals taking large amounts of the herb. The herb should not be taken in combination with stimulants including those containing caffeine. Dosage is 200 to 500 mg day of the standardized extract or 1 to 4 g of powdered root a day. Ginseng is contraindicated in individuals with high blood pressure and during pregnancy.

Sexual Function

Preservation of sexual function after transurethral surgery for LUTS includes both antegrade ejaculation and erectile function. Retrograde ejaculation after TURP is reported in 62-100 of men but in only 035 of men after TUIP (8-10,30,47,57,59,60). The successful preservation of antegrade ejaculation after transurethral surgery is most likely related to the quantity of residual tissue. Studies have noted that preservation of antegrade ejaculation is more likely in those men treated with a single incision than in those treated by the two-incision technique (46,61). The risk of erectile dysfunction after TUIP is estimated at 3.9-24.4 . Other investigators have reported a 100 potency preservation rate when TUIP was performed with the holmium yttrium-aluminum-garnet laser (45).

Ginseng

Tertiary Structure Ginsenoside

The roots of the herbaceous plants Panax ginseng (Araliaceae) from China, Korea, and Russia, and related Panax species, e.g. P. quinquefolium (American ginseng) from the USA and Canada, and P. notoginseng (Sanchi-ginseng) from China, have been widely used in China and Russia for the treatment of a number of diseases including anaemia, diabetes, gastritis, insomnia, sexual impotence, and as a general restorative. Interest in the drug has increased considerably in recent years and ginseng is widely available as a health food in the form of powders, extracts, and teas. The dried and usually peeled root provides white ginseng, whereas red ginseng is obtained by steaming the root, this process generating a reddish-brown caramel-like colour, and reputedly enhancing biological activity. Ginseng is classified as an 'adaptogen', helping the body to adapt to stress, improving stamina and concentration, and providing a normalizing and restorative effect. It is also widely promoted as an...

The Sexual Response

The sexual response depends on a complicated series of reflexes that involve the neuromuscular transmissions stimulated by a wide variety of visual, tactile (touch), olfactory (smell), and emotional sensations. Sexual excitement and response begin in the brain. Electrical signals are transmitted from the brain areas involved via the spinal cord to the sexual organs or genitals, through nerves that exit near the base of the spinal cord. The pathways between the brain and the genitals are long and complex, and demyelination may short-circuit them. Impulses leave the CNS from the sacral spinal cord via the auto-nomic nervous system, which controls bodily functions that are considered automatic. For example, this system controls the arousal that men and women experience without external stimulation, such as that which occurs during sleep. There are two divisions to the autonomic nervous system, the parasympathetic and the sympathetic. The parasympathetic section controls the erectile...

Erectile Dysfunction

Open prostatectomy can have an adverse impact on sexual performance. The review conducted by McConnell and associates revealed postoperative erectile dysfunction in 32 , 16 , and 18 in patients undergoing perineal, retropubic, and suprapubic prostatectomy, respectively (21). In theory, leaving an intact and nonviolated prostatic capsule should mitigate against the development of either incontinence or erectile dysfunction. It has been assumed that preexisting erectile dysfunction may be more pervasive than previously suggested. However, the study conducted by Ertekin et al. documented postoperative erectile dysfunction in more than half of patients who claimed preoperative potency and subsequently underwent suprapubic prostatectomy (25). In that study, however, there was no clear connection between surgical technique and development of erectile dysfunction. As anticipated, the incidence of retrograde ejaculation is very high, occurring in about 77 of all cases, a rate similar to that...

Current Clinical Urology

Male Sexual Function A Guide to Clinical Management, Second Edition, edited by Nakada and Margaret S. Pearle, 2005 Oral Pharmacotherapy of Male Sexual Dysfunction A Guide to Clinical and Patient Follow-Up, edited by Culley C. Carson, III, 2002 Male Sexual Function A Guide to Clinical Management, edited by John J. Mulcahy, 2001

Conclusions From Original Reports

This study shows the effectiveness of intracavemosal injections of vasoactive agents (phentolamine and papaverine) in treating impotence of various etiologies (psychogenic, neuropathic, and arteriogenic). These results also suggest that any placebo effect is minimal in this group of patients, in which there is a considerable psy-chogenic overlay to their impotence.

Other Important Publications

Lancet 22 2(8556) 421-423, 1987. Susset J, Tessier C, et al. Effect of yohimbine hydrochloride on erectile impotence a double-blind study. J Urol 141(6) 1360-1363, 1989. Vogt H, Brandl P, et al. Double-blind, placebo-controlled safety and efficacy trial with yohimbine hydrochloride in the treatment of nonorganic erectile dysfunction. Int J Impot Res 9(3) 155-161, 1997. Morales A. Yohimbine in erectile dysfunction the facts. Int J Impot Res 12 (Suppl 1) S70-74, 2000.

Inclusion Criteria

Men with erectile dysfunction of 6 months duration and of organic (70 ), psychogenic (11 ), or mixed (18 ) origins. Men with ED n 532- Men with ED n 329- Sildenafil 25mg Sildenafil 50mg Sildenafil 100mg Sildenafil (open-label) Figure 12.1. Phase III pivotal study of sildenafil. Double-blind placebo controlled escalating dose study design SILDENAFIL UTILITY CONFIRMED 47

Functional Neuroanatomy Of Penile Function

Ischiocavernosus Erection

Penile Erection PENILE ERECTION AND FLACCIDITY PHYSIOLOGICAL MECHANISMS Penile erection is a neurovascular event controlled by corporal smooth muscle tone. In the flaccid state, the corporal smooth muscle of cavernous arteries, helicine arteries, and trabeculae are tonically contracted. This limits the blood flow to the penis at 5 mL min, which is sufficient for nutritional purposes (39). There are four physiological components necessary to achieve a penile erection Fig. 5. Schematic representation of neural innervation of the pelvic structures and penile erection. Fig. 5. Schematic representation of neural innervation of the pelvic structures and penile erection. Vascular pulsation of the fully erect penis becomes visible when a steady state has been achieved. Pressure in the lacunar space during an erection results from the equilibrium between the perfusion pressure in the cavernosal artery and the resistance to blood outflow through the compressed subtunical vessels. Therefore, the...

Spinal Mechanisms And Pathways

Additionally, bilateral anterolateral cordotomies in humans result in the complete loss of erectile function and block orgasm-associated sensations. Because touch and two-point discrimination are not altered by this procedure, it appears likely that the erotic quality of genital stimulation depends on the ascending fibers running with the spinothalamic pathways for pain and temperature. In monkeys, electrical stimulation along the course of the spinothalamic pathways at the level of the brain stem elicits erection and ejaculation (219). The relevant fibers could be traced to the caudal thalamic intralaminar nuclei, which may be the receiving area for erotic genital sensation. Stimulation of these nuclei in humans has been reported to cause erotic feelings and orgasm. Under normal conditions, it seems likely that psychogenic and reflexic stimuli act in a synergistic manner to produce erections. Psychogenic erections in paraplegic men are usually short-lived, only partial, and lack the...

Relevance

Although phenoxybenzamine has largely been replaced by prostaglandin E1 (PGE1) and mixes of vasorelaxant agents, until the arrival of sildenafil intracavernosal administration was the mainstay of therapy. Even after the arrival of sildenafil, there is still relatively widespread use of injectables, and indeed some patients prefer the quality of the erection achieved.

Outcome Measures

Patient reported complete return to satisfactory sexual functioning with erections sufficient for penetration (confirmed by partner). Partial response. Patient and partner reported some improvement in quality of erections (frequency or rigidity) but insufficient to restore satisfactory sexual performance. Failure. Patient and partner reported no change in erectile functioning from pretreatment levels.

