Mental Impotence Treatment

Mental Impotence Healer Program

The Mental Impotence Healer is a real revolution in the men health genre because the author Mike Miller wrote this program based on scientific facts which link erectile dysfunction to mental condition. And the author taps into this topic in a positive way and he leads the men to truly be connected with their mental power and heal their condition. The program itself is easy to follow and anyone could do the exercises and understand the instructions easily. The mental impotence healer is consisted of the main book with a lot of illustrations to help the reader follow understand the exercises and follow them. The mental bonus which is a great book in of itself because it helps you tab into your mental power more and more because to harness your mental power means you become the best version of yourself. The last but not the least is a free membership to monthly subscription which holds a great deal of information and it provides you with a lot of inspirational posts and new ideas. If you learn about the mental impotence you will know that no man should be impotent and this program is intended to achieve that goal for all men Read more...

Mental Impotence Healer Program Summary

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4.8 stars out of 17 votes

Contents: Ebook
Author: Mike Miller
Official Website: www.mentalimpotencehealer.com
Price: $37.00

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My Mental Impotence Healer Program Review

Highly Recommended

I usually find books written on this category hard to understand and full of jargon. But the author was capable of presenting advanced techniques in an extremely easy to understand language.

My opinion on this e-book is, if you do not have this e-book in your collection, your collection is incomplete. I have no regrets for purchasing this.

Erect At Will Cures ED

Japanese people have everything their own way, you know this. But no matter how weird their ways are, the world knows that they work. The same is true for the product Erect At Will. It is derived from the ancient Japanese culture and is brought to you exclusively by the author of it. Appropriately named, the product Erect At Will is a PDF on the number 1 technique that has even 82 years old elderberries get boners like teenagers. That technique had a say in the history of Japan and it still has a lot of share in the bedtime stories of its present. Calling it a technique is conservative because it is, in fact, a formula made out of simple ingredients you can buy today from your local store. The ingredients used, thus, are entirely natural and they can be found conveniently, as said. Erect At Will has this formula enhanced and evolved to an erectile dysfunction buster shake that can be prepared easily and consumed easily. That's not all. You also get two bonuses: Become Her Sex Addiction, Premature Ejaculation Conqueror. Both of these bonuses focus on their topic. Read more...

Erect At Will Cures ED Summary

Contents: Ebooks
Author: Ronald Richards
Price: $47.00

Overcoming Feelings of Impotence The Competent Patient

The decision to initiate new treatments after relapse has to be taken by the patient. In order to face a new series of treatments, it is necessary that the patient expresses his or her readiness to enter a new treatment phase. An important element in overcoming the first feelings of impotence after relapse is to perceive that there is a choice. Indeed, a patient may or may not accept a new treatment line. Choice is a powerful tool to overcome feelings of impotence this is one of the reasons why this choice has to be left to the patient and why clinicians should not present the situation as if there is only one option. Not only from a psychological point of view, but also from a legal and ethical point of view, the patient has the right to refuse further treatments. In order to present this choice to the patient in an adequate way, the clinician first has to accept that there is such a choice and that there are patients who may refuse a treatment, even if this seems, from a medical...

Is Sildenafil for

Softness The Tip Erect Penis

Sildenafil is a prescription medication that is used to treat erectile dysfunction. It is the first oral medication for this purpose approved by the US Food and Drug Administration. Sildenafil is not an aphrodisiac. It will not arouse or increase sexual desire. It is not a means to improve erections in men who do not have erectile dysfunction. It is not a chemical substitute for working on a relationship. Sildenafil blocks an enzyme in the penis that naturally breaks down a chemical called cGMP, which is produced during sexual stimulation and plays an important role in creating and sustaining normal erections. cGMP allows smooth muscle in the penis to contract, allowing more blood to enter the penis and producing a firmer erection. The longer cGMP remains in the penis, the better the chance of reaching and maintaining an erection. Sildenafil allows more cGMP to remain in the penis, but it does not increase the body's How sildenafil should be taken Sildenafil comes in three dosages...

