Archive for ◊ March, 2009 ◊

Monday, March 16th, 2009
Category: Sexual |  Tags: Good, Healthy, Mind | Leave a Comment

Healthy mind is the essential component for the good sex; you can even say that good mental condition is directly proportional to the good sex drive. Many a times it has been observed that problems in the sex are mainly due to the psychological things i.e. unhealthy mental conditions. Sexual satisfaction is the basic necessity of every individual, and if it is unsatisfied then certainly it may lead to the problems in the men-women relationship. It more…

Sunday, March 15th, 2009

Everybody wants to get the guaranteed satisfaction from whatever they buy and if the product fails to do it then certainly next time the customer goes for the new choice. So, it is necessary for every product manufacturer to provide the guaranteed solution for the customer requirement. In the case of the medicines, if the medicine is not able to treat the disease then it becomes a serious case as it may deteriorate the health of the patient. Medicines more…

Thursday, March 12th, 2009
Category: Sexual |  Tags: Essential | Leave a Comment

Sex is always termed as the feeling of lust and concupiscence; sometimes it is even termed as a sin when done to satisfy prurient desires. But, sex is not a sin it is the most essential part of the life, which plays a vital role in making you happy. Sex improves the overall quality of life, and even gifts an individual by increasing his longevity. It has been observed during the studies that person who practices sex regularly lives for more years more…

Tuesday, March 10th, 2009

A great deal of progress has been made in the pharmacological treatment of ED. Modern treatment of ED
has been revolutionized by the worldwide availability of the three PDE5 inhibitors (sildenafil, tadalafil,
vardenafil) for oral use, which are associated with high efficacy and safety rates, even in difficult-to-treat
populations (e.g. diabetes mellitus, radical prostatectomy). Patients should be encouraged to try all three
PDE5 inhibitors and to develop their own opinions. They will choose the compound perceived by them to
have the best efficacy, as well as considering other features such as time of onset, duration of action,
window of opportunity and their own individual experience with side-effects.
Treatment options for patients not responding to oral drugs (or contraindicated) include
intracavernous injections, intraurethral alprostadil, vacuum constriction devices and implantation of penile
It must be emphasized that the physician should warn the patient that sexual intercourse is
considered to be a vigorous physical activity, which increases heart rate as well as cardiac work.
Physicians should assess the cardiac fitness of patients prior to treating ED.
Any successful pharmacological treatment for erectile failure demands a degree of integrity of the
penile mechanisms of erection. Further studies of individual agents and synergistic activity of available
substances are underway. The search for the ideal pharmacological therapy for erectile failure aims at
fulfilling the following characteristics: good efficacy, easy administration, freedom from toxicity and sideeffects,
with a rapid onset and a possible long-acting effect.