Sjjfc Humana Press

Male sexual function a guide to clinical management edited by John J. Mulcahy. -- 2nd ed. ISBN 1-58829-747-0 (hardcover) (alk. paper) ISBN 1-58829-969-4 (paperback) 1. Impotence. I. Mulcahy, John J. (John Joseph), 1941- . II. Series. DNLM 1. Impotence--therapy. WJ 709 M24565 2006 RC889.M3475 2006 616.6'922--dc22

Erectile Tissue

Penile Artery

The tunica albuginea of the corpus spongiosum is much thinner than that of the corpora cavernosa and contains more elastic fibers. Cadaveric studies have demonstrated that the thinnest portion of the tunica is at the 6 o'clock position over the urethra, which explains the epidemiology of perforation during penile prosthesis implantation. Emissary veins run between the inner and outer bundles obliquely and, therefore, can be occluded easily by the shearing action of the tunical layers during erection. The outer layer appears to play an additional role in compression of the veins during erection. However, dorsal artery branches take a more direct perpendicular route and are protected by compression during erection by a peri-arterial fibrous sheath. The tunica albuginea provides tough uniform backing for engorged sinusoidal spaces. injury to these structures during deep pelvic surgery can lead to vasculogenic erectile dysfunction. Collateral vessels may open in the setting of...

Herbal Therapy And Nutritional Supplements

Botanical medicine or herbal therapy is a type of complementary alternative therapy that uses plants or herbs to treat various disorders. Individuals worldwide use both herbal therapy and nutritional supplements extensively. According to the World Health Organization (WHO), 80 of the world's population relies on herbs for a substantial part of their health care. Herbs have been used by virtually every culture in the world throughout history, from the beginning of time until now. For example, Hippocrates prescribed St. Johns Wort, currently a popular herbal remedy for depression. Native Americans used plants such as coneflower, ginseng, and ginger for therapeutic purposes. Herbal therapy is part of a group of nontraditional therapies commonly known as complementary alternative medicine (CAM). Unfortunately, CAM therapies are not widely taught in medical schools. A 1998 survey revealed that 75 of 117 US medical schools offered elective courses in CAM or included CAM topics in required...

The Spinal Cord Coordinates Many Autonomic Reflexes

Reflexes coordinated by centers in the lumbar and sacral spinal cord include micturition (emptying the urinary bladder), defecation (emptying the rectum), and sexual response (engorgement of erectile tissue, vaginal lubrication, and ejaculation of semen). Sensory action potentials from receptors in the wall of the bladder or bowel report about degrees of distenion. Sympathetic, parasympathetic, and somatic efferent actions require coordination to produce many of these responses.

Symptoms of Normal Pituitary Hormone Loss

The next hormones to become deficient are usually the gonadotropins. Prepubertal children have no effects from gonadotropin deficiency, but adults develop oligoamenorrhea, impotence, and or infertility. Deficiencies of TSH, which leads to hypothyroidism, and ACTH, which leads to hypoadrenalism, are less common, even with large tumors. Deficiency of prolactin (PRL) is also uncommon and only presents in the postpartum period as a failure to lactate. Diabetes insipi-

Development Of 5aReductase Inhibitors

As discussed, although other approaches to androgen ablation and androgen inhibition (antiandrogens) have been evaluated in the past, these methods produced only a moderate desired impact and had many side effects, thus limiting their use (14). Typical antiandrogen (e.g., flutamide) side effects include onset of erectile dysfunction, impairment in libido and ejaculation, gastrointestinal distress, nausea, flatulence, gynecomastia, breast pain, diminished energy levels, impairment in spermatogenesis, and decreased muscle mass. In contrast, because mature (postpubertal) patients with 5 a-reductase deficiency did not appear to have impaired sexual function or diminished external mascu-linization, the 5 a-reductase enzyme was a logical target for treating men with clinically significant BPH. The potential blockade of 5a-reductase seemed to provide hope for decreasing prostate growth and minimizing side effects. blocking 5a-reductase without affecting the binding of T to the androgen...

Nitric oxide is a gas that can act as a second messenger

The spectacular discovery of NO as a second messenger explained the action of nitroglycerin, a drug that has been used for over a century to treat angina, the chest pain caused by insufficient blood flow to the heart. Nitroglycerin releases NO, which results in relaxation of the blood vessels and increased blood flow. Penile erection is also caused by the dilation of blood vessels in that organ, and the new drugs that promote erection are NO synthesis activators.

Win Races and Lose Racing The Example of Physical Enhancements

What is a human performance and what is an excellent one And what makes it excellent as a human performance For it seems that some performance-enhancing agents, from stimulants to blood doping to genetic engineering of muscles, call into question the dignity of the performance of those who use them. The performance seems less real, less one's own, less worthy of our admiration. Not only do such enhancing agents distort or damage other dimensions of human life - for example, by causing early death or sexual impotence - they also seem to distort the athletic activity itself. What is at stake here is the very meaning of human agency, the meaning of being at-work in the world, being at-work as myself, and being at-work in a humanly excellent way. (President's Council on Bioethics 2003 140-141)

Other Potential Causes of Androgen Deficiency

Men with pre-existing testicular dysfunction (including renal failure) may be more susceptible to further impairment of steroidogenesis caused by medications or illnesses. HMG-CoA reductase inhibitors inhibit cholesterol synthesis and may, therefore, impair steroidogenesis, particularly because adverse events consistent with androgen deficiency (gynecomastia and impotence) have been reported. A prospective, open-label study of 25 nephrotic, hyperlipidemic men with moderate chronic renal failure treated for 12 mo with lovastatin (40 mg d) showed no change in baseline and GnRH-stimulated LH, FSH, and testosterone levels (38). A more discerning test of testicular steroidogenesis, such as testosterone response to submaximal hCG stimulation, was not reported. Adrenal steroidogenesis (plasma cortisol before and after adrenocor-ticotropic hormone ACTH stimulation) was comparable with age-matched healthy controls at entry and remained unchanged by lovastatin treatment. Not surprisingly,...

Treatment Of Sexual Dysfunctionan Integrated Approach

Masters & Johnson (1966, 1970) proposed an approach to the treatment of sexual difficulties that took these problems out of the realm of long-term psychotherapy. Their investigation of sexual functioning, and focused therapy for sexual difficulties, was an important shift in treatment which created the specialty of 'sex therapy'. Their approach was essentially behavioral in its focus and based around the in vivo desensitization, anxiety control and positive rehearsal of appropriate intimacy skills, all incorporated into the 'sensate focus' technique. The third phase of treatment is an educative phase, which confirms the appropriate knowledge of the patient or couple, but most importantly corrects any misinformation the patient accepts about their own sexual functioning or responses or 'normality'. Inappropriate beliefs and understanding, while becoming less common, are still frequently implicated in the aetiology or maintenance of sexual difficulties.

Hypnosis In Enhancing Anxiety Reduction

While relaxation is not a requirement of hypnosis, the use of hypnosis can facilitate relaxation and reduction in the anxiety which may directly or indirectly impair sexual functioning. Hypnotically cued relaxation may be utilized at the time of sexual intimacy, during self-stimulation or during the sensate focus or pleasuring technique, a process of in vivo desensitization. This use of cued relaxation may also overcome the anxiety accompanying sexual guilt.

Metaphorical Therapies

Metaphors and stories may also be employed to assist attitude change towards one of successful sexual functioning. For example, a recently married patient, experiencing severe vaginismus, responded well to a story of a young couple moving into a new house (she was currently looking for a house in which she and her husband would live), discovering that one room was locked and apparently without a key. Attempts to break the door down were unsuccessful and painful. A search led to the discovery of a number of keys in a drawer in the basement, and the husband attempted to unlock the door. As he was in such a hurry he repeatedly fumbled with the keys, dropped them and was unable to get the key into the lock. His wife's more patient and systematic use of each key resulted in her being calmly able to unlock the door. While finding the key was an essential first step in opening the door, subsequent attempts were initially found to be difficult, as the door had been closed for some long period...

