Erectile Dysfunction Causes and Treatment

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Diabetes And Erectile Dysfunction

The ability to get an adequate erection depends upon adequate blood flow to the penis and intact nerve function. Men with diabetes whose nerves to the penis are damaged and or whose blood supply to the penis is reduced may not be able to get a strong erection. Before blaming nerve damage and blood supply problems for erectile dysfunction, however, it is important to exclude other causes such as low testosterone levels, medicines (for blood pressure and depression), alcohol, and cannabis (marijuana). Psychological issues such as depression, job stress, and other relationship problems may also contribute to erectile dysfunction. There are a number of treatment options for erectile dysfunction PDE5 enzyme inhibitors. Sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis) are the medicines prescribed for erectile dysfunction. These medicines block an enzyme (called cyclic GMP-specific phosphodiesterase type 5), prolonging the blood flow into the penis and so improving the...

Experimental Erectile Dysfunction

Experimental erectile dysfunction in experimental diabetes and aging has been studied in the rat (40-42). Rat studies typically consist a measurement of intracavernous pressure in response to electrical stimulation of the cavernous nerve in normal and diabetic rats (43). The pathophysiology of erectile dysfunction in DAN appears to mimic the human condition wherein it is vasculogenic resulting in engorgement of corpora cavernosa and is because of a deficiency of nitric oxide (40,44-46). In the penile corpora cavernosa, nitric oxide is produced mainly by the activation of the neuronal nitric oxide synthase (NOS) in the nerve terminals and, to a lesser extent, by endothelial NOS in the lacunar and vascular endothelium (40,46). Nitric oxide stimulates guanylate cyclase cGMP activation of phosphokinase G reduction of intracellular Ca2+ relaxation of the smooth muscle cells penile engorgement. Support for this concept in the rat derives from a number of observations. Nitric oxide...

Impotence

The testicle-suggesting tubers of EARLY PURPLE ORCHID would ensure that Salep, a preparation made from them, enjoyed a reputation for curing impotence. Salep, which has medicinal value, was extremely popular, particularly in eastern countries, for the purpose. It was treated as an aphrodisiac. ANISE was used as a Greek cure for the condition ointments were made of the root of narcissus mixed with the seeds of anise or nettles (Simons). The early Persian and Arabian doctors prescribed GINGER for impotence (Dalby), 'hot' making the reason fairly obvious, and SESAME seed, blended with crow's gall, made an embrocation for impotence (Lehner & Lehner).

Erectile Dysfunction

Penile Neuropathy

Erectile dysfunction (ED), defined as the consistent or recurrent inability of a man to attain and or maintain a penile erection sufficient for sexual activity (15), is one of the most common sexual dysfunctions in men. ED is more common with advancing age, and since the aged population will increase, its prevalence will continue to rise (16). Diabetes mellitus is the most frequent organic cause for ED, the onset of which starts about 15 years earlier in the diabetic than in the nondiabetic population. In the Massachusetts Male Aging Study (MMAS), the age-adjusted prevalence of minimal, moderate, or complete ED was 17, 25, and 10 among 1238 men without diabetes and 8, 30, and 25 among 52 treated men with diabetes, respectively (17). Thus, although the number of diabetic subjects in the MMAS was low, this population based study showed an increased prevalence particularly of complete ED among men with diabetes. In the Cologne Male Survey (18) the prevalence of ED was threefold...

Surgical Considerations

Denonvilliers' fascia is intimately adherent to the anterior mesorectal fat but only loosely adherent to the seminal vesicles. During anterior rectal dissection, the deep parasympathetic nerves situated in the narrow space between the rectum and the prostate and seminal vesicles may be damaged, leading to impotence 72 . For benign disease, most surgeons will tend to stay posterior to Denonvilliers' fascia in an attempt to protect the pelvic nerves. For malignant disease, the choice is less straightforward, because dissection behind rather than in front of the fascia may, in theory, be associated with incomplete resection and or local recurrence.

Prescription Medications

Certain prescription medications can diminish a man's fertility. High doses of anabolic steroids often reduce sperm count. Additionally, these anabolic steroids can also lead to abnormal sperm, erectile dysfunction, and atrophy of the testicles. Impotence can become a factor for men who take a beta-blocking medication. Beta-blockers are sometimes prescribed to control blood pressure and for certain heart conditions. Examples of beta-blockers include atenolol, propranolol, and nadolol.

