An Asia Pacific sexual health survey in 13 countries including India has uncovered staggering levels of sexual dissatisfaction among 60 percent of both men and women, thanks to erectile dysfunction (ED).

The Asia Pacific Sexual Health and Overall Wellness (AP SHOW) survey found that men with “suboptimal erections” are less satisfied with sex and other aspects of the sexual experience.

The survey also found that men and women who are “completely” or “very satisfied” with sex are more than three times more likely to feel good about their relationships and life overall compared to those who are only “somewhat” or “not at all satisfied” with sex.

Fifty four percent of men with optimal erectile function say that it is “very true” that they feel good about their relationships compared to 47 percent with suboptimal erections.

Among women, this difference is significantly more pronounced - 65 percent of women whose partners have optimal erection function say that it is “very true” that they feel good about their relationships, compared to only 32 percent of women whose partners have suboptimal erections.

The data was based on survey of 3,957 sexually active men and women (2,016 males and 1,941 females). The respondents were aged between 25-74 years and had had sexual intercourse at least once in the past 12 months.

The 13 countries surveyed were India, Australia, China, Hong Kong, Indonesia, Japan, Malaysia, the Philippines, Singapore, South Korea, Taiwan, Thailand and New Zealand.

Rosie King, sexual health physician, Sydney Centre for Sexual and Relationship Therapy, said: “A person’s willingness to talk about sexual health and performance is heavily influenced by diverse cultural beliefs and practices - most patients and even doctors are uncomfortable initiating such discussions. Therefore, a great many people remain untreated.”

Suboptimal erections are a common problem, affecting more than 50 percent of men aged 40 to 70 years. Erection problems and suboptimal erections are not a normal part of ageing. An older male has just as much right to normal sexual functioning as younger men.

Suboptimal erections can be due to an underlying illness or medication, and is not always due to psychological factors alone. Suboptimal erections often have a mixed genesis, both organic and psychological. Concomitant physical disease is an important cause of suboptimal erections, said a Sydney Centre release.

Effective and convenient treatments are available and international medical consensus has affirmed that in suitable patients with suboptimal erections or ED, oral medications should be the first-line treatment.

This is a post from Erectile Dysfunction Central

Sub-optimal Erections and Satisfying Sex

• The effect of male erectile dysfunction on the psychosocial, relationship, and sexual characteristics of heterosexual women in the United States.
• Correlations between increased erection hardness and improvements in emotional well-being and satisfaction outcomes in men treated with sildenafil citrate for erectile dysfunction.
• Women’s satisfaction with partners’ penile implant. Inflatable vs noninflatable prosthesis.
• Sexual dysfunction in the United States: prevalence and predictors.
• Behind the scenes: partners’ perceptions of quality of life post radical prostatectomy.

A new fast-acting oral drug for erectile dysfunction (ED) is ready for a crucial trial phase.

It’s going to be a multicentre, randomised, double-blind, placebo-controlled trial that will evaluate the safety and efficacy of Avanafil in the treatment of ED in men with type-1 or type-2 diabetes.

“There has not been a new treatment option for men with ED in more than five years,” stated Andrew McCullough, associate professor of clinical urology, New York University (NYU) School of Medicine and the study’s clinical investigator.

“Early data suggest that Avanafil may provide a fast-acting therapy with a short half-life, which, if approved, may represent a noteworthy advance for the millions of men living with ED and searching for new options,” he added.

This study will enrol approximately 375 patients at about 30 locations in the US. Subjects are instructed to attempt sexual intercourse 30 minutes after taking Avanafil, with no restrictions on food or alcohol consumption.

Erectile dysfunction, or ED, the inability to attain or maintain an erection sufficient for intercourse, was reported by 35 percent of men aged between 40 and 70 years in the US.

Subjects who meet the inclusion criteria will undergo a four-week non-treatment run-in period followed by 12 weeks of treatment.

Diabetes is one of the most common causes of ED; clinical data suggest that at least 50 percent of diabetic men will experience difficulties with erectile function. Diabetic men are up to three times more likely to have ED than non-diabetic men.

“Evidence suggests that there is room for significant improvement in the current treatment of ED,” said Charles Bowden, senior director, clinical development, VIVUS, which is developing the drug.

“We’re pleased with the promising results demonstrated thus far with Avanafil, and with the momentum behind our Phase III programme. Enrolment in our first pivotal study, REVIVE, initiated in December to evaluate Avanafil in ED, is ongoing. REVIVE-Diabetes will be conducted at many of the same sites as REVIVE.”

VIVUS previously reported positive results from the Phase 2 studies of Avanafil. Following a four-week, non-treatment, run-in period, 284 patients were treated for 12 weeks with placebo or Avanafil at various doses.

