Impotence , What is erectile dysfunction? men biggest problem

Impotence, also known as erectile dysfunction, is a common problem among men characterized by the consistent inability to sustain an erection sufficient for sexual intercourse or the inability to achieve ejaculation, or both. Impotence can have emotional causes but most often it is due to a physical problem.

What is erectile dysfunction?

Erectile dysfunction (ED), also known as impotence, is the inability to achieve or sustain an erection for satisfactory sexual activity. Erectile dysfunction is different from other conditions that interfere with sexual intercourse, such as lack of sexual desire and problems with ejaculation and orgasm. This article focuses on the evaluation and treatment of erectile dysfunction.

How common is erectile dysfunction?

Erectile dysfunction (ED, impotence) varies in severity; some men have a total inability to achieve an erection, others have an inconsistent ability to achieve an erection, and still others can sustain only brief erections. The variations in severity of erectile dysfunction make estimating its frequency difficult. Many men also are reluctant to discuss erectile dysfunction with their doctors, and thus the condition is under-diagnosed. Nevertheless, experts have estimated that erectile dysfunction affects 30 million men in the Untied States.

While erectile dysfunction can occur at any age, it is uncommon among young men and more common in the elderly. By age 45, most men have experienced erectile dysfunction at least some of the time. According to the Massachusetts Male Aging Study, complete impotence increases from 5% among men 40 years of age to 15% among men 70 years and older. Population studies conducted in the Netherlands found that some degree of erectile dysfunction occurred in 20% of men between ages 50 to 54, and in 50% of men between ages 70 to 78. In 1999, the National Ambulatory Medical Care Survey counted 1,520,000 doctor-office visits for erectile dysfunction.

What is normal penis anatomy?

The penis contains two chambers, called the corpora cavernosa, which run the length of the upper side of the penis (see figure 1 below). The urethra, which is the channel for urine and ejaculate, runs along the underside of the corpora cavernosa. Filling the corpora cavernosa is a spongy tissue consisting of smooth muscles, fibrous tissues, spaces, veins, and arteries. A membrane, called the tunica albuginea, surrounds the corpora cavernosa. Veins located in the tunica albuginea drain blood out of the penis.

How does erection occur?

Erection begins with sexual stimulation. Sexual stimulation can be tactile (for example, by touching the penis), or mental (for example, by having sexual fantasies). Sexual stimulation generates electrical impulses along the nerves going to the penis and causes the nerves to release nitric oxide, which in turn increases the production of cyclic GMP (cGMP) in the smooth muscle cells of the corpora cavernosa. The cGMP causes the smooth muscles of the corpora cavernosa to relax, and allow rapid blood flow into the penis. The in-coming blood fills the corpora cavernosa, making the penis expand.

How is erection sustained?

The pressure from the expanding penis compresses the veins (blood vessels that drain the blood out of the penis) in the tunica albuginea, helping to trap the blood in the corpora cavernosa, thereby sustaining erection. Erection is reversed when cGMP levels in the corpora cavernosa fall, causing the smooth muscles of the corpora cavernosa to contract, stopping the inflow of blood and opening veins that drain blood away from the penis. The levels of the cGMP in the corpora cavernosa fall because it is destroyed by an enzyme called phosphodiesterase type 5 (PDE5)

What are the causes of erectile dysfunction?

The ability to achieve and sustain erections require:

A healthy nervous system that conducts nerve impulses in the brain, spinal column, and penis,

Healthy arteries in and near the corpora cavernosa,

Healthy smooth muscles and fibrous tissues within the corpora cavernosa, and

Adequate levels of nitric oxide in the penis.

Erectile dysfunction can occur if one or more of these requirements are not met. The causes of erectile dysfunction include:

Aging: There are two reasons why older men are more likely to experience erectile dysfunction than younger men. First, older men are more likely to develop diseases (such as heart attacks, angina, strokes, diabetes mellitus, and high blood pressure) that are associated with erectile dysfunction. Second, the aging process alone can cause erectile dysfunction in some men; primarily by decreasing the compliance of the tissues in the corpora cavernosa, although it has been suggested, but not proven, that there is also decreased production of nitric oxide in the nerves that innervate the corporal smooth muscle within the penis.

Diabetes mellitus: Erectile dysfunction tends to develop 10-15 years earlier in diabetic men than among nondiabetic men. In a population study of men with type I diabetes for more than 10 years, erectile dysfunction was reported by 55% of men between the ages of 50 to 60 years. The increased risk of erectile dysfunction among men with diabetes mellitus may be due to the earlier onset and greater severity of atherosclerosis that narrows the arteries and thereby reduces the delivery of blood to the penis. When insufficient blood is delivered to the penis, it is not possible to achieve an erection.

Diabetes mellitus also causes erectile dysfunction by damaging both sensory and autonomic nerves, a condition called diabetic neuropathy. Smoking cigarettes, obesity, poor control of blood glucose levels, and having diabetes mellitus for a long time further increases the risk of erectile dysfunction in diabetes. In addition to atherosclerosis and/or neuropathy causing ED in diabetes, many diabetic men develop a myopathy (muscle disease) as their cause of ED in which the compliance of the muscle in the corpora cavernosa is decreased and clinically this presents as an inability to maintain the erection. For additional information, please read the Diabetes article.

Hypertension (high blood pressure): Patients with essential hypertension or arteriosclerosis have an increased risk of developing erectile dysfunction. Essential hypertension is the most common form of hypertension; it is called essential hypertension because it is not caused by another disease, (for example, by kidney disease). It is not clearly known how essential hypertension causes erectile dysfunction; however, patients with essential hypertension have been found to have low production of nitric oxide by the arteries of the body, including the arteries in the penis. Scientists now suspect that the decreased levels of nitric oxide in patients with essential hypertension may contribute to erectile dysfunction. For more information, please read the High Blood Pressure article.

Cardiovascular diseases: The most common cause of cardiovascular diseases in the United States is atherosclerosis, the narrowing and hardening of arteries that reduces blood flow. Atherosclerosis typically affects arteries throughout the body and is aggravated by hypertension, high blood cholesterol levels, cigarette smoking, and diabetes mellitus. When coronary arteries (arteries that supply blood to the heart muscle) are narrowed by atherosclerosis, heart attacks and angina occur. When cerebral arteries (arteries that supply blood to the brain) are narrowed by atherosclerosis, strokes occur. Similarly, when arteries to the penis and the pelvic organs are narrowed by atherosclerosis, insufficient blood is delivered to the penis to achieve an erection. There is a close correlation between the severity of atherosclerosis in the coronary arteries and erectile dysfunction. For example, men with more severe coronary artery atherosclerosis also tend to have more erectile dysfunction than men with mild or no coronary artery atherosclerosis. Some doctors suggest that men with new onset erectile dysfunction should be evaluated for silent coronary artery diseases (advanced coronary artery atherosclerosis that has not yet caused angina or heart attacks). For more information, please read the Heart Attack Prevention article.

Cigarette smoking: Cigarette smoking aggravates atherosclerosis and thereby increases the risk for erectile dysfunction. For more information, please read the Smoking and Quitting Smoking article.

Nerve or spinal cord damage: Damage to the spinal cord and nerves in the pelvis can cause erectile dysfunction. Nerve damage can be due to disease, trauma, or surgical procedures. Examples include injury to the spinal cord from automobile accidents, injury to the pelvic nerves from prostate surgery, multiple sclerosis (a neurological disease with the potential to cause widespread damage to nerves), and long-term diabetes mellitus.

Substance abuse: Marijuana, heroin, cocaine, and alcohol abuse contribute to erectile dysfunction. Alcoholism, in addition to causing nerve damage, can lead to atrophy of the testicles and lower testosterone levels. For more information, please visit the Drug Abuse Center.