Gender Ethnicracial And Life Span Considerations

Bladder cancer occurs most frequently in persons over 50 years of age, with more than half of the cases occurring in individuals over 72 years of age. It is rare in persons under age 40. Bladder cancer is more common in men (1 in 30) than women (1 in 90). Incidence is highest among European American men, with a rate twice that of African American men and four times that of European American women. Asians have the lowest incidence of bladder cancer. Younger men have reported less impotency following radical cystectomy than have older men. Persons living in urban areas are at higher risk for bladder cancer than persons living in rural areas.

Reconstructive Surgery

Small defects can be closed by primary suturing, especially where only the pliable scrotal skin is involved. Split thickness skin grafting is most often used and yields acceptable results, even in large defects (Hessel-feldt-Nielsen et al. 1986). Healthy skin from the legs, buttocks, and arms can be used, in a single or multiple settings. Skin defects on the penile shaft should be liberally grafted so as to prevent fibrotic scar formation with future erectile problems.

Placebochallenging Design

Defined as an erection sufficient to achieve vaginal penetration and lasting from 30 to 80 minutes. At the start of treatment, subjects are required to undergo an in-clinic evaluation of a double-blind placebo-challenge (i.e., subjects will be randomized to receive either the placebo or the active dose at the level identified during the titration). After this first period of in-clinic study, all subjects are to receive a three-month home treatment period at the dose identified during the titration. At the end of three-month treatment, a second in-clinic double-blind placebo-challenging is conducted. Note that at the second placebo-challenging, patients are randomly assigned to receive either the placebo or the active dose. As a result, the above design is in fact the combination of a titration design and a four-sequence, two-period (4 X 2) crossover design. In other words, during the crossover phase, there are four sequences of treatments, namely, PP, PA, AP, and AA. As an example,...

Neuroanatomical Basics of Radical Prostatectomy

With regard to the neuroanatomy of radical prostatectomy the discussion here focuses on the localisation of the NVB, the question of autonomic innervation of urethral sphincter structures and the existence of nerve connections between autonomic and somato-sensory systems. Historically, the discussion about neural structures concerned with continence and erectile function began as early as 1863, when Eckhard 13 defined the nervi erigentes in animal experiments. In a landmark paper in 1982, Walsh and Donker 14 highlighted the clinical relevance of cavernosal nerves for the preservation of potency at radical prostatectomy.

Parasympathetic System

2.1.4 show that the cavernosal nerves of the penis traverse the apex of the prostate at a distance of only a few millimetres from the prostatic capsule at the 5 and 7 o'clock positions. Together with the deep artery and vein of the penis (A. et V. profunda penis), the cavernosal nerves of the penis enter the crura after exiting from the muscular pelvis. Stimulation of para-sympathetic nerves leads to dilatation of smooth-muscle-lined cavernosal sinuses which effects influx of blood with subsequent tumescence. Hence, the parasympathetic system is the main neural component for erectile function.

Interactions With Humans

The mystery and aesthetic beauty of beetles has been captured in paintings, sculptures, dances, poems, songs, and other art forms. Beetles have been used by many cultures for decoration. The brilliant metallic elytra of Buprestidae serve as natural sequins on textiles, and as biological gems in jewelry. In some cultures, beetle horns are included in jewelry because they are thought to increase sexual potency.

Symmetrical Neuropathies

On clinical examination there is little evidence of objective signs of nerve damage, apart from a reduction in pinprick and temperature sensation, which are reduced in a stocking and glove distribution. There is relative sparing of vibration and position sense (because of relative sparing of the large diameter Ap fibers). Muscle strength is usually normal and reflexes are also usually normal. However, autonomic function tests are frequently abnormal and affected male patients usually have erectile dysfunction. Electrophysiological tests support small-fiber dysfunction. Sural sensory conduction velocity may be normal, although the amplitude may be reduced. Motor nerves appear to be less affected. Controversy still exists regarding whether small-fiber neuropathy is a distinct entity or an earlier manifestation of chronic sensory motor neuropathy (28,29). Said et al. (28) studied a small series of subjects with this syndrome and showed that small-fiber degeneration predominated...

Discovery and Nonclinical Development

The discovery of new products for patient use takes place in laboratories at universities, in the government, or in pharmaceutical companies actually, it starts in the minds of scientists with a scientific innovation or idea for creating a new therapeutic molecule that may be a biological or drug. This research is performed through carefully done studies, either with the physiology of humans or other species, disease models, or some core structure of a molecule, through a host of different scientific technologies. Sometimes, a drug discovery is an accidental finding related to an unexpected action of a drug being studied for other uses, such as Viagra for impotence. Each molecule may have an impact on a general physiologic process such as inflammation and thus have the potential to be used in many organ systems and diseases, or it may impact a specific receptor on a cell, such as a tyrosine kinase, and be used only when the receptor system goes awry. Knowledge of the discovery and...

