Herbal Treatment for Erectile Dysfunction

Mental Impotence Healer

Mike Millers Mental Impotence Healer is an eBook that utilizes guided imagery to help you cure your psychological impotence. In guided imagery, you will be guided into imagining a scenario to help you overcome physical and psychological issues. It commonly uses descriptive language and guidelines that have direct affects on the brain. Since the mind greatly influences the body, this approach helps you have rock-hard erections when you need them most. Simply listen to The Mental Impotence Healer Program for 2 months and completely annihilate your sexual fears and in next to immediately you will become a brand new You! Recharged with sexual energy, bursting with self-confidence, strong on command, and conditioned to be aware that your days of Psychological Impotence are gone, for all time! The Mental Impotence Healer Program gives you your confidence back and will maximize your self-esteem to amazing new heights. Listen to the beautiful, calm and relaxing Guided Imagery session and it will totally transform your sex life. You will have control over your erections without taking any harmful medication or dangerous pills. Grab a set of headphones and the recordings will go to work while you relax. The carefully mastered binaural beats and subliminal messages will reprogram your subconscious mind into a radically altered state of heightened sexual awareness and desire! More here...

Mental Impotence Healer Summary


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Author: Mike Miller
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Female Sexual Dysfunction

In 1966, Masters and Johnson21 first described the female sexual response consisting of four successive phases -excitement, plateau, orgasmic, and resolution. This was later modified to the phases of desire, arousal, orgasm, and resolution. It is well recognized today that the female sexual cycle is not just a sequence of events, but a very complex

Physiology of Female Sexual Function

The underlying physiologic processes in both normal female sexual function and FSD are not yet well understood. Normal female sexual function is based on an interaction between intact anatomic, vascular, and neurologic factors. Sexual arousal is marked by physiologic changes secondary to increased genital blood flow, which leads to vaginal congestion and lubrication, facilitating intercourse. The normal vascular response is a result of cavernosal and arteriole smooth muscle relaxation via the androgen-dependent nitric oxide synthase system during sexual stimulation and arousal. This produces a vascular engorgement of the vestibule and clitoris. Vaginal lubrication is a transudate of serum that results from this normal increase of pelvic blood flow with arousal. Patients with arousal disorders may complain of decreased vaginal lubrication and dyspareunia. sympathetic outflow tract. In women with diabetes or spinal cord injuries, the neuropathy may result in diminished levels of sexual...

Adjusting to Changes in Sexual Function in MS

Normal sexual function changes throughout one's lifetime, but having multiple sclerosis (MS) can profoundly affect an individual's sexual experience in a variety of ways. The most frequently reported change in men is diminished capacity to obtain or maintain an erection (impotence), while the most frequent change reported by women is partial or total loss of libido (sexual desire). Certain MS medications can also interfere with sexual functioning. For example, certain antidepressants can cause this difficulty.

Coping With Msrelated Changes In Sexual Response

Coping with Altered Genital Sensations To enhance sexual response, increase stimulation to other responsive areas such as Coping with Erectile Problems A number of oral medications are available to treat erectile dysfunction. The FDA has approved several medicines called phos-phodiesterase-type-5 (PDE-5) inhibitors. PDE-5 inhibitors work by blocking a chemical in the erectile tissues that causes erections to become flaccid. These medicines include sildenafil (Viagra ), vardenafil (Levitra ), and tadalafil (Cialis ). To date, only sildenafil has been completed in clinical trials with men who have MS, although the other medicines are highly similar and can be prescribed for persons with MS. These medicines do not improve libido, but are helpful in maintaining erections when they occur. They are typically taken an hour before anticipated sexual activity. The effects of vardenafil and tadalafil are reported to last somewhat longer than sildenafil, although they have not been directly...

Model for understanding sexual response

For heuristic purposes, the sexual response cycle can be divided into four phases of functioning desire, arousal, orgasm, and satisfaction. Dysfunctions of sexual response found in both DSM-IV1,' and ICD-10(1.4) mirror this theoretical model, but also include another dimension, that of sexual pain disorders. These ideas are an elaboration of Masters and Johnson's psychophysiological research as well as the independent theoretical contributions of Kaplan (15 and LiefA16. Two assumptions underlie this model (1) each phase of sexual function has relatively discrete underlying psychophysiological mechanisms and (2) disturbances in one phase do not necessarily denote dysfunctions in another. This conceptualization, however, does not preclude a dysfunction in one area precipitating secondary impairments in another phase. For example, the loss of erectile capacity may eventually dampen a man's interest in engaging in any sexual activity. The strength of this four-phase model is that it...

Unresolved Issues With Viagra

Following its launch in 1998, sildenafil ( Viagra ) continued to attract a lot of interest in 1999. In August 1998, the American College of Cardiology (ACC) and the American Heart Association (AHA) issued interim recommendations for silde-nafil prescribing in patients with cardiovascular disease.717 2 Subsequently, in January 1999, an expert consensus document was released by the ACC and AHA reiterating their previously released recommendations.738 2 The ACC and AHA also stated that more research is needed into the effects of sildenafil in certain high-risk patients with significant cardiovascular disease. Other unresolved issues identified by the ACC and AHA included interactions with non-aspirin antiplatelet agents, interactions with other phosphodiesterase inhibitors, central nervous system (CNS) effects, hypotensive effects in high-risk cardiac patients (e.g. those with severe heart failure), and musculoskeletal effects (myalgia and chest pains) that may be mistaken for angina. In...

The EPOR modela human sexual response cycle model

Proposed a four-phase linear, sequential, and incremental model of the human sexual response cycle ( Fig 1). The phases were described as the excitation (E) phase (stimuli from somatogenic or psychogenic sources raise sexual tensions), the plateau ( P) phase (sexual tensions intensified), the orgasmic (O) phase (involuntary pleasurable climax), and finally the resolution (R) phase (dissipation of sexual tensions). The great success of this EPOR model was its wide compass it could characterize the sexual responses of women and men, both heterosexual and homosexual, ranging from simple petting to vaginal or anal coitus with orgasm. However, it had several weaknesses. Fig. 1 The development of the linear-sequence human sexual response model from (a) the original EPOR model of Masters and Johnson (29 through (b) the DEOR

Physiology Of Penile Erection

The physiology of penile erection involves an interplay of anatomical, hemodynamic, neurophysiological, and sex hormone interaction. Penile erection is the result of a complex interaction between the central nervous system and other local factors. This physical event also can be influenced by psychological factors. 5-Hydroxytryptamine (5-HT), dopamine, and nor-epinephrine play important roles as central neurotrans-mitters in the process of erection. Still other substances or hormones, such as endorphins, oxytocin, vasopressin, adrenocorticotropic hormone (ACTH) and related peptides, and prolactin, appear to participate in the complex and coordinated process of penile erection. Central nonadrenergic neurons also may influence male sexual behavior. Nitric oxide (NO) released during nonadrenergic, noncholinergic (NANC) neurotransmission and from the vascular endothelium is most likely the major neu-rotransmitter mediating penile erection. NO is a mediator of relaxation of the corpus...

Female Sexual Dysfunction and Colorectal Surgery

In contrast, FSD after CRS is not as well understood. The findings in the literature are controversial whereas some authors believe that female sexual function does not change or even improves after surgery,10,11 others have reported deteriorated function, despite cure of the disease.6,12 This discrepancy in results may be attributed to the fact that most studies were retrospective, included a small number of female patients, lacked a baseline functional status, and did not use a validated sexual inventory. Therefore, the available literature data warrant cautious evaluation. Table 5-1.5 summarizes the results of 14 studies in women who underwent major colorectal procedures. After CRS, sexual dysfunction in women may be attributed to disorders of desire, arousal, orgasm, and or pain. Sexual desire has been shown to maintain or improve in 76 to 80 of women after CRS and is often accompanied by increased frequency in sexual activity and sexual satisfaction.13,14 Such an improvement may...