Low testosterone levels: Testosterone (the primary sex hormone in men) is not only necessary for sex drive (libido) but also is necessary to maintain nitric oxide levels in the penis. Therefore, men with hypogonadism (diminished function of the testes resulting in low testosterone production) can have low sex drive and erectile dysfunction.

Medications: Many common medicines produce erectile dysfunction as a side effect. Medicines that can cause erectile dysfunction include many used to treat high blood pressure, antihistamines, antidepressants, tranquilizers, and appetite suppressants. Examples of common medicines that can cause erectile dysfunction include beta-blockers such as propranolol (Inderal), hydrochlorothiazide, digoxin (Lanoxin), amitriptyline (Elavil), famotidine (Pepcid), cimetidine (Tagamet), metoclopramide (Reglan), indomethacin (Indocin), lithium (Eskalith; Lithobid), verapamil (Calan, Verelan, Isoptin), phenytoin (Dilantin), and gemfibrozil (Lopid). For more, please visit the Medications Index.

Depression and anxiety: Psychological factors may be responsible for erectile dysfunction. These factors include stress, anxiety, guilt, depression, low self-esteem, and fear of sexual failure. For more information, please visit the Depression Center.

How is erectile dysfunction diagnosed?

Patient history

A diagnosis of erectile dysfunction is made in men who have repeated inability to achieve and/or maintain an erection for satisfactory sexual performance for at least 3 months. Candid communication between the patient and the doctor is important in establishing the diagnosis of erectile dysfunction, assessing its severity, and determining the cause. During patient interviews, doctors try to answer the following questions:

Is the patient suffering from erectile dysfunction or from loss of libido or a disorder of ejaculation?

Is erectile dysfunction due to psychological or physical factors? Healthy men have involuntary erections in the early morning and during REM sleep (a stage in the sleep cycle with rapid eye movements). Men with psychogenic erectile dysfunction (erectile dysfunction due to psychological factors such as stress and anxiety rather than physical factors) usually maintain these involuntary erections. Men with physical causes of erectile dysfunction (for example; atherosclerosis, smoking, and diabetes) usually do not have these involuntary erections.

Are there physical causes of erectile dysfunction? A prior history of cigarette smoking, heart attacks, strokes, and poor circulation in the extremities suggest atherosclerosis as the cause of the erectile dysfunction. Diminished sensation of the penis and the testicles, bladder dysfunction, and decreased sweating in the lower extremities suggest diabetic nerve damage. Loss of sexual desire and drive, lack of sexual fantasies, gynecomastia (enlargement of breasts), and diminished facial hair suggest low testosterone levels.

Is the patient taking medications that can contribute to erectile dysfunction?

Physical examination

The physical examination can reveal clues for physical causes of erectile dysfunction. For example, if the penis does not respond as expected to touching, a problem in the nervous system may be the cause. Small testicles, lack of facial hair and enlarged breasts can point to hormonal problems such as hypogonadism with low testosterone levels. A reduced flow of blood as a result of atherosclerosis can sometimes be diagnosed by finding diminished arterial pulses in the legs or listening with a stethoscope for bruits (the sound of blood flowing through narrowed arteries). Unusual characteristics of the penis itself could suggest the root of the erectile dysfunction, for example, bending of the penis during erection could be the result of Peyronie's disease.

Laboratory tests

Common laboratory tests to evaluate erectile dysfunction include:

Complete blood counts

Urinalysis: An abnormal urinalysis may be a sign of diabetes mellitus and kidney damage

Lipid profile: High levels of LDL cholesterol (bad cholesterol) in the blood promotes atherosclerosis.

Blood glucose levels: Abnormally high blood glucose levels may be a sign of diabetes mellitus.

Blood Hemoglobin A 1c: Abnormally high levels of blood hemoglobin A 1c in patients with diabetes mellitus establish that there is poor control of blood glucose levels.

Serum creatinine: An abnormal serum creatinine may be the result of kidney damage due to diabetes.

Total testosterone levels: Blood samples for total testosterone levels should be obtained in the early morning (before 8 am) because of wide fluctuations in the testosterone levels throughout the day. A low total testosterone level suggests hypogonadism. Measurement of bio-available testosterone may be a better measurement than total testosterone, especially in obese men and men with liver disease, but measurement of bio-available testosterone is not widely available.

PSA levels: PSA (prostate specific antigen) blood levels and prostate examination to exclude prostate cancer is important before starting testosterone treatment since testosterone can aggravate prostate cancer.

Other tests

Monitoring erections that occur during sleep (nocturnal penile tumescence) can help distinguish between erectile dysfunction of psychological and physical causes. If nocturnal erections do not occur, then the cause of erectile dysfunction is likely to be physical rather than psychological, however, tests of nocturnal erections are not completely reliable. Scientists have not standardized the tests and have not determined in whom they should be done.

Psychosocial examination

A psychosocial examination using an interview and questionnaire may reveal psychological factors contributing to erectile dysfunction. The sexual partner also may be interviewed to determine expectations and perceptions encountered during sexual intercourse.

What are the treatments for erectile dysfunction?

Treatments for erectile dysfunction in 2004 include:

Working with doctors to select medications that do not impair erectile function,

Making life style improvements (for example; quitting smoking, and exercising more),

Drugs such as sildenafil (Viagra), vardenafil (Levitra) or tadalafil (Cialis),

Inserting medications into the urethra (intraurethral suppositories),

Injecting medications into the corpora cavernosae (intracavernosal injections),

Vacuum constrictive devices for the penis,

Penile prostheses, and

Psychotherapy.

Adjusting medications

Many common medications for treating hypertension, depression, and high blood lipids can contribute to erectile dysfunction (see above). Treatment of hypertension is an example. There are many different types (classes) of anti-hypertensive medications (medications that lower blood pressure); these include beta-blockers, calcium channel blockers, diuretics (medications that increase urine volume), angiotensin converting enzyme inhibitors (ACE inhibitors), and angiotensin receptor blockers (ARBs). Anti-hypertensives may be used alone or in combination(s) to control blood pressure. Different classes of anti-hypertensives have different effects on erectile function. Inderal (a beta blocker) and hydrochlorothiazide (a diuretic) are known to cause erectile dysfunction, while calcium channel blockers and ACE inhibitors do not seem to affect erectile function. On the other hand, angiotensin receptor blockers (ARBs) such as losartan (Cozaar) and valsartan (Diovan), may actually increase sexual appetite, improve sexual performance, and decrease erectile dysfunction. Therefore, choosing an optimal anti-hypertensive combination is an important part of treating erectile dysfunction

Lifestyle improvements

Quitting smoking, exercising regularly, losing excess weight, curtailing excessive alcohol consumption, controlling hypertension, and optimizing blood glucose levels in patients with diabetes are not only important for maintaining good health but also may improve erectile function. Some studies suggest that men who have made lifestyle improvements experience increased rates of success with oral medications.

How effective is testosterone in treating erectile dysfunction?

In patients with hypogonadism, testosterone treatment can improve libido and erectile dysfunction, but the response of erectile dysfunction in men with hypogonadism to testosterone is not complete; many men still may need additional oral medications such as sildenafil, vardenafil or tadalafil.

In men 40 years of age or older, a breast examination, digital examination of the prostate and a PSA level (prostate specific antigen) should be done to exclude breast and prostate cancer before starting testosterone treatment since testosterone can aggravate breast and prostate cancers. Patients who have breast and prostate cancers or are suspected of having them should not use testosterone.

Oral phosphodiesterase type 5 (PDE5) inhibitors

Sildenafil (Viagra)

What is sildenafil (Viagra)?