Multiplesystem Atrophy

The parkinsonian features are usually unresponsive to levodopa therapy. There may be gait and limb ataxia, orthostatic hypotension, erectile dysfunction, constipation, and decreased sweating. Whereas multiple-system atrophy is a distinct neuropathological entity, the consensus diagnostic criteria depend on specific clinical features. Pathologically, glial cytoplasmic inclusions and degeneration are found throughout the basal ganglia, substantia nigra, brainstem autonomic nuclei, and Purkinje cells of the cerebellum.

Fsh and lhomas Pituitary Tumors Secreting Fsh Or Lh

FSH- and LH-secreting tumors are usually clinically silent. Rare cases of tumors presenting with clinical features have been reported. A 28-yr-old Finnish woman presented with oligoamenorrhea and pelvic pain. A detailed assessment revealed elevated FSH and estradiol with an appropriately suppressed LH enlarged ovaries with multiple cysts were seen on pelvic ultrasound examination. Both gonadotropins and the a-subunit exhibited a paradoxic response to TRH, and MRI revealed a pituitary macroadenoma. After removal of the pituitary tumor, all hormone values normalized, and the patient resumed normal menstrual cycles. In another report, transsphenoidal tumor resection was found in a girl who presented with precocious puberty. LH hypersecretion from a pituitary adenoma was also documented in two cases. Thus, varying degrees of hypopituitarism may occur in these patients, with decreased libido and erectile dysfunction in men and oligo- or amenorrhea in women. Alternatively, central...

Direct Stimulation Of Nerve And Muscle

Implantable cardiac pacemakers have been around since the late 1950s. More recently, the same basic techniques have been applied to stimulate the vagus nerve for the control of epilepsy, to stimulate the sacral roots to control the bladder and correct erectile dysfunction, and to stimulate nerves in the spine for the control of pain and angina. In addition, interest in functional electrical stimulation (FES) has grown rapidly during recent years, due primarily to progress made in miniaturized hardware that makes multichannel stimulators possible. New surgical techniques enable the use of chronically implanted stimulators to stimulate specific nerves and brain sections directly within the body, making it possible to restore function lost due to disease or trauma. Advances are being made rapidly in the development of implants for restoring limbs, sight (e.g., through artificial retinas or by direct stimulation of the visual cortex), and hearing (e.g., through cochlear implants) Loeb,...

Protecting against anthracycline induced cardiac damage

A number of agents have been used to protect the heart from anthracycline induced damage. They include, probucol 29 amifostine,30 carvedilol31 and sildenafil.32 However none of these have been evaluated in context of a randomized trial and it is unclear as to whether they interfere with the anti-tumor activity of anthra-cyclines. The most studied agent is dexrazoxane or ICRF-187.33 A number of randomized controlled trials have reported on the cardioprotectant effect of dexrazoxane. One study, in adults with breast cancer, suggested that the concomitant use of dexrazoxane though cardioprotective, diminished the tumoricidal activity of doxorubicin.34 Study 1 reports that in

Human Studies of Endothelium Dependent Vasodilation

Human studies evaluating the effects of DM on endothelium-dependent vasodilation have yielded some conflicting results, although they generally corroborate those found in animal studies. Saenz de Tejada et al. (60) studied penile tissue excised from men with erectile dysfunction and found that endothelium-dependent relaxation is reduced in the corpus cavernosa of impotent men with diabetes relative to those who are nondiabetic.

Prevalence and Epidemiology

Faecal incontinence, irrespective of the underlying cause, had incontinence symptoms noted in their medical charts 9 . It is likely that the lack of recognition of faecal incontinence reflects both the patient's failure to volunteer the information, perhaps because of embarrassment, and the reluctance of medical practitioners to ask about it, perhaps because they feel that little can be done for such patients. Whereas the relative importance of the two factors is unknown, it appears certain that diabetic patients frequently fail to report disturbances in defecation, even when symptoms are severe, whether this is in a primary, secondary, or tertiary care setting. This has been shown to be the case with erectile dysfunction in diabetics. Faecal incontinence may, however, result in dramatic behavioural and personality changes, with patients becoming socially withdrawn and reluctant to leave their homes. Hence, it is essential that health care professionals become proactive and ask...

Primary Nursing Diagnosis

If drug therapy for chronic bacterial prostatitis is unsuccessful, on rare occasions the patient may undergo a transurethral resection of the prostate (TURP) to remove all infected tissue. Because this procedure may lead to retrograde ejaculation and sterility, it is usually done on older men. A total prostatectomy also has the risk of causing impotence and incontinence and is performed only when necessary.