Modelling the human sexual response cycle

A direct way of investigating normal sexual function is to observe and measure the body changes that take place when men and women become sexually aroused. From these data, models have been constructed of the normal sequence of changes during sexual arousal and coitus. The first models described a simple sequence of increasing arousal and excitement culminating in rapid discharge by orgasm, displayed graphically as an ascent, peak, and then descent. (l7 As the investigations became more sophisticated, understanding of the body responses grew and the models became more detailed and complex. J, ,11,18,,19)

Treatment of erectile dysfunction

Sildenafil (Viagra) is the only oral medication available for erectile dysfunction. A type-5-phosphodiesterase inhibitor, the drug potentiates the effects of nitrous oxide on sinusoidal smooth muscle. It comes in 25, 50, and 100 mg tablets which should be taken about 1-1.5 hours prior to intercourse. Initial dose is 50 mg at a maximum frequency of one per day. The dose can be increased up to 100 mg. The drug can potentiate the hypotensive effects of nitrates therefore, nitrate us is an absolute contraindication. Adverse reactions include headache and changes in vision. Other oral medications awaiting FDA approval include phentolamine C. Vacuum constriction devices (VCD) are an effective treatment alternative for erectile dysfunction. The design involves a plastic cylinder that is placed on the penis with negative pressure created. A constriction band is placed at the base of the penis. Almost every patient can be a candidate for these devices. Contraindications include penile...

SEXuAl Response Cycle

Two pioneering researchers, William Masters and Virginia Johnson, identified four stages of sexual response. These stages excitement, plateau, orgasm, and resolution are known as the human sexual response cycle. Two basic processes occur during sexual response vasocongestion and myotonia. Vasocongestion refers to the concentration of blood in the blood vessels and in the tissues of the genitals and breasts. In men, vasocongestion occurs when arterial blood flow to the penis increases and venous outflow decreases. Erection is a result of increased blood flow to the spongy tissue (corpora cavernosa) of the penis, causing these tissues to expand. In women, this inflow of blood causes the clitoris to enlarge, the labia to swell, and the vagina to lubricate. Myotonia, or neuromuscular tension, refers to the increase of energy in nerves and muscles. During sexual activity, myotonia takes place throughout the body, affecting both involuntary and skeletal muscles. plateau phase of the sexual...

Antidepressants and Female Sexual Dysfunction

Although numerous medications can have an adverse impact on sexual function, few classes of medications have been demonstrated to have more impact on sexual function than antidepressants. Although many of the various classes of antidepressant agents can affect sexual function, the selective serotonin reuptake inhibitors (SSRIs), such as paroxetine, sertraline, or fluoxetine, have been shown to adversely affect libido, arousal, as well as the ability to reach orgasm.27 Under a physician's care, options may include switching agents, dose reduction, or drug holiday. Bupropion (Wellbutrin) may be an effective alternative.28 In addition, studies have suggested that the use of sildenafil with

Causes of Female Sexual Dysfunction

Similar to its counterpart in the male, there are numerous causes of FSD (Table 5-1.3). In fact, any factors influencing normal physiology, or any step of the sexual response in women, may contribute to FSD. The etiologies can be grouped as being either psychogenic or organic in nature, although overlap often exists. Psychogenic FSD may be noted as either a result of, or a causative factor for, depression. In fact, it behooves the physician to rule out a primary diagnosis of depression in any women presenting with symptoms of FSD, especially poor libido. Likewise, the temptation to assign a diagnosis of depression to a woman without at least screening for the presence of sexual dysfunction should be avoided. Other facets of psychogenic FSD may include interpersonal relationship issues, abuse, performance anxiety, and psychological distress. These psychological factors often accompany organic factors. components of the sexual response can cause FSD. Vascular causes of FSD include...

Sexual Function after Pelvic Surgery

Pelvic surgery to correct prolapse may affect sexual function for a number of reasons including narrowed vaginal canal, poor lubrication, and fear of urinary incontinence. Some studies suggest that sexual dysfunction can occur up to 20 of the time after surgery for prolapse or incontinence. It is thought that the vaginal dissection may lead to pelvic floor neuropathy affecting the pudendal nerve, which subsequently affects vaginal sensation and orgasm. Hysterectomy has been associated with sexual dysfunction. It is thought that removal of the cervix alters the upper portion of the vaginal canal and causes a neuropathy, which is the source for dyspareunia as well as anor-gasmia. However, studies in the literature are conflicting as to the exact cause of sexual dysfunction after hysterec-tomy.22 Another possible cause for dyspareunia is poor estrogenization of the vaginal mucosa in those women who undergo surgical menopause at the time of a hysterectomy. Techniques used to repair the...

Modelling normal sexual functionthe sex survey

One obvious way of describing normal sexual function is to ask people what they do. Two classic sex surveys were conducted by Kinsey and his coworkers who Surveys give a selective picture of sexual function. Results depend on the formulation of the questions, they rely on self-reports, and they represent only those prepared to describe their sexual behaviour. It is known, for example, that females tend to under-report their premarital sexual experiences (12) while males tend to over-report their lifetime partners.( 9 Berk et al.(1J studied the recall by 217 university students of their sexual activity over a 2-week period assessed by questionnaires answered 2 weeks after the recording period, and by daily diaries kept over the same 2 weeks. Subjects reported more sexual activity in the questionnaires than in their diaries. Women reported giving and having more oral sex than the men. Clearly, data from questionnaire surveys should be treated cautiously.

The Female Sexual Response

The female sexual response, as described in the mid 1960s by Masters and Johnson,6 begins with excitement, leading to plateau, orgasm, and finally, resolution. In 2000, Dr. Rosemary Basson,7 a pioneering researcher in the field of FSD, proposed a new, nonlinear female sexual response cycle. Dr. Basson suggested that the sexual response is driven by the desire to enhance intimacy, and begins with a state of sexual neutrality8 (Table 5-1.2). As the woman seeks a sexual stimulus and responds to it, she becomes sexually aroused. Arousal leads to desire, thus stimulating a woman's willingness to receive or provide additional stimuli. Emotional and physical satisfaction are gained by an increase in sexual desire and arousal. Emotional intimacy is then ultimately achieved. Various biological and psychological factors can negatively affect this cycle, thus leading to FSD.

Sexual function

A diminution in sexual interest, a decrease in activity, and impaired performance are the most common aspects of sexual dysfunction in epilepsy. Men have been studied more thoroughly than women. Erectile impotence is a common complaint. The levels of free testosterone, the biologically active male hormone, is diminished in treated male epileptics due to the action of anticonvulsant drugs. Hyposexuality may be more pronounced in patients with partial epilepsy, but this may simply reflect the refractory nature of partial epilepsy and the greater amount of drugs prescribed. (15


Sildenafil (Viagra) was developed more than 10 years ago as an antihypertensive and antianginal drug. It Sildenafil is a selective inhibitor of cGMP-specific PD-5 and therefore inhibits the degradation of cGMP. PD-5, the predominant type in the corpus cavernosum, also is present in other tissues (e.g., lungs, platelets, and eye). The selective inhibition of this enzyme facilitates the release of nitric oxide and smooth muscle relaxation of the corpus cavernosa. Sildenafil enhances erection by augmenting nitric oxide-mediated relaxation pathways. It has been suggested that sildenafil's mechanism of action is due to cross-talk between cGMP- and cAMP-dependent transduction pathways within the cavernous muscles. Sildenafil is readily absorbed after oral administration and reaches peak plasma levels after about an hour. It undergoes hepatic metabolism and has a terminal half-life of about 4 hours. An initial dose of 50 mg is taken about an hour prior to sexual activity to induce penile...


Panax ginseng describes the root from two species of plants, Asian ginseng (Panax ginseng) and American ginseng (Panax quinquefolius), popularly used for improving stamina and providing a sense of well-being. The terms red and white ginseng refer to how the root is processed, not the species of origin. Red ginseng roots are steam-cured prior to drying, while white ginseng is bleached and dried. Panax ginsengs contain triterpenoid saponins called ginsenosides (also called panaxosides), of which up to 18 types are recognized as having differing and sometimes opposing pharmacological properties. Siberian ginseng (Eleutherococcus senticosus) should not be confused with Panax ginseng. Although it belongs to the same plant family (Araliaceae), it is a much larger, more abundant, and consequently less expensive plant. Like Panax ginseng, however, it is used as a tonic and adaptogen, a nonmedical term meaning that it helps the body adapt to stress in a variety of ways. Siberian ginseng does...

