Impotence and Libido

Understanding The Effects Of Sildenafil Treatment On Erection Maintenance And Erection Hardness

2010-11-11T10:58:00.000+01:00

UroToday.com - In our recent article published in the Journal of Sexual Medicine, we used statistical modeling to make the first-reported estimate of the extent to which treatment of erectile dysfunction (ED) affects erection maintenance directly versus indirectly via erection hardness. Because erection maintenance (along with erection hardness) is a physiologic requirement for satisfactory sexual performance, our aim was to guide treatment goals toward optimizing erection maintenance and therefore achieving successful sexual intercourse.

Our statistical models (longitudinal modeling, mapping, and mediation modeling) explored the interrelationships among effective treatment of ED, erection hardness, and erection maintenance in men with ED, using patient reported outcomes from a multinational randomized, double-blind placebo-controlled trial of fixed-dose sildenafil (100 or 50 mg, 8 wk) with open-label extension of flexible-dose sildenafil (50 and 100 mg, 4 wk). Longitudinal models obtain measurements on the same individuals repeatedly through time to estimate within-individual changes in the response variable and to relate these changes to inter-individual differences in selected covariates (eg, treatment group). Mapping enables interpretation of an outcome of interest (eg, erection maintenance) in terms of a known outcome (eg, erection hardness). A mediation model seeks to identify and explain the mechanism that underlies an observed relationship between an independent variable (eg, treatment) and a dependent variable (eg, erection maintenance) via the inclusion of a mediator variable (eg, erection hardness). The mediator variable clarifies the nature of the interrelationships among variables. In our models, measures of interest included the Erection Hardness Score (EHS) to gauge erection hardness and the two maintenance items (items 4 and 5) on the International Index of Erectile Function (IIEF) to gauge erection maintenance (see Tables). Separate models were implemented for each of the two maintenance items.

Maintenance: International Index of Erectile Function
Item 4: During sexual intercourse, how often were you able to maintain your erection after you had penetrated (entered) your partner?
Item 5: During sexual intercourse, how difficult was it to maintain your erection to completion of intercourse?

Hardness: Erection Hardness Score
"How would you rate the hardness of your erection?"
0: Penis does not enlarge.
1: Penis is larger but not hard.
2: Penis is hard but not hard enough for penetration.
3: Penis is hard enough for penetration but not completely hard.
4: Penis is completely hard and fully rigid.

Longitudinal mean differences on the outcomes for sildenafil 100 and 50 mg vs. placebo (in the double-blind phase) were high (P<0.0001 for each), with large standardized effect sizes (>0.8).

For the mapping of erection hardness (EHS) onto maintenance (items 4 and 5 on IIEF), which included all available data and combined all treatment groups, correlations between EHS and IIEF items 4 and 5 ranged from 0.54 to 0.73 - and the mapping of the relationship between EHS and IIEF items 4 or 5 can be approximated as linear.

In our mediation model, which used data in the double-blind portion and pooled sildenafil into one active treatment, erection hardness was defined by the EHS and erection maintenance was defined by item 4 and, separately, by item 5 on the IIEF. The indirect effect of sildenafil treatment (vs. placebo) via erection hardness accounted for 55.4% (standard error [SE]=7.9%) and 43.1% (SE=6.8%) of the total effect of sildenafil treatment on IIEF maintenance item 4 and item 5, respectively, whereas the direct effect of treatment on IIEF items 4 and 5 was 44.6% (SE=7.9%) and 56.9% (SE=6.8%), respectively (P<0.0001 for each).

Sildenafil treatment significantly improved erection maintenance, a physiologic requirement for satisfactory sexual performance. According to our model, only approximately half of the effect of sildenafil on erection maintenance was estimated to be driven through direct effects. Rather, the effect of sildenafil on erection maintenance seems to be substantially driven by erection hardness. Therefore, achievement of optimal initial erection hardness appears to be an important treatment goal for enhancing erection maintenance and achieving successful ED treatment.

Written by Hubert IM Claes, MD, PhD,* Irwin Goldstein, MD,† Stanley E. Althof, PhD,‡ Michael M. Berner, MD,§ Joseph C Cappelleri, PhD, MPH,** Andrew G Bushmakin, MS,** Tara Symonds, PhD,†† and Gabriel Schnetzler, MD‡‡ as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations, etc., of their research by referencing the published abstract.

Department of Urology, University Clinics Gasthuisberg, Leuven, Belgium; †Sexual Medicine, Alvarado Hospital and Department of Surgery, University of California at San Diego, CA, USA; ‡ Miller School of Medicine, University of Miami, Miami, FL,USA; §University Hospital Medical Center, Freiburg, Germany; **Pfizer Inc, Global Research & Development, New London, CT, USA; ††Pfizer Ltd Outcomes Research, Sandwich, UK; ‡‡Pfizer International Operations, Paris, France

Acknowledgments:

The study on which this report is based was sponsored by Pfizer Inc. Editorial support was provided by Deborah M. Campoli-Richards, BSPHA, RPh, of Complete Healthcare Communications, Inc., and was funded by Pfizer Inc.

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Dangers Of Untreated Erectile Dysfunction

2010-07-22T08:54:00.000+02:00

Research carried out by a visiting professor at the University of Hertfordshire has found that up to six million European men fail to seek help for Erectile Dysfunction (ED) which could result in underlying cardiovascular disease going undetected.

According to Professor Mike Kirby, a Visiting Professor at the University's Health and Human Sciences Research Institute, who has just published a paper in The Journal for Sexual Medicine, ED is a highly prevalent condition affecting more than half of men of over forty, of which under thirty per cent seek help, leaving the majority untreated.

In his research paper entitled: Characteristics, Behaviours, and Attitudes of Men Bypassing the Healthcare System When Obtaining Phosphodiesterase Type 5 Inhibitors, Professor Kirby describes how he and his co-researchers conducted a large observational study among 11,889 subjects across Europe to assess how sexually active men in the general population obtained a phosphodiesterase type 5 inhibitors (PDE5is), which is the first-line treatment option for ED.

They found that three out of ten men who use a PDE5i obtained it without interaction with a healthcare provider and accessed it via unregulated Internet sites.

"Our research indicates that in Europe approximately six million men may be currently bypassing the healthcare system to obtain a PDE5i," said Professor Kirby. "They not only expose themselves to the risks of using unapproved and uncontrolled products, but also miss important information on product use and contraindications. Furthermore, they miss the opportunity to receive appropriate health information regarding the importance of medical follow-up for unrecognised cardiovascular disease often seen in combination with ED."

Source: Hertfordshire University

Sexual dysfunction in obese and overweight women

2010-06-01T00:13:00.002+02:00

Both overweight and obesity have been identified as risk factors for sexual dysfunction in men, but the relationship between sexual function and amount of body fat in females is still obscure.
There are few reported studies in women assessing the relationship between female sexual function index (FSFI) and body weight. The aim of this study was to identify the frequency of female sexual dysfunction (FSD) among obese and overweight women.

A total of 45 obese and overweight and 30 age-matched voluntary healthy women serving as a control group were evaluated by a detailed medical and sexual history, including the FSFI questionnaire.
Serum prolactin, cortisol, luteinizing hormone (LH), follicle-stimulating hormone (FSH), dehydroepiandrosterone-SO4 (DHEA-S), testosterone, estradiol and sex hormone-binding globulin (SHBG) levels were measured. No significant difference was observed between controls and patients in terms of the FSH, LH, estradiol, free thyroxine and thyrotropin (TSH), testosterone and DHEA-S levels. The comparison of total FSFI scores between patients and controls showed no significant difference (P=0.74).
As the FSFI score of 26.55 indicated FSD, 86% of obese patients and 83% of controls were considered to have sexual dysfunction.
The mean total FSFI score was 22.1±4.3 for obese patients and 23.1±3.7 for healthy women. FSFI scores were not correlated with any of the anthropometric measurements (body mass index (BMI), waist-to-hip ratio (WHR) and fat percent).
The levels of total testosterone and DHEA-S were not correlated with total FSFI scores.