Age Regression And Age Progression

Age regression may be used in the form of the affect bridge of Watkins (1978) to take the patient back to the first experience of the inhibiting or traumatic affect that is interfering with sexual functioning. Regression may also be used to take the patient back to a time of adequate sexual functioning, if such a time existed prior to the onset of the sexual dysfunction. Such an approach encourages expectation of successful sexual functioning, assists in systematic desensitization and in sexual rehearsal of successful intimacy. Lastly, regression techniques may assist in exploring the emotional basis of the sexual difficulties, with the understanding that information obtained may not represent a factual account of past events. The dangers of the false, confabulated or suggested memory need to be considered in this context. Age progression of the patient beyond the current difficulties to successful sexual functioning is a similar method of producing satisfactory results.

Treatment Of Premature Ejaculation

Premature ejaculation is one of the most treatable of male sexual dysfunctions a variety of direct and indirect suggestions have been used in its treatment. Many approaches have focused on anxiety reduction as the primary goal, as performance anxiety is the most common cause of a rapid ejaculatory response. Hypnotically assisted desensitization and rehearsal of appropriate sexual responding are applicable to this anxiety-driven disorder. Creative uses of healthy dissociation and distraction can also assist the male in being able to psychologically distance themselves from overarousal.

Herbal Alert Larginine

L-arginine is commonly sold in health food specialty shops as a supplement capable of improving vascular health and sexual function in men. The herb may be beneficial in improving health in individuals with congestive heart failure, peripheral artery disease, angina, hypertension, hyperlipidemia, and type 2 diabetes. The herb appears to increase nitric oxide concentrations. Abnormalities of the vascular endothelial cells may cause vasoconstriction, inflammation, and thrombolytic activity. These abnormalities are partially attributable to degradation of nitric oxide. L-arginine's ability to increase nitric oxide is the basis for its effectiveness in improving some vascular disease states. Oral doses of 9 to 30 g per day are well tolerated. No adverse reactions were reported in those taking 9 g d. Higher doses may cause nausea and mild diarrhea. L-arginine may exacerbate sickle cell crisis and should be used with caution in those with sickle cell anemia.

Assessment Of Response To Gamma Knife Treatment

Because GH production is influenced by age and gender (GH secretion declines with increasing age), it is necessary to have the IGF-1 level measured in a laboratory that provides normal values in relation to age and gender. In patients with CD, the 24-h UFC concentration is the best measure of integrated cortisol production. A normal 24-h UFC is an excellent measure of excessive cortisol production but is not helpful to assess adrenal insufficiency. A single serum PRL measurement in a patient with a prolactinoma is sufficient to assess the response to Gamma Knife therapy. Gonadal function is assessed by a history of normal libido and erectile function and a normal serum testosterone in men. In premenopausal women, regular menses indicate normal ovarian function. Men should have serum testosterone measured regularly, and menstrual history and serum estradiol levels should be measured in premenopausal women. In patients with Nelson's syndrome (increased serum ACTH...

Herbal Alert Warfarin Interaction

Warfarin, a drug with a narrow therapeutic index, has the potential to interact with many herbal remedies. For example, warfarin should not be combined with any of the following herbs because they may have additive or synergistic activity and increase the risk for bleeding celery, chamomile, clove, dong quai, feverfew, garlic, ginger, ginkgo biloba, ginseng, green tea, onion, passion flower, red clover, St. John's wort, and tumeric. Any herbal remedy should be used with caution in patients taking warfarin.

Muscleinvasive bladder cancer MIBl

The typical morbidities after radical cystectomy are erectile dysfunction and disturbed sexual life on the one hand, and urinary leakage and stoma problems on the other.3-6 Change of body image and disturbed sexuality may be followed by decreased self-esteem. High-dose radiotherapy is another therapeutic option which in non-randomized series seems to result in similar survival rates comparable to patients with small tumours (T2).7 An important condition for a favourable outcome of such an approach is the feasibility of qualified follow-up combined with salvage cystectomy if necessary. Typical radiotherapy related side-effects are diarrhoea due to the irradiated bowel, irritative symptoms from the bladder, dryness of the vagina and erectile dysfunction. Dependent on age and co-morbidity, 64 of the patients with MIBC recorded erectile dysfunction present before any treatment was given, and 51 recorded decreased libido.8 Urinary symptoms were present in 2661 of the patients with...

Some Sources Of Herb Plants And Seeds

China Herb Co., 428 Soledad, Salinas, CA 93901 Cottage Herbs, P.O. Box 100, Troy, ID 83871 De Giorgi Co., 6011 N St., Omaha, NE 68117 Fragrant Fields, Dongola, IL 62926 Herbs-Liscious, 1702 S. Sixth St., Marshalltown, IA 50158 Hsu's Ginseng Enterprises, P.O. Box 509, Wausau, WI 54402 Jude Herbs, Box 56360, Huntington Station, NY 11746 Otto Richter and Sons, Box 260, Goodwood, Ontario, LOC 1A0

Are All Drugs In The Group The Same With The Same Side Effects

There are several drugs (made by different companies) within each group or family of drugs. They tend to be very similar, with only slight differences, because they have a similar chemical structure. Usually, if one of the group causes impotence, another will do the same. Sometimes, it's worth switching to another drug in the same group to find out. If a drug causes impotence, stopping it should cure the problem. If it doesn't, it is unlikely that the drug is responsible. Patients with impotence should discuss this with their internist or cardiologist.

Indications to urethrectomy

A more important factor in the last decade is the availability of procedures for successful reconstruction of the lower urinary tract. Bladder substitution procedures in male, and more recently in female, patients have become routine practice and the presence of the urethra is of pivotal importance in the overall management of the patient. A new trend towards potency-sparing cystectomy is also going against urethrectomy as it has been shown that resection of the urethra significantly impairs sexual function.9-11 Finally, it has been reported that simultaneous urethrectomy increases morbidity, or gives rise to perineal pain and

Erection Emission and Ejaculation

Bulbourethral Gland Inflammation

Erection is achieved by parasympathetic nerve-induced vasodilation of arterioles that allows blood to flow into the corpora cavernosa of the penis. The neurotransmitter that mediates this increased blood flow is now believed to be nitric oxide (fig. 20.23). Nitric oxide released by parasympathetic axons and produced by the endothelial cells of penile blood vessels activates guanylate cyclase in the vascular smooth muscle cells. Guanylate cyclase catalyzes the production of cyclic GMP (cGMP), which closes Ca2+ channels in the plasma membrane (fig. 20.23). This decreases the cytoplasmic Ca2+ concentration, causing smooth muscle relaxation (chapter 12). The penile blood vessels thereby dilate to increase the blood flow into the erectile tissue, producing an erection. As the erectile tissues become engorged with blood and the penis becomes turgid, venous outflow of blood is partially occluded, thus aiding erection. The term emission refers to the movement of semen into the urethra, and...

Total Proctocolectomy with Brooke End Ileostomy

As a general rule, such an extensive operation should be avoided. However, current candidates for total proctocolectomy with Brooke end ileostomy include elderly patients in good condition with poor anal sphincter function, patients with massive rectal bleeding or distal rectal cancer invading the anal sphincter and patients who have a personal preference for this surgical option. Complications, such as impotence and perineal wound breakdown, can be reduced if an intersphincteric proctectomy is performed. Continent ileostomy as functioning Kock pouches 44-46 , the Barnett pouch or the T-pouch 34, 47 have achieved some level of acceptance. However, these procedures are associated with numerous complications and are performed largely in referral centres where the need for reoperations is lower than 10 .