F Ginseng Panax sp

Ginseng is indigenous to Korea, China, Vietnam, Japan, India, and North America. Its primary bioactive constituents are the triterpene saponins ginsenosides, which are present in the root, leaf, and berry of the plant more than 30 ginsenosides have been described. Ginseng induces changes in general metabolism characterized by enhanced carbohydrate utilization or accelerated lipid, protein, or nucleic acid synthesis. In patients with non-insulin-dependent diabetes, a significant lowering of

S Sensitive but thorough problem assessment

The great variety of possible problems that people with MS may have can make it difficult for health care professionals to detect all relevant changes. We have recommended that health service professionals in regular contact with people with MS, should consider in a systematic way whether the person with MS has a 'hidden' problem contributing to their clinical situation, such as fatigue, depression, cognitive impairment, impaired sexual function or reduced bladder control. The main text of the guideline details the various problems that a person with MS may have and appropriate ways of treating these problems.

A pAdrenergic receptor blockers

Common adverse effects of p-blockers include decreased exercise tolerance, cold extremities, depression, sleep disturbance, and impotence, although these side effects may be less severe with the p1-selective blockers (ie, metoprolol, atenolol, bisoprolol). The use of p1-selective agents also helps minimize adverse effects associated with

Supplemental Reading

A patient who has been a heavy smoker (2 packs of cigarettes per day for 30 years) comes to you for advice to quit smoking. You inform your patient that sudden cessation of smoking will result in withdrawal symptoms that may include restlessness, irritability, anxiety, tension, stress, intolerance, drowsiness, frequent awakenings from sleep, fatigue, depression, impotence, confusion, impaired concentration, gastrointestinal disturbances, decreased heart rate, and impaired reaction times. You advise your patient that successful cessation of tobacco use requires attention to both the positive and negative (withdrawal) reinforcement properties of nicotine and tobacco use. You plan, therefore, to combine both psychological and pharmacological treatment. What are some therapeutic approaches you can suggest

Prolactinsecreting Tumors

Ninety percent of such tumors are in females with secondary amenorrhea as the common presenting feature. Galactorrhea is not always present, perhaps because a permissive level of estrogen may be required for milk production. In men, impotence with decreased sperm count is the endocrinological equivalent. Women, possibly owing to a greater awareness of the effects of hypersecretion, tend to present at a younger age with microadenomas, while men present later in life with visual field disturbances.

Presentation and Clinical Features

The three main presenting features are similar to pituitary adenomas endocrine disturbance, headache and visual impairment. In a recent large series of over 28 RCCs 1 , the mean age at presentation was 45 years. Clinically, endocrine disturbance was the most common presentation (50 ), including amenorrhea (37.5 of female patients), growth retardation, impotence and DI. Biochemically, hypopitu-itarism, hyperprolactinemia and gonadotrophin deficiencies were the common endocrine findings. Headache was a major feature in 32.1 and visual disturbance in14.3 . Patterns of visual disturbance included central field loss as well as the peripheral field loss expected in sellar region lesions. Four patients had pre-operative DI, a feature that, in the authors' opinion, excludes pituitary adenoma.

The Brain And Spinal Cord And Ms

Sexual response is controlled by emotional responses in concert with the central nervous system the brain, and the spinal cord. The brain is involved in many aspects of sexual functioning, including sexual desire, the perception of sexual stimuli and pleasure, movement, sensation, cognition, and attention. Throughout the sexual response cycle, sexual messages are communicated between the brain, spinal cord, and the genitals. Because MS can cause lesions along myelinated pathways, it is not surprising that changes in sexual function are reported so frequently by people with MS.

Combination of Pharmacophores

Some highly specific mono-target drugs have clearly proven the usefulness of mono-target medicine. Examples are phosphodiesterase 5 inhibitors such as sildenafil, the a-1a antagonist drugs such as tamsulosine, selective COX-2 inhibitors such as celecoxib and kinase-specific anticancer drugs such as imatinib. However, in addition to one-target drugs, clinicians are more and more convinced that modulating a multiplicity of targets can be an asset in treating a range of disorders. An extreme example of a multi-target drug is clozapine, which exhibits nanomolar affinities for more than a dozen different receptors.

Preoperative Evaluation

Intraventricular tumors are often slow-growing and benign. These lesions frequently grow large before clinical manifestations and, ultimately, produce symptoms secondary to hydrocephalus, either by obstruction of the normal pathways of cerebrospinal fluid flow or by its overproduction. Most patients present with headaches 2 . Colloid cysts, which typically occur anteriorly and superiorly within the third ventricle, have a tendency to intermittently obstruct the foramen of Monro, resulting in acute lateral ventricular hydrocephalus with symptoms of intracranial hypertension. Visual loss, impotence and diabetes insipidus may be caused by tumors invading the floor of the third ventricle. Asymmetric bitemporal hemianopia, starting with inferior temporal field loss, may occur due to dilatation of the third ventricle with pressure on the optic chiasm from above. The extension of the tumor may cause a variety of visual field defects, including homonymous hemianopia, binasal field defects,...

Reference Country Medication

The treatment of dysthymia should continue in most cases for 2 years or more. Tricyclic antidepressants have too many side-effects in clinically effective doses (desipramine equivalent of 150 mg or more per day). Given dietary and medication prohibitions, monoamine oxidase inhibitors are also not practical as first-line drugs. Overall good tolerance in long-term use, despite sexual side-effects, has made the SSRIs the first-line intervention treatment for dysthymia given that many people with dysthymia are young individuals who should be eager to form families, their acceptance of long-term SSRI use is an indication that the alleviation of the depressive suffering of dysthymia is genuine and far outweighs the sexual dysfunction. However, 75 to 150 mg bupropion-SR (an antidepressant available in the United States) can be taken in the morning on the desired day of sexual union, but preferably no more than once a week. If severe, sexual dysfunction can be reversed by switching to...

Paradigm Shift Involving Patients in Healthcare Decisions

Many clinical decisions are not purely scientific matters, but also involve value judgments that vary from person to person. For example, the right choice, for a patient choosing between surgical and radiation treatment of his prostate cancer, depends on how much he thinks he would be bothered by surgical complications such as impotence or incontinence and on how important he feels it is to have the cancer physically removed from his body. Similarly, whether a woman should begin receiving annual mammography at age 40 or 50 depends on how she feels about the inconvenience and discomfort of mammography, the financial costs of screening, the consequences of false-positive testing, and the benefits of receiving more aggressive screening.

Emotional Mispredictions

Such mispredictions are common in health settings.49 For example, patients with inflammatory bowel disease expect that having a colostomy would make them miserable, and yet patients emotionally adapt to colostomies relatively quickly.50 People predict that they would be miserable if they had kidney failure, and yet most dialysis patients are happy.51 Such mispredictions could influence patients' healthcare decisions. If a prostate cancer patient overestimates how much he will be bothered by impotence or incontinence, he may forgo potentially beneficially treatments.

Psychotherapysexual counselling

Sex therapy today involves integrating medical and psychotherapeutic interventions. The conventional role of the mental health clinician in the treatment of erectile dysfunction had been to treat those with psychogenic erectile problems. Now with the advent of efficacious, reversible, and safe medical therapies the role of the Many men with erectile dysfunction can achieve a significant recovery in sex therapy those with acquired disorders typically fare better than those with lifelong problems. In an excellent review of the treatment studies for erectile dysfunction, Mohr and Beutler(44) wrote that the 'component parts of these treatments typically include behavioural, cognitive, systemic and interpersonal communications interventions. Averaging across studies, it appears that approximately two-thirds of the men suffering from erectile failure will be satisfied with their improvement at follow-up ranging from six weeks to six years.'

Adrenoceptor Blocking Agents

P-Adrenoceptor antagonists, such as propranolol (Inderal), have been widely used in the treatment of cardiovascular diseases (see Chapters 16 and 20). These p-blockers also are useful in some forms of anxiety, particularly those that are characterized by somatic symptoms or by performance anxiety (stage fright). There is general agreement that p-blockers can lessen the severity and perhaps prevent the appearance of many of the autonomic responses associated with anxiety. These symptoms include tremors, sweating, tachycardia, and palpitations.

Interactions Between CAM and Conventional Oncologic Therapy

Metabolic interactions Many botanicals are known to modify the activity of cytochrome CYP450 3A4, affecting the blood levels of drugs metabolized on this pathway.77 St. John's wort, for example, induces CYP450 3A4 in vitro,77 and in a randomized cross-over study, the plasma concentration of SN-38, irinotecan's active metabolite, was dramatically reduced when patients concurrently used St. John's wort.78 Several other popular botanicals, such as Echinacea and goldenseal, also were shown to modify CYP450 3A4 activity by an in vitro screen.77 Antioxidants Many cytotoxic therapies, notably radiotherapy, depend on producing oxidative damage within the cancer cell. The activity of radiotherapy depends at least in part on the production of free radicals. Many botanicals, such as grape seed extract and ginseng, contain antioxidant constituents. Patients may unwittingly exacerbate the problem by taking additional antioxidants in the form of other dietary supplements. It is widely thought that...