We found a significant negative correlation between BMI and orgasm (P=0.007, r=−0.413). Satisfaction was also negatively correlated with BMI (P=0.05, r=−0.305) and weight (P=0.03, r=−0.326). Testosterone levels were negatively correlated with only satisfaction domain scores of FSFI (P=0.01, r=−0.385).

We found that 86% of obese women and 83% of controls had sexual dysfunction. Although obesity does not seem to be a major contributor to sexual dysfunction, it affects several aspects of sexuality.

source: Nature-Received 1 December 2009; Revised 5 April 2010; Accepted 8 April 2010 Published online 20 May 2010.

G F Yaylali1, S Tekekoglu2 and F Akin1

1Department of Endocrinology and Metabolism, Faculty of Medicine, Pamukkale University, Denizli, Turkey
2Department of Internal Medicine, Faculty of Medicine, Pamukkale University, Denizli, Turkey
Correspondence: Dr GF Yaylali, Department of Endocrinology and Metabolism, Faculty of Medicine, University of Pamukkale, Kinikli Campus, 20070, Denizli, Turkey. E-mail: guzinf@gmail.com

For Patients With Erectile Dysfunction (ED) , Treatment With Oral Medications Demonstrates Significant Improvements In Sexual Intercourse And ED

2010-04-08T08:34:00.002+02:00

The American College of Physicians (ACP) has issued recommendations for the treatment of erectile dysfunction (ED). ACP, the nation's largest medical specialty organization and second-largest physician group, strongly recommends that physicians initiate therapy with an oral phosphodiesterase type 5 (PDE-5) inhibitor in men who seek treatment for ED unless they have a contraindication to PDE-5 inhibitors, such as nitrate therapy.

As for which PDE-5 inhibitor to use, ACP recommends that physicians base the choice on the individual preferences of patients including ease of use, cost of medication, and adverse effects profile.
"The evidence is insufficient to compare the effectiveness or adverse effects of different PDE-5 inhibitors for the treatment of ED because there were only a few head-to-head trials," explained the lead author of the guideline, Amir Qaseem, MD, PhD, MHA, FACP, senior medical associate at the American College of Physicians.

The guideline authors analyzed evidence gathered from 130 randomized controlled trials that evaluated oral PDE-5 inhibitors alone or combined. Treatment with a PDE-5 inhibitor resulted in statistically significant and clinically relevant improvements in sexual intercourse and erectile function in patients with ED, regardless of the cause (e.g., diabetes, depression, prostate cancer) or baseline severity. The magnitude of benefit increased with severity of ED.

Overall, the evidence showed that PDE-5 inhibitors were relatively well-tolerated and were associated with mild or moderate adverse effects, such as headaches, flushing, upset stomach, and runny nose.

ACP does not recommend for or against routine hormonal blood tests or treatment in the management of patients with ED because the evidence is inconclusive about the effectiveness in patients with low testosterone levels. Physicians should individualize decisions to measure hormone levels based on the clinical symptoms (e.g., decreased libido, premature ejaculation, fatigue, etc.) and physical findings (for example, testicular atrophy, muscle atrophy) that suggest hormonal abnormality.
"Hormonal Testing and Pharmacologic Treatment of Erectile Dysfunction: A Clinical Practice Guideline from the American College of Physicians" appears on the Web site of Annals of Internal Medicine (http://www.annals.org/)

About ED
ED can be a persistent inability to achieve or maintain penile erection sufficient for satisfactory sexual performance, an inconsistent ability to do so, or a tendency to sustain only brief erections. These variations make defining ED and estimating its incidence difficult. Estimates range from 15 million to 30 million in the U.S., depending on the definition used. Estimates from the National Health and Nutrition Survey suggested that the cost of treatment of ED in the U.S. could reach $15 billion if all men sought care.

ED is a common disorder of male sexual function and affects all age groups especially individuals with advanced age, diabetes, vascular diseases, psychiatric disorders, and possibly hypogonadism (low testosterone). ED may be caused by chronic diseases such as obesity, hypertension, dyslipidemia, cardiovascular disease, or smoking; medications; psychosocial factors; or hormonal abnormalities.
ED lasting for three months is considered a reasonable length of time to warrant evaluation and consideration of treatment.

Source: Steve Majewski
American College of Physicians

Urologist Dr. J. Francois Eid, MD Warns Against The Dangers Of Online Herbal Remedies For Erectile Dysfunction (ED)

2010-03-05T11:04:00.000+01:00

News reports coming out of the UK and Australia show evidence of prescription ingredients in many "natural" herb remedies sold on the Internet to treat erectile dysfunction (ED). These popular online supplements, which claim to consist only of homeopathic ingredients, are often improperly labeled and may actually contain dangerous ingredients. Dr. J. Francois Eid, director and founder of Advanced Urological Care in New York City, is concerned about this practice, especially since, in his experience, men with erectile dysfunction choose to suffer in silence rather than seek medical help for their condition.

The Medicines and Healthcare products Regulatory Agency (MHRA), the governing body for medication sales in the United Kingdom, tested 138 unlicensed ED treatments and found random, uncontrolled quantities of prescription ingredients in almost two-thirds of them. "Erectile dysfunction is a condition that is easily treatable in a variety of safe ways under the careful watch of a physician," said Dr. Eid, who has successfully treated ED patients over the last 22 years of practice. "However, since many men are embarrassed by ED, they look for help elsewhere and expose themselves to serious problems such as heart attack, stroke and severe hypertension."

Even more troubling is the fact that many of these "natural" products falsely claimed to be approved by the Food and Drug Administration. In actuality, more than one-third of the supplements that claim to treat ED or enhance sexual performance contain sildenafil, the active ingredient in Viagra, or vardenafil, the active ingredient in Levitra. Advertisements for Viagra, Levitra and other drugs for ED warn of the dangers of taking these drugs if you are also on prescription medications that contain nitrates. Nitrates are prescribed for conditions such as angina or coronary artery disease in patients that also may suffer from ED.

The combination of nitrates with the active ingredients in ED medications could potentially lower blood pressure to an unsafe level. Under a physician's care, blood pressure levels are carefully monitored. However, an online consumer of these supplements, not approved by a doctor, will be unaware of the Viagra- or Levitra-type of ingredients in these supplements, which could either present a serious problem or exacerbate a pre-existing condition.

Conversely, according to Bloomberg News, Pfizer's Viagra patent was partially rejected after it was discovered that the active ingredient [sildenafil citrate] was too similar to a Chinese herb known as Horny Goat Weed. An appeals board upheld the decision that "an element, or claim, of the patent for a method of treating male erectile dysfunction didn't cover a new invention." The patent claim was part of an infringement suit Pfizer filed in 2002 against Eli Lilly over its rival Cialis drug. The decision on that part of the patent will now go into appeals.

So should men go with the prescription drugs or the supplements? "The take-away message is that many men may not realize that some medicines or supplement may actually cause or worsen ED," said Dr. Eid. "Only your physician can determine the best course of medication and mitigate these side effects successfully." A world-renowned surgeon and a foremost specialist in urological prosthetic reconstruction, Eid believes that, with so many approved treatment options for ED, there is no reason for men to take unnecessary risks with ED. "Many advances in this area have resulted in performance guarantees of at least 20 years, allowing men to have full control of their durability, rigidity and reliability," said Dr. Eid.

ED is not a problem that will just correct itself, which is why Dr. Eid advises anyone suffering from the condition to not take matters into their own hands and, instead, consult with their doctor. Eid initially treats ED by suggesting exercise, diet, avoiding tobacco and alcohol, before prescribing medications or more comprehensive treatments, such as pumps or implants (IPP). Eid believes in the efficacy of IPP's, since he has performed more internal penile implant surgeries than anyone in the world, over 300 per year. Eid developed the "No-Touch" penile prosthesis surgery, which boasts an infection rate of less than one percent. His practice, Advanced Urological Care, is dedicated to erectile dysfunction treatment and urinary incontinence treatment.

"ED is very under-reported because many men choose to suffer in silence, but this can wreak havoc not only on your health but on your relationships and self-esteem," says Dr. Eid. In many instances, investigating one problem might uncover another underlying health concern, such as cardiovascular disease, which is important especially when dealing with ED. This is why medical intervention is so important. "The first step in any difficult situation is acknowledging there is a problem and then deciding to take care of it, the right way," concluded Eid.