Tuesday, March 10th, 2009
Category: Ed Tablets |  Leave a Comment

Sildenafil is the first PDE5 inhibitor. More than 20 million men have been treated over a 6-year post-marketing
experience. It is effective (erection with rigidity sufficient for vaginal penetration) within 30-60 minutes from
administration. Its efficacy is reduced after a heavy fatty meal due to prolonged absorption. It is administered in
25, 50 and 100 mg doses. The recommended starting dose is 50 mg and should be adapted according to the
patient’s response and side-effects. Efficacy may be maintained for up to 12 hours (34). The pharmacokinetic
data of sildenafil are presented in Table 5. Adverse events (Table 6) are generally mild in nature and self-limited
by continuous use, with the drop-out rate due to adverse events similar to placebo (35).
In pre-marketing studies, after 24 weeks of treatment in a dose-response study, improved erections
were reported by 56%, 77% and 84% of men taking 25, 50 and 100 mg of sildenafil, respectively, compared
with 25% of men taking placebo (11). Sildenafil statistically improved IIEF, sexual encounter profile 2 (SEP2),
SEP3 and general assessment question (GAQ) and satisfaction scores.
The efficacy of sildenafil in almost every subgroup of patients with ED has been successfully established
(36). In diabetic patients, 66.6% reported improved erections (GAQ) and 63% successful intercourse attempts,
respectively, compared with 28.6% and 33% of men taking placebo (37). In patients after bilateral nerve-sparing
radical prostatectomy, 76% responded to sildenafil (defined as successful vaginal intercourse) (38).
Tadalafil is effective from 30 minutes after administration, but its peak efficacy is expected in about 2 hours’
time. Efficacy is maintained for up to 36 hours (39). Its efficacy is not influenced by food. It is administered in
10 and 20 mg doses. The recommended starting dose is 10 mg and should be adapted according to the
patient’s response and side-effects. Pharmacokinetic data of tadalafil are presented in Table 5. Adverse events
(Table 6) are generally mild in nature, self-limited by continuous use, and the drop-out rate due to adverse
events is similar to placebo (40).
In pre-marketing studies, after 12 weeks of treatment and in a dose-response study, improved
erections were reported by 67% and 81% of men taking 10 mg and 20 mg of tadalafil compared with 35% of
men in the control placebo group (13). Tadalafil statistically improved IIEF, SEP2, SEP3 and GAQ and
satisfaction scores. These results were confirmed in post-marketing studies (41).
Tadalafil also improved erections in difficult-to-treat subgroups. In diabetic patients, 64% reported
improved erections (i.e. improved GAQ) compared to 25% of patients in the control group and the final IIEF
erectile function domain score change was 7.3 compared to 0.1 for placebo (42). In patients after bilateral
nerve-sparing radical prostatectomy, the mean percentage of successful penetration attempts was 54% and
the mean percentage of successful intercourse attempts was 41%. For a subgroup with evidence of
postoperative tumescence, these values were 69% and 52%, respectively. Improved erections were reported
by 62% of all patients randomized to tadafil and 71% of subgroup patients randomized to tadafil (43).
Vardenafil is effective after 30 minutes from administration. Its effect is reduced by a heavy fatty meal (> 57%
fat). It is administered in 5, 10 and 20 mg doses. The recommended starting dose is 10 mg and should be
adapted according to the patient’s response and side-effects. In vitro, it is 10-fold more potent than sildenafil;
however, this does not necessarily imply greater clinical efficacy (44). Pharmacokinetic data of vardenafil are
presented in Table 5. Adverse events (Table 6) are generally mild in nature and self-limited by continuous use,
with a drop-out rate similar to placebo (45).
In pre-marketing studies, after 12 weeks of treatment and in a dose-response study, improved
erections were reported by 66%, 76% and 80% of men taking 5 mg, 10 mg and 20 mg of vardenafil,
respectively, compared with 30% of men taking placebo (46). Vardenafil statistically improved IIEF, SEP2,
SEP3 and GAQ and satisfaction scores. Efficacy is confirmed in post-marketing studies (47).
Vardenafil has also improved erections in difficult-to-treat subgroups. In diabetic patients, 72%
reported improved erections (i.e. improved GAQ) compared to 13% of patients taking placebo and the final
IIEF erectile function domain score was 19 compared to 12.6 for placebo (48). In patients after bilateral nervesparing
radical prostatectomy, the average intercourse success rate per patient receiving 20 mg vardenafil was
74% in men with mild to moderate ED and 28% in men with severe ED, compared to 49% and 4% for placebo,
respectively. Positive GAQ responses were reported by 71.1% of patients (49).

Tuesday, March 10th, 2009
Category: Ed Tablets |  Leave a Comment

The basic work-up must identify reversible risk factors for ED. Lifestyle changes and risk factor modification
must precede or accompany ED treatment. These guidelines include lifestyle modification (e.g. weight loss,
exercise) for ED, but also address psychosocial issues, adverse side-effects of prescription or non-prescription
drugs and the presence of hypogonadism as a modifiable aetiology or comorbidity of ED.
The potential benefits of lifestyle changes may be of special relevance in individuals with ED and
specific comorbid cardiovascular or metabolic diseases, such as diabetes or hypertension (9,29,30). For these
men, the positive consequences of aggressive lifestyle changes may be of special benefit not only for
improving erectile function, but also for improving overall cardiovascular and metabolic health. Recent studies
support the potential value of lifestyle intervention, for both ED and overall health benefits (10).
Clearly, further studies are needed to expand and clarify the role of lifestyle changes in the management
of ED and related cardiovascular disease (CVD). Lifestyle changes may be recommended independently
or in combination with PDE5 therapy. Some studies have suggested that the therapeutic effects of PDE5
inhibitors may be enhanced if other comorbidities or risk factors are aggressively managed (31). Although
suggestive, these results have yet to be confirmed in well-controlled, long-term studies. Given the success of
pharmacological therapy for ED, clinicians in the future will need to provide specific evidence for the potential
benefits of lifestyle change. Hopefully, further evidence for these benefits will become available in the future.