Paradoxical intention

Finally, the technique of paradoxical intention is useful in situations where performance anxiety has developed, i.e. where the effort to produce a response inhibits that response itself. The paradoxical instruction is to allow sleep to occur naturally through passively attempting to remain quietly wakeful rather than attempting to fall asleep. Paradox may be regarded as a decatastrophizing technique since it appears to act upon the ultimate anxious thought (of remaining awake indefinitely) initially by focusing on and enhancing this thought (a habituation model) and then subjecting it to appraisal through rationalization and experience. By intending to remain awake, and failing to do so, the strength of the sleep drive is re-established, and performance effort is reduced.

Sleepinduced respiratory disturbances

Clinical features include night-time and daytime symptoms. Night-time symptoms are represented by loud snoring, apnoeic episodes ending with sonorous breathing resumption, nocturia, severe fatigue upon awakening, and sometimes headache. Daytime symptoms are dominated by excessive sleepiness which varies in intensity among patients. Other symptoms include irritability, negligence, loss of concentration, loss of libido, impotence, and sometimes depression.

Autonomic and Endocrine Effects

All antipsychotics except clozapine and perhaps olanzapine produce hyperprolactinemia by removing the inhibitory actions of dopamine on prolactin secretion. This results in amenorrhea, galactorrhea, and infertility in women and in loss of libido and impotence in men. Inhibition of the release of follicle-stimulating and luteinizing hormones may also play a role. In addition, weight gain is common, and food intake must be monitored.

Treatment of acute mountain sickness

Which reduces the reabsorption of bicarbonate and sodium at the level of the renal tubules, leading to a metabolic acidosis within an hour of ingestion. An oral dose of acetazolamide 250 mg twice daily can be used for mild acute mountain sickness. Side-effects include peripheral paresthesias, polyuria, nausea, drowsiness, impotence, and myopia.

Results of Surgical Repair

Although frequently performed, posterior colporrhaphy has been described as among the most misunderstood and poorly performed gynecologic surgeries.13 Although many authors have reported satisfactory anatomic results, conflicting effects on bowel and sexual function postoper-atively have been noted. Several authors have reported high sexual dysfunction rates of up to 50 of women reporting dyspareunia or apareunia after posterior colporrhaphy.14 Some authors caution the performance of rectocele repair in patients with preoperative abnormal colonic transit studies secondary to continued constipation postopera-tively.15 Other authors performed preoperative defecogra-phy on all patients and found that the grade of rectocele emptying did not influence long-term outcome. In addition, pre- and postoperative defecography was reported to show an increase in maximal anal resting pressure postop-eratively, suggesting that it may be caused by levator plication (Table 8-5.1).16

Injury to the L5 Segment

At L5, neural decompression is best achieved posteriorly via a laminectomy with a trans-pedicular approach. In the case of severe neural compression, an anterior decompression can be performed through a paramedian abdominal incision. The lower lumbar spine can then be exposed via a transperitoneal or retroperitoneal approach. The transperitoneal approach provides more extensive exposure but it also entails mobilization of the great vessels and the hypogastric nerve plexus. Mobilization of the latter structure is associated with an increased risk of impotence.

Comparison With National Data

Where appropriate, comparisons are made between event rates in PEM studies and other data resources, e.g. national statistics. An example is the analysis of cardiovascular events of the PEM study on sildenafil (Shakir et al., 2001) (the product used for erectile dysfunction). Reported deaths from myocardial infarction and ischaemic heart disease in users of sildenafil in the PEM study were found to be no higher than expected according to national mortality statistics. The precautions with regard to possible sources of bias and confounding also apply to external comparisons.

Measuring Outcomes Of Care

The ideal situation is when a therapy intervention improves all three of the above-mentioned health outcomes (clinical, economic, and humanistic) (Table 9.1, Scenario 1). A major ethical issue surfaces when one or more of these outcomes does not improve, but rather worsens as a result of treatment (Table 9.1, Scenarios 2-6). For example, suppose a drug reduces the incidence of myocardial infarction, but negatively affects patient quality of life due to side-effects such as depression, erectile dysfunction, and insomnia. In the total view, this drug is less cost-effective than alternative treatments to prevent myocardial infarction (Table 9.1, Scenario 2). In other words, it provides a negative economic outcome. Although it achieves the targeted clinical outcome (prevention of myocardial infarctions), one must ask whether treatment with this medication is ethical. This is an example where the three outcomes (clinical, economic, humanistic) are not affected in the same direction,...

Epidemiology and Demographics

Psychological testing on women with vulvar vestibulitis has found higher rates of introversion, somatization, and interference with sexual function. Overall levels of psychological distress, negative feelings toward sex, self-esteem, and marital satisfaction are conflicted in the literature with some studies showing no difference from matched controls and others finding opposite results. Furthermore, the order of causation remains unclear, with many authors suggesting a circular relationship of the physical condition and psychological changes.8-10

Spinal cord and root compression neurological effects

The lower sacral roots are involved early, producing loss of motor and sensory bladder control with detrusor paralysis. Overflow incontinence ensues. Impotence and faecal incontinence may be noted. A l.m.n. weakness is found in the muscles supplied by the sacral roots (foot plantarflexors and evertors), the ankle jerks are absent or impaired and a sensory deficit occurs over the 'saddle' area.

Clinical premotor symptoms

Female PD patients mainly report difficulties with arousal, whereas males complain about erectile dysfunction and premature ejaculation, all of which result in difficulties reaching orgasm and or attaining sexual satisfaction in half of the patients (Bronner, 2004).

Cancer Preventative Properties Of Soyasaponins

There are many more in-depth reports on the potential anticancer activity of ginseng saponins compared to soyasaponins. Most of the anticancer activity of soybeans has been associated with their phytoestrogen activity however, as with ginseng saponins, evidence is mounting outlining a specific effect of soyasaponins on antioxidant activity, immune system modulation, and an ability to inhibit the growth of cultured cancer cells. Generally, the saponin content of soybean and processed soy products ranges between 0.2 and 2 . The variability depends on the source of the soybean, the part of the soybean plant, and the choice of analytical method.86 The basic structure of soyasaponins can be divided into three main groups with varying combination of sugar moieties attached to the chemical backbone (Figure 22.5). Similar to ginsenosides, soyasaponin anticancer properties generally are characterized according to chemical structure-related properties, such as hydrophobic-hydrophilic balance....

S Evidence statements

Four systematic reviews which included men with erectile dysfunction were identified.432-435 All were of good quality (Ia). Two reviews examined the effects of sildenafil (Viagra), one looked at yohimbine (a herbal preparation) and the fourth looked at a variety of interventions including both yohimbine and sildenafil. There was overlap in the trials included in these reviews. All three reviews which looked at the effectiveness of sildenafil reported that it was significantly better than placebo in the treatment of sexual dysfunction in men.432,433,435 One review also reported that sildenafil was effective in all subgroups investigated.433 Both the review which looked exclusively at yohimbine434 and the review which also looked at a variety of other treatments432 found that yohimbine was significantly better than placebo in the treatment of erectile dysfunction. The side effect profile of both drugs was reported to be good. The review which looked at a large variety of interventions...

Route of Administration

In general, it is recommended that both the substrate and interacting drug be administered in the same way these drugs are used (or going to be used clinically). However, if multiple routes of administration are possible, it might be necessary in some cases to investigate the possibility of drug interactions with the different routes of administration. This is particularly true for drugs that undergo gut wall metabolism whereby the amount of metabolism will differ between the oral and intravenous routes. Therefore it is thought that the differences in exposure that result from a drug interaction will be different depending on the route of administration (viagra interaction with erythromycin), which will consequently result in different dosing adjustment recommendations, then in such cases one is better off obtaining the true magnitude of interaction for the different routes of administration.