Gender Ethnicracial And Life Span Considerations

Bladder cancer occurs most frequently in persons over 50 years of age, with more than half of the cases occurring in individuals over 72 years of age. It is rare in persons under age 40. Bladder cancer is more common in men (1 in 30) than women (1 in 90). Incidence is highest among European American men, with a rate twice that of African American men and four times that of European American women. Asians have the lowest incidence of bladder cancer. Younger men have reported less impotency following radical cystectomy than have older men. Persons living in urban areas are at higher risk for bladder cancer than persons living in rural areas.

From Concept To Market

The therapeutic uses of many of the drugs prescribed today were discovered by accident either from natural extracts (eg digoxin, aspirin, quinine, morphine, actinomycin D, vincristine, tubocurarine, penicillin) or as unintended side-effects (eg practolol, iproniazid, tamoxifen, minoxidil, sildenafil).

Placebochallenging Design

Defined as an erection sufficient to achieve vaginal penetration and lasting from 30 to 80 minutes. At the start of treatment, subjects are required to undergo an in-clinic evaluation of a double-blind placebo-challenge (i.e., subjects will be randomized to receive either the placebo or the active dose at the level identified during the titration). After this first period of in-clinic study, all subjects are to receive a three-month home treatment period at the dose identified during the titration. At the end of three-month treatment, a second in-clinic double-blind placebo-challenging is conducted. Note that at the second placebo-challenging, patients are randomly assigned to receive either the placebo or the active dose. As a result, the above design is in fact the combination of a titration design and a four-sequence, two-period (4 X 2) crossover design. In other words, during the crossover phase, there are four sequences of treatments, namely, PP, PA, AP, and AA. As an example,...

The scale of the problem

Thyrotropin-releasing hormone neurons that indirectly regulate the thyroid gland corticotrophin-releasing hormone neurons that indirectly control the adrenal gland, magnocellular vasopressin neurons that control the kidney and magnocellular oxytocin neurons that are responsible for controlling parturition and lactation in addition, smaller, centrally projecting oxytocin neurons regulate gastric function, and centrally projecting vasopressin neurons that regulate body temperature and blood pressure, some of which project into the spinal cord (as do some oxytocin neurons, a subpopulation that seems to be involved in penile erection). Below this, the suprachiasmatic nucleus is the body's principal circadian pacemaker one population of neurons here makes vasoactive intestinal peptide, another makes vasopressin these cells are governed by clock genes that confer 24-h cyclicity on their behavior. Behind the suprachiasmatic nucleus is the arcuate nucleus, that in addition to growth-hormone...

Endogenous Depression

Foods For Depression And Sleeplessness

In this condition, the patient experiences profound misery (beyond the observer's empathy) and feelings of severe guilt because of imaginary misconduct. The drive to act or move is inhibited. In addition, there are disturbances mostly of a somatic nature (insomnia, loss of appetite, constipation, palpitations, loss of libido, impotence, etc.). Although the patient may have suicidal thoughts, psychomotor retardation prevents suicidal impulses from being carried out. In A, endogenous depression is illustrated by the layers of somber colors psychomotor drive, symbolized by a sine oscillation, is strongly reduced.

Coffee Coffea spp Rubiaceae

Within the large, alkaloid-rich, tropical family Rubiaceae, Coffea, with approximately 90 species, shares fame with the notable medicinal and psychoactive genera Cephaelis (formally Cephaelis) (from which is derived ipecacuanha, used as an emetic and expectorant), Cinchona (quinine), Pausinystalia (yohimbine, used in a prescription drug to treat male erectile dysfunction), and Uncaria (cat's claw, traditionally used in South American folk medicine, and shown to be an immunostimulant). Three economically important species of the Coffea family are the major source of stimulant beverages arabica coffee, C. arabica L. robusta coffee, C. canephora (C. robusta) and liberica coffee, C. liberica. There is a large discrepancy in relative importance of the three coffee species in international commerce C. arabica, with 75.5 percent of the market, is mostly cultivated in tropical America C. canephora, with 24 percent, is produced mostly in Africa and C. liberica, with 0.5 percent, has mostly a...

