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Erect At Will Cures ED Summary


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Neuroimaging Studies Of Sexual Response

These studies have primarily examined responses to erotic films or photographs, and have reported activations across a wide range of cortical and subcortical areas involved in perception, attention, emotion and motivation, and physiological responses (Beauregard, Levesque, & Bourgouin, 2001 Holstege et al., 2003 Redoute et al., 2000 Stoleru et al., 1999 for a comprehensive review of neuroimaging studies focusing on male sexual responses, see Sumich, Kumari, & Sharma, 2003). More recently, attention has turned to investigating women's responses to sexual stimuli and to characterizing sex differences. Studies of nonhuman animals have identified several sex differences in brain regions that mediate reproductive behavior, which may provide clues to brain regions underlying sex differences in human sexual response. For example, the amygdala has long been known to play a role in primate sexual behavior, from landmark studies such as those of Kl ver and...

Erectile Dysfunction

Erectile dysfunction (ED), the inability to achieve or maintain a penile erection sufficient to permit satisfactory sexual intercourse, is estimated to affect over 100 million men worldwide, with a prevalence of 39 in those of 40 years.6 Its numerous causes include cardiovascular disease, diabetes mellitus and other endocrine disorders, alcohol and substance abuse, and psychological factors (14 ). While the evidence is not conclusive, drug therapy is thought to underlie 25 of cases, notably from antidepressants (SSRI and tricyclic), phenothiazines, cypro-terone acetate, fibrates, levodopa, histamine H2-receptor blockers, phenytoin, carbamazepine, allopurinol, indomethacin, and possibly 3-adrenoceptor blockers and thiazide diuretics. Sildenafil (Viagra) is a highly selective inhibitor of PDE5 (x 70 more so than isoenzymes 1,2,3 and 4 of PDE), which prolongs the action of cGMP, and thus the vasodilator and erectile response to normal sexual stimulation. Its emergence as an agent for...

Guideto Further Reading

2 Self-experimentation has always been a feature of clinical pharmacology. A survey of 250 members of the Dutch Society of Clinical Pharmacology evoked 102 respondets of whom 55 had done experiments on themselves (largely for convenience) (van Everdingen et al 1990 Lancet 336 1448). A spectacular example occurred at the 1983 meeting of the American Urological Association at Las Vegas, during a lecture on pharmacologically-induced penile erection, when the lecturer stepped out from behind the lectern to demonstrate personally the efficacy o) the technique (Zorgniotti A W 1990 Lancet 336 1200)

Psychosocial and Supportive Care

This is a period when sexuality, intimacy, and reproduction are central. A young adult is supposed to attract a mate and reproduce. However, the young adult with cancer may feel or look unattractive, may be uninterested in or unable to have sex, and may be infertile. A feeling of impotence can pervade.

Paraneoplastic Syndromes Of The Nervous System

Lambert-Eaton myasthenic syndrome (LEMS) This disorder is characterized by generalized weakness which worsens on exertion, starting from lower extremity and spreading to the upper limbs. Weakness affects more often proximal muscles and many patients complain of autonomic dysfunction such as dry mouth, blurred vision and impotence 33 . Peripheral neuropathy In most cancer patients peripheral neuropathy is not a consequence of paraneoplastic syndrome but rather of other causes, such as chemotherapy, nutritional or metabolic. The peripheral neuropathy which is paraneoplastic occurs in patients with anti-Hu antibodies and SCLC 32 . The polyneuropathy can be motor, sensory, mixed type or autonomic. The motor neuropathies include the Guillan-Barre syndrome which occurs more commonly in patients with Hodgkin's disease and a subacute motor neuropathy affecting the anterior horn cells of patients with lymphomas. The sensory neuropathies can be subacute and affect distal neurons or an acute...

Sexual function and cardiovascular drugs

All drugs that interfere with sympathetic autonomic activity, including diuretics, can potentially interfere with male sexual function, expressed as a failure of ejaculation or difficulty in sustaining an erection. Nevertheless, placebo-controlled trials have emphasised how common a symptom this is in the untreated male population (approaching sometimes 20-30 ). It is also likely that hypertension itself is associated with an increased risk of sexual dysfunction since loss of NO production by the vascular endothelium is an early feature of the pathophysiology of this disease. Laying the blame on antihypertensive medication is probably

Myths and Misconceptions

Myth 4 Erectile dysfunction (ED) is always caused by psychological problems. Truth Erectile dysfunction is a common problem in the healthy population, with around 10 of adult men being affected, and increasing with age. The most common cause of ED is so-called vas-culogenic erectile dysfunction, which is associated with the development of atherosclerosis. Accordingly diabetes, hypertension, hyperlipidemia, and smoking are all risk factors for the development of ED. Erectile dysfunction is often seen in conjunction with other manifestations of atherosclerosis such as cardiovascular, cerebrovascular, and peripheral vascular disease. Myth 5 Impotence and lack of sex drive always occurs when one has heart disease. Truth Both men and women can have a normal sex life after a cardiac event.