Sildenafil (Viagra) was the first oral phosphodiesterase type 5 (PDE5) inhibitor approved by the FDA in the United States for the treatment of erectile dysfunction (it is not approved for women). Sildenafil inhibits PDE5, which is an enzyme that destroys cGMP. By inhibiting the destruction of cGMP by PDE5, sildenafil allows cGMP to accumulate. The cGMP in turn prolongs relaxation of the smooth muscle of the corpora cavernosa. Relaxation of the corpora cavernosa smooth muscle allows blood to flow into the penis resulting in increased engorgement of the penis. In short, sildenafil increases blood flow into the penis and decreases blood flow out of the penis.

How effective is sildenafil (Viagra)?

Sildenafil is used for the treatment of erectile dysfunction of either physical or psychological cause. It has been found to be effective in treating erectile dysfunction in men with coronary artery disease, diabetes mellitus, hypertension, depression, coronary artery bypass surgery, and men who are taking antidepressants and several classes of anti-hypertensives.

In randomized controlled trials, an estimated 60% of men with diabetes, and 80% of men without diabetes experienced improved erections with sildenafil.

How should sildenafil (Viagra) be administered?

Sildenafil is available as oral tablets at doses of 25, 50, and 100 mg. It should be taken approximately one hour before sexual activity. In some men, the onset of action of the drug may be as early as 11-20 minutes. Sildenafil should be taken on an empty stomach for best results since absorption and effectiveness of sildenafil can be diminished if it is taken shortly after a meal, particularly a meal that is high in fat.

What is the dose of sildenafil (Viagra)?

In prescribing sildenafil, a doctor considers the age, general health status, and other medication(s) the patient is taking. The usual starting dose for most men is 50 mg, however, the doctor may increase or decrease the dose depending on side effects and effectiveness. The maximum recommended dose is 100 mg every 24 hours, however, many men will need 100 mg of sildenafil for optimal effectiveness, and some doctors are recommending 100 mg as the starting dose.

Metabolism (breakdown) of sildenafil is slowed by aging, liver and kidney dysfunction, and concurrent use of certain medications (such as erythromycin--an antibiotic, and protease inhibitors, for HIV). Slowed breakdown allows sildenafil to accumulate in the body and potentially may increase the risk of side effects. Therefore in men over 65, in men with substantial kidney and liver disease, and in men who also are taking protease inhibitors, the doctor will initiate sildenafil at a lower dose (25 mg) to avoid accumulation of sildenafil in the body. A protease inhibitor ritonavir (Norvir) is especially potent in increasing the accumulation of sildenafil, thus men who are taking Norvir should not take sildenafil doses higher than 25 mg and at a frequency of no greater than once in 48 hours.

What are the side effects of sildenafil (Viagra)?

Sildenafil has been found to be well tolerated without important side effects. The reported side effects are usually mild, and include headache, flushing, nasal congestion, nausea, dyspepsia, diarrhea, and abnormal vision (seeing a bluish hue or brightness).

Sildenafil can cause hypotension (abnormally low blood pressure that can lead to fainting and even shock) when given to patients who are taking nitrates. Therefore, patients taking nitrates daily, even patients taking nitrates only once a day, should not take sildenafil. Nitrates are used most commonly to relieve angina (chest pain due to insufficient blood supply to the heart muscle because of narrowing of the coronary arteries); these include nitroglycerine tablets, patches, ointments, sprays, and pastes, as well as isosorbide dinitrate, and isosorbide mononitrate. Other nitrates such as amyl nitrate and butyl nitrate also are found in some recreational drugs called "poppers".

Sildenafil should be used cautiously in men on alpha blockers such as doxazosin (Cardura), terazosin (Hytrin), and tamsulosin (Flomax). There have been occasional reports of low blood pressure in men who have taken the two classes of drugs simultaneously and therefore it is recommended that there be at least a span of 4-6 hours between the ingestion of sildenafil and alpha blockers.

There have been rare reports of priapism (prolonged and painful erections lasting more than 6 hours) with the use of PDE5 inhibitors such as sildenafil, vardenafil, and tadalafil, especially when sildenafil is used in combination with injection of medications into the corpora cavernosa or intraurethral suppositories. Patients with blood cell diseases such as sickle cell anemia, leukemia, and multiple myeloma have higher than normal risks of developing priapism. Priapism untreated can cause injury to the penis and lead to permanent impotence. Therefore, sildenafil should not be used in combination with intraurethral suppositories and corpora cavernosa injections. If there is prolonged erection (longer than 4 hours), immediate medical assistance should be obtained.

Is it safe for men with heart disease to use sildenafil (Viagra)?

Sildenafil has been found to be effective and safe in the treatment of erectile dysfunction in men with stable heart disease due to atherosclerosis of the coronary arteries, provided that they are not on nitrates. The real concern is not as much the safety of sildenafil but the risk of sexual activity in triggering heart attacks or abnormal heart rhythms in patients with heart disease.

The risk of developing heart attacks or abnormal heart rhythms during sex is low in men with well controlled hypertension, mild disease of the heart's valves, well controlled heart failure, mild and stable angina (with a favorable treadmill stress test), successful coronary stenting or bypass surgery, and a remote history of heart attack (more than 8 weeks previously). Sildenafil can be used safely in men in these low risk groups.

The risk of heart attack or abnormal heart rhythms during sex is higher in men with unstable angina (angina that occurs at rest or with minimal exertion), poorly controlled hypertension, moderate to severe heart failure, moderate to severe disease of the heart's valves, recent heart attack (less than 2 weeks previously), potentially life threatening disorders of heart rhythm such as recurrent ventricular tachycardia, and moderate to severe disease of the heart's muscle. In these men, doctors usually stabilize or treat the heart conditions before prescribing sildenafil.

Before starting sildenafil for erectile dysfunction, a doctor may need to determine whether the heart can safely achieve the workload necessary for sexual activity. For example, in men with coronary artery heart disease, a doctor may perform a treadmill stress test to determine whether there is adequate blood supply to the heart muscle while exercising at levels comparable to sexual activity.

What is vardenafil (Levitra)?

Vardenafil (Levitra) was the second oral medicine approved by the United FDA in the US for the treatment of erectile dysfunction. Like sildenafil (Viagra), vardenafil (Levitra) inhibits PDE5 which destroys cGMP (as discussed earlier).

How effective is vardenafil (Levitra)?

Vardenafil was evaluated in four multicenter, randomized, placebo-controlled trials involving more than 2400 men (78% white, 7% black, 2% Asian, 3% Hispanic) with erectile dysfunction. Two of these trials were conducted in special erectile dysfunction populations; one in men with diabetes mellitus, another in men who developed erectile dysfunction after prostate surgery. The doses of vardenafil in the four studies were 5 mg, 10 mg, and 20 mg.

In all four studies, vardenafil was significantly better than placebo in improving men's ability to achieve and maintain erections in all age categories (less than 45, 45-65,and greater than 65 years of age) and in all races.

How should vardenafil (Levitra) be administered?

The recommended starting dose of vardenafil is 10 mg taken orally approximately 1 hour before sexual activity. The dose may be adjusted higher or lower depending on efficacy and side effects. The maximum recommended dose is 20 mg, and the maximum recommended dosing frequency is no more than once per day. Vardenafil can be taken with or without food.

What are the side effects of vardenafil (Levitra)?

Vardenafil is generally well tolerated with only mild side effects. These side effects include headache, flushing, nasal congestion, dyspepsia, body aches, dizziness, nausea, and increased blood levels of the muscle enzyme creatine kinase.