Hypoactive Sexual Desire Disorder

The treatment of reduced sexual desire may focus on anxiety reduction with respect to emotional intimacy or sexual involvement or the resolution of relationship difficulties. Hammond (1990) provides a script for using the 'master control room' metaphor to step-wise increase sexual functioning. Negotiation and the use of post-hypnotic suggestions in association with the control room analogy also offer ways of improving sexual responsiveness and overcoming patient resistance. Hypnosis offers good opportunities to become absorbed in fantasy, and since a hypnotized subject may respond to fantasy as if it were reality, hypnotic techniques provide good opportunities for rehearsal of effective sexual functioning. The use of revivification of previous sexual arousal successes if appropriate, has been reported. Where anger is the inhibitory emotion metaphoric suggestions of extinguishing a powerful force may be used, such as putting out the inner fire of anger with water or sand the volcano...

Occlusive Disease of the Aorta and Branches

Mra Leriche

The vast majority of stenotic (Fig. 19) and occlusive diseases of the aorta in the western world result from atherosclerosis. Occlusion of the abdominal aorta can be acute or chronic. Abrupt occlusion of the aortic bifurcation is rare. It is characterized by the sudden onset of pain, pallor, paralysis, and coldness in the legs. Usually a filling defect-meniscus on MIP projections indicates embo-lus. Urgent embolectomy is indicated and can usually be performed transfemorally. Chronic occlusion of the aortic bifurcation (Leriche's syndrome) is usually due to arteriosclerosis, is most frequently seen in the elderly, especially males with a history of smoking and manifests as intermittent claudication in the legs and buttocks and erectile impotence (Fig. 20). Leriche syndrome typically re-

Nitric Oxide and Carbon Monoxide as Neurotransmitters

In the PNS, nitric oxide is released by some neurons that innervate the gastrointestinal tract, penis, respiratory passages, and cerebral blood vessels. These are autonomic neurons that cause smooth muscle relaxation in their target organs. This can produce, for example, the engorgement of the spongy tissue of the penis with blood. In fact, scientists now believe that erection of the penis results from the action of nitric oxide, and indeed the drug Viagra works by increasing this action of nitric oxide (as described in chapter 20 see fig. 20.23). Nitric oxide is also released as a neurotransmitter in the brain, and has been implicated in the processes of learning and memory. This will be discussed in more detail later in this chapter.

Hormone Production Sexual Development and Activity Hormone Production

Cryptorchid Testicular Volume

Although there is no reason to expect a disturbance in sexual activity because men who were formerly cryptorchid have normal development and testosterone levels and a normal interest and abilities for sexual functioning, an early report suggested that sexual drive seemed to be diminished (130). Also, men who were formerly cryptorchid have been reported to be less sexually active as adults when judged by frequency of intercourse, although the mean age of onset of masturbation and coitus were not different than normal. It is of interest that a direct relationship was found between frequency of intercourse and both testicular volume and testosterone levels (142). Also, unpublished data from the Children's Hospital of Pittsburgh cohort of formerly cryptorchid men indicate that frequency of intercourse is lower than in control men. These data are not well substantiated.

Indications For Open Prostatectomy

There are a number of factors that should prompt the serious consideration of suprapubic transvesical prostatectomy. These include the following (1) adenomas 75 g (2) transition zone hyperplasia associated with a large, prominent subtrigonal component (3) presence of a physiologically relevant diverticulum (4) multiple large bladder calculi (5) confounding orthopedic problems such as severe spinal stenosis and fusion ankylosis of the hip joints (6) large scrotal hernia or massive hydrocele (7) rigid or semirigid penile prosthesis (8) multiple urethral strictures (9) trigonal distortion resulting from trauma or previous surgery that places the ureteral orifices in close proximity to the bladder neck (10) expectations prejudices of the patient and (11) skill experience of the surgeon (1). There are two major reasons for the infrequent use of simple perineal prostatectomy for the management of BPH. First, there is a general attrition of perineal surgical skills. Second, this approach has...

Functional Gonadotropin Deficiency

Pulse Frequency

Before inception of dialysis and half having regular hemodialysis, hCG (2000 units on alternate days) treatment for 120 d markedly improved sperm output and quality but only in the group that did not receive dialysis (30). Sexual function was improved, especially in men who did not receive dialysis. These studies suggest that hCG treatment may have a role in managing the reproductive effects of uremia, particularly before dialysis, but well-controlled studies of adequate power are not available. The somatic effects of hCG treatment on androgen-responsive tissues, notably bone, muscle, cognition, and quality of life in uremia, as recently studied in nonuremic older men (31), have not been evaluated in a well-controlled study.

Clinical Aspects of the Male Reproductive System

Transurethral Incision The Prostate

ERECTILE DYSFUNCTION Erectile dysfunction, also called impotence, is the male lack of ability to perform intercourse because of failure to initiate or maintain an erection until ejaculation. The disorder may be broadly characterized as psy-chogenic, in which case it is caused by emotional factors, or organic, caused by some physical problem such as an anatomic defect or circulatory problem. More specifically, neurogenic impotence results from a disorder of the nervous system, such as a central nervous system lesion, paralysis, or neurologic damage complicating diabetes. Erectile dysfunction may also be a side effect of drug treatment. Drugs that are used to treat erectile dysfunction work by dilating arteries in the penis to increase blood flow to that organ. One highly prescribed drug of this sort is sildenafil (trade name, Viagra). Penile vacuum pumps and penile prostheses are nondrug approaches to therapy for erectile dysfunction. A lack of ability to perform intercourse in the man...

Reproductive Disorders Are Associated With Hypogonadotropic or Hypergonadotropic States

Lactinemia, whether from hypothalamic disturbance or pituitary adenoma, often results in decreased GnRH production, hypogonadotropic state, impotence, and decreased libido. It can be treated with dopaminergic agonists (e.g., bromocryptine), which suppress PRL release (see Chapter 38). Excess androgens can also result in suppression of the hypothalamic-pituitary axis, resulting in lower LH levels and impaired testicular function. This condition often results from congenital adrenal hyperpla-sia and increased adrenal androgen production from 21-hydroxylase (CYP21A2) deficiency (see Chapter 34).

Protocol For Treatment And Followup

New hormone deficiency or deficiencies are identified by obtaining a thorough clinical history and physical examination and measurement of appropriate hormone concentrations. Fatigue, weight gain, decreased mental alertness, and constipation suggest hypothyroidism. Fatigue, orthostatic symptoms, diminished appetite, and weight loss suggest adrenal insufficiency. A decrease in libido or erectile dysfunction suggests hypogonadism in men and a change in menses (irregular menses, amenorrhea), diminished libido, or hot flashes suggest gonadal failure in women. The symptoms of GH deficiency overlap with other hormone deficiencies and include fatigue, decreased exercise tolerance, increase in abdominal adiposity, and diminished sense of well-being. Appropriate hormone studies include measurement of serum thyroxine (or free thyrox-ine, free T4), early morning cortisol, testosterone (men), and estradiol (women). Measurement of serum thyroid-stimulating hormone (TSH) is not helpful and may be...

The Effects of EGCG on Chemokine Production by Legionellalnfected Dendritic Cells

It is also important to note that upregulation of various parameters often associated with a heightened immune response is not always beneficial to the host in combating microbial infection. Sepsis is a severe and systemic illness caused by the excessive inflammatory response to microbial infections, often with fatal results. Both Gram-negative and Gram-positive bacterial infections are capable of causing sepsis. In this respect, medicinal properties of plant-derived agents need to be considered from the aspect of not only their ability to stimulate immune activity but also their possible role in downregulating excessive inflammatory responses. Ginsan, an acidic polysaccharide prepared from Panax ginseng appears particularly effective in this regard. Mice treated with ginsan before bacterial challenge with Staphylococcus aureus (S. aureus) are reportedly highly protected from sepsis-induced death while still maintaining antibacterial capacity. Interestingly, the phagocytic activity of...

Finasteride Phase Iii Clinical Trials

In both phase III trials, adverse side effects associated with finasteride were evaluated. On the basis of these studies, finasteride was shown to be clinically safe. The incidence of adverse side effects for finasteride patients in both studies was limited and was generally quite similar to the incidence in placebo patients. Exceptions to this included a higher incidence of decreased libido, erectile dysfunction, and diminished ejaculate volume in patients receiving finasteride.