Molecular Basis For The Side Effects Of Anticholinergics

Many synthetic quaternary ammonium compounds may block acetylcholine at ganglia at high doses. Ganglionic-blocking agents cause impotence as a side effect. High doses of methantheline may also cause impotence, an effect rarely produced by pure antimuscarinic drugs and indicating ganglionic blockade. Toxic doses of quaternary ammonium compounds (e.g., menthantheline, propantheline, and oxyphenonium) block acetylcholine at the somatic neuromuscular junction and paralyze respiration.

Initial Evaluation

RC is a 43-yr-old man who presented without complaints for routine care. His past medical history is notable for seasonal allergic rhinitis and erectile dysfunction but is otherwise unremarkable. He has never smoked and eats a typical Western diet. He has a sedentary job but recently started exercising several days a week. He is concerned that his father died suddenly from an MI at the age of 60 his mother survived a stroke at the age of 68. His medications include fexofenadine as needed for allergies, and sildenafil as needed. He wants to know if he should start taking an aspirin every day.

Modulation of Pain by the Hypothalamic PituitaryAdrenal Axis

Mast Cell Crh Stress

During stress, the increased secretion of CRH and arginine vasopressin (AVP) into the hypophysial-portal system of the anterior pituitary enhances the synthesis and release of ACTH (Fig. 4), which can be demonstrated in both the cerebrospinal fluid and blood (74,75). Elevated ACTH content in blood, in turn, increases the synthesis and release of adrenal glucocorticoids, which act in synergy with catecholamines to produce lipolysis, glycoge-nolysis, and protein catabolism, resulting in increased blood glucose content, essentially providing a readily available energy source to aid in the stress response. The delivery of energy substrates is enhanced by increased blood flow as a result of glucocorticoid- and catecholamine-induced increases in cardiovascular tone. Prolonged exposure to elevated stress hormones, however, can present a risk. Glucocorticoids and catecholamines promote the suppression of anabolic processes, muscle atrophy, decreased sensitivity to insulin, and a risk of...

Screening for polyps and colorectal cancer

Cancer is low, ranging from 20 to 68 . In addition, because the DRE has a high rate of false positives, further testing by transrectal ultrasound or even biopsy is common. Many professional societies recommend annual DRE between the ages of 40 or 50 and 70. In contrast, the U.S. Preventive Health Services Task Force currently recommends against routine screening by DRE until there is more definitive evidence of increased survival from early detection and of decreased adverse effects from testing and even surgery (prostatectomy carries up to a 20 risk of impotence and a 5 risk of urinary incontinence). Instead, the Task Force advises clinicians to counsel all men requesting screening about the utility of testing and the benefits and harms of early detection and treatment.

Diabetes and Sexual Dysfunction

A clear physiological association between diabetes and male sexual dysfunction is well established. In a comprehensive review of the literature, Eretekin (1998) found ample research evidence for chronic progressive impotence directly related to diabetes mellitus. It is either neuropathic or vascular, or both. In some instances impotence may lead to the discovery of the disease. Another rare sexual dysfunction affecting 1 to 2 of diabetic men is retrograde ejaculation. However, some researchers have suggested that this problem may be more common than generally believed. Psychological factors, which until recent times were seen as critical in the explanation of sexual problems associated with diabetes, have lost considerable ground as physical explanations have emerged. compared to the hypertensive group (43.6 ), the authors warned that the concept of diabetic impotence was misleading and oversimplified. The diabetic men with sexual dysfunction constituted a heterogeneous group with...

Diabetic Neuropathy and Digestive System Dysfunction

Thesias over the limbs and trunk with spontaneous resolution usually occurring within a year. In 1974, Ellenberg reported on six patients with diabetic neuropathy who complained of profound weight loss and severe neuropathic pain. These patients were all males, chiefly in the sixth decade of life, had bilateral symmetrical peripheral neuropathy, severe emotional disturbance, anorexia, impotence, mild diabetes, simultaneous onset of neuropathy and diabetes, the absence of other specific diabetic complications, and a uniformly spontaneous recovery in about 1 year. Neurologic examination revealed severe muscle wasting and atrophy in all patients. Motor nerve conduction velocity studies and electromyographic studies corroborated the presence of neuropathy in all cases. Biopsies of muscle and nerve showed neu-rogenic atrophy in muscle and marked involvement of the nerves, with decrease of axon fibres. Ellenberg coined the term 'diabetic neuropathic

Prostate Cancer

SYMPTOMS Common symptoms of prostate cancer are a need to urinate frequently, especially at night difficulty starting urination or holding back urine inability to urinate weak or interrupted flow of urine painful or burning urination difficulty in having an erection painful ejaculation blood in urine or semen or, in advanced stages, frequent pain or stiffness in the lower back, hips, or upper thighs.