There have been rare reports of priapism (prolonged and painful erections lasting more than 6 hours) with the use of oral PDE5 inhibitors such as vardenafil, sildenafil and tadalafil. Patients with blood cell diseases such as sickle cell anemia, leukemia, and multiple myeloma have higher than normal risks of developing priapism. Priapism untreated can cause injury to the penis tissue and lead to permanent loss of potency. If there is prolonged erection (longer than 4 hours), immediate medical assistance should be sought.

Who should not use vardenafil (Levitra)?

Vardenafil (Levitra) can cause hypotension (abnormally low blood pressure, which can lead to fainting and even shock) when given to patients who are taking nitrates. Patients taking nitrates daily, even patients taking nitrates only once a day, should not take vardenafil. Most commonly used nitrates are medications to relieve angina (chest pain due to insufficient blood supply to heart muscle because of narrowing of the coronary arteries). These include nitroglycerine tablets, patches, ointments, sprays, pastes, and isosorbide dinitrate and isosorbide mononitrate. Other nitrates such as amyl nitrate and butyl nitrate are found in some recreational drugs called "poppers".

Vardenafil should not be used with alpha-blockers, medicines used to treat high blood pressure and benign prostate hypertrophy (BPH), because the combination of vardenafil and an alpha-blocker may lower the blood pressure greatly and lead to dizziness and fainting. Examples of alpha-blockers include tamsulosin (Flomax), terazosin (Hytrin), doxazosin (Cardura), alfuzosin (Uroxatrol), and prazosin (Minipress).

Men with a rare heart condition known as long QT syndrome should not take vardenafil since this may lead to abnormal heart rhythms. The QT interval is the time it takes for the heart's muscle to recover after it has contracted. The QT interval is measured with an electrocardiogram (EKG). Some patients have longer than normal QT intervals, and they may develop potentially life-threatening abnormal heart rhythms, especially when given certain medications. Since long QT syndrome can be inherited, men with a family history of long QT syndrome should not take vardenafil. Furthermore, vardenafil is not recommended for men who are taking medications that can affect the QT interval such as quinidine (Quinaglute, Quinidex), procainamide (Pronestyl; Procan-SR; Procanbid), amiodarone (Cordarone), and sotalol (Betapace).

There is insufficient information on the safety of vardenafil in men with the following conditions:

Unstable angina (chest pain due to coronary artery disease that occurs at rest or with minimal physical exertion)

Low blood pressure (a resting systolic blood pressure less than 90mm Hg)

Uncontrolled high blood pressure (greater than 170/110 mm Hg)

Recent stroke or heart attack (within 6 months)

Uncontrolled, potentially life-threatening abnormal heart rhythms

Severe liver disease

Severe kidney failure requiring dialysis

Severe heart failure or disease of the heart's valves, for example, aortic stenosis

Retinitis pigmentosa

Therefore, men with these conditions should not use vardenafil without having these conditions evaluated and stabilized first. For example, men with uncontrolled high blood pressure should have their blood pressure controlled; and men with potentially life-threatening abnormal heart rhythms should have these rhythms controlled.

When there is angina or heart failure, the doctor may need to determine whether the heart has enough reserve to safely carry out the work necessary for sexual activity by performing cardiac treadmill stress testing.

What precautions should be taken when using vardenafil (Levitra)?

Metabolism (breakdown) of vardenafil can be slowed by aging, liver disease, and concurrent use of certain medications (such as erythromycin, ketoconazole (Nizoral), and protease inhibitors). Slowed breakdown allows vardenafil to accumulate in the body and potentially increase the risk for side effects. Therefore, in men over age 65, with liver dysfunction, or who are also taking medication(s) that can slow the breakdown of vardenafil, the doctor will initiate vardenafil at low doses to avoid its accumulation. For example:

Men taking erythromycin or ketoconazole should not take more than 5 mg of vardenafil in a 24-hour period.

Men taking high doses of ketoconazole (Nizoral) should not take more than 2.5 mg of vardenafil in a 24-hour period.

Men with moderately severe liver disease also should not take more than a 5 mg dose of vardenafil in a 24-hour period.

Men taking the protease inhibitor (for the treatment of HIV/AIDS) indinavir (Crixivan ) should not take more than 2.5 mg of vardenafil in a 24-hour period.

Men taking another protease inhibitor ritonavir (Norvir) should not take more than 2.5 mg of vardenafil every 72 hours.

What is tadalafil (Cialis)?

Tadalafil (Cialis) is the third oral medicine approved by the United FDA in the US for the treatment of erectile dysfunction. Like sildenafil (Viagra) and vardenafil (Levitra), tadalafil inhibits PDE5 (as described earlier).

How effective is tadalafil (Cialis)?

The safety and efficacy of tadalafil in the treatment of erectile dysfunction was evaluated in 22 clinical trials involving more than 4,000 men. Seven of these trials were randomized, prospective, placebo-controlled studies of 12 weeks' duration. Two of these studies (involving 402 men) were conducted in the Untied States, and the other five studies (involving 1112 men) were conducted outside the Untied states. Two of these trials were conducted in special erectile dysfunction populations; one in men with diabetes mellitus, another in men who developed erectile dysfunction after nerve-sparing prostate cancer surgery.

Effectiveness of tadalafil in these studies was assessed using a sexual function questionnaire. Study participants also were asked if they were able to achieve vaginal penetration and to maintain erections long enough for successful intercourse.

In all seven trials, tadalafil was significantly better than placebo in improving men's ability to achieve and maintain erections. Improvements in erectile function was observed in some patients at 30 minutes after taking a dose; and improvements can last for up to 36 hours after taking Cialis when compared to placebo.

How should tadalafil (Cialis) be administered?

The recommended starting dose of tadalafil for most patients is 10 mg taken orally approximately 1 hour before sexual activity. The dose may be adjusted higher to 20 mg or lower to 5 mg depending on efficacy and tolerability. The maximum recommended dosing frequency is once per day, although for many patients tadalafil can be taken less frequently since the improvement in erectile function may last 36 hours. Tadalafil may be taken with or without food.

What are the side effects of tadalafil (Cialis)?

Tadalafil is generally well tolerated with only mild side effects. The most common side effects reported include headache, indigestion, back pain, muscle aches, facial flushing, and nasal congestion.

Back pain and muscle aches occurred in less than 7% of patients, and usually occurred at 12 to 24 hours after taking tadalafil. The back pain and muscle aches associated with tadalafil were characterized by mild to moderate muscle discomfort in the lower back, buttocks and thighs, often aggravated by lying down. The back and muscle aches resolved in most patients without treatment within 48 hours. When treatment was necessary, acetaminophen (Tylenol) and non-steroidal antiinflammatory drugs (NSAIDs) such as Motrin, Advil, or Aleve were effective. Approximately 0.5% of all the patients using tadalafil discontinued the drug due to back pain or muscle aches.

Reports of abnormal vision were rare, it occurred in less than 0.1% of patients using tadalafil.

There have been rare reports of priapism (prolonged and painful erections lasting more than 6 hours) with the use of oral PDE5 inhibitors such as vardenafil, sildenafil and tadalafil. Patients with blood cell diseases such as sickle cell anemia, leukemia, and multiple myeloma have higher than normal risks of developing priapism. Priapism untreated can cause injury to the penile tissue and lead to permanent loss of potency. If there is prolonged erection (longer than 4 hours), immediate medical assistance should be sought.

Who should not use tadalafil (Cialis)?

Tadalafil can cause hypotension (abnormally low blood pressure, which can lead to fainting and even shock) when given to patients who are taking nitrates. Patients taking nitrates daily, even patients taking nitrates only once a day, should not take tadalafil. Most commonly used nitrates are medications to relieve angina (chest pain due to insufficient blood supply to heart muscle because of narrowing of the coronary arteries). These include nitroglycerine tablets, patches, ointments, sprays, pastes, and isosorbide dinitrate and isosorbide mononitrate. Other nitrates such as amyl nitrate and butyl nitrate are found in some recreational drugs called "poppers".