Source
Advanced Urological Care

NERI Research Findings Show That Erectile Dysfunction May Be Early Warning Of Future Cardiovascular Disease

2010-01-22T18:20:00.002+01:00

In the first study of its kind, New England Research Institutes, Inc. (NERI) in collaboration with the Division of Cardiology, San Francisco General Hospital and the University of California, San Francisco tested whether erectile dysfunction (ED) can be used to reclassify patients according to their future risk of developing cardiovascular disease (CVD) beyond traditional risk factors (such as smoking, high blood pressure, high cholesterol, etc).
Results of the 12-year research study are published in the January 26, 2010 issue of the Journal of the American College of Cardiology and show that ED may be a warning sign of a future cardiovascular event like heart attack, stroke, atherosclerosis, coronary artery bypass graft surgery, and congestive heart failure. However, while ED is significantly related to CVD independent of traditional risk factors, it does not improve the prediction of who will and will not develop CVD beyond these risk factors.
"This is an important study because it is the first to explicitly test whether ED can predict the future development of CVD beyond a predictive tool called the Framingham risk score," said Andre Araujo, PhD, Director of Epidemiology at NERI and lead researcher of the study. "Although the answer is no, this is not necessarily surprising given how strongly the Framingham risk score is related to CVD," said Araujo. "Our data indicate that ED is as strongly related to the development of CVD as the Framingham risk score."

The study followed 1,057 men (ages 40-70) from the Massachusetts Male Aging Study (MMAS) - a prospective observational study of aging, health, and endocrine and sexual function - over an average of 12 years. These men were free of diabetes and CVD at the start of their study participation. However, during the follow-up years, 261 new cases of CVD occurred. ED predicted the development of CVD, independent of age, traditional risk factors, and Framingham risk score. Men with ED showed a 40 percent higher risk of developing CVD compared to men without ED.

According to data from the National Health and Nutrition Examination Survey, ED affects approximately 18 million men aged 20 years or older in the US. ED and CVD share a number of risk factors like smoking, obesity, and high blood pressure. Physiologically, the link between ED and CVD can be explained by the fact that the penis and the heart are both vascular organs that are subject to atherosclerosis or thickening of the arteries. Since atherosclerosis affects the entire body, the small arteries in the penis can become blocked sooner than the larger arteries in the heart. Blocked arteries reduce blood flow which can result in a reduced ability to have an erection.
"Even though the study showed that ED does not improve risk prediction beyond the Framingham risk score, an ED assessment can be done at very low cost and presents no risk to patients (unlike other novel CVD screening tests)," said Araujo. "Previous work from our study shows that a simple single question ED measure correlates well with an independent physician's assessment. Therefore, health professionals should consider asking about ED in their older male patients," continued Araujo. "Also, when a patient presents with ED, health professionals should work the patient up for CVD as there may be a window of opportunity for men to improve their health before a CVD event occurs."

This work was supported by grants from the National Institute on Aging, the National Institute of Diabetes and Digestive and Kidney Disorders, and an unrestricted educational grant to NERI from Bayer Healthcare. The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation/approval of the manuscript.
Source
New England Research Institutes, Inc.

Modernizing The Treatment Of Sexual Dysfunction In Men

2009-12-29T19:45:00.000+01:00

Modern, couple-oriented treatment for male sexual dysfunction takes the psychosocial aspects of sex into account, as well as focussing on the purely physical aspects of the problem. The importance of this biopsychosocial approach, whether one looks at disorders of desire, arousal or orgasm, is supported by intercultural comparisons, among other data. But sexual dysfunction can also arise as a consequence of a variety of diseases and their treatments, such as depression or diabetes, or can even be an early warning sign of serious physical illness such as heart disease. Hence an interdisciplinary approach, drawing on both medical and psychological techniques and insights, is essential.
In last week's Deutsches Ärzteblatt International, Urologist Dirk Rösing and coauthors (Dtsch Arztebl Int 2009; 106[50]: 821-8) present an overview of current thinking and practice in the area of male sexual dysfunction.
The authors use research on prostate cancer to underline the place of one important new development in German sex therapy, a form of the internationally familiar "couples" therapy called "syndiastic" therapy. Questionnaire surveys to men with prostate cancer show that while the importance of the genital aspects of sexuality decreased in importance following radical surgery, the relationship and physical intimacy remained as important as before. "Syndiastic" sex therapy was introduced in Germany in 2004, and focussed for the first time explicitly on fundamental psychosocial needs, in a wider way, rather than purely on sexual function itself. Derived from a word Aristotle uses, meaning a disposition to "live in pairs" or "belonging," this approach differs importantly from some other somatic or psychological treatments which focus mainly on restoring sexual function. Instead, it aims to broaden the understanding of sexuality, extend the range of physical experience, and improve overall satisfaction within the relationship.
Source:
E. Bartholomaeus
Deutsches Aerzteblatt International

Viagra For Women? Drug Developed As Antidepressant Effective In Treating Low Libido

2009-11-18T10:01:00.000+01:00

The drug flibanserin, which was originally created as an antidepressant, is effective in treating women with low libido, pooled results from three separate clinical trials have found.

These trials were the first ever to test a therapy that works at the level of the brain to enhance libido in women reporting low sexual desire, said John M. Thorp Jr., M.D., McAllister distinguished professor of obstetrics and gynecology at the University of North Carolina at Chapel Hill School of Medicine and the principal investigator for North America in the studies.

"Flibanserin was a poor antidepressant," Thorp said. "However, astute observers noted that it increased libido in laboratory animals and human subjects. So, we conducted multiple clinical trials and the women in our studies who took it for hypoactive sexual desire disorder reported significant improvements in sexual desire and satisfactory sexual experiences.

"It's essentially a Viagra-like drug for women in that diminished desire or libido is the most common feminine sexual problem, like erectile dysfunction is in men," Thorp said.

Studies have shown that the prevalence of hypoactive sexual desire disorder in the U.S. ranges from 9 percent to 26 percent of women, depending on age and menopausal status. Flibanserin is currently an investigational drug and is available only to women taking part in clinical trials.

The results reported here were presented Monday, Nov. 16, at the Congress of the European Society for Sexual Medicine in Lyon, France. The presentation was given by Elaine E. Jolly, M.D., overall principal investigator and a professor at the University of Ottawa in Canada.

Jolly, Thorp and colleagues pooled data from four clinical trials of flibanserin conducted in the U.S., Canada and Europe. A total of 1,946 pre-menopausal women ages 18 and older were randomized to receive either flibanserin or placebo for 24 weeks, with 4 weeks of pre-treatment baseline measurement and 4 weeks of post-treatment follow-up.

Initially, four different dosing regimens were used in the trials: 25 milligrams twice a day, 50 milligrams once a day at bedtime, 50 milligrams twice a day and 100 milligrams once a day at bedtime. The dosing regimens totaling 50 milligrams a day were not effective while the regimens totaling 100 milligrams were. So, the results being reported are from only three of the four trials and are based on the 100 milligrams once a day dosing regimen only.

The trials measured mean changes from baseline on the following six variables as reported by the women each week: number of satisfying sexual events (SSE), electronic diary (eDiary) desire score, female sexual function index (FSFI) desire domain score, FSFI total score, female sexual distress scale-revised (FSDR-R), and FSDR-R Item 13 (which focuses specifically on desire/libido).

The researchers concluded that treatment with 100 milligrams of flibanserin once a day was associated with significant improvements versus placebo in the number of satisfying sexual events (SSE) reported, sexual desire (as measured by eDiary and FSFI desire domain), a reduction in distress associated with sexual dysfunction (as measured by FSDS-R and its Item 13), and sexual functioning as measured by FSFI.

"These results point to a novel approach to pharmacologic treatment of the sexual problem that plagues reproductive age women the most, and may over time prove to be an effective treatment without the side effects of androgen replacement therapy, which is the only treatment currently available," Thorp said.

The trials were funded by Boehringer Ingelheim Pharmaceuticals, the manufacturer of flibanserin.