The primary endpoints used to assess treatment efficacy included the percentage of erections sufficient for vaginal penetration and the percentage of erections lasting long enough for successful intercourse.

Avanafil produced erections sufficient for vaginal penetration on 76, 79, 80 and 84 percent of sexual attempts on the 50, 100, 200 and 300 mg doses, respectively, said a VIVUS release.

Erections lasting long enough for successful intercourse were achieved on 54, 59, 62 and 64 percent of attempts, respectively.

This is a post from Erectile Dysfunction Central

Fast acting erectile disorder drug goes on trial again

• Treatment of men with erectile dysfunction with transurethral alprostadil. Medicated Urethral System for Erection (MUSE) Study Group.
• Intracavernous alprostadil alfadex is more efficacious, better tolerated, and preferred over intraurethral alprostadil plus optional actis: a comparative, randomized, crossover, multicenter study.
• Treatment of erectile failure with prostaglandin E1: a double-blind, placebo-controlled, dose-response study.
• Sub-optimal Erections and Satisfying Sex
• Role of the nitric oxide donor linsidomine chlorhydrate (SIN-1) in the diagnosis and treatment of erectile dysfunction.

An unusual outbreak of dangerously low blood sugar has been traced to illegal anti-impotence drugs and herbal remedies contaminated with a drug for diabetics, doctors warn.

Between Jan. 1 and May 26, 2008, 150 non-diabetic patients with severe hypoglycemia were admitted to public hospital in Singapore. There were four deaths, and seven patients remained comatose, Dr. Kok Onn Lee of National University Hospital in Singapore report in Thursday’s New England Journal of Medicine.

All of the patients except one were men, and they ranged in age from 19 to 97, with an average age of 51.

The drugs included counterfeit Cialis and herbal remedies called Power 1 Walnut and Santi Bovine Penis Erecting Capsule.

The drug packaging listed names of fictitious overseas factories, so it is not known whether the contamination was deliberate or accidental, the doctors said.

“We believe that physicians should be cognizant of this phenomenon when evaluating patients with severe unexplained hypoglycemia, particularly if a clustering of cases is noted,” the team wrote.

They also called for better collaboration between national and international drug regulators and enforcement agencies to address clandestine manufacturing processes, the cross-border movement of drugs, and the sale of adulterated medications online.

This is a post from Erectile Dysfunction Central

Fake Cialis caused dangerously low blood sugar

• Structural elucidation of a tadalafil analogue found as an adulterant of a herbal product.
• You’ve Got One of Those Four-Hour Erections
• HMG CoA reductase inhibitors and impotence: two case series from the Spanish and French drug monitoring systems.
• Internet websites selling herbal treatments for erectile dysfunction.
• Structural identification of a new acetildenafil analogue from pre-mixed bulk powder intended as a dietary supplement.

“The highest risk for coronary heart disease was in younger men,” says researcher Jennifer St. Sauver, Ph.D. The study was published in the February 2009 issue of Mayo Clinic Proceedings. The results suggest that younger men and their doctors may need to consider erectile dysfunction a harbinger of future risk of coronary heart disease — and take appropriate steps to prevent it, says Dr. St. Sauver.

“The importance of the study cannot be overstated,” writes Martin Miner, M.D., in an editorial in the same issue of Mayo Clinic Proceedings. The results “raise the possibility of a ‘window of curability,’ in which progression of cardiac disease might be slowed or halted by medical intervention,” writes Dr. Miner, who practices at the Men’s Health Center, Miriam Hospital, Providence, R.I.

Erectile dysfunction is common, and prevalence increases with age. It affects 5 to 10 percent of men at age 40. By age 70, from 40 to 60 percent of men have the condition.

Dr. St. Sauver says researchers wanted to learn more about the connections between age, cardiovascular disease and erectile dysfunction. Two previous studies, both published in 2005, laid groundwork for the Mayo Clinic study. One found that erectile dysfunction predicted an increased risk of heart disease, but the erectile dysfunction of the study participants was not assessed with an externally validated questionnaire and cardiac events were not subjected to standardized review for diagnostic accuracy [Thompson et al, JAMA, 2005]. The second predicted that future cardiovascular disease would be higher in younger men with erectile dysfunction, but wasn’t able to follow the men to determine if heart disease developed [Ponholzer et al, Eur Urol, 2005].

For the Mayo Clinic study, the investigators identified 1,402 men who lived in Olmsted County, Minn., in 1996 and did not have heart disease. Every two years for 10 years, these men were assessed for urological and sexual health.