Tadalafil should not be used with alpha-blockers (except Flomax), medicines used to treat high blood pressure and benign prostate hypertrophy (BPH), because the combination of tadalafil and an alpha-blocker may lower the blood pressure greatly and lead to dizziness and fainting. Examples of alpha-blockers include tamsulosin (Flomax), terazosin (Hytrin), doxazosin (Cardura), alfuzosin (Uroxatrol), and prazosin (Minipress). The only alpha-blocker that can be used safely with tadalafil is tamsulosin (Flomax). When tadalafil (20 mg) was given to healthy men taking 0.4 mg of Flomax daily, there was no significant decrease in blood pressure and so patients on this dose of tamsulosin (Flomax) can be prescribed tadalafil. The only alpha blocker that has not been tested with tadalafil is alfuzosin (Uroxatrol) and no recommendations can be made regarding the interaction between the two.

Tadalafil is not recommended for men with the following conditions:

Unstable angina (chest pain due to coronary artery disease that occurs at rest or with minimal physical exertion)

Low blood pressure (a resting systolic blood pressure less than 90mm Hg)

Uncontrolled high blood pressure (greater than 170/110 mm Hg)

Recent stroke or heart attack (within 6 months)

Uncontrolled, potentially life-threatening abnormal heart rhythms

Severe liver disease

Severe heart failure or disease of the heart's valves, for example, aortic stenosis

Retinitis pigmentosa

Therefore, men with these conditions should not use tadalafil without having these conditions evaluated and stabilized first. For example, men with uncontrolled high blood pressure should have their blood pressure controlled; and men with potentially life-threatening abnormal heart rhythms should have these rhythms controlled.

When there is angina or heart failure, the doctor may need to determine whether the heart has enough reserve to safely carry out the work necessary for sexual activity by performing cardiac treadmill stress testing.

What precautions should be taken when using tadalafil?

In most healthy men, some of the drug will remain in the body for more than 2 days after a single dose of tadalafil. Metabolism (clearing of the drug from the body) of tadalafil can be slowed by liver disease, kidney disease, and concurrent use of certain medications (such as erythromycin, ketoconazole, and protease inhibitors). Slowed breakdown allows tadalafil to stay in the body longer and potentially increase the risk for side effects. Therefore, the dose and frequency of tadalafil has to be lowered in the following examples:

Medications such as erythromycin, ketoconazole (Nizoral), itraconazole (Sporanox), ritonavir (Norvir), and indinavir (Crixivan) can slow the breakdown of tadalafil. Therefore men taking these medications should not take more than 10 mg of tadalafil and should not take tadalafil more frequently than every 72 hours.

No tadalafil dose adjustment is necessary for men with only mild kidney disease. Men with moderately severe kidney impairment should start tadalafil at 5 mg every 24 hours, and not to exceed the maximum dose of 10 mg taken every 48 hours. In men with severe kidney disease and on dialysis, the maximum dose should not exceed 5 mg.

Men with severe liver disease should not take tadalafil. Men with mild to moderate liver disease should not exceed tadalafil dose of 10 mg once daily.

What are intracavernosal injections?

Medications can be injected directly into the corpora cavernosa to attain and maintain erections. Medications such as papaverine hydrochloride, phentolamine, and prostaglandin E1 can be used alone or in combinations to attain erections. Combining small amounts of each drug is preferred over using a single drug because of increased efficacy and fewer side effects. Even though such injections can be effective, they are not widely used because the injections are painful, there may be scarring of the penis, and there is a risk of developing priapism.

Intraurethral suppositories

What are intraurethral suppositories?

Prostaglandin E1 can be inserted in a pellet (suppository) form into the urethra to attain erections. This technique also is not popular because of occasional side effects of pain in the penis and sometimes in the testicles, mild urethral bleeding, dizziness, and vaginal itching in the sex partner. Men also need to remain standing after inserting the pellet in order to increase blood flow to the penis, and it may take 15-30 minutes to attain an erection. Prostaglandin can cause uterine contractions and should not be used by men having intercourse with pregnant women unless condoms or other barrier devices are used.

Vacuum devices

What are vacuum devices?

Mechanical vacuum devices cause an erection by creating a vacuum around the penis that draws blood into the penis, engorging it and expanding it. The devices have three components:

A plastic cylinder, in which the penis is placed;

A pump, which draws air out of the cylinder; and

An elastic band, which is placed around the base of the penis, to maintain the erection after the cylinder is removed and during intercourse by preventing blood from flowing back into the body

Surgery for erectile dysfunction

Surgery for erectile dysfunction may have as its goal:

To implant a device that causes the penis to become erect;

To reconstruct arteries in order to increase the flow of blood to the penis, or

To block veins that drain blood from the penis.

Implantable devices, known as prostheses, can cause erections in many men with impotence.

Malleable implants usually consist of paired rods, which are inserted surgically into the corpora cavernosa, the twin chambers running the length of the penis. The user manually adjusts the position of the penis and, therefore, the rods. Adjustment does not affect the width or length of the penis.

Inflatable implants consist of paired cylinders, which are surgically inserted inside the penis and can be expanded using pressurized fluid (see figure 3). Tubes connect the cylinders to a fluid reservoir and pump, which also are surgically implanted. The patient inflates the cylinders by pressing on the small pump, located under the skin in the scrotum. Inflatable implants can expand the length and width of the penis somewhat. They also leave the penis in a more natural state when not inflated.

Possible problems with prostheses include mechanical breakdown and infection. Mechanical problems have diminished in recent years because of technological advances.

Surgery to repair arteries can reduce impotence caused by obstructions that block the flow of blood to the penis. The best candidates for such surgery are young men with discrete blockage of an artery because of a physical injury to the pubic area or a fracture of the pelvis. The procedure is less successful in older men with widespread blockage of arteries.

What about psychological therapy?

Experts often treat psychologically based impotence using techniques that decrease anxiety associated with intercourse. The patient's partner can help apply the techniques, which include gradual development of intimacy and stimulation. Such techniques also can help relieve anxiety when physical impotence is being treated.

What will the future bring for erectile dysfunction?

Several medications are being studied for treating erectile dysfunction; they include IC351 (another PDE5 inhibitor), sublingual apomorphine, and the combination of yohimbine and L-arginine. Scientists also are studying gene therapy to treat erectile dysfunction.

Erectile Dysfunction At A Glance

Erectile dysfunction (ED), also known as impotence, is the inability to achieve or sustain an erection for satisfactory sexual activity.

Erectile dysfunction is common; experts have estimated that erectile dysfunction affects 30 million men in the Untied States.

The causes of erectile dysfunction include aging, high blood pressure, diabetes mellitus, cigarette smoking, atherosclerosis, depression, nerve or spinal cord damage, medication side effects, alcoholism or other substance abuse, and low testosterone levels.

Erectile dysfunction is treatable in all age groups.

Treatments include psychotherapy, adopting a healthy lifestyle, oral PDE5 inhibitors (Viagra, Levitra, and Cialis), intraurethral medications, intracavernosa injections, vacuum devices, surgery, and working with doctors to avoid medications that can impair erectile function

semen health What is blood in the semen?

What is blood in the semen?

The presence of blood in the semen (ejaculate) is also called hematospermia. Hematospermia is an uncommon condition.


What are the causes of blood in the semen?

Blood in semen can be caused by many conditions affecting the male genitourinary system. Areas affected include the bladder, urethra, the testicles, the tubes that distribute semen from the testicles (known as the seminal vesicles), the epididymis (a segment of the spermatic ducts that serves to store, mature and transport sperm), and the prostate gland.