Genitourinary Complications

Damage the lower sacral nerves, can result in sexual dysfunction, and should be discussed with the patient early if suspected. Recent work using the Brief Male Sexual Function Inventory (BMSFI) found that pelvic fractures of all types had a significantly profound negative effect on the sexual function of male patients, persisting for at least two years and possibly longer (101). Erectile dysfunction after blunt trauma and pelvic fracture has been documented to be between 20 and 80 (102).

Further investigations of male infertility

Where surgical sperm retrieval may be considered while elevated levels are suggestive of failure of spermatogenesis (Table 45.13). In rare cases undetectable levels of FSH can be suggestive of hypogonadotrophic hypogonadism where treatment with exogenous FSH may be effective. Testosterone and LH measurements are helpful in the assessment of men where androgen deficiency is suspected or where there is a need to exclude sex steroid abuse or steroid secreting tumours of the testes or adrenals. As men with hyperprolactinaemia have sexual dysfunction, it is necessary to exclude elevated prolactin levels in men with loss of libido and impotence. Persistently elevated prolactin levels warrant further investigations such as imaging of the pituitary gland.

Conventional treatment for male infertility

Sildenafil is an effective treatment in men with erectile dysfunction (Burls et al. 2001). Medical treatment of an ejaculation has included the use of alpha-agonists like imipramine and pseudoephedrine or parasympath-omimetic drugs such as neostigmine. The former are less successful than the latter (19 versus 51 ) (Kamischke and Nieschlag, 1999). Medical treatment of retrograde ejaculation has relied on measures to increase sympathetic stimulation of the bladder and decrease parasympathetic stimulation, but no clear difference in effectiveness has been found between alpha-agonists and anticholinergic drugs in this context. Sperm recovery from urine has been used successfully in some cases of retrograde ejaculation. Electro ejaculation may be considered in others, especially in men with neurological impairment. In the absence of other options, surgical sperm retrieval followed by IVF ICSI may be considered.

Advantages Of The Laparoscopic Approach

Blood loss and transfusion rates are significantly less with the laparoscopic approach. The tamponading effect of pneumoperitoneum is one factor that results in decreased bleeding. The antegrade approach to the prostatectomy where the pedicles are controlled early may also be a contributory factor. In most laparoscopic series the estimated blood loss was less than 500 mL compared to an about 1000 mL blood loss after open surgery (12). The urinary continence following surgery appears satisfactory. A recent report studied continence among patients in their experience of 228 patients. At 12 mo the continence rate (with no pads) was 78.3 (13). Erectile function may not completely recover for 1-2 yr following surgery. The efficacy of the nerve-sparing technique in the LRP has therefore not been adequately studied. The potency rates in the published series have not been adequately assessed in all patients owing to the learning curve, and inadequate follow-up. Magnification and better...

Discharge And Home Healthcare Guidelines

Inform the patient that if a unilateral orchiectomy was performed, he is still fertile and should not experience impotence. Make sure the patient understands that he has the option of undergoing reconstructive surgery and placement of a testicular prosthesis. Refer the patient to the American Cancer Society to assist with obtaining information and support.

Secondary Adrenal Insufficiency

Cranial mass, such as headache or visual field defects, or defects in other pituitary hormones such as gonadotropins, which usually are lost first (female irregular or absent menses male erectile dysfunction), followed by hypothyroid symptoms, followed finally by loss of ACTH.

Neurophysiologic Investigations

A short clinical assessment should precede the neurophysiological tests, along with a history of the patient's complaints. Usually the main symptoms described are pain variably located in the low back and perineal and sacral areas, paresthesias, leg weakness, erectile dysfunction, and bladder and bowel disturbances. Scoring systems for symptoms of fecal incontinence are used and have been validated against the severity of the bowel disorder 105 . The Cleveland Clinic Florida Fecal Incontinence (CCF-FI) scoring system is one of the most recognized method for quantifying the degree of symptoms in patients undergoing neurological sphincter assessment 106 .

Genetic Testing and Alzheimers Disease

The extent of the syndrome ranges from complete androgen insensi-tivity and development of normal external (but not internal) female sexual anatomy, to partial insensitivity, with altered or ambiguous male or female genitals, to mild insensitivity, with normal male genitals, enlarged breasts, and possibly impotence. Treatments depend on the extent of the syndrome, and may include hormone therapy, surgery, and psychological counseling. Gene testing and genetic counseling are available for families with affected members.