Source
University of North Carolina at Chapel Hill School of Medicine

High levels of workplace exposure to Bisphenol-A may increase the risk of reduced sexual function in men

2009-11-13T23:15:00.001+01:00

High levels of workplace exposure to Bisphenol-A may increase the risk of reduced sexual function in men, according to a Kaiser Permanente study appearing in the journal Human Reproduction, published by Oxford Journals. [1]

The five-year study examined 634 workers in factories in China, comparing workers in BPA manufacturing facilities with a control group of workers in factories where no BPA was present. The study found that the workers in the BPA facilities had quadruple the risk of erectile dysfunction, and seven times more risk of ejaculation difficulty.

This is the first research study to look at the effect of BPA on the male reproductive system in humans. Previous animal studies have shown that BPA has a detrimental effect on male reproductive system in mice and rats.

Funded by the U.S. National Institute of Occupational Safety and Health, this study adds to the body of evidence questioning the safety of BPA, a chemical made in the production of polycarbonated plastics and epoxy resins found in baby bottles, plastic containers, the lining of cans used for food and beverages, and in dental sealants.

The BPA levels experienced by the exposed factory workers in the study were 50 times higher than what the average American male faces in the United States, the researchers said.

"Because the BPA levels in this study were very high, more research needs to be done to see how low a level of BPA exposure may have effects on our reproductive system," said the study's lead author. De-Kun Li, MD, Ph.D., a reproductive and perinatal epidemiologist at Kaiser Permanente's Division of Research in Oakland, Calif. "This study raises the question: Is there a safe level for BPA exposure, and what is that level? More studies like this, which examine the effect of BPA on humans, are critically needed to help establish prevention strategies and regulatory policies."

The researchers explained that BPA is believed by some to be a highly suspect human endocrine disrupter, likely affecting both male and female reproductive systems. This first epidemiological study of BPA effects on the male reproductive system provides evidence that has been lacking as the U.S. Food and Drug Administration, and various U.S. government panels have explored this controversial topic.

This study is the first of series of studies that examine the BPA effect in humans and are to be published by Dr. Li and his colleagues.

The study finding, Dr. Li also points out, may have implications of adverse BPA effects beyond male sexual dysfunction. Male sexual dysfunction could be a more sensitive early indicator for adverse BPA effects than other disease endpoints that are more difficult to study, such as cancer or metabolic diseases.

For this study, researchers compared 230 workers exposed to high levels of BPA in their jobs as packagers, technical supervisors, laboratory technicians and maintenance workers in one BPA manufacturing facility and three facilities using BPA to manufacture epoxy resin, in several regions near Shanghai, to a control group of 404 workers in the same city from factories where no BPA exposure in the workplace was recorded. The factories with no BPA exposure produced construction materials, water supplies, machinery, garments, textiles, and electronics. The workers from the two groups were matched by age, education, gender, and employment history.

Researchers gauged BPA levels by conducting spot air sampling, personal air sample monitoring and walk-through evaluations, by reviewing factory records and interviewing factory leaders and workers about personal hygiene habits, use of protective equipment, and exposures to other chemicals. A subset of workers also provided urine samples for assaying urine BPA level to confirm the higher BPA exposure level among the workers with occupational BPA exposure.

Researchers measured sexual function based on in-person interviews using a standard male sexual function inventory that measures four categories of male sexual function including erectile function, ejaculation capability, sexual desire, and overall satisfaction with sex life.

After adjusting for age, education, marital status, current smoking status, a history of chronic diseases and exposure to other chemicals, and employment history, the researchers found the BPA-exposed workers had a significantly higher risk of sexual dysfunction compared to the unexposed workers.

The BPA-exposed workers had a nearly four-fold increased risk of reduced sexual desire and overall satisfaction with their sex life, greater than four-fold increased risk of erection difficulty, and more than seven-fold increased risk of ejaculation difficulty.

A dose-response relationship was observed with an increasing level of cumulative BPA exposure associated with a higher risk of sexual dysfunction. Furthermore, compared to the unexposed workers, BPA-exposed workers reported significantly higher frequencies of reduced sexual function within one year of employment in the BPA-exposed factories.

Other authors on this study include: X. Weng, Ph.D., J.R. Ferber, MPH, and L.J. Herrinton of the Kaiser Permanente Division of Research; Z. Zhou, Ph.D., MD, Y. He, Ph.D., and T. Wu MD, Ph.D. of the Department of Occupational Health and Toxicology, School of Public Health & WHO Collaborating Center for Occupational Health, Fudan University, Shanghai, China; D. Qing, , M. Miao, PhD, J. Wang, Ph.D, Q. Zhu, MD, E. Gao, MD, MPH, Ph.D., and W. Yuan of Shanghai Institute of Planned Parenthood Research and National Population & Family Planning Key Laboratory of Contraceptive Drugs and Devices; and H. Checkoway, Ph.D. of Department of Environmental Health, University of Washington, Seattle.

[1] Occupational exposure to bisphenol-A (BPA) and the risk of self-reported male sexual dysfunction. Human Reproduction journal. doi:10.1093/humrep/dep381 http://www.oxfordjournals.org/news/dep381.pdf

Source: Danielle Cass
Kaiser Permanente

Potential Relationship Between Androgen Deficiency And Cardiovascular Disease

2009-09-29T10:11:00.001+02:00

Researchers from Boston University School of Medicine (BUSM) in collaboration with researchers from Lahey Clinic Northshore, Peabody, Mass., believe that androgen deficiency might be the underlying cause for a variety of common clinical conditions, including diabetes, erectile dysfunction, metabolic syndrome and cardiovascular disease (CVD). These findings appear in the September/October 2009 issue of the Journal of Andrology.

Androgens are a steroid hormone, such as testosterone, that controls the development and maintenance of male characteristics. In a number of studies, androgen deficiency has been linked to an increased mortality in men. Testosterone (T) is an anabolic hormone with a wide range of beneficial effects on men's health. However, according to the BUSM researchers, the therapeutic role of T in men's health remains a hotly debated issue for a number of reasons, including the purported risk of prostate cancer.

To evaluate the relationships between T deficiency and risk factors of CVD and to determine the implications of androgen deficiency in men with cardiovascular risk factors, the researchers performed a comprehensive literature search with the use of Pub Med from 1980 through 2008. Relevant articles pertinent to androgen deficiency and vascular disease were evaluated and it was determined that a relationship did exist between androgen deficiency and CVD.

"In view of the emerging evidence suggesting that androgen deficiency is a risk factor for CVD, androgen replacement therapy could potentially reduce CVD risk in hypogonadal men. It should be emphasized, however, that androgen replacement therapy should be done with very thorough and careful monitoring for prostate diseases," said lead author Abdulmaged M. Traish, MBA, PhD, a professor of biochemistry and urology as well as the director of Laboratories for Sexual Medicine, Institute for Sexual Medicine at BUSM.

To further elucidate the role of androgen deficiency in vascular disease, the researchers recommend large, long-term, double-blind, randomized, placebo-controlled clinical trials be carried out. "Although challenges might lie ahead regarding how data from such clinical trials are to be properly interpreted and whether long-term safety can be established with T supplementation, these findings warrant definite investigation into the beneficial role that androgens might have in preventing cardiovascular risk in androgen-deficient men," added Traish.

Source:
Gina DiGravio
Boston University Medical Center

Sexual side effects of Antidepressants

2009-08-01T10:53:00.003+02:00

Antidepressants often cause unpleasant side effects. Many of these side effects last only a few weeks and then go away on their own. Even if a side effect doesn't go away, you can learn ways to manage it. Don't stop taking your antidepressant or reduce the dosage without first talking to your doctor or mental health provider. Suddenly stopping can cause withdrawal-like health problems. Always tell your health care provider about your side effects, because some can be serious.

Sexual side effects
Sexual side effects include decreased desire (libido), erectile dysfunction, delayed ejaculation and decreased orgasm. These can last throughout treatment.
Selective serotonin reuptake inhibitors (SSRIs) are more likely to cause sexual side effects, particularly delayed orgasm or inability to achieve orgasm (anorgasmia).
Tricyclic antidepressants (TCAs) are more likely to cause erectile dysfunction.