Blood in the semen is most commonly a result of a prostate-gland biopsy. More than 80% of men who undergo a prostate biopsy may have some blood in their semen that persists for three to four weeks. Likewise, vasectomy can lead to bloody semen for about one week after the procedure.

In men with hematospermia who have not had a recent prostate biopsy or vasectomy, a number of benign and malignant conditions of the male genital system may be the cause. In many situations, no definitive cause is found.

The following conditions have been reported in association with hematospermia:

benign or malignant tumors of the prostate, bladder, testes, or seminal vesicles,


infections (including, but not limited to, chlamydia, herpes, cytomegalovirus, and trichomoniasis),


inflammation of the prostate (prostatitis), epididymis (epididymitis), or urethra (urethritis),


calculi (stones similar to kidney stones) in the seminal vesicles or prostate,


polyps in the urethra,


ejaculation-duct obstructions,


metastatic cancers (that have spread from other sites in the body) located in the genitourinary system, and


cysts, hemorrhage, or other abnormalities in the seminal vesicles.

What are the symptoms of blood in the semen?

The symptoms that accompany blood in the semen may be any of the following, depending upon the cause (these are not all inclusive):

painful urination,

pain with ejaculation,

blood in urine,

lower back pain,

fever,

tenderness in the testes and/or scrotum,

swelling in the testes and/or scrotum, or

swelling or tenderness in the groin area. 

How is blood in the semen evaluated?

A number of diagnostic tests may be performed after the clinical history is evaluated and a physical examination is performed. Some of the most commonly performed diagnostic tests are a urinalysis and cultures to identify any sexually transmitted or other infections. When indicated, imaging studies such as ultrasound or MRI may reveal tumors or other abnormalities. In some cases, a semen analysis may be recommended.

How is blood in the semen treated?

Treatment of blood in the semen is directed toward the underlying cause if a cause has been found. Sometimes, treatment with antibiotics for a presumptive diagnosis of prostatitis (inflammation of the prostate gland) is given, since some studies have shown that up to about one-fourth of men with hematospermia have prostatitis. However, the benefit of such treatment has not been definitively established.

In many cases, if blood in the semen is not associated with any known abnormality of other troubling symptoms, no treatment is given, and the condition usually resolves on its own with time in these situations. Persistent hematospermia (for a month or more) even in the absence of other symptoms warrants further or follow-up evaluation.

The prognosis relates to the underlying cause of blood in the semen if a cause can be identified. However, most cases of hematospermia are benign and resolve without treatment. While cancer is a rare cause of blood in the semen, the majority of cases are not related to cancer, especially in younger men.

Blood in Semen At A Glance

• Blood in the semen is known as hematospermia.
• Prostate biopsy is the most common cause of blood in the semen.
• Blood in the semen can be caused by tumors, infections, anatomical abnormalities, stones, or inflammation in many sites throughout the genitourinary system.
• Usually blood in the semen is benign and resolves on its own.
• Treatment, if indicated, depends upon the underlying cause.
•  

Blood in semen (hematospermia) may be caused by infections, prostatitis, urethritis, epididymitis, cysts, prostate biopsy, vasectomy, metastatic cancers, polyps, stones in the seminal vesicles, or ejaculation-duct obstructions. Symptoms that may accompany blood in semen include low back pain, blood in the urine, fever, painful urination, pain with ejaculation, tenderness, and swelling in the testes or groin area. Urinalysis, ultrasound, and MRI may be used to diagnose blood in the semen. Treatment depends upon the underlying cause of blood in the semen.

Benign Prostatic Hyperplasia man deseases

at is the prostate gland?

The prostate is a small organ about the size of a walnut. It lies below the bladder (where urine is stored) and surrounds the urethra (the tube that carries urine from the bladder). The prostate makes a fluid that helps to nourish sperm as part of the semen (ejaculatory fluid).
Prostate problems are common in men 50 and older. Most can be treated successfully without harming sexual function. A urologist is a specialist in diseases of the urinary system, including diagnosing and treating problems of the prostate gland.

How does the doctor detect prostate enlargement?

A doctor usually can detect an enlarged prostate by rectal exam. The doctor also may examine the urethra, prostate, and bladder using a cytoscope, an instrument that is inserted through the penis.

What is benign prostatic hyperplasia?

Benign prostatic hyperplasia is nonmalignant (noncancerous) enlargement of the prostate gland, a common occurrence in older men. It is also known as benign prostatic hyperplasia and abbreviated as BPH.

When does benign prostatic hyperplasia start?

BPH generally begins in a man's 30s, evolves slowly, and most commonly only causes symptoms after 50.

What happens in BPH? What are symptoms of BPH?

In BPH, the prostate gland grows in size. It may compress the urethra which courses through the center of the prostate. This can impede the flow of urine from the bladder through the urethra to the outside. It can cause urine to back up in the bladder (retention) leading to the need to urinate frequently during the day and night. Other common symptoms include a slow flow of urine, the need to urinate urgently and difficulty starting the urinary stream. More serious problems include urinary tract infections and complete blockage of the urethra, which may be a medical emergency and can lead injury to the kidneys.

How common is BPH? Are there any risk factors?

BPH is extremely common. Half of all men over 50 develop symptoms of BPH, but only 10% need medical or surgical intervention.

Is BPH a type of cancer?

No! BPH is completely benign. It is not a precursor (a forerunner) to prostate cancer.

Circumcision Doesn’t Reduce Male-to-Female Transmission of HIV By Madeline Ellis

In recent years, the male foreskin—a double-folded tube of skin and mucous membrane that covers the head of the penis—has taken center stage in the battle against HIV. The foreskin is rich in Langerhans cells, immune cells that are particularly easy for the virus to access. Following infection, these cells not only serve as reservoirs for replicating the virus, but also transport it to nearby lymph nodes where HIV spreads to other immune cells. Studies have shown that removal of the foreskin can reduce a man’s risk of heterosexually acquired HIV infection by 50 to 65 percent, findings that prompted large-scale circumcision campaigns in countries with high infection rates, such as sub-Saharan Africa, where heterosexual sex is primarily responsible for the HIV epidemic. Studies had also suggested that circumcision could reduce the rate of male-to-female transmission of the virus, but that turns out not to be the case.

A Ugandan study, led by Dr. Maria J. Wawer of Johns Hopkins Bloomberg School of Public Health in Baltimore, was stopped early after it became apparent that male circumcision offered no protection to female partners. The study involved 922 uncircumcised, HIV-infected men between 15 and 49 years of age who were randomly chosen to either be circumcised or remain uncircumcised. The HIV-free female partners of the male participants were also enrolled in the study, 90 in the circumcised group and 70 in the uncircumcised group, and their HIV status was evaluated after 6, 12 and 24 months. All participants were intensively schooled in HIV prevention and provided free condoms.

After two years, 18 percent of the women in the circumcised group had become infected with HIV, compared with 12 percent in the uncircumcised group. Cumulative probability of HIV infection at 24 months was 22 percent among women in the circumcised group and 13 percent among those in the uncircumcised group. The majority of the infections in the circumcised group occurred within the six months following the procedure. The researchers said the infections were caused because some of the men had intercourse before their circumcision wounds had healed, exposing their female partners to HIV-infected blood in the vagina.

The researchers said though they were disappointed with the outcome of the study, circumcision campaigns are still valid. “The efficacy of male circumcision for prevention of HIV in uninfected men is clear, and reductions in male acquisition of HIV attributable to circumcision are likely to reduce women's exposure to HIV-infected men. Male circumcision programs are thus likely to confer an overall benefit to women," the researchers concluded.