Treatment of Additional Pelvic Injuries

Arcuate Lines

From a lower abdominal midline incision, the dome of the bladder is opened and the lesion repaired intravesically with 3 0 absorbable sutures. To avoid secondary complications such as urinary incontinence or erectile dysfunction (ED), injuries of the bladder neck, the proximal urethra, the prostate, or the vagina must be excluded. These injuries should be carefully reconstructed intravesically via the bladder dome incision. If the vagina is affected, a formal repair from a transvaginal approach is necessary.

Fecal Incontinence in Peripheral Neuropathies

Diabetes mellitus is the most common cause of polyneuropathy in developed countries. Diabetic neuropathy is a chronic symmetrical sensorimotor polyneuropathy that usually begins after years of hyperglycemia and is frequently associated with autonomic neuropathy and bowel, bladder, and sexual dysfunction. Severe diabetic autonomic neuropathy (DAN) is almost always associated with insulin-dependent diabetes. Symptoms of autonomic involvement include impairment of sweating and of vascular reflexes, constipation, nocturnal diarrhea and fecal incontinence, atonic bladder, sexual impotence, and occasionally postural hypotension. The pathogenetic mechanism of the constipation is uncertain, but autonomic neuropathy causing parasympathetic denervation is likely to be implicated. Diarrhea typically occurs at night or after meals, is a more troublesome complication of diabetes, and may be an isolated symptom of autonomic dysfunction. It is usually chronic, but it is intermittent and alternates...

Endocrine Complications

Because most patients harbor macroadenomas, hypopituitarism develops from compression of normal surrounding pituitary tissue by the expanding tumor mass causing amenorrhea and impotence in half of acromegalic patients (15,37), with secondary hypothyroidism and hypoadrenalism in approximately 20 .

Physiological changes occurring in sleep stages

During REM sleep, men commonly experience nocturnal penile tumescence (NPT) 39 . The occurrence of NPT, which is unrelated to the sexual content of dreaming and persists into old age, can be used to establish whether cases of impotence are biological or psychogenic in origin. However, testing for NPT is no longer commonly performed due to newer pharmacological methods of evaluating impotence 40 . In women, during REM sleep, a phasic increase in vaginal blood flow as well as clitoral engorgement and erection occur, phenomena which are also unrelated to the sexual content of dreaming activity 41 .

Reproduction And Development

Each ejaculation releases 2 to 5 mL of semen, the fluid containing the sperm. Semen normally contains between 20 and 100 million sperm per milliliter. The sperm consists of a 5-p.m head containing the nucleus, a midpiece containing mitochondria, and a 55-p.m-long flagellum, or tail, which can propel the sperm at a speed of 1 to 4 mm min. The seminal vesicles and the prostate gland produce much of the liquid that makes up semen, which includes fructose to provide energy for the sperm, and alkalinity to counter the acidity of the vagina. When the male becomes sexually excited, nerves of the autonomic nervous system produce dilation of arterioles in the penis, causing blood to enter that organ faster than it can leave. This causes the erectile tissue to become engorged, causing an erection. The male then inserts the penis into the female's vagina in the act of copulation, injecting the semen by rhythmic contractions called ejaculations.

Second Edition

Heart Disease Diagnosis and Therapy A Practical Approach, Second Edition, edited by M. Gabriel Khan, md, frcp, frcp(c), facc, 2005 Cardiovascular Genomics Gene Mining for Pharmacogenomics and Gene Therapy, edited by Mohan K. Raizada, phd, Julian F. R. Paton, phd, Michael J. Katovich, phd, and Sergey Kasparov, md, phd, 2005 Surgical Management of Congestive Heart Failure, edited by James C. Fang, md and Gregory S. Couper, md, 2005 Cardiopulmonary Resuscitation, edited by Joseph P. Ornato, md, fap, facc and Mary Ann Peberdy, md, facc, 2005 CT of the Heart Principles and Applications, edited by U. Joseph Schoepf, md, 2005 Heart Disease and Erectile Dysfunction, edited by

Anise Aniseed

This is one of the herbs supposed to avert the evil eye (Grieve. 1931), and it was used in a Greek cure for impotence ointments were made of the root of narcissus mixed with the seeds of nettle or anise (Simons). Gerard claimed, among other things, that it helpeth the yeoxing or hicket, hiccup, that is both when it is drunken or eaten dry the smell thereof doth also pre-vaile very much. It is best known as an indigestion remedy. The Romans offered an anise-flavoured cake at the end of rich meals to ease indigestion.

