Erectile Dysfunction Causes and Treatment

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Female Sexual Dysfunction

Female sexual dysfunctions (FSD) include persistent or recurrent disorders of sexual interest desire, disorders of subjective and genital arousal, orgasm disorder, pain and difficulty with attempted or completed intercourse. The scientific knowledge on sexual dysfunction in women with diabetes is rudimentary. Sexual dysfunction was observed in 27 of women with type 1 diabetes. FSD was not related to age, BMI, HbAlc, duration of diabetes, and diabetic complications. However, FSD was related to depression and the quality of the partner relationship (71). Recently, the prevalence of FSD in premenopausal women with the metabolic syndrome was compared with the general female population. Women with the metabolic syndrome had reduced mean full female sexual function index score, reduced satisfaction rate, and higher circulating levels of C-reactive protein (CRP). There was an inverse relation between CRP levels and female sexual function index score (72).

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...

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...

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).

Sexual Functioning

Pelvic fractures have also been shown to affect genitourinary and sexual functioning in both males and females. These effects have been found to be both physiological and psychological in nature. All studies have reported that pelvic fractures create a risk for genitourinary and sexual dysfunction, and that multifactorial, genitourinary, and sexual dysfunction have been shown to have a profound impact on a person's life. 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...

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...

Ginseng

(Panax schinseng, and Panax quinquefolium) The latter is a North American species, a substitute for the real thing when it became rare. It was actually exported to China from the early 19th century (Dalby). This American ginseng was used by native Americans as an ingredient in a love charm. Meskwaki women wanting a mate made up a potion from ginseng roots, mixed with gelatine and snake meat. The Pawnees combined it with wild columbine, cardinal flower and carrot-leaved parsley in their version of the love charm (Weiner). In domestic medicine, Alabama mothers gave ginseng tea to babies who had colic (R B Browne), and it is, in fact, used in the southern states as a remedy for all kinds of stomach troubles (Thomas & Thomas). The true ginseng, from northern China, is now rare because of the extensive use of the root in Chinese medicine. The forked root was treated like the human form (like mandrake, in fact it would seem that the whole of the mandrake legend spread to China, and became...

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.

Clinical consequences of the decline in activity of the hormonal systems

It is not known whether T therapy in older men has beneficial effects on muscle function, sexual function, sense of well-being and quality of life, and whether this therapy can be done safely. Studies involving physiological replacement therapy of testosterone in older men are limited. However, the results of these studies are consistent reported are treatment-related declines in body fat mass ranging from DHEA has received great attention from the general population as potentially being able to increase the sense of well-being and sexual function, and to partially reverse the ageing process. So far, however, results are neither clear nor consistent. It seems prudent to await more trials, in order to be certain that exogenous DHEA is beneficial and can be used safely.

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.

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. Reflections on sexual changes in patients after abdominoperineal resection discussion of protection of pelvic plexus to preserve postoperative sexual function Experience from potency-preserving rectal surgery investigation of embryos and newborns relationship between nervi erigentes, anterior rectal wall, pelvic floor and diaphragmatic part of urethra before entering...

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...

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

Cauda Equina and Lumbosacral Plexus Disorders

The incidence and prevalence of cauda equina lesions are not known, but it is estimated that they constitute from 1 to 5 of spinal pathology 78 . Cauda equina compression is an acute emergency that may develop as a sudden major disk prolapse in a patient with a long history of sciatica or of previous lumbar or sacral laminectomy, sometimes postoper-atively following disk excision with hemorrhage at the operative site. The disk usually involved is L4-L5, but herniations at other levels can occur, inducing a similar syndrome. The clinical picture is characterized by weakness and sensory loss in the lower limbs, buttocks, and perineum, usually with marked impairment of bladder, bowel, erectile, and ejacula-tory function. Symptoms and signs vary depending on the nerve roots involved, the size and position of the disk herniated, and the dimension of the spinal canal. The patient complains usually a loss of sensation and burning pain in the perineum, with a characteristic saddle...

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.

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.

Hypothesis of Pathophysiology

Also influence nerve sparing male gender, tumor size, intraoperative blood loss, and surgeon expertise. When urinary incontinence and or disturbances of sexual function occur as secondary effects of nerve damage, they contribute to worsening of the patient's clinical condition 39 .

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 .