Answers to questions from the Brief Male Sexual Function Inventory, a statistically validated questionnaire, were used to determine erectile dysfunction. The baseline prevalence of erectile dysfunction in study participants was: 2.4 percent in men aged 40-49; 5.6 percent in men aged 50-59; 17 percent in men aged 60-69 and 38.8 percent in men 70 years and older. Those initial data and the increasing incidence of erectile dysfunction over time were linked to data from a long-term study of heart disease in Olmsted County residents, led by Veronique Roger, M.D., Mayo Clinic cardiologist.

Over 10 years of follow-up, researchers found that men with erectile dysfunction were 80 percent more likely to develop coronary heart disease compared to men without erectile dysfunction. The highest risk of new heart disease was seen in the youngest study participants who had erectile dysfunction. In men 40 to 49 years old when the study began, the number of new cases in men with erectile dysfunction was more than 50-fold higher than in men without erectile dysfunction. Statistically, that’s a cumulative incidence of 48.52 per 1,000 person years in those with erectile dysfunction compared to 0.94 per 1,000 person years in those without erectile dysfunction).

In men in their 50s, 60s and 70s, the total incidence of new cases of heart disease also was higher in those with erectile dysfunction. However, the differences were not as striking as those seen among the 40- to 49-year- olds.

“In older men, erectile dysfunction may be of less prognostic importance for development of future heart disease,” says Dr. St. Sauver.

This study did not determine reasons for the increased risk of heart disease among men with erectile dysfunction. Some have theorized that erectile dysfunction and coronary artery disease may be different manifestations of the same underlying disease process. A buildup of plaque that can block arteries around the heart may plug the smaller penile arteries first, causing erectile dysfunction. Alternatively, arteries may lose elasticity over time, contributing to heart disease. This arterial stiffening may affect the smaller penile arteries first.

This is a post from Erectile Dysfunction Central

Young Men With Erectile Dysfunction Have Double Risk Of Heart Disease

• The risk of coronary heart disease in men with erectile dysfunction.
• Erectile dysfunction is associated with a high prevalence of hyperlipidemia and coronary heart disease risk.
• Heart disease risk factors predict erectile dysfunction 25 years later: the Rancho Bernardo Study.
• Is erectile dysfunction an indicator for increased risk of coronary heart disease and stroke?
• Erectile dysfunction and coronary risk factors: prospective results from the Massachusetts male aging study.

This is a post from Erectile Dysfunction Central

When Viagra doesn’t work. Treating erectile dysfunction.

• Evaluation and treatment of organic impotence in the male with diabetes mellitus.
• Diabetes quiz. How much do you know about treating impotence?
• New tools 2003.
• Testosterone and diabetes. What’s the connection?
• Say yes to intimacy. Treatment options for erectile dysfunction.

Department of Psychiatry, University of New Mexico School of Medicine, 2400 Tucker NE, MC 09 5030, Albuquerque, NM 87131-0001, USA. gnurnberg@salud.unm.edu

CONTEXT: Antidepressant-associated sexual dysfunction is a common adverse effect that frequently results in premature medication treatment discontinuation and for which no treatment has demonstrated efficacy in women. OBJECTIVE: To evaluate the efficacy of sildenafil for sexual dysfunction associated with selective and nonselective serotonin reuptake inhibitors (SRIs) in women. DESIGN, SETTING, AND PARTICIPANTS: An 8-week prospective, parallel-group, randomized, double-blind, placebo-controlled clinical trial conducted between September 1, 2003, and January 1, 2007, at 7 US research centers that included 98 previously sexually functioning, premenopausal women (mean [SD] age 37.1 [6] years) whose major depression was remitted by SRIs but who were also experiencing sexual dysfunction. INTERVENTION: Forty-nine patients were randomly assigned to take sildenafil or placebo at a flexible dose starting at 50 mg adjustable to 100 mg before sexual activity. MAIN OUTCOME MEASURES: The primary outcome measure was the mean difference in change from baseline to study end (ie, lower ordinal score) on the Clinical Global Impression sexual function scale. Secondary measures included the Female Sexual Function Questionnaire, the Arizona Sexual Experience scale-female version, the University of New Mexico Sexual Function Inventory-female version, a sexual activity event log, and the Hamilton Depression Rating scale. Hormone levels were also assessed. RESULTS: In an intention-to-treat analysis, women treated with sildenafil had a mean Clinical Global Impression-sexual function score of 1.9 (95% confidence interval [CI], 1.6-2.3) compared with those taking placebo (1.1; 95% CI, 0.8-1.5), with a mean end point difference of 0.8 (95% CI, 0.6-1.0; P = .001). Assigning baseline values carried forward to the 22% of patients who prematurely discontinued resulted in a mean end point in the sexual function score of 1.5 (95% CI, 1.1-1.9) among women taking sildenafil compared with 0.9 (95% CI, 0.6-1.3) among women taking placebo with a mean end point difference of 0.6 (95% CI, 0.3-0.8; P = .03). Baseline endocrine levels were within normal limits and did not differ between groups. The mean (SD) Hamilton scores for depression remained consistent with remission in both groups (4.0 [3.6]; P = .90). Headache, flushing, and dyspepsia were reported frequently during treatment, but no patients withdrew because of serious adverse effects. CONCLUSION: In this study population, sildenafil treatment of sexual dysfunction in women taking SRIs was associated with a reduction in adverse sexual effects. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00375297.