Female Sexual Arousal Disorder

The diagnostic criteria of female sexual arousal disorder revolve around inability to attain or maintain adequate sexual arousal, including vaginal vasocongestion, lubrication and vaginal expansion to allow satisfactory sexual activity. This disorder may manifest itself as a dyspareunia but is not classified as such if arousal difficulties are the primary aetiology. The use of fantasy with or without masturbation is an important strategy in the treatment of female sexual dysfunctions which centre around insufficient arousal. By its nature hypnosis allows absorption in fantasy and since in the hypnotic state a hypnotized subject may respond to fantasy as if it were reality, hypnotic techniques provide good opportunities for rehearsal of effective sexual functioning. Hammond (1990) provides some ideas about the appropriate suggestions to use to enhance sexual arousal and encourage vaginal lubrication. These strategies may be similarly applied in hypo-active desire disorders, dyspareunia...

Proscar Longterm Efficacy And Safety Study

No difference in the incidence of serious adverse events between the two groups was observed. In fact, the only adverse effects that were drug-related and for which the incidence was greater than or equal to 1 and greater than placebo were symptoms of sexual dysfunction (impotence, decreased libido, decreased ejaculate volume, ejaculation disorder), breast enlargement tenderness, and rash. Interestingly, two cases of breast cancer were diagnosed in the placebo group neither man had an antecedent history of gynecomastia. No cases of breast cancer were detected in the finasteride group during the study.

An Electroencephalogram Records Electrical Activity of the Brains Surface

Abnormal Eeg Waves

REM sleep is also known as paradoxical sleep, because of the seeming contradictions in its characteristics. First, the EEG exhibits unsynchronized, high-frequency, low-amplitude waves (i.e., a beta rhythm), which is more typical of the awake state than sleep, yet the subject is as difficult to arouse as when in stage 4 slow-wave sleep. Second, the autonomic nervous system is in a state of excitation blood pressure and heart rate are increased and breathing is irregular. In males, autonomic excitation in REM sleep includes penile erection. This reflex is used in diagnosing impotence, to determine whether erectile failure is based on a neurological or a vascular defect (in which case, erection does not accompany REM sleep).

Sexual Dysfunction Secondary to Surgical Treatment

Normal sexual function in males is under the control of both the sympathetic and parasympathetic system erection is mainly mediated by parasympa-thetic fibres, while sympathetic fibres are primarily responsible for deposition of the semen in the posterior urethra and contemporaneous closure of the bladder neck during ejaculation. Damage of this mechanism will result in retrograde ejaculation. There are no randomised controlled trials on this aspect and the only study that has compared results after mesorectal (111 patients) or close rectal (45 patients) dissection for IBD, did not show significant differences between the two techniques in terms of permanent impotence (4.5 vs. 2.2 ) or minor erectile difficulties (13.5 vs. 13.3 ) 128 . In the event of postoperative impotence, a period of observation is always indicated, because dysfunction is transitory in the majority of cases. In the mean time, other possible causes such as psychological or vascular causes should be excluded....

Lambert Eaton Myasthenic Syndrome Clinical features

Active Zone Freeze Fracture Endplate

Lambert-Eaton myasthenic syndrome (LEMS) is a presynaptic disorder of neuromuscular transmission which is caused by the production of antibodies to voltage-gated Ca2+ channels at the motor nerve terminals. This results in a marked reduction in acetylcholine release, the failure of neuromuscular transmission and muscle weakness. Muscle weakness is most common in the limbs, so that patients complain that their legs feel stiff or weak and they find difficulty in walking indeed, in some individuals the symptoms of the disease may be sufficiently severe to render them bedbound. Tendon reflexes are also weak or absent. Unlike myasthenia gravis, in LEMS muscle weakness does not increase with exercise in fact, muscle strength and tendon reflexes are briefly enhanced during the first few seconds of maximal effort. LEMS is also associated with symptoms indicative of disturbance of the autonomic nervous system, including decreased salivation and sweating, constipation and impotence. In most, but...

Long Term Complications

Long-term complications following TURP primarily include urinary tract infection, obstruction, incontinence, and erectile dysfunction, although there is debate about whether the latter is truly associated with the procedure. Interestingly, despite the use of prophylactic and perioperative antibiotics, delayed genitourinary infection is still a significant problem after TURP, accounting for nearly half of long-term complications (4 ) (21). This is probably not a result of persistent bacteriuria from the procedure but is more likely the result of some of the complications discussed below, including obstruction and incontinence. be at greater risk for perforation of the capsule and thus may be more susceptible to problems with erection (28). Rates of new-onset erectile dysfunction are debatable, ranging from 5 to 33 depending on the study and risk factors of the patient (28,29). Wasson et al. found no differences in the incidence between men with BPH managed with either watchful waiting...

Hypnotic Absorption In Fantasy Including Sexual Fantasy Causes The Fantasy To Be Responded To As Reality

A great advantage of the use of hypnosis is that the sexual suggestions or fantasies created either by direct suggestion or indirectly by metaphor are responded to as though they were reality. As well as distracting the patient from negative self talk, this provides for effective sexual desensitization, sexual rehearsal of successful sexual functioning and attitude change.

Hypogonadism Can Result From Defects at Several Levels

To establish the cause(s) of reproductive dysfunction, physical examination and medical history, semen analysis, hormone determinations, hormone stimulation tests, and genetic analysis are performed. Physical examination should establish whether eunuchoidal features (i.e., infantile appearance of external genitalia and poor or absent development of secondary sex characteristics) are present. In men with adult-onset reproductive dysfunction, physical examination can uncover problems such as cryptorchidism (nondescendent testes), testicular injury, varicocele (an abnormality of the spermatic vasculature), testicular tumors, prostatic inflammation, or gynecomastia. Medical and family history help determine delayed puberty, anosmia (an inability to smell, often associated with GnRH dysfunction), previous fertility, changes in sexual performance, ejacula-tory disturbances, or impotence (an inability to achieve or maintain erection).

Physiopathology of Hypogonadism

Prolactinomas are the most common functional adenomas of the anterior pituitary (representing 60 of hormone-secreting pituitary tumors). Men with prolactinomas usually present with macroadenomas (tumors 10 mm in diameter) and with high prolactin (PRL) levels, erectile dysfunction, loss of libido and or infertility. These symptoms are related to the hypogonadism that occurs secondary to hyperprolactine-mia (3). Infertility Decreased libido Impotence Gynecomastia Galactorrhea Loss of pubic hair Osteoporosis Apathy

Introduction Acquired and Genetic Disorders of Iron Metabolism

Iron related disorders leading either to exhausted or to overloaded iron stores, are extremely common in all parts of the world. Iron deficiency as a cause for anaemia has been recognized for centuries. Probably the first report on the beneficial effects of iron in anaemia comes from Greece in 1500 BC. It was told that prince Iphyclus of Thesaly suffered from sexual impotence (Fairbanks etal, 1971). He was treated by the physician Melampus who scraped the rust from the blade of an old knife into some wine, which was given to Iphyclus to drink. The result was spectacular the impotence of Iphyclus was cured and the dynasty of Thesaly was saved. The cause of the discomfort of the prince may have been blood loss from playing with another, hopefully not rusty, knife. Interestingly, impotence may also be caused by severe iron overload. Although the pathophys-iology is rather different, many symptoms of iron deficiency are identical with those observed in haemochromatosis. In both conditions...

The Brain Is a Target Site for Androgen Action

In normal men, no correlation is found between circulating testosterone levels and sexual drive, frequency of intercourse, or sexual fantasies. Similarly, there is no correlation between testosterone levels and impotence or homosexuality. Castration of adult men results in a slow decline in, but not a complete elimination of, sexual interest and activity. See Clinical Focus Box 37.2 for a discussion of the effects of testosterone administration.