Assessment

Determine if the patient has a history of recent infection, steroid use, or adrenal or pituitary surgery. Establish a history of poor tolerance for stress, weakness, fatigue, and activity intolerance. Ask if the patient has experienced anorexia, nausea, vomiting, or diarrhea as a result of altered metabolism. Elicit a history of craving for salt or intolerance to cold. Determine presence of altered menses in females and impotence in males.

Alcohol

Consuming alcohol of more than one or two drinks per day can affect the quality and quantity of sperm, lower testosterone levels, and contribute to impotence. A 1996 research study from Finland showed that moderate alcohol consumption can kill off some sperm-producing cells within the testicles and also may cause abnormal sperm shapes. A normally shaped sperm should resemble a streamlined tadpole with an oval head and long tail. Abnormally shaped sperm vary in appearance and may have two tails, a tapered head, a crooked kinky shape, or an unusually large or small head. Any of these abnormalities make it so that the sperm is unable to penetrate the surface of the egg and therefore unable to successfully fertilize the egg. Men who partake in heavy alcohol consumption that is, more than six drinks per day are more likely to suffer from low sperm count, poor sperm motility, and abnormal sperm shape.

Bird Cherry

Birch tea is used for urinary complaints, especially dropsy. But it is useful also for gout, and has even been recommended as being helpful for the heart (Schaunberg & Paris). It has also been given for rheumatism (Grieve), and another folk remedy for the complaint, from Russia in this case, involved boiling birch leaves in water for half an hour, and putting that water into a hot bath. One bath daily before going to bed, for 30 days at least, is prescribed (Kourennoff). But there were some strange claims made in times gone by, perhaps the most hopeful being from the Physicians of Myddfai - for impotency. Take some birch, digest it in water, and drink. A pure transference charm is recorded in Suffolk, for toothache, by clasping the tree in one's arms, and then cutting a slit in it. Cut a piece of hair with one's left hand from behind the ear. That has to be buried in the slit, and when the hair has disappeared so will the toothache (Burn).

Canada Balsam

It has certainly been claimed that there are some stimulant properties attached to camphor, and it has been used quite a lot in India that way. According to Lewin, there were in the earlier part of the 20th century many camphor-eaters in England and America, the drug being taken solely for its stimulating and exciting properties, though women claimed that it was good for the complexion. Maddox says, too, that it has been prescribed as a nerve stimulant, while in the Far East it has been in use for heart disease for centuries (Tosco). But to show with what grave suspicion such a strong-smelling drug was regarded, Browne. 1646 found it necessary to refute the belief that camphor eunuchates, or begets in men an impotency unto venery. As he points out, observation will hardly confirm (it) and we have found it to fail in cocks and hens, though given for many days But black mothers in the southern states of America used to rub camphor oil on their breasts to dry up the milk after weaning...

Sexuality

By contrast, medical complaints of male sexual dysfunction undoubtedly increase with age. While all functional aspects of male sexuality libido, potency and ejaculation are reduced in older men, the major impact of ageing is the exponential increase of erectile dysfunction with age (Ayta et al 1999). The last decade has seen a major paradigm shift in understanding of male sexual dysfunction. This includes a public relations makeover in nomenclature (impotence becoming erectile dysfunction), a shift in beliefs about causation (from prevailing Freudian psychoanalytic beliefs on psychosomatic causation, to erectile dysfunction being due to organic neurovascular disorders of cavernosal hydraulics) and development of the first effective pharmacotherapy. The development of vasoactive cavernosal pharmacotherapy was inaugurated by the accidental discovery of papaverine effects during vascular surgery and soon surpassed by the equally fortuitous discovery of oral sildenafil during clinical...

Conception aids to

Women who wanted children were told to eat LEEKS, and not only in Wales, though Evelyn noted that the Welch, who eat them much, are observed to be very fruitful, and the Welsh medical text known as the Physicians of Myddfai lists among the virtues of leeks that it is good for women who desire children to eat (them). Perhaps the reason for such claims lies in the Germanic peoples' belief that leeks contribute to manly vigour (Wimberley), clearly derived from their upstanding growth. CARAWAY, at least according to Gerard, helpeth conception, but he did not go into details. BIRTHWORT must obviously be included here. The doctrine of signatures, from the shape of the flowers which constrict into a tube that opens into a globular swelling at the base, interpreted as the womb and the birth passage, ensured its use to help delivery, etc., The generic name is Aristolochia, which comes from two Greek words meaning 'best birth'. As well as helping delivery, it was said to encourage conception -...