Hypospadiasepispadias Introduction

The goal of treatment of this defect is to reconstruct a straight penis with a meatus close to the normal anatomic location. Repair is being performed at progressively younger ages to avoid emotional distress in the young child. Currently, the recommended age for repair is between 3 and 12 months (for hypospadias epispadias or urethroplasty) and during the first year (for chordee repair or orthoplasty). Three objectives of surgical correction of this defect are to ensure the child's ability to void in the standing position with a straight stream (will minimize child and parent anxiety) to improve the child's physical appearance and ensure a positive body image and to preserve sexual function.

Ethics And Personal Responsibility

Fearing that formal review agencies will hold us accountable after the fact stresses and distresses some of us. Some agencies, such as local, state, and national professional ethics committees, focus specifically on the ethical aspects of our work. Others, such as state licensing boards and the civil courts, enforce professional standards of care that may reflect ethical responsibilities. The prospect of review agencies second-guessing us with the benefit of hindsight can make difficult judgments a nightmare for some therapists. They may suffer a debilitating performance anxiety, dread going to work, and discover that the focus of their work has changed from helping people to avoiding a malpractice suit.

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.

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.

Transgenic crops for improved medicinal plants and pharmaceutical products

Yang and Choi (2000) obtained transgenic plants from hairy roots of Panax ginseng. Starting from three culture lines, they obtained embryogenic callus induction, somatic embryo formation and their complete germination into adult plants. The transformed ginseng plantlets showed an actively growing root system with abundant lateral roots (Yang and Choi, 2000).

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.

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.

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...

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.

Genetic Considerations

The course of acromegaly is slow, with very gradual changes over 7 to 10 years. Reviewing a patient's old photographs may reveal the progressive changes in facial features. Determine if the patient has had a change in hat, glove, ring, or shoe size because of an overgrowth of the hands and feet. Ask the patient if he or she has had headaches or visual disturbances, which in acromegaly are caused by the growth of the adenoma, which exerts pressure on brain tissue and cranial nerves III, IV, and VI. Establish a history of altered sexual function, which may be an indicator of decreased gonadotropin production. Ask about the presence of pain in the hands, feet, and spine, which is probably caused by bone growths also ask about problems with chewing, swallowing, or talking, which may be caused by tongue, jaw, and teeth enlargement. Note the presence of a deepening of the voice, recurrent bronchitis, excessive sweating, heat intolerance, fatigue, and muscle weakness. Check for a...

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.

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...

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,...

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,...

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).

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.

Stigma and Quality of Life

A community-based research programme 11 explored the feelings of exclusion secondary to FI. This study ran over the course of 5 years and involved a group of women suffering from multiple sclerosis (MS). Some of the main concerns in this group were in managing double incontinence, the effects of MS on sexuality and sexual relationships, and trying to live well despite their chronic illness. The shared group experience gave them the freedom to talk openly about sex and incontinence, subjects about which they had previously felt compelled to be silent. Norton and Chelvanayagam 12 ran two focus groups at St. Mark's Hospital in the UK to develop a research questionnaire titled Effects of Bowel Leakage . For many participants, this was the first time they had ever spoken openly about their FI, and it was found to be mutually supportive to be able to speak openly to peers about the ever-present stress and risk of potential humiliation. As with Australian women 11 , access to...

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.

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...

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

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).

Medical therapy

Progestogen (medroxy progesterone acetate (MPA)) was effective after 4 months' treatment as reflected in pain scores (OR 2.64, 95 CI 1.33-5.25, n 146) and a self-rating scale (OR 6.81,95 CI 1.83-25.3, n 44), but benefit was not sustained 9 months post-treatment 27,28 . MPA plus psychotherapy was effective in terms of pain scores (OR 3.94, 95 CI 1.2-12.96, n 43) but not the self-rating scale at the end of treatment. Benefit was not sustained post-treatment. Venography scores, symptom and examination scores, mood and sexual function were improved to a greater extent 1 year after treatment with goserelin compared to progestogen 29 .

Responses to ART

Symptoms of reduced libido and sexual dysfunction that result in hypogo-nadism should improve within a few weeks of instituting adequate T replacement. Strength and energy complaints may take somewhat longer to improve. Although there are several excellent studies showing beneficial affects of ART upon muscle mass, strength, sexual function, libido, and skeletal mass in men with severe hypogonadism (34,35), fewer data are available regarding patients with more subtle T deficiency. Since ART is designed primarily to improve quality of life, it is my practice to discontinue such therapy after 3 mo in patients who find no symptomatic benefit.