In an editorial accompanying the study, Dr Jared M. Baeton, from the University of Washington in Seattle, and colleagues stressed the importance of circumcision programs for men at risk of HIV, and argued for more effort being focused on people in relationships where one partner is HIV-infected and the other is not. “Prevention services for this population, including HIV testing for couples, facilitated disclosure of HIV seropositivity, and ongoing counseling services, should be a public health priority,” they write. “Such services should be incorporated into male circumcision programs, thereby providing further protection to HIV uninfected women.”

An estimated 33 million people worldwide are living with HIV/AIDS, but the World Health Organization (WHO) says circumcision has the potential to dramatically reduce the toll of the virus, averting an estimated 5.7 million new infections and three million deaths over the next 20 years in sub-Saharan Africa alone.

Pregnancies & Sexually Transmitted Diseases on the Rise Among Teens

More teenagers and young adults are having sex, sparking an increase in teen births in both 2006 and 2007, and putting an end to more than a decade of significant decline. In fact, nearly three quarters of a million pregnancies occurred among American females under the age of 20 in 2004 that reversed the downward trend from 1991 to 2004.

To make matters work, sexually transmitted diseases (STDs) among young Americans are also on the rise. The annual rate of AIDS cases among boys ages 15 to 19 has almost doubled over the past decade, while the number of syphilis diagnoses are up among both teens and young adults. In addition, almost a quarter of teen girls aged 15 to 19 were infected with a human papilomavirus (HPV) from 2003 to 2004, as were almost half of young women between the ages of 20 and 25.

The troubling news comes from the Centers for Disease Control and Prevention (CDC) in their Morbidity and Mortality Weekly Report. The report was based on data compiled during the years 2002 through 2007 that was gathered from the National Vital Statistics System, the National Health and Nutrition Examination Survey, the National Survey of Family Growth and studies of hundreds of thousands children and young adults ranging in age from 10 to 25.

According to the report, the numbers indicate that the American youth is in need of better sex education that includes emphasis on STD and pregnancy prevention. In the report, the CDC writes, “The data presented in this report indicate that many young persons in the United States engage in sexual risk behavior and experience negative reproductive health outcomes.”

The report found that although more than 80 percent of boys and girls reported having received formal instruction before age 18 on how to say no to sex, among those 18 to 19 years of age, only 49.8 percent of girls and just 35 percent of boys had discussed methods of birth control with a parent. In general, nearly 70 percent of teen girls as well as 66 percent of boys reported receiving instruction on methods of birth control.

Other discoveries included that for boys ages 15 to 17, about 32 percent had engaged in sex compared to thirty percent of girls in the same age range. However, among those ages 18 to 19, almost 65 percent of boys and 71 percent of girls had experienced sex. Disturbingly, nearly 10 percent of young women ranging from 18 to 24 years reported that their first intercourse had been involuntary. About 100,000 females among the age range of 10 to 24 were treated in hospital emergency departments for non-fatal sexual assault injuries during the period between 2004 and 2006.

Among those sexually active teens, infections with the human immune deficiency virus that causes AIDS rose from 1.3 cases per 100,000 in 1997 to 2.5 cases in 2006 among boys aged 15 to 19. The syphilis rates among females aged 15 to 19 increased from 1.5 cases per 100,000 in 2004 to 2.2 cases per 100,000 in 2006 after having significantly declined between 1997 and 2005. Gonorrhea infections rates have leveled off after decreasing for more than two decades. Approximately 1 million American teens and young adults ages 10 to 24 reported contracting chlamydia, gonorrhea or syphilis in 2006, accounting for nearly half of all incident sexually transmitted diseases and 25 percent of the sexually active population.

The researchers concluded from their findings, “The sexual and reproductive health of America's young persons remains an important public health concern,” and also noted, “Earlier progress appears to be slowing and perhaps reversing."

Gardasil is Now Recommended for Males to Fight Against HPV

Soon, boys may also be eligible to obtain the Gardasil vaccine, which is currently given to girls and young women to help prevent infection by four types of human papillomavirus. An advisory committee from the Food and Drug Administration voted Wednesday to recommend that the vaccine be made available to boys and young men between the ages of 9 and 26 to help protect against genital warts that are caused by HPV.

The Gardasil vaccine helps protect against four type of HPV, and two of those are believed to be responsible for approximately 70 percent of anal and cervical cancers, as well as HPV-associated penile and throat-and-neck cancers. Researchers say that the other two types cause approximately 90 percent of all cases of genital warts.

At Wednesday’s meeting for the advisory committee, pharmaceutical giant Merck & Co., maker of the Gardasil vaccine, presented data from three clinical trials that the company claims supports broadening the distribution of the vaccine to include boys and young men. The three trials included more than 5,400 boys and men that were from 23 countries and 6 continents.

According to Anna Giuilano, who is an independent scientist at Moffit Cancer Center located in Tampa, Florida, and the trials’ principal investigator, “The data clearly demonstrates that there was a benefit to men in receiving Gardasil. Overall, we saw a 90 percent reduction in disease—genital warts and pre-cancerous lesions—caused by HPV in men and an 89 percent reduction in genital warts incidence. Essentially, we have a really fantastic opportunity to extend the benefit of the vaccine to men. This is a sexually transmitted infection’ if we can reduce infection and related diseases in men, we have the potential to have a much broader public health impact by reducing the overall burden of infection and disease in the community at large.”

Guiliano stated that there were no serious adverse events that were related to the vaccine. There were some minor side effects such as running a low grade fever and pain at the injection site. The Gardasil vaccine would be administered in boys and young men exactly the same way it has been given to girls and young women: three doses over a span of six months. Pan Eisele, who is a spokeswoman for Merck, said that the cost will be $130 dollars per dose.

According to the Centers for Disease Control and Prevention, approximately 20 million Americans are infected with HPV. There are approximately 6.2 million new infections annually. The CDC states that at least 50 percent of women and men that are sexually active get an HPV infection at some point in their life. The American Social Health Association said that HPV is the most common sexually transmitted virus and puts that number at 75 percent or above.

The CDC says that although HPV is very common for both sexes, most men will not develop symptoms or any serious health problems, and there is no test that will detect the virus in men. The only test that is approved for HPV on the market is for women, for the use in cervical-cancer screening.

The advisory committee has also voted that Cervarix, which is new HPV vaccine that is made by GlaxoSmithKline, appeared to be safe and effective for girls and young women between the ages of 10 and 25.  Cervarix has already been approved for us in Europe.

Barbara Howe, who is the vice president and director of North American vaccine development for GlaxoSmithKline, said, “This is an important step in cancer prevention for the millions of girls and young women at risk for cervical cancer. If approved, Cervarix will provide protection against cervical cancer, a devastating disease that is responsible for thousands of deaths in U.S. women each year.”

Still, the panel recommend that GlaxoSmithKline do more studies that would closely monitor miscarriages and other problems that were reported by patients. In a final review of this proposal, both of the applications will be considered by the FDA, which usually—but not always—follows the recommendations of its advisory committees

New Stent Aims to Help Erectile Dysfunction Patients

We are all used to getting spam e-mails offering discounts on medications such as Viagra, Cialis, or Levitra, but if the new clinical trial is successful, men that suffer from erectile dysfunction may one day be flooded with e-mails for something other than a magic pill: a pelvic stent.

Medtronic has begun testing on a pelvic stent for the men who have not been helped out by the the "little blue pill" and other prescription medications. The researchers will begin with 50 patients from 10 different medical centers. 

Dr. Krishna Rocha-Singh, who is the director of the Prairie Vascular Institute in Springfield, Illinois and installed the stent in the first patient last week said, “This is a common problem. Men many times do not have satisfactory results from first-line medical therapies.” Singh also stated that erectile dysfunction can also be a sign of a larger problem, with potential blockages of some major blood vessels.