Antidiuretic Hormone ADH and Derivatives B

Cimetidine Induced Gynecomastia

Trin-producing pancreatic tumors, Zollinger-Ellison syndrome). Cimetidine, the first -antihistamine used thera-peutically, only rarely produces side effects (CNS disturbances such as confusion endocrine effects in the male, such as gynecomastia, decreased libido, impotence). Unlike cimetidine, its newer and more potent congeners, ranitidine, nizatidine, and famotidine, do not interfere with the hepatic biotransformation of other drugs.

Multiplesystem Atrophy

The parkinsonian features are usually unresponsive to levodopa therapy. There may be gait and limb ataxia, orthostatic hypotension, erectile dysfunction, constipation, and decreased sweating. Whereas multiple-system atrophy is a distinct neuropathological entity, the consensus diagnostic criteria depend on specific clinical features. Pathologically, glial cytoplasmic inclusions and degeneration are found throughout the basal ganglia, substantia nigra, brainstem autonomic nuclei, and Purkinje cells of the cerebellum.

Physiological Effects

The plateau stage of drug effects lasts 3-4 hours. The principal desired effect, according to most users, is a profound feeling of relatedness to the rest of the world. Most users experience this feeling as a powerful connection to those around them, as well as to the universe (Leister, Grob, Bravo, & Walsh, 1992). Although the desire for sex can increase, the ability to achieve arousal and orgasm is greatly diminished in both men and women (Buffum & Moser, 1986). MDMA has thus been termed a sensual, not a sexual, drug. The prescription drug sildenafil (Viagra) may be taken in order to counteract this effect, and may be sold along with MDMA (Weir, 2000) the successor medications involving sexual enhancement can be expected to be used in this manner. The array of physical effects and behaviors produced by MDMA is remarkably similar across mammalian species (Green et al., 1995) and includes mild psychomotor restlessness, bruxism, trismus, anorexia, diaphoresis, hot flashes,...

Disorders of the Bladder and Urethra

Until recently, nearly all men experienced erectile dysfunction after bladder removal surgery, but surgical improvements have reduced the likelihood of this side effect. However, men who have had their prostate gland and seminal vesicles removed no longer produce semen, so they do not ejaculate when they have an orgasm, and they are infertile.

New Research Areas

Symptoms in many patients.74 These were no different to those reported in spontaneous attacks52 and occurred well after any vascular change would have been present. Secondly, downstream activation of the cyclic guanosine monophosphate pathway by sildenafil can induce migraine without any change in middle cerebral artery diameter.75 Thirdly, dilation of the internal carotid artery after nitroglycerin administration in cluster headache patients is dissociated in time from the onset of the attack.76 Together these observations suggest that, while NO mechanisms may play a role in some part of the pathophysiology of these disorders, it need not be a vascular effect. A role for inducible NO synthase has been suggested,77 and inhibition of trigeminocervical complex fos expression occurs with NO synthase blockade.78 Both examples provide a nonvascular approach, although potentially with rather different NO synthase subtype targets. The available data, therefore, suggest that NO-based...

Dialysis deferral 4 years

For five years he had known of kidney involvement, and also had been hypertensive. Urinary protein was said to be 0.8 to 1.0 g per day, but we found only about 350 mg per day. He had been on insulin, an ACE inhibitor, and allopurinol. He had restricted dietary protein to about 50 g per day. His symptoms included muscle cramps, impotence, loss of vision, and neuralgia. Nevertheless, he got regular exercise and kept his blood sugar very well controlled. There was a strong family history of diabetes. Except for diabetic retinal damage, his physical exam was normal. He was not started on a very-low-protein diet initially, because his symptoms didn't warrant it. Throughout 1994 and 1995, his

Hormones and Reproduction

Nerve impulses and hormonal signals serve to control and regulate ( p. 4) the metabolism and internal milieu (blood pressure, pH, water and electrolyte balance, temperature, etc.), physical growth and maturation, reproductive functions, sexual response, and responses to the social environment. The signals received by sensors ( sensory receptors) in the inner organs, musculoskeletal system, skin and the sensory organs, as well as psychological factors, skeletal muscles and other factors also play a part in regulation and control. The signals are used by many feedback mechanisms in the body ( p. 4).