This is a post from Erectile Dysfunction Central

Sildenafil treatment of women with antidepressant-associated sexual dysfunction: a randomized controlled trial.

• Efficacy and safety of sildenafil in men with serotonergic antidepressant-associated erectile dysfunction: results from a randomized, double-blind, placebo-controlled trial.
• Tadalafil for treatment of erectile dysfunction in men on antidepressants.
• Efficacy and safety of tadalafil in men with erectile dysfunction with a high prevalence of comorbid conditions: results from MOMENTUS: multiple observations in men with erectile dysfunction in National Tadalafil Study in the US.
• Treatment of antidepressant-associated sexual dysfunction with sildenafil: a randomized controlled trial.
• The efficacy of tadalafil in clinical populations.

ten Duis K, van Dalen T.

Diakonessenhuis, afd. Heelkunde, Utrecht. kajtenduis@hotmail.com

A 50-year-old man presented with a sacral tumour due to a sacrococcygeal chordoma.

This is a post from Erectile Dysfunction Central

[Diagnostic image (376). A man with a tumour in the anal seam]

• [Intracavernous injections in erection disorders]
• [Somatization of erectile disorders by the introduction of sildenafil]
• [Drug treatment of sexual disorders in men]
• [Non-surgical treatment of erection disorders]
• [Total mesorectal excision: a new standard for the surgical treatment of rectal carcinoma]

Department of Internal Medicine, Universityof Utah, Salt Lake City 84112-5820, USA. mmunger@hsc.utah.edu

OBJECTIVE: To determine the safety of a US-based, state-regulated Internet system vs a multispecialty primary care system for prescribing phosphodiesterase type 5 (PDE-5) inhibitors for erectile dysfunction. PATIENTS AND METHODS: From January 1, 2001, through December 31, 2005, 500 e-medicine clients (mean+/-SD age, 47+/-11 years; hypertension, 60%; type 2 diabetes mellitus, 2%; mean+/-SD number of medications, 0.4+/-0.8) vs 500 traditional medicine patients (mean+/-SD age, 57+/-12 years; hypertension, 50%; type 2 diabetes mellitus, 23%; mean+/-SD number of medications, 5.1+/-3.1) with erectile dysfunction symptoms were assessed. Noninferiority safety was assessed in this retrospective, cross-sectional study with stratified random sampling by identification of prescribing in the presence of clinically important PDE-5 inhibitor drug interactions with or without high-risk cardiovascular disease, by asking about diagnostic symptoms specific to erectile dysfunction, and by determining frequency of patient counseling. RESULTS: Noninferiority of the e-medicine system was shown for the 6 safety end points, relative to a traditional medicine system. Numbers of inappropriate prescriptions, after correction for disease and medication covariates, did not differ between systems. Medication counseling showed superiority of the e-medicine system. Standard diagnostic questions were required for e-medicine prescribing but were infrequently asked in traditional medicine. CONCLUSION: Safety in prescribing PDE-5 inhibitors for erectile dysfunction was similar between a US-based, state-regulated Internet prescribing system and a multispecialty primary care system.

This is a post from Erectile Dysfunction Central

Safety of prescribing PDE-5 inhibitors via e-medicine vs traditional medicine.

• Safety of Internet Prescribed Erectile Dysfunction Drugs
• Pharmacokinetics, pharmacodynamics, and efficacy of phosphodiesterase type 5 inhibitors.
• A study of the management of erectile dysfunction in general practice.
• Pharmacotherapy of erectile dysfunction: focus on cardiovascular safety.
• [Advances in studies of Chinese herbs for improving relaxability of corporal smooth muscle]

This is a post from Erectile Dysfunction Central

Can Viagra really cause hearing and vision loss? If so, is this a reason to avoid using it?

• I’ve heard of an herbal alternative to Viagra for impotence. Does it work and is it safe?
• Do I need to see a doctor to get a prescription for Viagra? I’ve seen ads offering Viagra direct by mail.
• Standard bicycle seats can lead to erectile dysfunction.
• Beyond Viagra. What are your options?
• FDA approves impotence pill.