Tuesday, March 10th, 2009
Category: Ed Tablets |  Leave a Comment

There is a high prevalence of cardiovascular disease among patients seeking treatment for sexual dysfunction
and the potential cardiac risks associated with sexual activity are well established. Furthermore, recent
epidemiological studies have underscored the association between cardiovascular and metabolic risk factors
and sexual dysfunction in both men and women (3,22).
The pharmacological properties of phosphodiesterase (PDE) type 5 inhibitors, including their effects
on cardiac smooth muscle activity and overall cardiovascular safety, have similarly been intensively
investigated. In light of these developments, a consensus conference on sexual dysfunction and cardiac risk
was convened on June 4-5, 1999, in Princeton, New Jersey (23), which was updated on June 11-12, 2004
(Second conference on sexual dysfunction, J Am Coll Cardiol, in press). The proposed management
recommendations have been adapted by the current panel.
Patients with ED initiating or resuming sexual activity can be stratified into three risk categories (Table
2). Exercise tolerance, as determined from the history, can guide the clinician in estimating the risk of sexual
activity in most instances.
Low-risk category
The low-risk category includes patients who do not have any significant cardiac risk associated with sexual
activity. The ability to perform exercise of modest intensity (e.g. 6 or more metabolic equivalents of energy
expenditure in the resting state [METs]) without symptoms typically implies low risk. Based upon current
knowledge of the exercise demands or emotional stress associated with sexual activity, no special cardiac
testing or evaluation is indicated for these patients before the initiation or resumption of sexual activity or
therapy for sexual dysfunction.
Intermediate-risk, or indeterminate-risk, category
The intermediate- or indeterminate-risk category consists of those patients whose cardiac condition is
uncertain, or whose risk profile is such that further testing or evaluation is indicated before the resumption of
sexual activity. Based upon the results of testing, these patients may be subsequently assigned to either the
high- or low-risk group. Cardiology consultation in some cases may help the primary physician in determining
the relative safety of sexual activity for the individual patient.
High-risk category
The high-risk category consists of those patients whose cardiac condition is sufficiently severe and/or unstable
that sexual activity may constitute a significant risk. Most patients are moderately to severely symptomatic.
High-risk individuals should be referred for cardiac assessment and treatment. Sexual activity should be
deferred until the patient’s cardiac condition has been stabilized by treatment, or a decision has been made by
the cardiologist and/or internist that sexual activity may be safely resumed. Under some circumstances, the
patient’s evaluation of risk relative to the need for sexual activity may lead to a discussion with the physician
about the cardiovascular aspects of sexual activity, and the possible associated risks, and
a more or less restrictive approach to resuming sexual activity.

Tuesday, March 10th, 2009
Category: Ed Tablets |  Leave a Comment

The advances in basic and clinical research in ED made during the last 15 years have led to the development of
several new treatment options for ED, including new pharmacological agents for intracavernous, intraurethral,
and, more recently, oral use (11-13). Reconstructive vascular surgery is associated with poor outcomes in longterm
follow-up (14,15). As a result, treatment strategies have been significantly modified.
The current availability of effective and safe oral drugs for ED, together with the tremendous media
interest in this condition, has resulted in an increasing number of men seeking help for ED. Many physicians
without background knowledge and clinical experience of the diagnosis and treatment of ED are involved in
decision-making concerning the evaluation and treatment of these men. Therefore, some men with ED may
undergo little or no evaluation before treatment is initiated, or men without ED may seek treatment in order to
enhance their sexual performance. In such circumstances, the underlying disease causing the symptom (i.e.
ED) may remain untreated. Such observations have made the development of guidelines for the diagnosis and
treatment of ED a necessity.