Singh said that erectile dysfunction could be a symptom of a vascular source, which means it could be an early sign of what could lead to a stroke or heart attack. “The patients we’re treating in our practice [with erectile dysfunction] had the same problem elsewhere in other parts of the body.” The stent might help solve some of those problems by opening up the blood flow. However, it still remains to be seen which patients using the stent, a question everyone hopes the clinical trial will answer, would actually be help out.

Another question being asked is whether the stents are best used in younger men? Dr. Jerome Richie, who is the chief of urology at Brigham and Women’s Hospital in Boston, said, “I would foresee this stent as an application for younger individuals who have had traumatic injuries that decrease arterial inflow. Other than that selected group, I do not foresee widespread applicability.”

Dr. Ajay Nehra, who is a professor urology at the Mayo Clinic, also agreed that younger men whose erectile dysfunction stemmed from a traumatic injury would be the mostly likely candidates to be helped, and said that they may even prefer a stenting operation to taking a pill, since an erection would not feel as medically induced. Nehra said, “Men would ideally like to have natural, spontaneous erection, and that’s why the medical device is trying to look at alternative options than pills, per se.”

So will there be a demand for this surgical stent procedure? Current erectile dysfunction drugs work in only half of patients, so for this very reason, a number of doctors believe that the stent could become a commercial success. If women are willing to have plastic surgery to get breast implants, and men are willing to get penile implants, then the potential for the stent could be huge, if it is shown to work and has minimal side effects.

Dr. Ira Sharlip, who is a clinical professor of urology at the University of California at San Francisco, said, “All men with erectile dysfunction will want to know if they are candidates for the stent.” However, at the same time, he stated that it still remains to be seen if the stent really works and for whom.

Staying Healthy: Healthy Habits for Men

Juggling jobs, relationships, social obligations, bills, and staying on top of a healthy gym routine is a lot to handle. As a woman, trying to find the time to eat better seems to be the last thing on my list and it can’t be much easier for men. Here are a few tips for making men’s lives a little bit better from morning to night:

Eat Breakfast
Eating breakfast everyday keeps your metabolism in check, your weight down, and your cravings at bay. Filling up on fiber early on keeps you satisfied throughout the day. Dr. Oz recommends oatmeal with dried fruits, nuts, and his own personal touch…flaxseed oil.

Work through Pain
Sometimes taking the load off of a sore back, neck, or legs is worse for you than if you work through the pain. Experts suggest that nursing your pain isn’t always the best course of action because resting can weaken your muscles and you may lose strength over time. If you haven’t pulled any muscles or slipped any discs, take an anti-inflammatory pain reliever and stay on your feet.

Snack like a Squirrel
You don’t have to hoard nuts for the winter, but grabbing a handful during the middle of the day can actually keep you healthier than eating a bag of chips or waiting until dinner to satisfy your food cravings. Full of omega-3 fatty acids, these are the type of proteins we look for in our diets from fish, also known as good fats.

Sweat is Your Friend
While walking to the office or public transit is eco-friendly and cost efficient, chances are you don’t get the full cardio effect until you do your time on the treadmill. Sweat away your toxins and reduce your blood pressure and risk of heart attack by switching up your routine; the wetter the better. Tacking on weight training makes your body work harder to bulk up and lose any extra pounds that may be damaging to your frame. Aside from looking better to your partner, you may feel better and be able to get more sleep, more on that later. For more stamina, find a workout buddy!

Be Friendly
When men get stressed, they often clam up and don’t tend to talk about their problems. Women, on the other hand, can usually tell a story until their lips bleed. With more stress in the world than ever, it’s no wonder your body may not be feeling up to par. Grab a beer—or your partner—and tell them what’s on your mind, sharing may just save your life or keep the stress away.

Save for a Rainy Day
Like the harmful stressors everyone puts upon themselves at any moment, a lot of these have to deal with financial woes. If you are able, sock away some of your paycheck every month to save for a rainy day or an emergency by investing some of that worth in a separate savings account you can run to if you need to, but put your own limits on how you are allowed to spend it. Down the road, merely thinking about how to spend that extra cushion you set aside can make even the gloomiest day perk up a bit.

Go Between
We have all been conditioned to learn that brushing your teeth two times a day is the normal but in order to keep your oral health at its best, go deeper with floss. Your best bet is to floss before bedtime to clean the bacteria from the hard to reach spots in your mouth so it doesn’t grow into a problem overnight.

Sleep like a Baby
If you are a parent, you understand the importance of getting a child to go to bed at a certain time every night in order to keep their mind and body stable and free from grouchiness. You should treat your sleeping patterns the same way. Set a bed time and keep it—at least during the work week—and get at least seven hours of sleep. Professionals advise that sleeping regularly can stave off calories and stress because being groggy can incur bad decisions like eating greasy food or sucking down your usual morning coffee in half the time.

Maintaining Healthy Cholesterol Levels May Lower Risk of Prostate Cancer

Men who keep their cholesterol levels in check may decrease their chances of developing prostate cancer, in addition to keeping their heart healthy, as science has already shown. In fact, two recent studies indicate that maintaining healthy levels of cholesterol may be a good form of cancer prevention.

In one study, results showed that men who retained healthy levels of cholesterol in the range below 200 actually cut their risk of developing high-risk prostate tumors by more than 50 percent in comparison to men with high ranging cholesterol levels. In the second study, findings showed that men with high levels of good (HDL) cholesterol were slightly less likely to develop prostate cancer in any form, compared to men with very low HDL cholesterol levels.

The studies were recently published in the journal of the American Association for Cancer Research called Cancer Epidemiology Biomarkers & Prevention. Both studies support prior research indicating that by limiting fats in the bloodstream, the risk of cancer can be lowered.

According to Elizabeth Platz of Johns Hopkins University who led the first study, “There might be this added benefit to keeping cholesterol low.” For the study, Platz’s team analyzed data of 5,586 men aged 55 and older that came from the Prostate Cancer Prevention Trial conducted back in the 1990s. All of these men had been a part of the placebo group during the trial.

Among the group, a total of 60 of the men developed high-risk, aggressive tumors that are known to grow and spread quickly. By comparing cholesterol levels of all the men in the group, it was revealed that those men with cholesterol levels under 200 had a 59 percent less chance of developing one of these high-risk tumors than those men having high levels of cholesterol.

Platz acknowledged that cholesterol levels had no significant effect on the overall incidence of prostate cancer in the study. However, she pointed out that the association between low cholesterol levels and a reduced incidence of aggressive disease “is a notable reduction which is not often seen for prostate cancer.”
Although the decrease in risk is highly significant, it must be noted that the researchers could not account for the number of men in the study who were taking cholesterol-lowering medications such as statin drugs, which include such name brands as Lipitor, Zocor, and Crestor. Therefore, some of the reduction in risk may have been due to the use of such drugs rather than from generally having low cholesterol levels.

The results of the second study are based on data gathered over 18 years from following more than 29,000 Finnish men who were taking various vitamins and nutrients to test whether or not they could lower their risk for cancer. All of the participants in the study were smokers. According to study leader Dr. Demetrius Albanes of the National Cancer Institute, findings showed that those men having the highest levels of HDL cholesterol were 11 percent less likely to develop prostate cancer than those with lowest levels.

In a statement, Albanes said, “Our study affirms that lower total cholesterol may be caused by undiagnosed cancer.” He then added, “In terms of a public health message, we found that higher levels of good cholesterol seem to be protective for all cancers.”

Researchers from both studies agree that further research is necessary to confirm findings, as well as to identify the molecular mechanisms behind the association.

In the United States, prostate cancer is the most common cancer among men. It is estimated that over 192,000 new cases will develop this year alone, and of those, the disease will claim 27,360 lives.