Department of Medicine, Cardiology, Angiology and Pneumology, University Hospital Charit?, Berlin, Germany. Marko.Boehm@charite.de

Erectile dysfunction occurs extensively among patients with arterial hypertension. We investigated the safety of sildenafil for patients with and without antihypertensive medication. Our study included data from 35 double-blind, placebo-controlled, and randomized investigations, with a total of 8115 patients. The term of therapy was between 6 weeks and 6 months, for both the sildenafil group (5-200 mg, n=4819) as well as the placebo group (n=3296). We studied the adverse events in the men who received 1 or more hypertensives (n=2388), and in those who took no antihypertensive medication (n=5727). Our findings disclosed equal frequency of adverse events in both groups, without influence by the number of different antihypertensives administered. The occurrence of AEs associated with blood pressure was slight, and was comparable between the individual groups. These results support the conclusion that sildenafil is also well tolerated by patients taking one or more antihypertensives. Patients being treated with alpha blockers should be stable on this therapy in order to minimize the possibility of orthostatic hypotension. An initial dose of 25 mg should furthermore be considered for these patients.

This is a post from Erectile Dysfunction Central

Sildenafil is well tolerated by erectile dysfunction patients taking antihypertensive medications, including those on multidrug regimens.

• Effect of sildenafil in patients with erectile dysfunction taking antihypertensive therapy. Sildenafil Study Group.
• Safety and efficacy of vardenafil, a selective phosphodiesterase 5 inhibitor, in patients with erectile dysfunction and arterial hypertension treated with multiple antihypertensives.
• Sildenafil citrate for erectile dysfunction in men receiving multiple antihypertensive agents: a randomized controlled trial.
• Cardiovascular effects of tadalafil in patients on common antihypertensive therapies.
• [Interaction between sildenafil and antihypertensive drugs: what is evidence-based?]

Department of Urology, Weill Cornell Medical Center, New York, NY, USA.

OBJECTIVE: To define haemodynamic changes after radical retropubic prostatectomy (RP) and the predictive value of these for the outcome of erectile function (EF), as although there are predictors of the recovery of EF, penile vascular changes might also affect the recovery of EF. PATIENTS AND METHODS: Prospective data were analysed from men who had RP followed by duplex penile Doppler ultrasonography (DUS) within 6 months of RP. All men had functional erections before RP, based on self-report and partner corroboration, and all completed the International Index of Erectile Function (IIEF) questionnaire serially after RP. The EF, based on IIEF scores, was then correlated with the penile DUS results. RESULTS: In all, the study included 111 patients; 32 (29%) had normal erectile haemodynamics after RP, while 79 (71%) had abnormal haemodynamics. Twelve patients (11%) had a venous leak. There were no differences in mean patient age or comorbidity profile between those with and without haemodynamic changes. Comparing those with normal and abnormal haemodynamics, the mean IIEF EF domain scores were 25 and 17 (P = 0.025), the percentages of erectile rigidity at 18 months was 66% vs 35% (P = 0.013), the percentage of patients with normal EF domain scores was 28% vs 6% (P < 0.01), the percentage of patients with functional erections permitting sexual intercourse unassisted by pharmacological agents was 47% vs 22% (P = 0.018), and the percentage of patients responding to sildenafil citrate, as defined by vaginal penetration, was 72% vs 43% (P = 0.03), respectively. CONCLUSIONS: The results of this prospective study indicate that a patient’s penile vascular status is correlated with their EF after RP.18694409 [PubMed - indexed for MEDLINE]

This is a post from Erectile Dysfunction Central

Erectile haemodynamic status after radical prostatectomy correlates with erectile functional outcome.

• The use of an erectogenic pharmacotherapy regimen following radical prostatectomy improves recovery of spontaneous erectile function.
• Sex inventories: can questionnaires replace erectile dysfunction testing?
• Vardenafil restores erectile function to normal range in men with erectile dysfunction.
• Comparison of international index of erectile function with nocturnal penile tumescence and rigidity testing in evaluation of erectile dysfunction.
• Reliability of remembered International Index of Erectile Function domain scores in men with localized prostate cancer.

Global Pharma Consulting Ltd, 61 Abbey Street, Faversham, Kent, ME13 7BN, UK. m.wyllie@globalpharma.co.uk18694411 [PubMed - indexed for MEDLINE]

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Prostaglandin revival?

• Up and along; sex is now as good as it gets.
• Another year, another AUA.
• Circumventing side-effects.
• Diagnostic potential unmasked.
• One drug fits all.

This is a post from Erectile Dysfunction Central

The patient information that came with my Viagra prescription warned of sudden vision or hearing loss. Should I be worried?