Coping strategies

■Talk to your doctor about changing your dose.
■Consider a medication that requires only a once-a-day dose, and schedule sexual activity before taking that dose.
■Talk to your doctor about adding or switching to an antidepressant that may counteract these effects, such as bupropion (Wellbutrin, Wellbutrin SR, Wellbutrin XL).
■Talk to your doctor about taking a medication intended to directly treat sexual dysfunction.
■Talk to your doctor about a "drug holiday" — stopping medication for a day or so each week.

Source: Mayo Clinic

What you need to know about Erection Problems

2009-06-18T08:54:00.001+02:00

Some people can talk with their doctors about sex. Others feel that sex is private. They do not want to share details with anyone. But if you have problems getting or keeping an erection, you have good reasons to talk to a doctor: your health and your quality of life.
Erection problems used to be called "impotence." Now the term "erectile dysfunction" is more common. Sometimes people just use the initials ED.
ED can be a sign of health problems. It may mean your blood vessels are clogged. It may mean you have nerve damage from diabetes. If you don't see your doctor, these problems will go untreated.
Another reason to see your doctor is to treat ED itself. Your doctor can offer several new treatments. For many men, the answer is as simple as taking a pill. Other men have to try two or three options before they find a treatment that works for them. Don't give up if the first treatment doesn't work. Finding the right treatment can take time.

Points to Remember
• Erection problems may be a sign of health problems.
• A doctor can help you overcome erection problems.
• Smoking, being overweight, and avoiding exercise can contribute to erection problems.
• Most cases of ED have a physical cause, but counseling can help couples build a stronger relationship.
• Many men can take a pill to treat ED. These men should still treat the health conditions that caused ED.
• Taking a pill doesn't work for everybody.
• Men who take any of the medicines called nitrates should not take a pill to treat ED.

Recreational use of erectile dysfunction medication may decrease confidence in ability to gain and hold erections in young males

2009-01-02T23:26:00.002+01:00

Abstract.
Department of Psychology, Center of Excellence in Behavior Genetics, Åbo Akademi University, Turku, Finland

We aimed to estimate the frequency of recreational use of erectile dysfunction medication (EDM) and to identify any adverse effects on confidence in gaining and holding erections resulting from such use.
In addition, we explored differences in erectile function and sexual behavior between recreational and medicinal users of EDM to control for the possibility of recreational users having but not admitting erectile dysfunction.
A subset from the Genetics of Sex and Aggression population-based sample of 4428 males with a mean age of 29.51 (s.d.=6.77) years provided information on their use of EDM, erectile function during first intercourse and currently, sexual behavior and confidence in their ability to gain and hold erections.

There were 2.6% (n=115) recreational and 0.9% (n=39) medicinal users of EDM. Recreational users had currently significantly lower confidence in their erectile ability than non-users even though they had significantly better erectile function and significantly more unrestricted sexual behavior as well as had more confidence when initiating sexual activity.
More frequent use of EDM was associated with significantly less confidence in erectile ability among the recreational users.

We conclude that recreational users of EDM may be vulnerable for becoming psychologically dependent on pharmacologically induced erection.

With thanks to:
Department of Psychology, Center of Excellence in Behavior Genetics, Åbo Akademi University, Turku 20500, Finland

Are declining testosterone levels a major risk factor for ill-health in aging men?

2008-12-01T21:39:00.003+01:00

As men grow older, testosterone levels fall, with a steeper decline in unbound or free testosterone compared with total testosterone concentrations.
Lower testosterone levels have been associated with poorer cognitive function, and with impaired general and sexual health in aging men.
Recently, lower testosterone levels have been linked with metabolic syndrome and type II diabetes, both conditions associated with cardiovascular disease, and shown to predict higher overall and cardiovascular-related mortality in middle-aged and older men.
However, reverse causation has to be considered, as systemic illness may result in reduced testosterone levels.
Thus, the strength of these associations and the likely direction of causation need to be carefully considered. Furthermore, these conditions may overlap, for example aging, lower testosterone levels, erectile dysfunction and cardiovascular disease are interrelated.

Cross-sectional and longitudinal observational studies may be informative.
However, ultimately randomized controlled trials of testosterone therapy are needed to clarify its role in the maintenance of general and sexual health in aging men. Testosterone therapy should be considered in hypogonadal men who meet rigorous criteria for the diagnosis of androgen deficiency.
Additional consideration should be given to designing and testing interventions that may prevent or ameliorate the age-related decline in testosterone levels in men.

Source: 1School of Medicine and Pharmacology, University of Western Australia

Obesity and sexual dysfunction, male and female

2008-09-24T19:52:00.002+02:00

Abstract

Obesity has become a worldwide public health problem of epidemic proportions, as it may decrease life expectancy by 7 years at the age of 40 years: excess bodyweight is now the sixth most important risk factor contributing to the overall burden of disease worldwide.

Overweight and obesity may increase the risk of erectile dysfunction (ED) by 30–90% as compared with normal weight subjects. On the other hand, subjects with ED tend to be heavier and with a greater waist than subjects without ED, and also are more likely to be hypertensive and hypercholesterolemic.

The metabolic syndrome, characterized by a clustering of risk factors associated with insulin resistance and abdominal obesity, associates with ED.
Moreover, women with the metabolic syndrome have an increased prevalence of sexual dysfunctions as compared with matched control women.
Lifestyle changes aimed at reducing body weight and increasing physical activity induce amelioration of both erectile and endothelial functions in obese men. Moreover, preliminary evidence suggests that a Mediterranean-style diet might be effective in ameliorating sexual function in women with the metabolic syndrome.

Lifestyle changes, mainly focussing on regular physical activity and a healthy diet, are effective and safe ways to reduce cardiovascular diseases and premature mortality in all population groups; they may also prevent and treat sexual dysfunctions in both sexes.

With thanks to:
K Esposito1, F Giugliano2, M Ciotola1, M De Sio2, M D'Armiento2 and D Giugliano2

1. 1Division of Metabolic Diseases, Department of Geriatrics and Metabolic Diseases, University of Naples SUN, Naples, Italy
2. 2Division of Urology, Department of Geriatrics and Metabolic Diseases, University of Naples SUN, Naples, Italy

The prevalence of erectile dysfunction in heart failure patients by race and ethnicity

2008-08-14T15:07:00.001+02:00

Abstract

Erectile dysfunction(ED)is a common problem in male patients with heart failure(HF).
However,no study was found that estimates the prevalence of ED by US ethnic groups with HF.

The division of Cardiology, miller school of Medicine, University of Miami, USA, conducted an observational, cross-sectional study of patients enrolled in a HF disease management program in two sites Louisiana (N=329; 178 white, 99 black) and Florida (N=52; Hispanic).
All male patients with an ejection fraction 40% were included.
The Sexual Health Inventory for Men was used to estimate the prevalence of ED.
Overall prevalence of ED was 89% and ED severity did not vary by race/ethnic group.

Race/ethnic group differences were found for age, New York Heart Association functional classification, and blood pressure.
Hispanic patients had the lowest unadjusted and adjusted prevalence rate of ED (81, 85%) compared to Black (90, 95%) and White (91, 92%) patients.
There is a high prevalence of ED in Hispanic, Black and White ethnic groups with HF.