Causes of ageing effects

Found that sexual activity correlated more with age than with levels of free testosterone. Rowland et al.(22) studied 39 healthy males aged 21 to 82, assessing questionnaires and erectile response to visual stimuli. Erection decreased with age and this reduction was related to decreased penile threshold to electrical and vibrotactile stimulation. However, these latter measures correlated with age, so that cause could not be distinguished from effect. In a definitive study of male ageing, Feldman et a .(23) incriminated vascular disease as the cause of elderly erectile failure but did not assess neurological factors. Ford and Kellett(24) compared 28 elderly men with erectile failure with 26 age-matched controls who were potent using 40 measures covering vascularity, autonomic control, collagen, hormone, and psychological factors. The groups were distinguished by only two measures the number of sweat glands that responded to pilocarpine stimulus (p 0001) and a composite vascular factor...

Chapter References

Hawton, K., Gath, D., and Day, A. (1994). Sexual function in a community sample of middle aged women with partners effects of age, marital, socio-economic, psychiatric, gynaecological, and menopausal factors. Archives of Sexual Behavior, 23, 375-95. 12. Martin, C.E. (1981). Factors affecting sexual functioning in 60-79 year old married males. Archives of Sexual Behavior, 10, 399-420. 18. Masters, W. and Johnson, V. (1966). Human sexual response. Churchill, London. 20. Davidson, J., Chen, J., Crapo, L., Gray, G., Greenleaf, W., and Catania, J. (1983). Hormonal function and sexual function in aging men. Journal of Clinical Endocrinology and Metabolism, 57, 71-7 22. Rowland, D., Greenleaf, W., Dorfman, L., and Davidson, J. (1993). Aging and sexual function in men. Archives of Sexual Behavior, 22, 545-57. 23. Feldman, H.A., Goldstein, I., Hatzichristou, D., Krane, R., and McKinlay, J. (1994). Impotence and its medical and psychological correlates results of the Massachusetts male aging...

Carbonic Anhydrase Inhibitors

Common systemic effects are depression, stomach discomfort, tingling of the extremities, kidney stones, and impotence. A substantial metallic, chalky taste is also common. The tingling of the extremities is so pronounced that it has been suggested that you can judge a patient's compliance by asking if this sensation is present. Ocular effects with systemic therapy are rare. All CAIs, topical or systemic, are contraindicated in patients with sulfonamide allergies, severe kidney or heart diseases, and adrenocortical insufficiency.

Chemical Name Papaverine papavereen

Description Papaverine belongs to a group of medicines called vasodilators, which cause blood vessels to expand, thereby increasing blood flow. Papaverine is used in MS to treat erectile dysfunction. When papaverine is injected into the penis, it produces an erection by increasing blood flow to the penis.

Empathy Gaps In Self And Social Predictions

Ences and decisions would be in a hot, emotionally aroused state (Loewenstein, 1996 Loewenstein, O'Donoghue, & Rabin, 2003). For example, men who are not sexually aroused predict they would be less likely to engage in sexually aggressive behavior than men who are sexually aroused (Loewenstein, Nagin, & Paternoster, 1997). People who are sated because they have just eaten are less likely than hungry people who have not eaten to choose a high-calorie snack to consume just after a future lunch (Read & van Leeuwen, 1998). And people who are hungry because they have not eaten expect to be more interested in eating a plate of spaghetti for breakfast than people who are sated (Gilbert, Gill, & Wilson, 2002). These empathy gaps occur largely because people believe that their preferences and decisions are based primarily on the inherent desirability of choice alternatives rather than affectively influenced constructions of those alternatives (Griffin & Ross, 1991 Pronin, Gilovich, & Ross, 2004...

Interaction With Protease Inhibitors

Concerns were also raised in 1999 of a probable interaction between sildenafil and protease inhibitors leading to a potentiation of the effects of sildenafil and an increased likelihood of adverse effects.742 3 In Europe, Pfizer and European Union regulators agreed to a sildenafil labelling change that concomitant treatment with ritonavir is not advised, and planned to expand the drug interaction precaution to include other protease inhibitors.751 2 Similarly, in the United States, the FDA and Pfizer discussed updating the labelling of sildenafil to include a warning about possible interactions with protease inhibitors.751 2 In September, the Japanese Ministry of Health and Welfare issued another warning against unregulated use of sildenafil without proper consultation with a physician.769 2 At the time, a total of 33 adverse reactions associated with sildenafil had been reported in Japan, including 2 deaths sildenafil had been prescribed by a doctor in only 8 of the 33 cases. Also,...

AReductase Inhibitors

Finasteride (Proscar) is a 5a-reductase inhibitor that blocks the conversion of testosterone to DHT in target tissues. Since DHT is the major intracellular androgen in the prostate, finasteride is effective in suppressing DHT stimulation of prostatic growth and secretory function without markedly affecting libido. It is approved for the treatment of benign prostatic hyperpla-sia. Although there is usually some regression in the size of the prostate gland following administration of finasteride, clinical response may take 6 to 12 months. If the obstructive symptoms are severe, there is often not enough time to allow this compound to work. The principal adverse effects of finasteride are impotence, decreased libido, and decreased volume of ejaculate. The compound is generally well tolerated in men.

Qualityof Life Assessment Tools

The nature of pelvic floor dysfunction as multifactorial with involvement of multiorgan systems makes severity and impact assessment an exceedingly challenging aspect of the evaluation of a symptomatic patient. Various factors such as organ system function, anatomic alterations, lifestyle impact, and psychological well-being may be impacted differently by the disease process, and more importantly, by the therapy received by a patient with pelvic floor dysfunction. Historically, outcome assessment was limited to continence and normal anatomy restoration. As recently as 10 years ago, outcome assessment was focused solely on objective parameters such as urodynam-ics. Aspects of day-to-day living of great importance to the patient, such as lifestyle alterations, work capability, and interpersonal intimacy, were not addressed by clinicians. It is inappropriate to assess outcomes of a multiorgan system dysfunction by assessing only one-dimensional factors. This is particularly true in the...

Mechanism of Action

Ginsenosides are thought to be the active principles in Panax ginseng root. The various subtypes can have opposing pharmacological actions Rg1 stimulates the central nervous system (CNS) and elevates blood pressure, while Rb1 does just the opposite. Somehow these multiple ginsenoside constituents are thought to act in concert to provide increased stamina. In addition, these compounds have antiplatelet aggregation effects and antioxidant properties, and they may stimulate the immune system.

Adverse Reactions Contraindications and Interactions

Headache and GI symptoms are the most frequently reported side effects. It is possible to reduce GI side effects, such as nausea, abdominal discomfort, and diarrhea, by taking the extract with food. Theoretically, decreased libido or erectile dysfunction could also occur. Because of saw palmetto's possible hormonal effects (and lack of indications for use), pregnant and nursing women should avoid it. It is important to rule out prostate cancer in those taking saw palmetto for BPH, since the symptoms are similar. The effect of saw palmetto on prostatic cancer would likely be beneficial but not curative. No drug interactions have been reported.

The Evolutionary Neurodevelopmental Perspective

Finally, avoidants, dependents, compulsives, and negativists are all part of the so-called anxious cluster, personalities for whom anxiety is a prominent life concern. Avoidants and dependents are alike in sharing deep feelings of personal inadequacy but differ in their response to perceived inadequacy. When threatened with feelings of helplessness, dependents seek to bind others even closer to them by increasing their submis-siveness and attempting to please others all the more. In contrast, the avoidant is often very effective in nonsocial situations the dependent is not. Avoidants run away at the first sign of negative evaluation dependents stay and try to please. Both avoidants and compulsives share performance anxiety and a fear of evaluation, which they modulate with extraordinary self-control. Compulsives, however, are usually able to sublimate their anxiety into a preoccupation with rules, details, lists, and such avoidants are more likely to simply withdraw from social venues.

Antiparkinsonian Therapy And Hypersexuality

Sexual awareness or activity was reported in 3 to 4 instances. The authors noted that the 5 men in the 40 to 60 year age group, with a relatively mild form of parkinsonism and 1 to 2 year history of impotence, demonstrated improved motor function with therapy but did not report a change in sexual function. To assess the effect of L-dopa treatment on sexual behavior in 12 men and 7 women, treated for 3 to 15 months, semistructured interviews were conducted.14 The interviewers assigned numerical values to interview responses. Six men and one woman (37 ) reported activation of sexual behavior at some point during the therapy. There were strong negative trends between sexual activity and age of patient (r -.42) and duration of parkinsonism (r -.44). Three patterns of change in sexuality were described. In the first pattern, general improvement in overall function was accompanied by mild improvement in sexual function. This result depended on the patient's past sexual habits, age, and...