Tuesday, March 10th, 2009
Category: Ed Tablets |  Leave a Comment

Male erectile dysfunction has been defined as the persistent inability to attain and maintain an erection
sufficient to permit satisfactory sexual performance. Although ED is a benign disorder, it is related to physical
and psychosocial health, and has a significant impact on the quality of life of both sufferers and their partners
and families.
Recent epidemiological data have shown a high prevalence and incidence of ED worldwide. The first
large-scale, community-based study, Massachusetts Male Aging Study (MMAS), reported a combined
prevalence of 52% ED in non-institutionalized 40 to 70-year-old men in the Boston area (2). In this study, the
individual prevalences were 17.2, 25.2 and 9.6 for minimal, moderate and complete ED, respectively. In the
Cologne study (men 30-80 years old), the prevalence of ED was 19.2%, with a steep age-related increase
(2.3-53.4%) (3), while the prevalence of sexual dysfunctions (not specific ED) in the National Health and Social
Life Survey was 31% (4). Analysis of the longitudinal results from the MMAS study estimated that the incidence
of ED was 26 new cases per 1000 men annually (5), while the incidence rates (new cases per 1000 men annually)
of ED in a Brazilian (6) and in a Dutch (7) study were estimated at 65.6 (mean follow-up 2 years) and 19.2 (mean
follow-up 4.2 years), respectively. Differences in these studies can be explained by the methodology design of
the different surveys, the age and the socio-economic status of the populations studied.
Erection is a neurovascular phenomenon under hormonal control. It includes arterial dilatation,
trabecular smooth muscle relaxation and activation of the corporeal veno-occlusive mechanism (8). Several risk
factors have been identified based on our knowledge of the physiology of erection. Actually, it has become
clear that ED shares common risk factors with cardiovascular disease, such as a lack of exercise, obesity,
smoking, hypercholesterolaemia and the metabolic syndrome. Several lifestyle risk factors can be modified. In
the MMAS, men who initiated physical activity in midlife had a 70% reduced risk for ED relative to those who
remained sedentary, while in its longitudinal results, regular exercising showed a significantly lower incidence of
ED over an 8-year follow up period (9). A multicentre, randomized, open-label study compared 2 years of
intensive exercise and weight loss with an educational control in obese men with moderate ED (10).
Significant improvements in body mass index (BMI) and physical activity scores, as well as in erectile function,
were observed in the lifestyle intervention group, while those changes were highly correlated with both weight
loss and activity levels. However, it should be emphasized that controlled prospective studies are necessary to
determine the effects of exercise or other lifestyle changes in prevention or treatment of ED.

Tuesday, March 10th, 2009
Category: Ed Tablets |  Leave a Comment

• Inability to consistently attain or sustain an erection sufficient for satisfactory sexual performance.
• May occur with some partners and not others.
• May be able to get an erection, but penis becomes soft prior to or after insertion.
• Erectile Dysfunction is often referred to as ED.
Primary Erectile Dysfunction: Has never have been able to get an erection.
Secondary Erectile Dysfunction: Have been able to achieve and maintain erections in the past, but now unable to.
See a doctor if it lasts longer than two months or is recurring.
• Most males, at some point in their lives, will have difficulty getting or keeping an erection. This is very
• This occurs in males of all age groups, not just older men!
• It is estimated that 20-30 million men in U.S. suffer from recurring erectile problems.
Due to the increase of available prescription medications to treat erectile dysfunction, many people believe that
ED is almost always caused by a physical or medical problem. But for most college students who are healthy,
erectile problems are usually the result of issues that are interpersonal (having to do with the relationship),
situational or emotional in nature. If a man is able to get and maintain an erection during masturbation, it is
unlikely that the cause of erectile problems is physical or medical.
Many factors can influence a man’s ability to get or maintain an erection. Erectile functioning is complex, and
combines cognitive, behavioral, emotional, social, and physical features.