Ejaculatory Disorders

2008-07-23T13:49:00.002+02:00

Many conditions, drugs and environmental factors may affect seminal emission.
Organic causes of seminal emission disorders include various surgical procedures.
The most common ejaculation disorders are:
premature ejaculation, retrograde ejaculation, retarded ejaculation and anejaculation:

Retrograde ejaculation, where the ejaculate is directed backwards into the bladder, may be caused by true or functional sympathectomy, bladder neck incompetence due to organ disruption, diseases and certain drugs (e.g. methyldopa, phenoxybenzamine, prazosin, clozapine and thioridazine).
Retarded ejaculation may have an organic cause (e.g. certain diseases, surgical interventions, neurological and endocrinological factors, and drugs such as dopamine antagonists, antidepressants and anxiolytics), but is often related to psychological factors, in particular anger or resentment towards women.
Anejaculation is classified as primary, when ejaculation has never been experienced, or secondary, when normal ejaculation has preceded its onset.
Causes include psychological factors (e.g. a sexually repressive upbringing, gender confusion, anxiety, marital problems, fear of causing pregnancy) and organic causes such as prostatic and bladder neck surgery, diabetes mellitus, spinal cord injury and posterior urethral stricture.
Premature ejaculation is the most common male sexual disorder, and affects more than 30% of men.
Criteria for defining premature ejaculation include failure to achieve orgasm by the partner,duration of intercourse until ejaculation, number of intravaginal thrusts until ejaculation.
Premature ejaculation is further classified as being:
primary (from the first sexual experience)
secondary (when normal sexual functioning precedes onset)

Treatment of premature ejaculation includes pharmacological therapy and, very limited , surgical procedures.
Some treatment that have provided some benefit in premature ejaculation include:
-dopamine antagonists (e.g. antipsychotics such as pimozide, sulpiride, haloperidol, chlorpromazine and thioridazine)
-selective serotonin reuptake inhibitor antidepressants (e.g. fluoxetine, sertraline and paroxetine)
-some tricyclic anti- depressants (e.g. clomipramine), anxiolytics (e.g. chlordiazepoxide, lorazepam and alprazolam), phenoxybenzamine, topical anesthetics
-various other preparations such as the herbal formulation `SS-cream'.

Full discussion of the history with spouses should be undertaken to arrive at a correct diagnosis and to evaluate the efficacy of treatment.

Regular Intercourse Protects Against Erectile Dysfunction

2008-07-14T17:59:00.003+02:00

Abstract

Background

Erectile dysfunction is common among men aged more than 60 years.
Its cause involves both physiologic and psychosocial factors.

Methods
To evaluate the effects of coital frequency on subsequent risk of erectile dysfunction, data were analyzed from a population-based 5-year follow-up study that was conducted in Pirkanmaa, Finland, using postal questionnaires.
Assessment was based on the 5-item version of the validated International Index of Erectile Function. Men with erectile dysfunction at entry were excluded from the analysis.
The study sample consisted of 989 men aged 55 to 75 years (mean 59.2 years).
The most common comorbidities were hypertension (32%), heart disease (12%), depression (7%), diabetes (4%,) and cerebrovascular disorder (4%).

Results
The overall incidence of moderate or complete erectile dysfunction was 32 cases per 1000 person-years (95% confidence interval [CI], 27-38). After adjustment for comorbidity and other major risk factors, men reporting intercourse less than once per week at baseline had twice the incidence of erectile dysfunction compared with those reporting intercourse once per week (79 vs 33/1000, incidence rate ratio 2.2, 95% CI, 1.3-3.8). The risk of erectile dysfunction was inversely related to the frequency of intercourse. No relationship between morning erections and incidence of moderate or severe erectile dysfunction was found.

Conclusion
Regular intercourse protects against the development of erectile dysfunction among men aged 55 to 75 years. This may have an impact on general health and quality of life; therefore, doctors should support patients' sexual activity.
published online 05 June 2008.

With thanks to:
American Journal of Medicine
Elsevier

Androgen Deficiency May Accompany Erectile Dysfunction

2008-05-24T17:52:00.001+02:00

NEW YORK (Reuters Health) May 12 - Androgen deficiency is quite common in men with erectile dysfunction (ED) and is associated with age and hypercholesterolemia among other factors, according to Minneapolis-based researchers.
"There is a growing awareness that sexual dysfunction may be a symptom of underlying health issues in a man, such as cardiovascular disease or diabetes," senior investigator Dr. Manoj Monga told Reuters Health.
In the April issue of Urology, Dr. Monga and colleagues at the University of Minnesota note that ED and androgen deficiency in aging men often overlap, and to gain further information on the matter, they retrospectively reviewed data on 2794 men with ED for whom testosterone levels were available. They ranged in age from 25 to 80 years.
Some 7% of the men had a testosterone level of less than 200 ng/dL, and 23% had levels below 300 ng/dL. In all, 47% of men had levels below 400 ng/dL.
The team found a sharp increase in hypogonadism in men aged 45 to 50 years. Beyond that point, there was a plateau in prevalence until at least the age of 80 years.
Prostate-specific antigen and creatinine levels did not affect testosterone. However, the team found that age, the presence of uncontrolled diabetes, high total cholesterol, and anemia all correlated with significantly decreased testosterone levels.
Dr. Monga concluded, "Our study suggests that even though we are now in an age where effective oral medical therapies for erectile dysfunction exist," men with this complaint "should undergo a complete health check, including a hormonal evaluation."
Urology 2008;71:693-697.
________________________________________

Reuters Health Information 2008. © 2008 Reuters Ltd.

FDA Warns of "Natural" ED Supplements

2008-03-28T23:18:00.001+01:00

March 28, 2008 — The FDA is warning consumers not to buy or use "Blue Steel" or "Hero" dietary supplements promoted and sold online for erectile dysfunction (ED) treatment.

Those products are unapproved drugs that haven't proven their safety or effectiveness, and they contain unapproved chemicals similar to sildenafil, Viagra's active ingredient, according to the FDA.

Those chemicals, which aren't noted on the Blue Steel and Hero product labels, "may dangerously affect a person's blood pressure level," an FDA news release states.

"Because these products are labeled as 'all-natural dietary supplements,' consumers may assume that they are harmless and pose no health risk," says Janet Woodcock, MD, director of the FDA's Center for Drug Evaluation and Research. "But an unsuspecting consumer with underlying medical issues may take these products without knowing that they can cause serious side effects and interact in dangerous ways with drugs that a consumer is already taking."

The undeclared ingredients in these products could interact with nitrates found in some prescription drugs (such as nitroglycerin) and can lower blood pressure to dangerous levels.

People with diabetes, high blood pressure, high cholesterol, or heart disease often take nitrates. ED is a common problem in men with these medical conditions. Because they may have been advised against taking ED drugs, these men may seek products like Blue Steel and Hero because the products are marketed as "all natural" or as not containing the active ingredients in approved ED drugs, the FDA notes.

The FDA advises people who have used either of these products to discontinue use and consult their health care professional if they have experienced any adverse events that they feel are related to the use of these products.

Consumers or health care professionals can report adverse events to the FDA's MedWatch program by phone at 800-FDA-1088 or on the FDA's web site.

The FDA recommends that consumers talk to their health care professional about FDA-approved treatments for erectile dysfunction. The FDA also says it may take further regulatory actions to protect consumers from these illegal products.

Blue Steel is sold in bottles containing 10 blue capsules or blister packs containing two blue capsules. Hero is sold in blister packs containing two blue capsules.

SOURCE: News release, FDA.

New Ebook about impotence and libido loss.

2007-08-10T09:36:00.002+02:00

Recently a new Ebook has been published.
This Ebook is about impotence and libido loss.
It is of very high informational quality, still very easy to understand.
If you like to understand what ED and libido-loss is, read this eBook.

Association of body weight with sexual function in women

2007-04-02T11:33:00.001+02:00

Sexual difficulties in women appear to be widespread in society; the relationship between female sexual function and obesity is unclear.
This study aimed to investigate the relationship between body weight, the distribution of body fat and sexual function in women.

Fifty-two, otherwise healthy women with abnormal values of female sexual function index (FSFI) score (23) were compared with 66 control women (FSFI >23), matched for age and menopausal status.
All women were free from diseases known to affect sexual function.

FSFI strongly correlated with body mass index (BMI) (r=–0.72, P=0.0001), but not with waist-to-hip ratio (r=–0.09, P=0.48), in women with sexual dysfunction.
Of the six sexual function parameters, desire and pain did not correlate with BMI, while arousal (r=–0.75), lubrication (r=–0.66), orgasm (r=–0.56) and satisfaction (r=–0.56, all P<0.001) did. FSFI score was significantly lower in overweight women as compared with normal weight women, while cholesterol and triglyceride levels were higher.
On multivariate analysis, both age and BMI explained about 68% of FSFI variance, with a primacy of BMI over age (ratio 4:1).

In conclusion, obesity affects several aspects of sexuality in otherwise healthy women with sexual dysfunction.