• Viagra’s other health benefits.
• Viagra: a blueprint for safety and reliability.
• Enjoying lifelong sexual vitality.
• Attention men: what you don’t know can hurt you.
• New laser treatments ease severe BPH symptoms.

High cholesterol isn’t a disease, but if you have it you’re at risk for some serious health conditions.

High cholesterol can manifest with or without symptoms. And the No. 1 danger of this condition is that it clogs arteries, resulting in a condition called atherosclerosis, which reduces blood flow and increases the risk of heart attack or stroke.

But the reduced blood flow caused by high cholesterol also has been linked to sexual disorders.

Dr. Michael Krychman, the executive director of the Southern California Center for Sexual Health and Survivorship, said high cholesterol causes fatty deposits that clog blood vessels leading to the pelvic area. Men with high cholesterol sometimes end up with erectile dysfunction because they are not receiving enough blood flow to the penis, he explained.

“As soon as a man presents with erectile dysfunction, we begin measuring cholesterol and blood pressure,” he said.

Cholesterol is a waxy, fat-like substance found throughout the body that is carried in blood particles called lipoproteins. An excess of cholesterol can lead to a complete blockage of the coronary artery, which will trigger a heart attack.

High cholesterol and its blood flow-restricting mechanisms long have been viewed as a factor in male sexual dysfunction but only recently emerged as culprits in female sexual disorders, Krychman said.

“In the past we used to think if a woman is having sexual problems, she’s frigid, and she needs to go home and have a glass of wine and relax,” Krychman said. “However, there is emerging data associating underlying medical causes with female sexual dysfunction.”

In women, the fatty deposits from high cholesterol may impact lubrication, causing painful intercourse and a lowered libido, said Krychman, who also is director of sexual medicine at Hoag Memorial Hospital.

Men and women who believe high cholesterol may be affecting their sex lives should consult a physician to rule out other causes, Krychman said.

Once cholesterol is determined to be the problem, doctors usually advise patients to seek dietary and lifestyle changes, such as eliminating saturated fat (found in fatty meat and eggs) from the diet, quitting smoking and increasing exercise.

If necessary, doctors may recommend a cholesterol-lowering medication, Krychman added.

This is a post from Erectile Dysfunction Central

Is High Cholesterol Causing Your Erectile Dysfunction?

• Erectile dysfunction predicts heart problems: study
• Total cholesterol and high density lipoprotein cholesterol as important predictors of erectile dysfunction.
• Erectile dysfunction is associated with a high prevalence of hyperlipidemia and coronary heart disease risk.
• Vasodilating beta-adrenoceptor blockers as cardiovascular therapeutics.
• Sexual dysfunction in the United States: prevalence and predictors.

Can Viagra work for women?

By Margaret McCartney

Sex sells. I suppose this is why the results of a study entitled “Sildenafil Treatment of Women with Antidepressant Associated Sexual Dysfunction” were reported with great enthusiasm around the world after they were published in the Journal of the American Medical Association (Jama). Yet the study is interesting for a number of reasons.

Sildenafil was originally sold as Viagra. Despite its success in treating men, there has been no equivalent drug for women. In the UK, there is only one licensed drug, Intrinsa, which is used in specific circumstances for female libido problems after gynaecological surgery.

The lack of a “female Viagra” highlights questions over the broader issue of “female sexual dysfunction”. While men with sexual problems frequently respond to drugs, female sexual problems tend to be more complex and far less amenable to pharmacological treatment.

Indeed, as the British Medical Journal noted in 2003, when female sexual dysfunction as a disorder was mooted at an “international consensus development conference” on the subject, 18 of the 19 authors had “financial interests or other relationships with a total of 22 drug companies”. The obvious concern was that the potential for profit was being put higher than the likely benefit to women.

The latest Jama research seems to have found a use for sildenafil in women. Or has it? The women in the trial were experiencing “sexual dysfunction” as a side effect of taking medication – in this case antidepressants.

In order to take part in the trial, the women had to be sexually active before they became depressed, but to have experienced sexual problems for just four weeks – a relatively short space of time.

So how much difference did sildenafil make? When its effect was compared to that of a placebo, there was no difference in the women’s ratings of their desire or arousal and only a small, if statistically significant, effect on orgasm. Forty-three per cent of the women on sildenafil experienced headaches, and both groups had similar scores for depression at the end of the eight-week study.

The logic of using one drug to treat another one’s side effects may sound perverse, but it is frequently applied in the world of medicine. The issue is making sure that each is properly justified.

http://jama.ama-assn.org/cgi/content/short/300/4/395
http://www.bmj.com/cgi/content/full/326/7379/45

Margaret McCartney is a GP in Glasgow.