The penis contains two cylindrical, sponge-like structures that run parallel to the urethra. These structures,
which run along the length of the penis, become engorged with blood in response to nerve impulses. The blood
flow to the cylinders increases by about seven times the normal amount. This is what causes the penis to
become erect and stiff.

Three steps need to take place in order for the erection to occur, and then be maintained. First is sexual
arousal. The second step is the brain’s communication of the sexual arousal to the body’s nervous system
(which activates the blood flow). Thirdly, a relaxation of the blood vessels that supply blood to the penis must
occur, allowing the erection to take place. If something affects ANY of these three steps, arousal, nervous
system response or the vascular system response or the interplay between them, erectile dysfunction can
Myth: Men are always capable of having sex
Feeling tired or having concerns about schoolwork or family can affect the degree of a man’s desire and sexual
functioning. Men should not attempt intercourse if they are not in the mood.
Myth: Alcohol use causes erectile problems
While it is true that consuming too much alcohol can affect a man’s ability to get an erection, this doesn’t always
happen and is usually the case with high doses of alcohol (BAC above .08). For some men, particularly young
men, alcohol use can reduce anxiety and actually facilitate erections. However, the use of alcohol prior to or
during sex is not recommended. For older men, the use of alcohol, even in small amounts may inhibit erectile
capacity. In addition, long term over consumption of alcohol negatively affects all systems in the body, including
sexual functioning.
Myth: Real sex requires that a man have a good, hard erection
Many men feel that the sexual encounter must end if he starts to lose an erection. This can lead to further
anxiety about erections and sexual situations. Pleasure for both partners comes in many forms and can be
achieved in a variety of ways! Don’t limit your intimate or sexual contact to the erect penis only!
Myth: If the man is normal, erections should be automatic
Many men, like many women, need direct manual or oral stimulation for the penis to become sufficiently erect
for intercourse. Media images lead us to believe that men – at any moment, at any time – are ready for sex both
physically and psychologically. This is not true in real-life situations.
Myth: If a man has an erection, he is ready for sex
Men develop erections in non-sexual situations. Erections occur during normal, nightly sleeping patterns (REM
sleep). These erections are not related to erotic dreams. In addition, if a man experiences fear, (while sleeping
or awake), he may get an erection, which is not due to sexual arousal or pleasure. Men can also be with a
partner and have an erection without thinking sexual thoughts.
There are medications available to help treat ED. It is important to understand that these are not “magic pills”
that will allow erections to take place automatically. There are many factors that affect erectile functioning, and
erectile dysfunction is a complex issue that medications alone cannot always cure.
Medications such as Viagra, Levitra and Cialis help a person get and maintain an erection by relaxing the
corpus cavernosum muscle in the penis. Essentially, these medications enhance blood flow to the penis by
blocking the PDE-5 enzyme, and can be used whether the cause of ED is physical, emotional, and situational or
There are differences between these medications, and each person can have different experiences with them.
It is important to discuss with your doctor the different ways these medications work, the possible side effects
and any contraindications for use.
In addition to medications that are designed specifically for erectile dysfunction, some anti-anxiety medications
may also be helpful in addressing erectile problems, particularly if the erection problems result from
performance or generalized anxiety. Depression is also known to have a negative affect on sexual desire,
which can lead to decreases levels of arousal or excitement, making it more difficult to get or maintain an
erection. Taking medication or receiving treatment for depression may increase desire, and may help with

• Loss of erection is reversible; one can usually return to a previous level of arousal once conditions that
helped you get an erection return. Don’t panic, slow down and go back to foreplay.
• Be realistic about expectations for yourself and your partner.
• Look for ways that you might be distracting yourself during sexual activity.
• Avoid alcohol before or during sex.
Erectile Dysfunction has everything to do with your partner(s). Sexual health flourishes in healthy relationships.
If you are experiencing repeated episodes of erectile dysfunction, talk to your partner. If you do not think you
can communicate with your partner about sexual issues, you may have just identified one part of the problem!
ED is treatable! If the problem persists contact McKinley Health Center at 333-2700 to schedule an
appointment with your primary care physician, the Health Education Unit Sexual Health Educator at 333-2714 or
schedule an appointment with a male counselor at the Counseling Center at 333-3704..