Drugs That Interfere With Norepinephrine Storage

Peripheral nervous system side effects are the result of a reserpine-induced reduction of sympathetic function and unopposed parasympathetic activity symptoms include nasal congestion, postural hypotension, diarrhea, bradycardia, increased gastric secretion, and occasionally impotence. Because of the increased gastric secretion, reserpine is contraindicated for patients

Erection the conversion of the flaccid urinary penis to the rigid sexual penis

The vasodilatation of the arterial supply by VIP together with the relaxation of the vessels of the cavernosal tissue allows them to fill under arterial pressure stretching the chambers until they become stiff against their covering of unyielding tunica albuginea, and the veins (emissary) that pass obliquely through the tunica become occluded greatly reducing penile vascular drainage The flaccid urinary penis has been converted into the erect rigid sexual penis some 7 to 8 cm longer. The rigidity is essential for successful vaginal penetration and to stimulate its walls (especially the anterior) during penile thrusting. The striated muscles of the pelvic region, namely the ischiocavernosus and bulbocavernosus, are not normally involved in creating penile erection, (39) although they can be voluntarily contracted in bursts to aid its rigidity. The engorged corpus spongiosum is less rigid than the cavernosal chambers making the glans of the penis softer and less damaging to the female...

Syndromes related to a cultural emphasis on fertility and procreation Genital shrinking syndrome koro suoyang

The 'genital shrinking' syndrome is a transient state of acute anxiety associated with vegetative symptoms, in which the affected male subjectively experiences a shrinking of his penis and the affected female a shrinking of her breasts and or labia the sufferers anticipate not only impotence or sterility but, in the case of complete genital retraction, certain death. Moreover, the immediate human environment of the sufferers is convinced of the same outcome and this explains the 'life saving' measures commonly taken, such as holding on to the sufferer's genitals manually or with special instruments. The 'genital shrinking' syndrome came to the attention of European psychiatry in the late nineteenth century through reports of colonial physicians working in Southeast Asia and through the growing interest in traditional Chinese medicine. Chinese traditional medicine interprets suo-yang as yin-yang imbalance due to a deficiency of the 'warm' male principle yang and an excess of the 'cold'...

Case Study V Finasteride and Prostate Cancer

At the end of the 7-year trial, an endpoint biopsy was performed in all men, demonstrating a 24.8 lower cumulative incidence of prostate cancer in the finasteride compared to the placebo group.79 However, the finasteride group also had a higher rate of high-grade cancers (higher Gleason scores) than the placebo group. In addition, men in the finasteride group reported more problems with sexual function but fewer

Sources and medical uses of folliclestimulating hormone luteinizing hormone and human chorionic gonadotrophin

FSH and hCG also find application in the treatment of male subfertility or related conditions. Both are administered to males exhibiting hypogonadotrophic hypogonadism to stimulate sperm synthesis and normal sexual function. hCG has found limited application in the treatment of pre-pubertal cryptorchidism (a condition characterized by failure of the testes to descend fully into the scrotum from the abdomen). The ability of this hormone to stimulate testosterone production also caught the attention of some athletes, and, as a result, the International Olympic Committee has banned its use.

Levels of explanation and the reduction of mental processes

Many recent authors have also argued against the reduction of mental processes (e.g. Davidson 1980 Fodor 1983), but as we have seen the accompanying danger is that mental processes are stranded without a causal story, or one that separates them from other biological processes. However once the case for the pervasiveness of intentional processes in biology is presented then explanations of psychological processes are no more stranded than those of molecular biology. Nevertheless we do need to be quite specific about what can and cannot be reduced, and how far. We need also to be clear about levels of causal processes, for we are not referring to distinctions such as those of mental versus non-mental, or neuroscience versus biochemistry. That would be to create a dualism (or multilevelism) that is totally at odds with our analysis. For instance a rapid heart beat is part of the intentional response of fear, and an erection is part of male sexual excitement. These physiological responses...

Preface to the First Edition

Herbal remedies have become a major component of American health care. Botanicals like ginseng, ma huang, St. John's wort, and valerian are now household words throughout the world, and the sales of herbal medicine are increasing exponentially. This book describes the efficacy of Shing Jing in male fertility and erectile dysfunction and compares its efficacy with those brought about by levodopa, amylnitrite, vitamin E, and sildenafil (Viagra).

Psychophysiological assessment

Patients use a variety of tactics to conceal their sexual interest. There are a number of drawbacks to using penile plethysmograpy for the clinical assessment of deviant sexual response. One central issue is whether or not arousal responses seen in the laboratory are equal to similar arousal in the real world. Individuals undergoing psychophysiological assessment often deny any and all deviant sexual interest, and so penile plethysmography frequently involves measuring possible sexual interest that the patient has absolutely denied. This can be problematic when attempting to delineate deviant sexual interests through penile plethysmography. Recently, penile plethysmography has come under greater scrutiny because slides depicting nude children are frequently used to assess paedophilic interest. The use of nude slides is considered unethical and illegal in some countries such as the United States. Another problematic issue is the necessity of obtaining two separate rooms to complete...

Autonomic nervous system specific diseases

Automatic Nerves The Penis

In the latter disorder, features of extrapyramidal system involvement arc also found. Both disorders are characterised by postural hypotension anhidrosis (absent sweating) impotence Symptoms of autonomic dysfunction are common in long-standing insulin-dependent diabetics Impotence retrograde ejaculation. Autonomic involvement with orthostatic hypotension, impotence, diarrhoea and bladder involvement may accompany sensimotor neuropathy in the primary and hereditary forms. Amyloid infiltration affects autonomic ganglia. pressure rise, bradycardia, sweating, reflex penile erection (priapism).

Paraphilia not otherwise specified

Zoophilia is an activity that involves becoming sexually aroused by repetitively carrying out sexual activities with animals. Zoophiles usually have other sexual outlets, but participate in zoophilia because of the ease of accessing animals for sexual purposes and the low risk of apprehension for such activity. Therapists frequently view zoophilia as a trivial problem that serves as a butt for jokes. In actuality, zoophilia is a more serious paraphilia than suspected because of the consequences of the learned behaviour.

Causes Of Hypersexual Behavior

Different mechanisms have been suggested to explain hypersexuality in response to antiparkinsonian therapy. The dopaminergic system, which is widely distributed in the central nervous system (CNS) and pelvic organs, is necessary for male sexual arousal and ejaculation, as documented in animal experiments and human studies.65 The serotonergic system, which is also widely distributed in the CNS, has an inhibitory role in the sexual response cycle. Dopaminergic agents such as levodopa, bromocrip-tine, and pergolide may promote sexual behavior by activating the dopaminergic system and lowering serotonin concentrations at postsynaptic sites.25

Adhesion Proteins And Cancer Cell Migration

A number of natural compounds inhibit cancer cell migration. Many of these also inhibit immune cell migration, since the mechanisms that govern both can be similar. However, at least some natural compounds, such as PSK, appear to inhibit cancer cell migration preferentially. Ginseng may do the same. The reason some natural compounds inhibit cancer cell migration but not that of immune cells is probably because cancer cells rely on such abnormal signals for activity that their activity is more easily inhibited.

Using Combinations Of Polysaccharides

Shi Quan Da Bu Tang contains twelve common Chinese herbs, including Astragalus and ginseng. The for Bu Zhong Yi Qi Tang contains eight common Chinese herbs, including Astragalus and ginseng. Administration of this formula stimulated the immune system and suppressed the growth of cancer in mice.

Disorders of sexual behaviour

Impotence or reduced libido Reduced sexual activity and interest is the most common disorder of sexual behaviour associated with dementia, though it is the least likely to come to the attention of the clinician. It probably plays a part in the high rates of divorce seen, for example, in young couples after one partner has sustained a brain injury. Psychological effects, in particular the change in the patient's role in the partnership as a result of dementia, as well as the physiological effects of brain injury on erectile function, contribute to impotence and reduced libido.