K Esposito1, M Ciotola1, F Giugliano3, C Bisogni2, B Schisano1, R Autorino3, L Cobellis2, M De Sio3, N Colacurci2 and D Giugliano1
1Department of Geriatrics and Metabolic Diseases, University of Naples SUN, Naples, Italy
2Department of Gynecology, Obstetrics and Reproduction, University of Naples SUN, Naples, Italy
3Division of Urology, University of Naples SUN, Naples, Italy

source: International journal of Impotence Research advance online publication 8 February 2007; doi: 10.1038/sj.ijir.3901548

Erectile Dysfunction

2007-02-14T17:50:00.002+01:00

Erectile dysfunction (ED) or impotence is a sexual dysfunction characterized by the inability to develop or maintain an erection of the penis. There are various underlying causes, such as diabetes, many of which are medically reversible.

The causes of erectile dysfunction may be physiological or psychological. Psychological impotence can often be helped by almost anything that the patient believes in; there is a very strong placebo effect.
Due to its embarrassing nature and the shame felt by sufferers, the subject was taboo for a long time, and is the subject of many urban legends. Folk remedies have long been advocated, with some being advertised widely since the 1930s. The introduction of perhaps the first pharmacologically effective remedy for impotence, sildenafil (trade name Viagra), in the 1990s caused a wave of public attention, propelled in part by the newsworthiness of stories about it and heavy advertising.
The Latin term impotentia coeundi describes simple inability to insert the penis into the vagina. It is now mostly replaced by more precise terms.

Medical symptoms
Erectile dysfunction is characterized by the inability to maintain an erection. Normal erections during sleep and in the early morning suggest a psychogenic cause, while loss of these erections may signify underlying disease, often cardiovascular in origin. Other factors leading to erectile dysfunction are diabetes mellitus (causing neuropathy) or hypogonadism (decreased testosterone levels due to disease affecting the testicles or the pituitary gland).
Medical diagnosis
There are no formal tests to diagnose erectile dysfunction. Some blood tests are generally done to exclude underlying disease, such as diabetes, hypogonadism and prolactinoma. Impotence is also related to generally poor physical health, poor dietary habits, obesity, and most specifically cardiovascular disease such as coronary artery disease and peripheral vascular disease.
A useful and simple way to distinguish between physiological and psychological impotence is to determine whether the patient ever has an erection. If never, the problem is likely to be physiological; if sometimes (however rarely), it is more likely to be psychological. The current diagnostic and statistical manual of mental diseases (DSM-IV) has included a listing for impotence.

Clinical Tests Used to Diagnose ED
Duplex ultrasound
Duplex ultrasound is used to evaluate blood flow, venous leak, signs of atherosclerosis, and scarring or calcification of erectile tissue. Injecting prostaglandin, a hormone-like stimulator produced in the body, induces erection. Ultrasound is then used to see vascular dilation and measure penile blood pressure. Measurements are compared to those taken when the penis is flaccid.
Penile nerves function
Tests such as the bulbocavernosus reflex test are used to determine if there is sufficient nerve sensation in the penis. The physician squeezes the glans (head) of the penis, which immediately causes the anus to contract if nerve function is normal. A physician measures the latency between squeeze and contraction by observing the anal sphincter or by feeling it with a gloved finger inserted past the anus. Specific nerve tests are used in patients with suspected nerve damage as a result of diabetes or nerve disease.
Nocturnal penile tumescence (NPT)
It is normal for a man to have five to six erections during sleep, especially during rapid eye movement (REM). Their absence may indicate a problem with nerve function or blood supply in the penis. There are two methods for measuring changes in penile rigidity and circumference during nocturnal erection: snap gauge and strain gauge.
Penile biothesiometry
This test uses electromagnetic vibration to evaluate sensitivity and nerve function in the glans and shaft of the penis. A decreased perception of vibration may indicate nerve damage in the pelvic area, which can lead to impotence.
Penile Angiogram
Invasive test - allows visualization of the circulation in the penis and is used during the repair of a priapism.
Dynamic Infusion Cavernosometry
(Abbreviated DICC) technique in which fluid is pumped into the penis at a known rate and pressure. It gives a measurement of the vascular pressure in the corpus cavernosum during an erection. To do this test, a vasodilator like prostaglandin E-1 is injected to measure the rate of infusion required to get a rigid erection and to help find how severe the venous leak is.
Corpus Cavernosometry
Cavernosography is an adjunct to Dynamic Infusion Cavernosometry, where a contrast material is injected and then it is x-rayed to visualize any leakage.
Digital Subtration Angiography
In DSA, the images are acquired digitally. The computer creates a mask from lower-contrast x-rays of the same area and digitally isolates the blood vessels (this is done manually through darkroom masking with traditional angiography).
Magnetic resonance angiography (MRA)
This is similar to magnetic resonance imaging. Magnetic resonance angiography uses magnetic fields and radio waves to provide detailed images of the blood vessels. Doctors may inject a "contrast agent" into the patient's bloodstream that causes vascular tissues to stand out against other tissues. The contrast agent provides for enhanced information regarding blood supply and vascular anomalies. Aside from the IV used to introduce the contrast material into the bloodstream, magnetic resonance angiography is noninvasive and painless.

Pathophysiology
Penile erection is managed by two different mechanisms. The first one is the reflex erection, which is achieved by directly touching the penile shaft. The second is the psychogenic erection, which is achieved by erotic stimuli. The former uses the peripheral nerves and the lower parts of the spinal cord, whereas the latter uses the limbic system of the brain. In both conditions an intact neural system is required for a successful and complete erection. Stimulation of penile shaft by the nervous system leads to the secretion of nitric oxide (NO), which causes the relaxation of smooth muscles of corpora cavernosa (the main erectile tissue of penis), and subsequently penile erection.
Additionally, adequate levels of testosterone (produced by the testes) and an intact pituitary gland are required for the development of a healthy male erectile system. As can be understood from the mechanisms of a normal erection, impotence may develop due to hormonal deficiency, disorders of the neural system, lack of adequate penile blood supply or psychological problems.

Restriction of blood flow can arise from impaired endothelial function due to the usual causes associated with coronary artery disease, but can also include causation by prolonged exposure to bright light or chronic exposure to high noise levels.

A few causes of impotence may be iatrogenic (medically caused). Various antihypertensives (medications intended to control high blood pressure) and some drugs that modify central nervous system response may inhibit erection by denying blood supply or by altering nerve activity. Psychiatric medications, especially SSRIs have been shown to cause erectile dysfunction in patients, both males and females. Although usually reversible, these sexual side effects can, in rare cases, last for months or years or permanently after the drug has been completely withdrawn. This disorder is known as Post SSRI Sexual Dysfunction.
Surgical intervention for a number of different conditions may remove anatomical structures necessary to erection, damage nerves, or impair blood supply.Complete removal of the prostate gland or external beam radiotherapy of the gland are common causes of impotence; both are treatments for advanced prostate cancer. Some studies have shown that male circumcision may result in an increased risk of impotence,while others have found no such effect,and another found the opposite.
Excessive alcohol use has long been recognised as one cause of impotence, leading to the euphemism "brewer's droop," or "whiskey dick;" Shakespeare made light of this phenomenon in Macbeth.
A study in 2002 found that ED can also be associated with bicycling. The number of hours on a bike and/or the pressure on the penis from the saddle of an upright bicycle is directly related to erectile dysfunction.
Treatment
Treatment depends on the cause. Testosterone supplements may be used for cases due to hormonal deficiency. However, the cause is more usually lack of adequate penile blood supply as a result of damage to inner walls of blood vessels. This damage is more frequent in older men, and often associated with disease, in particular diabetes.
Treatments (with the exception of testosterone supplementation, where effective) work on a temporary basis: they enable an erection to be attained and maintained long enough for intercourse, but do not permanently improve the underlying condition.