Contraceptives

New Forest gypsies regarded NETTLES as a contraceptive, although they implemented the belief in a strange way. The man had to put nettle leaves inside his socks before intercourse But, unlikely as it may sound, nettles have been regarded as aphrodisiacs, perhaps as flagellants (Leland). It was the seeds that powerfully stimulate the sexual functions, and nettles figured in a Greek remedy for impotence (Simons). PARSLEY beliefs are often connected with conception and childbirth in a very confused way. While acting as an aid to conception, in the Cotswolds area, it is contraceptive (Briggs. 1974). Gerard noted that SPEARMINT acted as a contraceptive Dioscorides teacheth, That being applied to the secret part of a woman before the act, it hindreth conception.

Early Purple Orchid

(Orchis mascula) The commonest of the British native orchids. The tubers (and those of most of the Orchis species of Europe and Northern Asia), when prepared, yield salep, which had, at least according to the doctrine of signatures (the word orchid means testicle) a reputation for curing impotence (Pliny gemina radice, testiculus simili), a reputation flourishing in eastern countries particularly, though it is represented too in north-east Scotland, where the root was used as an aphrodisiac, the old tuber being discarded, and the new one used. It would be dried, ground, and secretly administered as a potion (Anson). John Moncrieff of Tippermalloch (in the 18th century) went further

Ginger

(Zingiber officinale) great Quantities of it are us'd by the Hawkers and Chandlers in the Country, who mix it with pepper they reduce it to Powder, and then call it white Spice (Pomet). Apart from its use as a spice and as a base for alcoholic liquors of one kind or another, ginger has for a very long time enjoyed a reputation for medicinal use, from the prescription of Arabian and Persian doctors for impotence (Dalby), to its still popular reputation as a stomach settler, and this use dates from the earliest records (Lloyd). Ginger tea, even ginger biscuits, help to combat travel sickness, or morning sickness and nausea generally (M Evans). Parihar & Dutt point out that ginger jam is still a favourite for colds and coughs, and it is even used to treat diabetes. In this case, it is ginger juice that is used, mixed with sugar candy.

Treatment

Nitrates (glyceryl trinitrate, isosorbide dinitrate, sodium nitroprusside) are also used to treat autonomic dysreflexia. If the blood pressure remains high an intravenous drip of sodium nitroprusside could be necessary. Before using these drugs (nitrates), the patient should be questioned regarding sildenafil or other PDE-5 inhibitors. If a PDE-5 inhibitor was used in the last 24 h an alternative short-acting, rapid-onset anti-hypertensive drug should be used. Drugs with these characteristics are captopril and prazosin.

Hyperprolactinemia

Hyperprolactinemia in women leads to amenorrhea, galactorrhea, and osteoporosis, while in men it may result in diminished sexual drive and impotence, or may be asymptomatic. The degree of hyperprolactinemia is directly related to the functionality of the prolactin-secreting tumor. Serum prolactin levels over 200 ng mL correlate well with the presence of a prolactinoma. Normal prolactin levels are in the ranges of 1 -20ng mL in men, and 1-25 ng mL in women.

Grapes

Since antiquity grapes have played an important role in the European diet. They were eaten fresh, especially in the grape-growing areas, added to dishes dried or in the form of grape juice, or they were made into wine, the drink of choice for anybody who could afford it. The wild grapevine, a climbing plant like the later cultivars, was indigenous to the area between the Black Sea and Afghanistan. The Phoenicians introduced the vine to Greece sometime after 1000 b.c. from there it spread throughout the Mediterranean. The ancient Egyptians grew grapes, as did the Romans, who were especially fond of various grape syrups in their cuisine. Among them were defrutum, or boiled-down unfermented grape juice, passum, a cooking wine that was even sweeter, and mulsum, a mixture of white wine and honey. As the Roman Empire expanded across Europe, so did the cultivation of grapes, and the art of wine making. In the Middle Ages, great quantities of wine were produced, traded, and consumed in...

Management Options

The fibrates, such as clofibrate, gemfibrozil, and fenofibrate, form the mainstay of therapy for lowering triglyceride levels. They facilitate the oxidation of free fatty acids by the liver and muscle, resulting in a decrease in release of VLDL into the circulation. They also tend to increase both LDL and HDL if the baseline concentrations are especially low. However, in the presence of both elevated triglyceride and LDL levels, the fibrates may lower the LDL. The most common side effects include gastrointestinal upset, increase in gallstone formation, and increased serum transaminases. Clofibrate can cause erectile dysfunction and the syndrome of inappropriate diuretic hormone (SIADH) and is rarely used at present because of the availability of safer, newer compunds. Finally, all the fibrates can cause myositis and rhabdomyolysis when used in patients with impaired renal function, especially when administered in combination with statins (26).