Current Medical Treatments For Hypertension

Possible new drugs are constantly on trial, for instance, vasopeptidase inhibitors.9 Sildenafil specializes in pulmonary vasodilation while it increases blood flow out of the heart, it has no effect on wedge pressure.35 One group of researchers attempted to determine whether benazepril or nitrendipine produced a greater reduction in left ventricular mass. The results were close benazepril had greater effect on diastolic pressure and nitrendipine decreased systolic pressure more.32 Attention is now paid to health-related quality of life (HR-QOL) issues in health services. The most common areas of inquiry on patient-completed questionnaires are cognitive function, symptomatic well-being, adverse effects, sexual function, psychological well-being, sleep dysfunction, social participation, and general health perception.16 A recent goal of treatment for hypertension, in addition to lowering blood pressure, is to reduce the adverse side effects of medications in order to increase patient...

Indications and contraindications

Many problems with sexual function would be suitable for couple therapy, including those couples where there is a disparity in sexual desire, or those where one partner has a specific phobia for sex. In some such cases there is also a need for individual therapy, especially where one partner is the survivor of earlier childhood sexual abuse.

Differentiation Of Pd From Multiple System Atrophy

Among the males with MSA in Chandiramani et al's series, 93 had erectile dysfunction (ED), including 48 where this complaint preceded the diagnosis of MSA. However, ED can also be seen in PD, although the proportion of early ED is less.32 One would also expect poor response to urological surgery targeting prostatism, even poorer than with PD. All 11 men with MSA in Chandiramani et al.'s series9 who had a TURP were incontinent postoperatively. See the section below, Effects of Urologi-cal Surgery.

Other Agents Of The Same Pharmacological Class

Specific chemical class usually associated with one therapeutic area but have later been developed or used clinically in an entirely different therapeutic area. Terfenadine is another typical example. It was discovered through a central nervous system programme aimed at synthesising new neuroleptic agents but because of its potent secondary pharmacological effects at the -antihistamine receptor, it was developed as the first non-sedating -antihistamine. It was a highly successful and popular drug until withdrawn due to reports of torsade de pointes resulting from drug interactions. Like all neuroleptics, it attracted considerable regulatory attention because of its effect on the QT interval. Sildenafil, originally intended for development as an antianginal drug, was developed instead for male erectile dysfunction and it is not surprising that at high concentrations, it has been shown to prolong cardiac repolarisation by blocking the rapid component of the delayed rectifier potassium...

Sexual pain disorders

Vaginismus is not necessarily limited to sexual situations. Typically, women with this disorder have been unable to insert tampons or permit insertion of a speculum during gynaecological examination. Interestingly, many women with vaginismus are quite capable of becoming sexually aroused, lubricating, and experiencing orgasm. Leiblum et al.(82) write, 'What is so striking in so many of these cases is the number of years the couple tolerates the difficulty before seeking treatment, because of ambivalence about resolving the problem often, it is the desire to have children that ultimately propels the couple to seek assistance'.

Modifying the EPOR model into the DEOR model

The first weakness of the EPOR model is that it was derived from the study of a highly selected group of American men and women volunteers who could arouse themselves to orgasm in a laboratory, on demand, and allow themselves to be watched filmed or measured for scientific and altruistic (or perhaps exhibitionistic) purposes. The second weakness was the lack of interobserver agreement about the changes observed and of confirmation of their sequential reliability. Robinson (21) examined the E phase and P phase, and concluded convincingly that the P phase was simply the final stage of the E phase. Helen Kaplan, (22) a New York sex therapist, proposed that before the E phase there should be a 'desire phase' (D phase). This proposal came from her work with women who professed to have no desire to be sexually aroused, even by their usual partners. She suggested that the desire must occur before sexual arousal can begin. Kaplan's subjects were attending a clinic and no studies were ever...

Adr Headlines From 1999

In 1999, confidence in vaccinations received another blow following the withdrawal of rotavirus vaccine ( RotaShield ) because of reports of intussusception, and there was misleading press coverage regarding the safety of the measles, mumps and rubella (MMR) vaccine. Investigations continued into the link between anorectic agents and valvular heart disease, the safety of sildenafil, and metabolic disorders associated with protease inhibitors. Fluoroquino-lones came into the spotlight when marketing of trovafloxacin and its IV formulation alatro-floxacin was suspended in Europe because of hepatotoxicity, and grepafloxacin was withdrawn worldwide later in the year following reports of fatal cardiovascular events.

Ganglionic Blocking Agents

The ganglionic blocking agents are extremely potent antihypertensive agents and can reduce blood pressure regardless of the extent of hypertension. Unfortunately, blockade of transmission in both the sympathetic and parasympathetic systems produces numerous untoward responses, including marked postural hypotension, blurred vision, and dryness of mouth, constipation, paralytic ileus, urinary retention, and impotence. Owing to the frequency and severity of these side effects and to the development of other powerful antihypertensive agents, the ganglionic blocking agents are rarely used.

Early Historical Forerunners

Eventually, the glory of ancient Greece and Rome disappeared. In the Middle Ages, the world was viewed through a religious paradigm. Faith in God offset hard times for humanity, including mass starvation, disease, pestilence, and war. By some estimates, a third of the population of Europe was killed by the Black Death alone. Humans naturally sought explanations to such paradoxical calamities. How could such horrors occur if God were just and loving Again, women were to blame. Those who ran afoul of social standards became natural scapegoats, being diagnosed according to the standard of the times as witches, in league with Satan. Through their sorcery, these evil beings could summon famine, plague, bad luck, and worst of all, impotence. Eventually, the widespread dread of witches found religious sanction in the Malleus Maleficarum, or Witches' Hammer, written by two German monks in 1496, a kind of Stephen King version of our modern DSM, complete with its own form of therapy burning at...

Available Qualityof Life Assessment Tools

Sexual function has significant generational differences. For many elderly patients, requesting information regarding their sexual activity is considered offensive. Many patients do not consider sex pleasurable, and their practices - even at sexual peak - were very conservative. For example, many elderly women are not comfortable with genital self-contact.

Consequences of Cigarette Smoke Induced Microvascular Dysfunction

Most smoke-related diseases point toward effects on the microcirculation. For one, the development of pulmonary emphysema occurs at the microcirculatory level of the delicate alveolar membranes, presumably due to a dysbalance between aggressive factors such as tissue degrading mediators and reactive oxygen species released from smoke-activated neutrophils (i.e., elastase, hydrolytic enzymes) and protective factors such as a-1 antiprotease, which are inactivated by cigarette smoke. Also, the association of cigarette smoking and chronic inflammatory conditions such as periodontal disease is a largely microcirculatory phenomenon that involves phagocyte dysfunction and other pathomech-anisms. Another important problem related to cigarette smoking-induced microcirculatory dysfunction is of major concern to plastic surgeons. There is an impressive literature on the adverse effects of cigarette smoking on the outcome after surgical interventions, such as (i) a significantly higher incidence...

Spinal Dysraphism in Adults

Adult patients with spinal dysraphism include those with new symptomatic onset of a previously unsuspected occult dysraphic condition and those with a known dysraphic lesion in childhood but with symptom onset only in adulthood. In both groups, unlike in childhood, pain is the most frequent presenting symptom. This may be poorly localized and bilateral, and coupled with weakness in the legs as well as sensory disturbance. Problems with bladder control, as well as erectile dysfunction, also occur frequently. Not infrequently, the problem only comes to light as a result of excessive stretching of the conus, as may occur in childbirth or trauma 25 . In those with a known dysraphic lesion, presentation in adulthood may be with a progressive scoliosis or foot deformity, although these features are generally not seen in an adult with a previously unsuspected dysraphism.

Herbal Immunostimulant Compounds

The (probable) active ingredients of the herbal compounds in Table 12.1 tend to fall into a limited number of chemical families one of these is high-molecular-weight polysaccharides, which are large sugar molecules. Natural compounds containing them include Astragalus, Ganoderma, Eleutherococcus, and PSK. A second family of immunostimulating compounds is the saponins. Natural compounds with these are Eleuthero-coccus and ginseng. It is tempting to speculate that the most effective combinations of herbal immune stimulants will contain compounds from both families, and in fact, most multiherb, immunostimulating formulas used in Chinese herbal medicine do have both. Some herbs themselves also include compounds from both families, as is the case with Eleutherococcus and ginseng.