This is a post from Erectile Dysfunction Central

Viagra for Women? revisited

• Viagra Improves Sexual Function In Women on Anti-Depression Drugs
• What Malaysian women believe about Viagra: a qualitative inquiry.
• Sildenafil treatment of women with antidepressant-associated sexual dysfunction: a randomized controlled trial.
• Viagra For Women, Not So Fast!
• Systematic review of randomised controlled trials of sildenafil (Viagra) in the treatment of male erectile dysfunction.

A innovative study published in this month’s issue of the Journal of Sexual Medicine examined if noseless bike seats would be effective against erectile dysfunction and groin numbness caused by traditional bicycle seats with a protruding nose extension.  The research revealed that men who switched from regular bike seats to noseless saddle seats had improved penile sensation and a reduction in erectile dysfunction (impotence).

Results from this research may be useful for all male recreational cyclists to alleviate perineal discomfort, potential erectile dysfunction and maintain sexual health.

The study tracked 90 bicycling police officers from 5 metropolitan regions in the United States.  The officers were evaluated using traditional saddles and then again after six months of using the noseless bicycle seat.  The noseless saddle seat reduces contact pressure in the perinieal region by cradleing the buttocks and providing freedom in the front.

Before switching seats, 82% of the 90 officers reported penile numbness while cycling.  After switching to the noseless saddle seats, only 27% reported numbness in the groin.

The findings show that use of the noseless saddle resulted in a reduction in saddle contact pressure in the perineal region and significant improvement in penile tactile sensation.  Use of the noseless saddle also resulted in significant increases in erectile function as assessed by the initial evaluation, but there were no significant changes to penile rigidity during sleep.  Officers who reported erectile dysfunction before switching saddles saw an improvement in the longevity of their bedroom encounters.

Most bicycle police officers were able to effectively use no-nose saddles in their police work, and 97 percent of officers completing the study continued to use the no-nose saddle afterward.

Researchers concluded that No-nose saddles are a useful intervention for bicycling police officers alleviating pressure to the groin and improving penis health. Different saddle designs may require some re-learning of ‘how to ride a bicycle,’ but the health benefits to having unrestricted vascular flow to and from the penis and less penile numbness is self-evident.

This is a post from Erectile Dysfunction Central

Special Bicycle Seat May Prevent Erectile Dysfunction in Men

• Only the nose knows: penile hemodynamic study of the perineum-saddle interface in men with erectile dysfunction utilizing bicycle saddles and seats with and without nose extensions.
• Cycling and penile oxygen pressure: the type of saddle matters.
• Bicycle riding and erectile dysfunction: an increase in interest (and concern).
• Digital three-dimensional modelling of the male pelvis and bicycle seats: impact of rider position and seat design on potential penile hypoxia and erectile dysfunction.
• Erectile dysfunction after a long-distance cycling event: associations with bicycle characteristics.

In the August issue of Mayo Clinic Proceedings, researchers from Utah and several colleagues compare the relative safety of two systems — an online prescribing service versus traditional physician consultation — for patients seeking medication to treat erectile dysfunction.

OBJECTIVE: To determine the safety of a US-based, state-regulated Internet system vs a multispecialty primary care system for prescribing phosphodiesterase type 5 (PDE-5) inhibitors for erectile dysfunction.

The Internet is rapidly becoming an important platform for health care communications. This technological advance is driven by the delivery of health care from single to multiple physicians, by direct-to-consumer advertising that empowers patients to make their own health care decisions, and by greater public demand for rapid delivery of health care information.

Unsurprisingly, the increase in demand for electronic health information has evolved in association with direct-to-consumer advertising of pharmaceuticals, which has led the public to seek Internet prescribing. However, prescribing via the Internet has resulted in legal, professional, confidentiality, and safety breaches that threaten public safety.⁴ In response to e-medicine prescribing, the health care industry has appropriately raised serious concerns about the safety of prescribing over the Internet.

The researchers randomly selected 1,000 patient medical records from patients seeking ED treatment from Jan. 1, 2001 to Dec. 31, 2005. Half (500) of these patients used the online prescriber (the e-medicine group), and 500 consulted a physician (the traditional medicine group) for treatment.

Phosphodiesterase type 5 (PDE-5) inhibitors were chosen for this study for several reasons. This drug class is safe and effective for erectile dysfunction, regardless of etiology, with clear contraindications. Further, recommendations for using the drug have been generally established by expert opinion, rather than by evidence, leading to variance in prescribing.