Male Erectile Disorder

Crasilneck (1979, 1982) reported an extensive follow-up study of the application of hypnosis to individual patients with erectile dysfunction. Direct suggestions of firm, hard erections can be of assistance, or metaphorical associations of erectile firmness may be suggested in indirect approaches. Suggestions of arm or finger catalepsy may be transferred to erectile functioning (Crasilneck & Hall, 1975 Araoz, 1982 Hammond, 1990). Post-hypnotic suggestions of erectile firmness have proved successful (Crasilneck & Hall, 1975). Hypnotically assisted age regression to a time of successful sexual functioning may be used (Kroger & Fezler, 1976) Hypnotically based desensitization and rehearsal of sexual success may aid in reestablishing confidence and the expectation of successful functioning. Hypnosis may also be used to explore and accentuate past or present sexual fantasies which may then be incorporated into contemporary sexual activity, either in reality with the current partner or in...

Selective Androgen Receptor Modulators SARMs

SARMs act via androgen receptor signaling and may be androgen agonists or antagonists, depending on the target tissues and their modulating effects on the coactivators or coinhibitors of the androgen receptor. An example of a steroid SARM is 7a-methyl 19 nor-testosterone (MENT). MENT is believed to be aromatized to an active estrogen but is not converted to a 5-a-reduced product. In rodents and monkeys, MENT has a greater stimulatory effect on skeletal muscle relative to the prostate (103-104). A clinical study showed that MENT could maintain sexual function and muscle mass in hypogonadal men. MENT is being developed as a long-acting implant (105). Other nonsteroidal orally active SARMs, which have potent actions on muscle and brain but little or substantially lower stimulatory effect on the prostate, are being developed by several pharmaceutical companies (106,107). SARMs may inhibit the synthesis and secretion of the gonadotropins, and, thereby, testosterone production will be...

Clinical Experience in BPH

Who did not have thermometry required catheterization. There were minor and transient effects such as hematuria and hematospermia, but minimal irritative symptoms were noted. No erectile dysfunction, transfusions, incontinence, or changes in sexual function were noted. Injury to the rectum or periprostatic tissue did not occur with the exception of insignificant subtrigonal extension in one patient seen on cystoscopy. Transient urinary retention was noted in 92 (46 50) of patients. Erectile function was not altered, but one patient had retrograde ejaculation. Other side effects were minor, except for one patient who had a

Clinical Focus Box 351

Diabetic neuropathy typically involves symmetric sensory loss in the distal lower extremities or autonomic neuropathy, leading to impotence, GI dysfunction, or anhidrosis (lack of sweating) in the lower extremities. The diabetic foot is an example of several complicating factors exacerbating one another. About 50 to 70 of non Diabetic peripheral neuropathy is also a common complication of long-standing diabetes. This disorder usually involves sensory nerves and those of the autonomic nervous system. Many persons with diabetes experience diminished sensation in the extremities, especially in the feet and legs, which compounds the problem of diminished blood flow to these areas (see Clinical Focus Box 35.1). Often, impaired sensory nerve function results in lack of awareness of severe ulcerations of the feet caused by reduced blood flow. Men may develop impotence, and both men and women may have impaired bladder and bowel function.

Healthy Dissociation Away From The Sexual Fears And Negative Cognitions

As a transitional part of therapy, during self-stimulation, the sensate focus or pleasuring experiences, and during actual sexual intimacy, the patient can be encouraged to use dissociation in a healthy and constructive way, to separate themselves from their sexual fears and negative cognitions about their sexual functioning. Hammond (1990) describes strategies for patients to distance themselves from an excessive focus on their sexual functioning. The approach described is equally applicable to masturbatory and actual intimate relations.

Indirect Outcome Measures

Given the similarity of improvement in indirect parameters, the lower risk profile associated with TUIP has become a major criterion for promotion of TUIP. These factors include the cost related to operative and hospitalization time, patient comfort related to catheterization time, risk of blood transfusion, stricture or bladder neck contracture, impotence, and retrograde ejaculation. The mean intervention time required for TUIP was 14-18 min compared with 32-44 min for the transurethral resection group (30,32,37,39,58).

Relating Acute Vasoconstriction and Vasoactive Mediators to Hypoxic Remodeling

Although a variety ofvasoactive blockers will lower pressure, endothelin (ET) receptor blockade appears to be most promising as a selective strategy in reversing acute hypoxic pulmonary vasoconstriction (HPV) as well as the remodeling associated with chronic hypoxia. For example, an ET-A receptor blocker has proven most effective in reducing the structural abnormalities associated with hypoxia-induced pulmonary hypertension in piglets (2). These studies have provided convincing evidence that the high ET levels are causally related to HPV. In addition, hypoxia inhibits ET-B receptor-mediated NO synthesis (NOS) (42). Impaired NOS and vasodilatation in chronic hypoxia is also associated with impaired cGMP-dependent mechanisms (6). To this end protection against the structural changes associated with chronic hypoxia has been achieved with sildenafil, related in part to the induction of natiuretic peptides (57). Agents also shown to be effective in the treatment of chronic hypoxic...

Sexual Problems in Multiple Sclerosis

Given the complexity of the sexual response in terms of the neuro-muscular transmissions involved, it is no surprise that sexual difficulties often are encountered in MS. Such difficulties frequently are clearly physical, although a psychological component may be involved in many or most instances of difficulty. More than 90 of all men with MS and more than 70 of all women with MS report some change in their sexual life after the onset of the disease. Men most often report impaired genital sensation, decreased sexual drive, inability or difficulty in achieving and maintaining an erection, and delayed ejaculation or decreased force of ejaculation. Women report impaired genital sensation, diminished orgasmic response, and loss of sexual interest they also may be bothered by intense itching, diminished vaginal lubrication, weak vaginal muscles, and a reflex pulling together of the legs (adductor spasms).

Pharmacologic Therapy

Because neither the anatomic nor the chemical source of dyspepsia was determined until the late 19th century, therapy before that time was empiric and often quite imaginative. Recommendations included sedum (stonecrop), chewing green tea, and magnesia. For centuries, relief from dyspepsia was provided by chalk, charcoal, and slop diets.94 At the turn of the 20th century, proprietary medicines were popular, and were offered not only as cures for heartburn but also for impotence and alopecia.94 Therapy at that time centered on avoidance of acidic foods, otherwise bland diets free of cap-saicin, milk, antacids, and elevation of the head of the bed. In addition to their acid-neutralizing effects, antacids were subsequently demonstrated to increase lower esophageal sphincter pressure and decrease gastroe-sophageal reflux.95,96 Alginic acid, which reacts with saliva to form a viscous coating that protects the esophagus (and stomach) was shown to have effects on reflux symptoms similar to...

Post Therapy Evaluation and Treatment of Hormone Deficiencies

Men should have a testosterone level measured 6 wk after surgery. If the testosterone level is low, testosterone therapy should be initiated to maintain sexual function, body composition, and bone mass. There are four ways to administer testosterone therapy to hypogonadal men (1) intramuscular injections every 2-3 wk, (2) daily transdermal patch, (3) daily testosterone gel, and

Information given to the patient

Radical cystectomy is a demanding procedure, associated with mortality and considerable morbidity and permanent changes in urinary and sexual function with consequent effects on mental and psychological wellbeing. Of fundamental importance is the honest pre-operative information given to the patient and, preferably, also to the partner, about the planned procedure and its consequences. Alternative methods that might be applicable for reconstruction should be described, including those of which the urologist has little or no experience. Withholding such information because referral of the patient may be necessary is an abomination and must not occur. Consulting with the patient twice before surgery is the minimal requirement. It is important that the patient is made fully aware of all the facts, especially of disadvantages with specific procedures, like risk of incontinence, need of self-catheterization, etc. To have the patient meet a patient with the type of reconstruction planned...