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

The traditional systems of medicine of Asia and the Pacific use about 50 species of plant species classified within the family Araliaceae that are of medicinal value and notably used as tonic. Examples od such plants are of Panax ginseng C. A. Meyer (ginseng), Panax notoginseng Burk. (san chi ginseng), Panax japonicus C. A. Meyer (Japanese ginseng), and Acanthopanax senticosus (Siberian ginseng). The evidence for the existence of immunostimulating and anabolic saponins in Panax and Acanthopanax species is strong and well documented, but much less work has been done with the dopami-nergic potentials of these saponins. Acanthopanax gracilistylus W. W. 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...

Cuckoopint

The aphrodisiac claim resulted from the form of growth of the plant, the spadix in the spathe, which to the common people stood for copulation. Friend.1883 said the cuckoo-pint is the symbol of zeal or ardour, and this may very well have been his way of giving some respectability to the subject. The very name of the plant, Cuckoo-pint, proclaims its reputation, for 'pint' is short for 'pintel', penis. Another of its names, Wake Robin, seems to say the same. 'Robin', so Prior claimed, is from the French robinet, which he said meant penis (quite possible, as the word in modern French means a tap). Wake Pintel is also recorded 'wake' probably means alive, so the name actually means erect penis. Shakespeare certainly understood the name perfectly, and so did his audience. He makes the mad Ophelia sing, For bonny sweet Robin is all my joy . So it is not surprising that cuckoo-pint was reckoned to be aphrodisiac. A quite recent name, Willy Lily (Mabey.1998), is as ribald as any of the many...

Olfactory Receptors

FIGURE 1 Organization of the olfactory epithelium. (A) Olfactory sensory neurons extend from the paired olfactory epithelial patches, through the cribriform plate into the overlying paired olfactory bulbs. The vomeronasal organ also contains olfactory neurons for pheromone detection and sexual function. (B) Olfactory neurons are embedded in the olfactory epithelium with their odor-sensitive cilia extending into the overlying mucus. They are flanked by supporting cells and basal cells, the latter giving rise to new olfactory neurons. Bowman's glands secrete the mucus that traps and transports airborne chemicals. FIGURE 1 Organization of the olfactory epithelium. (A) Olfactory sensory neurons extend from the paired olfactory epithelial patches, through the cribriform plate into the overlying paired olfactory bulbs. The vomeronasal organ also contains olfactory neurons for pheromone detection and sexual function. (B) Olfactory neurons are embedded in the olfactory epithelium with their...

Palsywort

PANACEA is defined as a universal medicine, a heal-all , like GINSENG. Indeed the generic name for ginseng, Panax, has the same derivation as panacea. Other plants, besides ginseng, have been given the name of All-heal, or Heal-all, MUGWORT, for example, perhaps as a tribute to the esteem with which it was regarded. SELF-HEAL (Prunella vulgaris) is another, as is VALERIAN. MISTLETOE Panax quinquefolium Panax schinseng GINSENG PANSY

Love Charms

The American GINSENG was used by some of the Indian peoples as a love charm. For instance, Meskwaki women wanting a mate made their potion from the roots, mixed with gelatine and snake meat. The Pawnees combined it with other plants, such as wild columbine, cardinal flower and carrot-leaved parsley in their version of the love charm (Weiner). The Ojibwe apparently used FROG ORCHID in a love charm, but no details were given (Yarnell). The American plant BLOODROOT formed another Indian love charm. A man would rub some of the root on the palm of his hand, and then contrive to shake hands with the girl he wanted, in the belief that after five or six days she would be willing to marry him (Corlett). African-Americans in the southern states of America would chew CROWN VETCH and rub it on their palms. That would give a man power over any woman with whom he later

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.

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...

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.

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...

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.

Aphrodisiacs

SESAME seed, soaked in sparrow's eggs, and cooked in milk, also bore this reputation, and so did GINSENG. The name is Chinese, Jin-chen, meaning man-like, a reference to the root, which, like those of mandrake, was taken to be a representation of the human form, and it was this supposed resemblance that resulted in the doctrine of signatures stating that the plant healed all parts of the body (W A R Thomson. 1976). The more closely the root resembled the human body, the more valuable it was considered, and well-formed examples were literally worth their weight in gold as an aphrodisiac (Schery Simons). It was the the Dutch who brought the root to Europe, in 1610, and its reputation as an aphrodisiac came with it. The court of Louis XIV in particular seemed to value this reputation (Hohn). AMBOYNA WOOD (Pterocarpus indicus) once had this sort of reputation, or at least was used as a man-attracting charm (C J S Thompson. 1897), as was PATCHOULI perfume, too (Schery)....

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