ED can in many cases be treated by drugs taken orally, injected, or as penile suppositories. These drugs increase the efficacy of NO, which dilates the blood vessels of corpora cavernosa. When oral drugs or suppositories fail, injections into the erectile tissue of the penile shaft are extremely effective but occasionally cause priapism. When pharmacological methods fail, a purpose-designed external vacuum pump can be used to attain erection, with a separate compression ring fitted to the penis to maintain it. These pumps should be distinguished from other "penis pumps" (supplied without compression rings) which, rather than being used for temporary treatment of impotence, are claimed to increase penis length if used frequently, or vibrate as an aid to masturbation.
More drastically, inflatable or rigid penile implants may be fitted surgically. Implants are irreversible and costly.
All these mechanical methods are based on simple principles of hydraulics and mechanics and are quite reliable, but have their disadvantages.
In a few cases there is a vascular problem which can be treated surgically.
Uncontroversial treatments
PDE5 Inhibitors
The cyclic nucleotide phosphodiesterases constitute a group of enzymes that catalyze the hydrolysis of the cyclic nucleotides cyclic AMP and cyclic GMP. They exist in different molecular forms and are unevenly distributed throughout the body. These multiple forms or subtypes of phosphodiesterase were initially isolated from rat brain by Uzunov and Weiss in 1972 and were soon afterward shown to be selectively inhibited by a variety of drugs in brain and other tissues (Weiss,1975; Fertel and Weiss, 1976). The potential for selective phosphodisterase inhibitors to be used as therapeutic agents was predicted as early as 1977 by Weiss and Hait. This prediction has now come to pass in a variety of fields, one of which is in the pharmacologic treatment of erectile dysfunction.
One of the forms of phophodiesterase is termed PDE5. The prescription PDE5 inhibitors sildenafil (Viagra®), vardenafil (Levitra®) and tadalafil (Cialis®) are prescription drugs which are taken orally. They work by blocking the action of PDE5, which causes cGMP to degrade. CGMP specific phosphodiesterase type 5cGMP]] causes the smooth muscle of the arteries in the penis to relax, allowing the corpus cavernosum to fill with blood.
Vacuum pump
An external vacuum pump will produce an engorged penis with success approaching 90%; a penis ring will maintain this state, although it should be removed after not more than 30 minutes. The erection is not as rigid or hard as a natural erection; drugs or injections, when they work, may be preferable. Various studies show the degree of satisfaction of users and their partners to be vary variable, even when drugs and injections do not work; in one study, about 20% of men who tried a (high-priced) pump decided to proceed to purchase one. Other studies show higher percentages of satisfied users.
In some cases frequent use of a vacuum pump can eventually improve the degree of erection attainable without use of the pump. Claims of cheap "penis pumps" to permanently increase maximum penis size should be viewed with caution, however.
Some vacuum pumps, such as Osbon ErecAid, are sold at a higher price with 100% refund within 90 days to dissatisfied users, with a somewhat lower price with 50% refund guarantee. This pump is supported by medical insurance schemes, including the UK's NHS and US Medicare and private insurers. The better-known pumps sell for prices of around 200 GBP/400 USD (2006). There is at least one vacuum pump with rings which sells for around one-fifth of this price.
(Specific devices are mentioned for information only; mention should not be taken as endorsement).
Dopamine Receptor Agonist
Apomorphine acts mainly on D2-like receptors and is administered sublingually in the presence of sexual stimulation. Studies have been inconclusive with efficacy rates ranging from 48-55% to 9-38%.Currently, the use of apomorphine is limited to pateints with mild ED.
Inflatable implant
Rigid implant
Surgical treatment of certain cases

Controversial and unapproved treatments
Bremelanotide
The experimental drug Bremelanotide (formerly PT-141) does not act on the vascular system like the former compounds but allegedly increases sexual desire and drive in males as well as females. It is applied as a nasal spray. Bremelanotide allegedly works by activating melanocortin receptors in the brain. It is currently in Phase IIb trials.
hMaxi-K
hMaxi-K is a form of gene therapy using a plasmid vector that expresses the hSlo gene, that encodes the alpha-subunit of the Maxi-K channel. It has undergone phase I safety trials.
Ginseng
A double-blind study appears to show evidence that ginseng is better than placebo.
Enzyte
Enzyte is a product that has been advertised by saturation coverage on television channels such as CourtTV. However, the Center for Science in the Public Interest (CSPI) has filed a complaint with the Federal Trade Commission (FTC) about Enzyte for deceptive advertising. It is manufactured by Berkeley Nutritionals, which is alleged to be the subject of an investigation by the Attorney General of Ohio and the defendant in class-action lawsuits.
Enzyte is a supplement that claims to increase the male libido or frequency of erections of the penis. Commercials for Enzyte are shown regularly on television. These commercials feature a man named Bob who never stops smiling, apparently because he had taken Enzyte and improved the size of his sex organs. The commercials are riddled with symbolic phallic imagery, e.g. golf clubs, remarkably tall glasses of iced tea, and a hose spraying barely a trickle of water (carried by someone who doesn't use Enzyte).
The effectiveness of Enzyte is in dispute. Some medical professionals in fact advise against taking Enzyte, saying that it can lead to damage. The Center for Science in the Public Interest have urged the Federal Trade Commission to disallow further television advertising for Enzyte due to a lack of proper studies supporting claims. Enzyte maker Berkeley Premium Nutraceuticals, Inc., is currently under a class action lawsuit for false advertising.
Enzyte is said to contain: Tribulus terrestris; Yohimbe Extract; Niacin; Epimedium; Avena sativa; Zinc Oxide; Maca; Muira Pauma; Ginkgo biloba; L-Arginine; Saw Palmetto. Other ingredients: gelatin, rice bran, oat fiber, magnesium stearate, silicon dioxide.
Herbal and other alternative treatments
These are generally ineffective when tested blind, but may be useful for their psychological (placebo) effect: if a good result is expected, any highly praised, and often expensive, treatment can be effective. Reputable drugs can also benefit from the same effect.
Prelox Prelox is a Proprietary mix/combination of naturally occurring ingredients, L-arginine aspartate and Pycnogenol. In double blind tests carried out by Dr. Steven Lamm at New York University School of Medicine, 81.1% of men overall judged Prelox to be effective in improving their ability to engage in sexual activity.Prelox® for improvement of erectile function: A review European Bulletin of Drug Research, Volume 11, No. 3, 2003. Steven Lamm, Frank Schoenlau, Peter Rohdewald Whilst the supplements should be taken daily, the manufacturers claim that it brings the spontaneity back into ones' love life; unlike other products which must be remembered to be taken a fixed time before sexual activity.

What do we know.

2006-01-26T18:00:00.003+01:00

Studies show that an estimated 400 million men and women worldwide suffer from impotence and libido loss and that less than 10 percent of them seek treatment.
That is because centuries long the doctors had little to offer.
The last decades there have been large changes and nowadays good, effective treatment is available for nearly each sexual dysfunction.
As usual more focused on men than women.
And all those people need help? I don't think so!
Towards, my idea tendentious, reporting, sponsored by the pharmaceutical industry,the whole world is suffering and therefore new products becomes available.You can't live without! Your life has come to it's end. Not bad , but also short sighted.

Two recent Dutch studies have shown that with aging more men report problems, but at the same time men don’t experience the dysfunction as a “stand alone“ problem.
Conclusion: there are millions men with erectile dysfunction which has absolutely no problem. And we must not talk men and women into the problem also.

Causes of sexual dysfunction can be physical and psychological, you can read a lot of this on the internet.
Most common are diseases, which can be diagnosed, and problems in the relation, stress at work.
But what about this?
We like to stay and look and behave young, but with aging, it is well known that the erections become less hard, the ejaculations less powerful and less intense, libido loss occurs also.
Living habits can work also negatively. Drinks, much food, much smoke, little physical exercise.
Finally, also sicknesses, medication and environmental pollution can be responsible.
But there are large individual differences and that probably the character of the man and woman plays a very important role.
My recommendation: don’t let anyone talk you into a sexual dysfunction.

And if you feel the need for treatment, look further than only pills, which will affect your whole body.
Many new harmless, but effective aids are available out there these day’s. http://www.optipotency.com
Look for them, despite of the aggressive marketing of the rich pharmaceutical companies.
There is more out there. Let's help eachother to discover.

Good luck, be happy and healthy.