Hypnotic Interventions in the Treatment of Sexual Dysfunctions

Clinical difficulties in sexual functioning can arise at any phase of the normal sexual response and can come about from a wide variety of causes. The phases represented in normal sexual response are respectively sexual interest sexual arousal sexual penetration sexual orgasm, post-sexual resolution and post-sexual feelings. At each phase of the emotional and physical response, male sexual functioning may be hindered. Factors involved in the likely aetiology of the respective disorders are dealt with later. A thorough evaluation of the nature of the disorder and its aetiology benefits from a multidisciplinary approach. With both male and female sexual dysfunction, medical evaluation is an absolute requirement before psychological treatment is commenced as interference with sexual functioning is an early symptom in a number of medical illnesses. General as well as specific genital, urological and neurological disease processes are investigated. Usage of illicit substances, legal...

Ureteral Injury

Male impotence and infertility is another possible side effect of medical therapy, especially during treatment with sulphasalazine 138-140 . This fact has also been noticed in a survey that compared the quality of life between patients with ulcerative colitis treated medically and patients who had received a restorative proctocolectomy utilising specific questionnaires, it emerged that 26 of patients under medical therapy suffered from impotence and another 16 reported regular failure of ejaculation, while these problems were present in only 8 of those who underwent surgery 141 . However, in most cases discontinuation or changing of the drug is sufficient to return to normality 138,139 .

Estrus

External estrus signals vary greatly by species. In every case, they are largely produced by hormonal influences, and are keyed to evoke specific sexual response from the male of the species. Such signals may be visual, behavioral, auditory, or scent-based, or may possibly draw on senses imperceptible to human observers.

HCV Treatment

Of serious psychiatric symptoms during interferon-alpha treatment may not be high, and that psychiatric illness or the possibility of psychiatric complications should not be used as a reason to refuse this treatment to patients with hepatitis C (Mulder et al. 2000). Nevertheless, psychiatric disorders may influence the course of treatment of HCV infection, and clinicians as well as internists should be aware of the substantial psychiatric comorbidity in these patients. Although neuropsychiatric complications of HCV itself are not a significant problem, some of the symptoms of liver failure, such as fatigue, loss of appetite, loss of sexual drive, and impotence, can overlap with the complications of interferon treatment, the symptoms of psychiatric disorders, and the side effects of psychotropic drugs.

Laser TUIP

The use of lasers for TUIP represented efforts to further decrease the risk of transfusion, catheterization time, and establish TUIP as an outpatient procedure (42-44). Investigators have described the use of both the neodymium yttrium-aluminum-garnet and Holmium lasers. In one series of 100 men, a single transmural incision out to the fat was made from the ureteral orifice to the verumontanum using holmium yttrium-aluminum-garnet laser energy (transmitted through a 400-nm fiber sheathed in a ureteral catheter). The patients reported rapid improvements in symptom scores (International Prostate Symptom Score decreased from 19.2 to 3.7 at 6 wk), urine flow rates (peak urinary flow rate decreased from 9.79 to 19.23), and postvoid residuals (decreased from 133.6 mL preoperatively to 27 mL after the procedure). All of these values were unchanged after 2-yr follow-up. Finally, laser TUIP was performed without the need for postoperative catheterization, and erectile dysfunction did not...

The sexual history

Sexual dysfunction and sexually transmitted diseases are common they are not confined to young adults, or to promiscuous individuals. Although such topics are often avoided by patients because of embarrassment, it is particularly important to ask patients about sexual function and activity and if they have any of the disorders known to predispose to sexual dysfunction. These include diabetes mellitus, alcohol abuse, chronic renal failure, marital difficulty or psychological disorder. Similarly, when sexually transmitted diseases are suspected, e.g. IIIV. hepatitis or pelvic inflammatory disease, a careful sexual history should be undertaken. In females, dyspareunia (pain related to sexual intercourse) or failure to achieve an orgasm are common and are frequently caused by. or lead to. psychological difficulties. In males, loss of libido, premature ejaculation and inability to maintain an erection may also be primarily psychological. Questions should be asked objectively with tact and...

Discussion

Roehrborn reported the following order of magnitude of symptomatic improvement attributed to therapies for LUTS transurethral resection, open prostatectomy, transurethral incision, balloon dilation, a-blocker therapy, placebo, and finasteride (68). Long-term outcome data from randomized trials revealed no statistically significant difference in total, irritative, or obstructive symptom improvement at all follow-up intervals for either the TURP or TUIP group (59). Operating time, estimated blood loss, time to catheter removal postoperatively, and duration of postoperative hospital stay were all significantly better with TUIP (59). The cost associated with TUIP may be reduced because of decreased operative time, decreased hospital stay, and the ability to perform the surgery using local anesthesia (69). Further, sexual function, including erectile function and ejaculation, are better preserved after TUIP. Finally, long-term success rates are probably less than with TURP or open...

Conclusion

Chronic renal failure, dialysis, and transplantation cause major effects on male reproductive health, notably impairment of spermatogenesis, steroidogenesis, and sexual function, through effects at all levels of the hypothalamic-pituitary testicular axis. Delayed growth and puberty, sexual dysfunction, androgen deficiency, and infertility are the clinical consequences. This chapter reviews the basis and scope for various clinical applications of gonadotropin and androgen therapy as an adjunct to standard medical care of men with chronic renal failure. Androgen therapy is considered as either androgen replacement therapy (using testosterone doses equivalent to endogenous production rates aiming to restore but not exceed physiological testosterone exposure) or as pharmacological androgen therapy (using any androgen in doses optimized for efficacy, safety, and cost-effectiveness).

Chinese Region

Many of the cultivated plants believed to have orginated in this region apparently came from the temperate and southern parts of China. Examples of widely known plants from this part of the world include bamboo, peach, litchi, walnut, persimmon, ginger, ginseng, gourds, camphor, tea, tung, soybean, buckwheat, horseradish, Chinese cabbage, and cucumber. While China is known for its centuries-old cultivation and consumption of rice, this cereal probably originated elsewhere in Asia.

Mood and Well Being

Whether quality-of-life measures improve after androgen replacement in young or elder hypogonadal men has not been studied systematically in randomized controlled clinical trials. Improvement in sexual function, mood, and increased vigor working in synchrony would most likely improve quality of life in hypogonadal men.

Anxiety

A sensitive, complete history and assessment, along with careful pacing of the emerging therapeutic relationship, will commonly yield ideas about the proper role of hypnotherapy for a particular child. For the common performance anxiety of stage fright, or palpitations or 'butterflies in the stomach' before a big game or a recital, it is often easily demonstrated to the child that their response, like a habit, has become a conditioned reaction association with negative expectations, and that it can in fact learn similarly to be modified and mastered.

Treatment

It is unclear whether asymptomatic hyperprolactinemia is of any clinical consequence, especially if the prolactin level is not extraordinarily elevated. In symptomatic patients with high prolactin levels, anti-psychotic dose reduction should always be considered as a first option, because hyperprolactinemia is usually dose related. In addition, there are now several prolactin-sparing antipsychotics available, including quetia-pine, olanzapine, and ziprasidone. Switching to one of these antipsychotics is thus a potential treatment option when dose reduction is not effective or feasible. Direct treatment of symptomatic hyperprolactinemia with a dopamine agonist (e.g., cabergoline, bromocriptine, amantadine) may be considered for patients who have had a good response to the current prolactin-elevating antipsychotic, who require depot antipsychotics, or who do not wish to switch medications (American Psychiatric Association 1997). There are numerous case reports of reduction...