Direct Stimulation Of Nerve And Muscle

Implantable cardiac pacemakers have been around since the late 1950s. More recently, the same basic techniques have been applied to stimulate the vagus nerve for the control of epilepsy, to stimulate the sacral roots to control the bladder and correct erectile dysfunction, and to stimulate nerves in the spine for the control of pain and angina. In addition, interest in functional electrical stimulation (FES) has grown rapidly during recent years, due primarily to progress made in miniaturized hardware that makes multichannel stimulators possible. New surgical techniques enable the use of chronically implanted stimulators to stimulate specific nerves and brain sections directly within the body, making it possible to restore function lost due to disease or trauma. Advances are being made rapidly in the development of implants for restoring limbs, sight (e.g., through artificial retinas or by direct stimulation of the visual cortex), and hearing (e.g., through cochlear implants) Loeb,...

Yohimbe and Yohimbine

Limited studies have evaluated the effectiveness and safety of yohimbe for sexual disorders. Some studies indicate that yohimbe may be beneficial for erectile dysfunction in men and decreased libido in women. However, it has many serious side effects, including severely decreased blood pressure, abnormalities of heart rhythm (arrhythmias), heart failure, and death. Other side effects include insomnia, anxiety, tremor, high blood pressure, rapid heart rate, headache, nausea, and vomiting. The FDA has determined that yohimbe is not safe or effective and that it should not be available for over-the-counter use. Yohimbine, the active ingredient in yohimbe, is available by prescription in the United States. People with MS may experience sexual disorders, including difficulties with erections and decreased libido. These sexual problems should be evaluated and treated by a physician or other health care professional. Yohimbine should only be used with physician supervision. For erectile...

Lower Urinary Tract Symptoms and Sexual Dysfunction

There is increasing evidence to suggest that moderate-to-severe LUTS are linked with erectile dysfunction. A recent large-scale study known as the Multinational Survey of the Aging Male (MSAM-7), which surveyed 12 815 men in the USA and Europe (France, Germany, Italy, Netherlands, Spain, and the UK), showed that the prevalence of sexual dysfunction increased with LUTS severity, independently of age (see ). The link between LUTS and sexual dysfunction is poorly understood, although a number of common components have been identified such as upregulation of -adrenoceptor activity, alteration in a1-adrenoceptor subtypes, decreased NO bioactivity, and sex hormone imbalance. -Adrenoceptors are involved in the maintenance of smooth muscle contraction and relaxation in penile tissue. It has been suggested that any impairment of these receptors and their regulators such as the Rho Rho-kinase pathway will contribute to smooth muscle dysfunction, which is evident in both LUTS and erectile...

Human Studies of Endothelium Dependent Vasodilation

Human studies evaluating the effects of DM on endothelium-dependent vasodilation have yielded some conflicting results, although they generally corroborate those found in animal studies. Saenz de Tejada et al. (60) studied penile tissue excised from men with erectile dysfunction and found that endothelium-dependent relaxation is reduced in the corpus cavernosa of impotent men with diabetes relative to those who are nondiabetic.

Success of Predictions

The uncertainty and variabilities present in in vitro experimental systems can also be complemented by a potentially large degree of this observed in vivo. Thus it is essential a priori to define the target of any extrapolative attempt. Various differences have been observed between the typical healthy volunteer of early clinical studies and the patient for whom the drug has been designed. Differences have been observed in both CYPs129'130 in addition to the disease-specific differences in demography, and other factors such as plasma protein concentrations.91 Using the example of ritonavir and sildenafil,131 it has been demonstrated that the individuals most likely to suffer extreme DDIs are those who would not usually be captured by early clinical investigation.

Primary Nursing Diagnosis

Radical prostatectomy has been the recommended treatment option for men with middle-stage disease because of high cure rates. This procedure removes the entire prostate gland, including the prostatic capsule, the seminal vesicles, and a portion of the bladder neck. Two common side effects of prostatectomy are urinary incontinence and impotence. The urinary incontinence usually resolves with time and after performing Kegel exercises, although 10 to 15 of men continue to experience incontinence 6 months after surgery. Impotence occurs in 85 to 90 of patients. All men who undergo radical prostatectomy lack emission and ejaculation because of the removal of the seminal vesicles and transection of the vas deferens. Newer surgical techniques (nerve-sparing prostatectomy) preserves continence in most men, and erectile function in selected cases. Transurethral resection of the prostate (TURP) may be recommended for men with more advanced disease, especially if it is accompanied by...