Penile Size

Forensic practitioners may be asked to provide evidence on the size of a defendant's penis in the flaccid state to support a hypothesis that a certain sexual act could not have occurred because of intergenital disproportion between the complainant and the defendant. However, such measurements are unhelpful because it is not possible to predict the maximum erectile size from the flaccid length, and there is no statistical support for the 'phallic fallacy' that the larger penis increases in size with full erection to a significantly greater degree than does the smaller penis (153). Furthermore, even when the erect penis is measured during automanipulation or active coition, the measurements are recognized to be unreliable (153).


Forensic practitioners may also be asked to comment on a person's ability to achieve a penile erection, particularly if the male is young or elderly. Masters and Johnson (153) note that during their research, penile erection has been observed in males of all ages ranging from baby boys immediately after delivery to men in their late eighties they report that one 89-year-old study subject was able to achieve a full penile erection and ejaculate. Therefore, it is not possible to reach a conclusion regarding erectile efficiency based on age alone. When a defendant reports erectile dysfunction, the expert opinion of a urologist should be sought. Penile erection may result from visual stimulation (including fantasy) or tactile stimulation. The penis, scrotum, and rectum are all sensitive to tactile stimulation (153), which may explain why involuntary penile erections can be experienced by a male subjected to nonconsensual anal intercourse.


Inhibitors of phosphodiesterase type 5 have an important role in maintaining a desired lifestyle treatment of erectile dysfunction caused by a variety of conditions. Originally developed for the treatment of angina (and not effective for this purpose), male test subjects reported the ease of having an erection, and the rest is history (32). A complex mechanism is involved. Nitric oxide (NO) activates guany-late cyclase, forming cyclic GMP (cGMP), which is hydrolyzed by a phosphodiesterase. Sildenafil Viagra, (50) and the newer compounds, cialis (51) and vardenafil (52), inhibit the phosphodiesterase. The selectivity is good, but it must be remembered that cyclic GMP, like cyclic AMP, is ubiquitous and, therefore, the phosphodiesterases required to hydrolyze these chemical transmitters are also ubiquitous. There are a wide variety of phosphodiesterase isoforms and their distribution tends to be uneven. In other words, phosphodiesterase type 5 tends to be found in the corpus caver-nosum...

Cancer Screening

Screening elderly men for prostate cancer is not routinely recommended, as it has not been definitively shown to prolong life and because of the risk of incontinence or erectile dysfunction caused by the treatments. An older woman should undergo annual mammography until her life expectancy falls below 5-10 years. Screening for colon cancer (either with colonoscopy every 10 years or with annual fecal occult testing plus flexible sigmoidoscopy every 5 years) can be stopped when a patient's life expectancy is less than 5-10 years.


Many drugs when an influenza epidemic swept through the laboratory and altered liver tests and created many adverse events. Placebo use does add data, but without placebos you will have difficulty interpreting data. Did those patients really have drug-induced bizarre dreams, trouble thinking, and penile erections Avoid exsanguinating a patient with unnecessary samples after a placebo dose, but do blind everyone appropriately. Blind the switch from placebo to active drug often subjects anticipate adverse events at this moment.

Speech and Thought

Clients may refer to many different types of delusions. Delusions of grandeur are false beliefs pertaining to a person's own ability or status. Most frequently, clients with delusions of grandeur believe they have extraordinary mental powers, physical strength, wealth, or sexual potency. They are usually unaffected by discrepancies between their beliefs and objective reality. In some cases, grandiose clients begin to believe they are a specific historical or contemporary figure (Napoleon, Jesus Christ, and Joan of Arc are particularly common).

Sexual function

Some cord-injured men already in the intensive care unit ask about their ability to have an active sex life and become fathers. The erectile dysfunction in men after spinal cord injury has different characteristics depending on level of lesion, and mainly follows the pattern of bladder dysfunction. The person with an upper motor neuron lesion usually has the capacity for reflex erection by tactile stimulation. The person with a lower motor neuron lesion has loss of all erectile function. The capacity of psychogenic erection is lost in all cord-injured men with a complete lesion. Retrograde ejaculation is the rule when there is an ejaculation at all. Today, we can offer drugs and different stimulations in order to improve erectile function and to produce an anterograde ejaculation. Vibration and electro-stimulation need careful monitoring of blood pressure since these methods readily evoke autonomic dysreflexia. By the means of vibration and electro-stimulation in combination with...