Using statistical analyses, the researchers compared the safety of both approaches — e-medicine versus traditional medicine — in treating patients who have ED. The safety comparisons looked at a number of criteria, including prescription appropriateness, how often the prescribers used a diagnostic tool called the International Index of Erectile Questions (IIEQs) and the level of patient education provided by prescribers.

Evaluating both systems for these safety criteria, the researchers concluded that the e-medicine system “outperformed the traditional system in most of the safety variables tested.” One area the e-medicine system appeared to excel was patient education. The authors noted that 100 percent of the e-medicine clients received written manufacturer product information, and 75.2 percent of e-medicine clients received tailored electronic messages. In comparison, study data showed that no medication instructions were recorded for 51.8 percent of patients who received prescriptions via a traditional physician consultation.

CONCLUSION

A state-regulated e-medicine system was shown to be similar to a traditional multidisciplinary primary care system for all safety end points in prescribing PDE-5 inhibitors. The e-medicine system outperformed the traditional system in most of the safety variables tested. Additional studies of e-medicine vs traditional medicine systems are needed to confirm our results.

See Here for Full Text Original Article: Safety of Prescribing PDE-5 Inhibitors via e-Medicine vs Traditional Medicine

This is a post from Erectile Dysfunction Central

Safety of Internet Prescribed Erectile Dysfunction Drugs

• Safety of prescribing PDE-5 inhibitors via e-medicine vs traditional medicine.
• The role of the Internet in patient-practitioner relationships: findings from a qualitative research study.
• Internet-based prescription of sildenafil: a 2104-patient series.
• Drivers and barriers to seeking treatment for erectile dysfunction: a comparison of six countries.
• Internet websites selling herbal treatments for erectile dysfunction.

Tests in rats showed two erectile dysfunction drugs — Schering-Plough’s Levitra and Pfizer’s Viagra — helped carry a chemotherapy drug past the blood-brain barrier, the team at Cedars-Sinai Medical Centre in Los Angeles said.

Viagra (sildenafil) and Levitra (vardenafil) are known as PDE5 inhibitors because they block an enzyme, phosphodiesterase5, which interrupts a series of biochemical events that cause the decreased blood flow of erectile dysfunction. This laboratory rat study, published online ahead of print in the journal, found that similar biochemical interactions in the small vessels of the brain play a major role in the blood-brain tumor barrier, which impedes delivery of anti-tumor drugs into brain tumors. PDE5 inhibitors were found to open the barrier and increase drug transport in this early animal study.

“We chose adriamycin for this study because it is one of the most effective drugs against brain tumour cell lines in the laboratory but it has very little effect in animals and humans because it is unable to cross the blood-brain tumour barrier,” neurosurgeon Dr. Keith Black, who led the study, said in a statement.

“The combination of vardenafil and adriamycin resulted in longer survival and smaller tumour size,” Black said.

Although the researchers exposed the laboratory animals to doses of sildenafil and vardenafil that are comparable to the dose range approved for erectile dysfunction in humans, there were no detectable side effects in the rats, and neither drug increased transport of tracers into normal brain tissue.

The experiments were conducted at Cedars-Sinai Medical Center’s Maxine Dunitz Neurosurgical Institute and published in Brain Research.

This is a post from Erectile Dysfunction Central

Erectile Dysfunction drugs help treat brain tumors: study

• Transient global amnesia after intake of tadalafil, a PDE-5 inhibitor: a possible association?
• [Epileptic seizures and vardenafil]
• [Drug counterfeiting--the risk to the public health]
• Testing of brain-stem function in 134 patients complaining of impotence.
• The effects of chronic phosphodiesterase-5 inhibitor use on different organ systems.

Stadler TC, Becker AJ, Stief CG.

Urologische Klinik und Poliklinik der Universit?t M?nchen, Klinikum Grosshadern. thomas.stadler@med.uni-muenchen.de18510118 [PubMed - indexed for MEDLINE]

This is a post from Erectile Dysfunction Central

[Modern treatment of erectile dysfunction]

• [Management of erectile dysfunction in the cardiac patient]
• [Benign prostatic syndrome (BPS). Ablative treatments]
• [The childless couple in the doctor's office. Andrological history]
• [Diarrhea, tachycardia, impotence. When the nerves fail in diabetic patients]
• [Erectile dysfunction--problem solved with sildenafil (Viagra)?]

This is a post from Erectile Dysfunction Central

Re-education about erectile dysfunction.

• Masculinity and urogenital cancer: sensitive issues in health care.
• Men’s expectations of physicians in sexual health concerns.
• Coverage of erectile dysfunction therapies within the managed care community.
• The role of the Internet in patient-practitioner relationships: findings from a qualitative research study.
• UK department of health guidance on prescribing for impotence following the introduction of sildenafil: potential to contain costs in the average health authority district.