Propranolol hydrochloride

Hematologic Agranulocytosis, thrombocytopenia. Allergic Fever, sore throat, respiratory distress, rash, pharyngitis, laryngospasm, anaphylaxis. Skin Fever, pruritus, rash. Ophthalmic Dry eyes. GU Decreased libido, impotence, urinary tract infection. Other Hypoglycemia. Respiratory Bron-chospasm, dyspnea, wheezing. Additional Side Effects Psoriasislike eruptions, skin necrosis, SLE (rare).

Discharge And Home Healthcare Guidelines

Inform the patient that if a unilateral orchiectomy was performed, he is still fertile and should not experience impotence. Make sure the patient understands that he has the option of undergoing reconstructive surgery and placement of a testicular prosthesis. Refer the patient to the American Cancer Society to assist with obtaining information and support.

Pulmonary Arterial Hypertension

More recently, endothelin antagonists have been evaluated in the therapy of pulmonary arterial hypertension. There are at least two types of endothelin receptors ETA and ETB. Activation of either receptor aggravates pulmonary arterial hypertension, but activation of ETA receptors appears to be more detrimental. A nonselective endothelin antagonist, bosentan (Figure 5), is used in the therapy of pulmonary arterial hypertension. Its use is based on the evidence that endothelin is overexpressed in patients with pulmonary hypertension and that overproduction of endothelin may lead to pulmonary vascular remodeling. Bosentan is active orally and has been shown to produce short-term benefits in patients with pulmonary arterial hypertension it improves exercise capacity and reduces pulmonary arterial pressure.47 Its side effects include liver toxicity (elevation of hepatic aminotransferase in 7-14 of patients), teratogenicity, and drug interactions, since bosentan is a substrate for and...

Cocaine and Other Stimulants

Methamphetamine use has reached almost epidemic proportions among gay men in urban centers and is often associated with risk behaviors including sharing of needles for those who inject and unprotected sexual activity. Some have suggested that met-hamphetamines are associated with more intense sexual excitement. When amphetamines are taken along with sildenafil (Viagra), referred to as sextasy, this combination allows for longer and rougher intercourse, which may promote tears in anal mucosa (Halkitis et al., 2001) and therefore promote HIV transmission. Compared to nonusers, gay men who use methamphetamine have been shown to have more sexual partners and to be more likely to participate in anal receptive intercourse, less likely to use condoms, and more likely to be HIV infected (Molitor et al., 1998 Shoptaw et al., 2002).

Sexual Desire and Aging

Male Steriod Facies

Among men, some sexual problems may increase with age, but not necessarily because of aging. The incidence of erectile dysfunction increases for men over 40 and escalates with each decade. The intensity of sexual sensation among men over 40 may be reduced, as may be the speed of erection and the force of ejaculation. Compared with younger men, middle-aged men (45 to 50 years old) are more likely to experience orgasm in one stage, involving a shorter orgasmic period and a rapid shrinking of the erection after ejaculation. The amount of time before another erection can be achieved usually increases, as does the amount of time an erection can be maintained. Among women, biological changes leading to menopause may extend over a 20-year period, with onset generally in the mid 30s and occasionally extending beyond the mid 50s. After menopause, the intensity of sexual response may be reduced, and for some postmenopausal women intercourse may be painful due to vaginal dryness. For many women,...

Second Edition

Heart Disease Diagnosis and Therapy A Practical Approach, Second Edition, edited by M. Gabriel Khan, md, frcp, frcp(c), facc, 2005 Cardiovascular Genomics Gene Mining for Pharmacogenomics and Gene Therapy, edited by Mohan K. Raizada, phd, Julian F. R. Paton, phd, Michael J. Katovich, phd, and Sergey Kasparov, md, phd, 2005 Surgical Management of Congestive Heart Failure, edited by James C. Fang, md and Gregory S. Couper, md, 2005 Cardiopulmonary Resuscitation, edited by Joseph P. Ornato, md, fap, facc and Mary Ann Peberdy, md, facc, 2005 CT of the Heart Principles and Applications, edited by U. Joseph Schoepf, md, 2005 Heart Disease and Erectile Dysfunction, edited by

Assessment

Determine if the patient has a history of recent infection, steroid use, or adrenal or pituitary surgery. Establish a history of poor tolerance for stress, weakness, fatigue, and activity intolerance. Ask if the patient has experienced anorexia, nausea, vomiting, or diarrhea as a result of altered metabolism. Elicit a history of craving for salt or intolerance to cold. Determine presence of altered menses in females and impotence in males.