A prolactin-secreting tumor of the pituitary gland can cause a dramatic hyperprolactinemia. One third of all hy-perprolactinemias are caused by hypersecreting tumors of the pituitary, and the prolactin level in serum rises to above 200 ng ml. Typical clinical symptoms are amenorrhea and galactorrhea among women, and loss of libido and erectile function in men, and less commonly, gynecomastia. Pro-lactinomas in women, who are often alarmed by the endo-crinological changes, are usually microadenomas, and are not usually associated with optic disc pallor or visual field defects.

Amyloid neuropathy

Nerves, dorsal ganglia, and autonomic ganglia.78 Sural nerve biopsy reveals axonal degeneration with a lesser degree of demyelination, affecting mostly unmyelinated or lightly myelinated fibers.79 The absence of blood-nerve barrier in dorsal root and sympathetic ganglia may predispose these sites to amyloid deposi-tion.80 Electrodiagnostic studies show decreased action potential amplitude, reduced sensory responses, and normal or mildly reduced conduction velocity.81 The neuropathy is progressive, sensory dominant, with prominent pain and temperature sense loss. The most common initial presentation is burning or painful paresthesia with mild weakness of lower extremities. Symptoms of autonomic dysfunction include ortho-static hypotension, impotence, and urinary retention.

Laboratory Features

Endocrine abnormalities were found in two-thirds of our patients at presentation. Hypogonadism was the most common abnormality, and 71 of males had erectile dysfunction. Twenty-four of 28 patients who had serum testosterone levels measured had a reduction. Gynecomastia was found in 17 men. Prolactin levels were not increased. Hypothyroidism was found in 14 of patients. An additional 12 had a mild increase in the thyroid-stimulating hormone level but had normal thyroxin levels. Abnormalities of the adrenal-pituitary axis were present in 16 . In five additional patients, adrenal insufficiency developed during follow-up.

Endocrine Effects

The effects of cannabis upon sexual performance are not clearly understood, and the published research available often yields conflicting results. Traditionally, high doses have been claimed to reduce libido and cause impotence, whilst more moderate intake has been associated with heightened pleasure from sexual contact (Buffman, 1982 Abel, 1981). If the drug has the ability to enhance the subjective experience of sex, then this might be due to cannabis-induced relaxation or increased tactile sensitivity.

Gemtuzumab zoqamicin

Goserelin -LHRH agonist -endocrine effects -hot flashes -decreased libido -gynecomastia -impotence -nausea and vomiting (uncommon) -transient increase in bone pain -hot flashes -decreased libido -gynecomastia (3 ) -breast tenderness -impotence (2 ) -nausea and vomiting (uncommon) -transient increase in bone pain -peripheral edema -dizziness, headache

Synopsis Of The Play

A 1972 Senate subcommittee investigation is ongoing in spotlighted testimony areas. In the prologue Nurse Eunice Evers gives her professional oath of faithfulness, confidentiality, loyalty, and devotion. In act 1 (1932-Contagion), she talks about her motivation to be a nurse and how she has become a PHS nurse-liaison to four tenant farmers, Hodman, Willie, Caleb, and Ben, who are variously fidgety, superstitious, and defiant, while being tested for bad blood. Hodman, 37, believes in magic cures like putting a knife under the bed to cut pain. Willie, 19, wants to win a gillee dancing contest and move North. The analytical Caleb, 25, is the most literate. At 57, compliant Ben writes his name with an X on the blackboard, but not wanting to rile nobody, hastily erases it. Evers gains their trust and entices them into the TSS with promises of hot food and free doctorin'. The men are afraid that blood-drawing to see if they were bitten by a parakeet...

Properties and Uses

Hysteria, rheumatism, gangrene and gout. It has also been employed as an antidote to strychnia, but with doubtful results. It is regarded as a medicine in impotence (Dymock et al, 1890). The Hindus consider camphor to be aphrodisiacal, but the Muhammadans hold a contrary opinion both regard it as a valuable application to the eyelids in inflammatory conditions of the eye (Watt, 1885 Morton, 1977).

Adverse Effects

Reboxetine is not structurally related to tricyclic agents and acts predominantly by noradrenergic reuptake inhibition. Antimuscarinic effects trouble only a minority of patients, postural hypotension may occur and impotence in males. It is relatively safe in overdose. Trazodone has structural similarities with TCAs but probably acts by antagonism of postsynaptic serotonin receptors and presynaptic a-adrenoceptors. It is an option for depressed patients where heavy sedation is required. Trazodone also has the advantages of lacking antimuscarinic effects and being relatively safe in overdose. Males should be warned of the possibility of priapism (painful penile erections), attributable to the drug's blockade of -adrenoceptors.

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Dealing With Erectile Dysfunction

Whether you call it erectile dysfunction, ED, impotence, or any number of slang terms, erection problems are something many men have to face during the course of their lifetimes.

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