Fascia and Ligaments of the Pelvic Floor

Pelvic Floor Ligament Suspension

Posterior to the rectum is the mesorectum, which contains both blood vessels and lymphatics that supply and drain the rectum. This is loosely bound down the front of the sacrum and coccyx by connective tissue known as the fascia propria. The lateral ligaments, which attach the rectum to the pelvic walls, are condensations of the fascia propria and contain loose areolar tissue, nerves, and small blood vessels. Thus, the mesorectum can be mobilized by dissection in the mesorectal plane leaving the mesorec-tum invested in this thin layer of fascia. The sacrum and coccyx are also covered in a thicker fascia, which extends downward and forward, just superficial to the anococ-cygeal ligament known as Waldeyer's fascia. Anteriorly the rectum is covered with a layer of visceral fascia that extends from the anterior peritoneal reflection to the urogenital diaphragm. This is Denonvilliers fascia and lies between the rectum and vagina (or prostate in men). Nerves important to bladder control and...

Symptomatology of Urogenital Atrophy

Typical symptoms of vaginal atrophy include vaginal dryness, vaginal irritation, as well as loss of vaginal caliber and depth in more advanced degrees of atrophy. The initial symptoms of vaginal atrophy can be promptly reversed with local estrogen therapy. However, the more long-term effects of urogenital atrophy such as loss of vaginal caliber and depth are less likely to be readily reversible. This has recently become a clinically important issue, because male erectile dysfunction can be treated pharmacologically, whereas the female partners' advanced urogenital atrophy has not been taken into account. Any attempt at sexual intercourse after a long hiatus of inactivity in a post-menopausal woman can result in sexual dysfunction and even vaginal trauma including lacerations upon attempted penetration. It is thus critical that both partners be considered when initiating erectile dysfunction therapy in the male.

Transvestic fetishism

Transvestic fetishist is usually a heterosexual male who is sexually aroused by cross-dressing and fantasizing himself as an alluring female (DSM-IV code 302.3 in ICD-10 the term is fetishistic transvestism, and the code is F65.1).(34) Fetishisim and transvestic fetishism are similar in that individuals in both categories have a sexual preference for adult females, but differ in that the fetishist is usually attracted to inanimate objects and generally does not cross-dress wearing the fetish item but holds or fondles it during masturbation. Effeminate egodystonic homosexuals and male-to-female transsexuals have a sexual preference for adult males. The manner in which individuals walk, sit, and stand reflects their gender motor behaviour. Fetishists have masculine gender motor behaviour, as do transvestic fetishists when not cross-dressing. Effeminate egodystonic homosexuals frequently show feminine gender motor behaviour, while transsexuals frequently display exaggerated feminine...

Transsexual patient subgroups

In addition to the subtypes of transsexuals based on their sexual orientation, a substantial number of male transsexual patients evolve through a diagnostic phase more closely fitting fetishistic transvestism. These patients have been more masculine in general lifestyle and appearance than other male transsexuals, cross-dressing has been sexually arousing, and they have usually been heterosexually oriented. However, with the passage of time gender dysphoria increases and fetishistic components of cross-dressing diminish or disappear. Many have been sexually aroused by fantasies of themselves as women. (31) There is some evidence that males evolving through a fetishistic cross-dressing phase, presenting as somewhat older at gender identity clinics, have a poorer prognosis after surgery. This is marginally evident in some follow-up studies. Primarily, it is the progression through the 'Real Life Test' that becomes the critical management guideline for patients, irrespective of their...

Androgens Testosterone

Androgen deficiency can lead to decreases in nocturnal erections and libido. Hypogonadism is associated with impotence, yet erection in response to visual stimulation is preserved in men with hypogonadism, suggesting that androgens are not essential for erection. Although androgens can enhance male sexual function, testosterone therapy for the treatment of ED should be discouraged unless the cause is clearly related to hypogo-nadism. Androgen therapy in normal men may enhance sexual behavior but is without significant effect upon erectile function. Usefulness of oral methyltestosterone is limited in men with hypogonadal impotence. Improvement following transdermal testosterone may require several months of therapy. Androgen replacement regimens for treating male hypogonadism include long-acting intramuscular injections (e.g., testosterone enanate, testosterone cypi-onate) and oral preparations (e.g. methyltestosterone, fluoxymesterone). Transdermal patches (Testoderm, Androderm) and...

Special Issues For The Transplant Patient

The hypothalamic-pituitary-gonadal (HPG) axis is markedly disturbed by chronic renal failure, and this is manifest in diminished testosterone levels and impaired spermatogenesis. These patients often present with complaints of diminished libido, erectile dysfunction (ED), and infertility. Upon evaluation, they have low serum testosterone levels and elevated follicle stimulating hormone (FSH) and luteinizing hormone (LH) levels.1 Interestingly, these patients usually retain a normal response to clomiphene citrate stimulation. Clomiphene citrate has antiestrogenic properties which result in a decrease in negative feedback by

Biochemistry Hormones

Testosterone from blood is correlated with sensation seeking, particularly that of the experience seeking and disinhibitory types (Aluja & Torrubia, in press Daitzman & Zuckerman, 1980), although Bogaert and Fisher (1995) and Dabbs (2000) found only nonsignificant tendencies toward association using salivary testosterone. Hypogonadal men with very low testosterone referred for complaints of erectile dysfunction were lower on sensation seeking than men with normal levels of testosterone (O'Carroll, 1984). Testosterone in young males correlates with their sexual experience, as defined by the number of sexual partners they have had (Bogaert & Fisher, 1995 Dabbs, 2000 Daitzman & Zuckerman, 1980). Other corelates of testosterone in males include assertiveness, impulsivity, and low self-control. A history of antisocial behavior, beginning in childhood, is found in men with high testosterone levels (Dabbs, 2000).

Clinical Studies With Chinese Herbal Formulas

No discussion on using natural immunostimulant compounds in cancer therapy would be complete without some consideration of the many clinical studies that have been done in China. Studies have been conducted on the combined use of chemotherapy and Chinese herbal medicine, as well as on the anticancer use of Chinese herbal medicine alone. The majority of herbal formulas used in the Chinese studies were composed primarily of immunostimulant herbs such as those in Table 12.1 (for example, most formulas included Astragalus or ginseng or both). In Chinese herbal medicine, most of these herbs are considered tonics for the qi, or vital energy.3 (For contents of the herbal formulas mentioned below, see Table H.2 in Appendix H for more information on the theory of using Chinese herbs in cancer treatment, see reference 68).

General Information

Eleutherococcus senticosus is a shrubby member of the ginseng family. Like Astragalus, it is a common Chinese herb and is mentioned in the Shen Nong Ben Cao Jing. A complex taxonomic controversy exists regarding similarities between the Eleutherococcus and Acanthopanax species, however, and it is not certain that the Shen Nong Ben Cao Jing was actually referring to Eleutherococcus senticosus. Some scholars have combined Eleutherococcus and Acanthopanax into the same (Eleutherococcus) genus, while others have recognized Eleutherococcus as a distinct genus. Today, most of the world's scientists refer to the plant as Eleutherococcus senticosus, while Chinese scientists refer to it as Acanthopanax senticosus. Not until the 1970s, when the plant was imported into the United States as an herbal adaptogen, was it given the common name Siberian ginseng.3 Extensive clinical research on the plant has been conducted in Russia since the 1950s.56

Urogynecology History

Sexual dysfunction frequently occurs in conjunction with incontinence and prolapse, and it should not be ignored. Although some symptoms may be primarily hormonal in nature (i.e., decreased libido, vaginal dryness) and others primarily neurologic (i.e., decreased vaginal sensation, secondary anorgasmic), there is frequently a combination of etiologic factors. In addition, parameters defining normal sexual function have not yet been determined because of varying individual characteristics, as well as cultural factors.


Problems with sexual function have been reported to occur in women with urinary incontinence and uterovaginal prolapse.27 However, the precise relationship between prolapse and sexual function has not been well documented. In a study that compared sexual function in women with and without uterovaginal prolapse, the authors found that overall sexual dysfunction in women without prolapse did not differ from women who had prolapse. In addition, the degree of prolapse did not have a role in whether sexual dysfunction occurred among those with prolapse. Psychological and relationship conflicts tended to have a greater impact on sexual function for both groups of


Several menopause-related changes in sexual function occur that have been described in the literature diminished sexual responsiveness, dyspareunia, decreased sexual activity, decrease in sexual desire, and a dysfunctional male partner. Sarrel29 described the underlying cause of biological changes that occurred with sexual dysfunction to be estrogen deficiency. The postmenopausal ovary has been shown to be responsible for up to 50 of the testosterone believed to be associated with libido. Many clinicians believe that a combination of both estrogen and testosterone is required to improve female sexual function.

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