Lettuce

Beneath a lettuce ( ), a boar ate the leaves, and by so doing managed to wound Adonis mortally (Gubernatis. 1878). Another version says that Adonis was struck by the boar after having eaten a lettuce (Gubernatis. 1872), something that probably means that he lost his sexual powers after eating it. (Gerard was saying the same thing a very long time afterwards, and so was Thomas Hill). This belief is an inversion of the original one, for lettuce was thought to have the power of arousing love and of promoting childbearing if eaten by a wife. But by the 19th century we have a saying O'er much lettuce in the garden will prevent a young wife's bearing (Notes and Queries. vol 7 1853p152). Women were wary of lettuce, for it would cause barrenness. The belief probably arose because it was thought that the plant itself was sterile, and was regarded as antaphrodisiac, according to the 10th cen-btury Geopontica (Rose). It is recorded that women in Richmond, Surrey, would carefully count the...

Nervesparing EERPE

Preservation of normal erectile function is possible in selected patients by unilateral or bilateral preservation of the neurovascular bundles. For appropriate stage evaluation of the tumor, standard biopsy with at least 12 samples is mandatory. Criteria for the performance of a nerve-sparing technique are the following 1. Preoperative erectile function sufficient for intercourse. This is a relative indication, since also the return to complete continence seems to be better following a nerve-sparing procedure. Therefore, a nerve-sparing procedure may also be indicated in patients with impaired sexual function 3 .

Sesame

(Sesamum indicum) In spite of the specific name, this is an African plant, though it was taken to India at an early date. From there it spread to China (Brouk), and, in times of slavery, to Brazil. Sesame oil is known as benne in West Africa, teel (til) or gingili in India, and sim-sim in East Africa. A confection of sesame and honey has always been popular in China, and in America bene candy is traditional (G B Foster). The seed, soaked in sparrow's eggs, and cooked in milk, was used for centuries as an aphrodisiac. Sesame oil was a cosmetic, it was mixed with vinegar as an ointment for the forehead, to strengthen the brain , and, blended with crow's gall, as an embrocation for impotence (Lehner & Lehner).

Symptoms

Uterovaginal prolapse in all but the most severe cases regresses when a woman is lying in bed. Prolapse often does not interfere with normal sexual activity. However, many women feel unhappy with the vaginal discomfort experienced through the day and the presence of the prolapse can inhibit couples from continuing normal sexual activity for mainly aesthetic reasons but also from concern about causing harm. Additionally, concern about continence or other urinary and bowel symptoms may be inhibiting. Some couples find that the loss of tone in the vagina leads to sexual dissatisfaction for both parties. The growth in interest in cosmetic vaginal surgery and drugs for male impotence may be influencing this area.

Emergency Surgery

Erectile Fracture

The association between residual displacement and outcome as far as pelvic fractures is concerned is difficult to quantify in absolute terms. More severe injury patterns (typified by type C injuries) do carry a worse prognosis however, it needs to be noted that these are also associated with greater chance of neurological injury, bladder and erectile dysfunction, and dyspareunia (17,20,21). Thus, despite achieving a good reduction, the patient's quality-of-life may be deeply affected by associated injuries.

Medicinal Araliaceae

Sm. (Acanthopanax spinosus Miq, Eleutherococcus gracilistylus), or wu chia (Chinese), gokahi (Japanese), or ogap'i (Korean), is a deciduous shrub growing to 3 m wild in East Asia and China. The leaves are palmatilobed and show five folioles that are elliptic lanceolate, fleshy, and serrate. The influorescence consists of small umbels up to 6 cm long. The drug consists of the root bark found in Chinese pharmacies in the form of yellowish-brown pieces it is used for rheumatism, general debility, impotency, and muscular pains. In Malaysia, the plant is used as carminative.

Sexual Functioning

In males, sexual function following pelvic fracture has been studied in relation to sexual drive and erectile function. Sexual drive focuses on overall satisfaction with sexual life as well as whether the man finds his sexual functioning personally problematic. Erectile function includes the quality, or firmness, of an erection, and the ability to attain an erection, maintain an erection, and ejaculate. Several studies have focused on erectile function following a pelvic fracture. A detailed description of all of these investigations is beyond the scope of this chapter however, a review article summarizing articles concerning erectile dysfunction after pelvic fracture estimated postinjury male sexual dysfunction to be as high as 30 (25). This percentage was even higher in males who incurred a concomitant urethral injury. Harwood et al. (25) state that studies as a whole have indicated that for these males the incidence of erectile dysfunction (ED) following pelvic injury was 42 . No...

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