Prostaglandins

Metabolite Pgi2

Delivered by continuous intravenous infusion. Alprostadil is also of value in male impotence, self-injectable preparations being used to achieve erection of the penis. An interesting modification to the structure of PGE1 is found in the analogue misoprostol. This compound has had the oxygenation removed from position 15, transferred to position 16, plus alkylation at position 16 to reduce metabolism (compare 15-methyl PGF2a above). These modifications result in an orally active drug which inhibits gastric secretion effectively and can be used to promote healing of gastric and duodenal ulcers. In combination with non-specific NSAIDs, it can significantly lower the incidence of gastrointestinal side-effects such as ulceration and bleeding.

Seahorses

Seahorse Species

Overfishing is a serious threat to the future of seahorses. The demand for them is large in traditional Asian medicine, where they are touted as cures for everything from asthma and heart disease to incontinence and impotence. An estimated twenty million seahorses are so used annually. Live animals are also sold for aquariums, where maintaining them is difficult because of their nutritional preference for live crustaceans and their

Anemia

Vehicle control as an i.v. bolus into the cubital vein. Simultaneous internal spermatic and peripheral vein sampling demonstrated that EPO increased spermatic vein testosterone secretion approx 12-fold, without concurrent change in peripheral LH, FSH, or testosterone or spermatic vein LH and FSH concentrations. In men with impaired renal function, EPO increases circulating testosterone concentrations in men on dialysis (65,69) as well as those not yet requiring dialysis (65). The clinical significance of such increases in circulating testosterone is conjectural, given the inconsistent effects of exogenous testosterone on sexual function, growth, and puberty as discussed. However, improved spermatogenesis is possible if intratesticular testosterone concentrations are sufficiently increased to promote spermatogenesis.

Sexual Dysfunction

Sexual function is frequently impaired by chronic renal failure (55) and is only partly reversed by transplantation, although few well-controlled studies are available. Contributory factors include vascular failure, pelvic autonomic neuropathy, antihypertensives (particularly centrally acting agents and beta blockers), and other medications, together with additive effects of age, depression, and general debility. Uremic sexual function is not consistently improved with androgen therapy (200-400 mg testosterone enanthate weekly) (56-58). Other proposed treatments, such as zinc supplementation (59), pro-lactin-lowering with bromocryptine (60), and tricyclic antidepressants (61), are equally inconsistent. Oral vitamin E supplementation (300 mg d for 8 wk) improved self-reported sexual function (libido, erectile activity, and coitus) in a balanced randomized, double-blind, placebo-controlled study of 24 men with uremia (62). The modest improvement was not associated with significant...

Complications

Erectile dysfunction after TURP or TUMT is rare if a patient is previously normal but is commonly observed in patients with prior erectile difficulties. Although the cause has not been fully elucidated, psychogenic factors, bladder neck trauma, and neurogenic voiding dysfunction probably play a role. Lower-energy TUMT protocols have a lower incidence of erectile dysfunction (28) reported an incidence of erectile dysfunction in 18.2 of patients undergoing high-energy TUMT, compared with 26.5 for TURP.

Circumcised Labia

Royal Family Hemophilia Pedigree

Note that in Drosophila, eye color has nothing to do with sex determination, so we see that genes on the sex chromosomes are not necessarily related to sexual function. The same is true in humans pedigree analysis has revealed many X-linked genes, yet few are related to sexual function.

Oral Androgens

Several new oral preparations are being developed for the U.S. market but have not been approved by the Food and Drug Administration (FDA). Buccal administration of testosterone (83) and sublingual testosterone cyclodextrin (84) result in high peaks and troughs lasting for approx 2 h. The PKs are represented as the sharp peaks and troughs in Fig. 2. Although sublingual testosterone improved sexual function, mood, and muscle mass, this preparation is not available for androgen replacement (16). A more

Steroids

The two pathways leading to terpenoids are described the mevalonate pathway and the recently discovered mevalonate-independent pathway via deoxyxylulose phosphate. Terpenoids may be classified according to the number of isoprenoid units incorporated, and hemiterpenes, monoterpenes and the variants irregular monoterpenes and iridoids, sesquiterpenes, diterpenes, sesterterpenes, triterpenes, tetraterpenes, and higher terpenoids are described in turn, representing groups with increasing numbers of isoprene units. Structures are rationalized through extensive use of carbocation mechanisms and subsequent Wagner-Meerwein rearrangements. Steroids as examples of modified triterpenoids are discussed in detail, including stereochemistry and molecular shape. There follows specific consideration of cholesterol, steroidal saponins, cardioactive glycosides, phytosterols, vitamin D, bile acids, corticosteroids and their semi-synthesis, progestogens, oestrogens, and androgens. Monograph topics giving...

Androgen Deficiency

Men with chronic renal failure exhibit features consistent with classical androgen deficiency reproductive manifestations, including gynecomastia, impotence, testicular atrophy, impaired spermatogenesis, and infertility, as well as somatic disorders of bone, muscle, and other androgen responsive tissues (1,2). However, only a single well-controlled study has examined androgen replacement therapy in men with uremia (34). Nineteen men who were receiving regular hemodialysis were randomized to receive either oral testosterone undecanoate (240 mg d) or placebo for 12 wk. Libido and sexual activity were increased, but hemoglobin was unchanged. There were no adverse clinical effects or hepatotoxicity. Effects on bone, muscle, cognition, and well-being were not reported. Further studies examining physiological androgen replacement therapy in men with chronic renal failure, notably using nonparenteral therapies in view of the increased bleeding risks in men with chronic renal failure, would...

Hypogonadism

Male hypogonadism is characterized by low testosterone levels in serum, accompanied by androgen deficiency symptoms, which depend on the time of manifestation. When hypogonadism begins before adolescence, it results in a failure to undergo puberty, whereas postpubertal hypogonadism causes a regression of reproductive function, with impaired libido and impotence, diminished body hair, soft skin, weakness and muscle atrophy, anemia, and osteoporosis. Low testosterone levels, in combination with high gonadotropin levels, indicate a testicular origin (hypergonadotropic or primary hypogonadism), whereas in combination with low gonadotropin levels, the cause is central (hypogonadotropic or secondary hypogonadism) (3). In both primary and secondary hypogonadism, androgen deficiency symptoms can be treated by testosterone substitution (see Chapter 18). In most causes of primary testicular failure, improvement of fertility is not possible, whereas in secondary hypogonadism, fertility may be...

Beta Blockers

The common side effects are cold hands and feet (and so are generally avoided in people with peripheral vascular disease), depression, bad dreams, sluggishness of thought and ability to do things (this is why they are sometimes used to calm people down), impotence and dizzy spells.

Endocrine disease

The most important endocrine disorder encountered in surgical patients is diabetes mellitus. Diabetics appear to be at slightly greater risk for postoperative death, likely because of the greater prevalence of ischemic heart disease in these patients. Several reports also suggest that diabetics with autonomic insufficiency (manifested by postural hypotension, impotence, nocturnal diarrhea) may be at risk for sudden cardiopulmonary arrest postoperatively. Numerous regimens for the management of diabetics in the perioperative setting have been reported. A common method is to give one-half of the patient's usual morning dose of NPH (neutral protamine Hagedorn) on the morning of surgery together with 5 dextrose.

Safety and Morbidity

The safety of any device is of obvious importance. Mebust et al. reviewed the immediate and postoperative complications of TURP, which serves as a benchmark for comparison (13). Immediate complications occurred in 18 of patients, with the most common being failure to void (6.5 ), bleeding requiring transfusion (3.9 ), clot retention (3.3 ), and infection (2.3 ). Intraoperative complications occurred in 6.9 of patients, with the most common complication being bleeding requiring transfusion (2.5 ). Dilutional hyponatremia caused by TUR syndrome occurred in 2 of patients. Late complications after TURP included bladder neck contracture (2.7 ), urethral stricture (2.5 ), mild stress incontinence (1.2 ), and significant incontinence (0.5 ). The reported incidence of impotence was variable and ranged from 4 to 13 . These complication rates were reported from a national survey of American urologists conducted by the AUA in 1987.

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