Atenolol

Ness, drowsiness, fatigue, hallucinations, insomnia, lethargy, mental changes, memory loss, strange dreams. GI Diarrhea, ischemic colitis, nausea, mesenteric arterial thrombosis, vomiting. Hematologic Agranulocytosis, thrombocytopenia. Allergic Fever, sore throat, respiratory distress, rash, pharyngitis, laryngos-pasm, anaphylaxis. Skin Pruritus, rash, increased skin pigmentation, sweating, dry skin, alopecia, skin irritation, psoriasis. Ophthalmic Dry, burning eyes. GU Dysuria, impotence, nocturia. Other Hypoglycemia or hyperglycemia. Respiratory Bronchospasm, dyspnea, wheezing. Drug Interactions See also Drug Interactions for Beta-Adrenergic Blocking Agents and Antihypertensive Agents.

Sexual Dysfunction

The mind and the body must work together for normal sexual function. Thoughts and emotions interact with the nervous, circulatory, and endocrine (hormone) systems of the body to produce a sexual response. The sexual response has four stages 2. Arousal (the state of sexual excitement) occurs as blood enters the genital area, leading to an erection in the male. Erectile Dysfunction Psychological problems, neurological problems, abnormalities in blood flow, damage to the genital organs, hormonal imbalance, and the use of drugs or medications all can interfere with any of the four stages of normal sexual function. Erectile dysfunction occurs when one or more of these factors persistently interfere with the ability to achieve and maintain an erection sufficient to complete sexual intercourse. Erectile dysfunction is often called impotence. Some experts object to the term impotence because of its negative implications and lack of precise meaning. The term erectile dysfunction is now used....

Penile Disorders

In some men, the penis becomes curved during an erection. This condition is called Peyronie's disease. The cause is unknown, but fibrous or scar tissue forms inside the penis and causes it to bend at an angle during an erection. This painful condition makes sexual penetration difficult or impossible. The disease often resolves itself over several months. Vitamin E is the first-line treatment for this condition. Injections of corticosteroids into the affected area are sometimes helpful. Ultrasound therapy also has worked for some men. Surgery may cure the disease, but it can cause further scarring and make the condition worse or cause erectile dysfunction. Another rare and not well-understood disease is priapism, a painful, persistent erection not brought on by sexual desire or stimulation. The underlying cause (possibly drugs, blood clots, a tumor in the pelvis or the spine, infection of the genitals, sickle-cell disease, or leukemia) results in blood vessel and nerve abnormalities...

Hyperprolactinemia

Hyperprolactinemia in women leads to amenorrhea, galactorrhea, and osteoporosis, while in men it may result in diminished sexual drive and impotence, or may be asymptomatic. The degree of hyperprolactinemia is directly related to the functionality of the prolactin-secreting tumor. Serum prolactin levels over 200 ng mL correlate well with the presence of a prolactinoma. Normal prolactin levels are in the ranges of 1 -20ng mL in men, and 1-25 ng mL in women.

Summary

I claim that social agendas appear in these stories through the obliteration of any female sexual response that is independent from her function as a reproducer. Autonomous, distinct female sexual response just disappears. published, in 1983, a technical discussion on optimal reproductive strategies for biped-alism, and took up Morris' anti-gravity line of argument. They argue that orgasm would be adaptive because it would keep the woman lying down, and hence keep the semen from escaping. In the context of these paragraphs on female orgasm, they state, ''it is widely acknowledged that intercourse frequently acts as a mild sedative. The average individual requires about five minutes of repose before returning to a normal state after orgasm.''25 The scientific reference they offer for this particular generalization is Kinsey 1948, which is, in fact, exclusively on male sexual response. In other words, this ''average individual'' which figures in their story about female orgasm, is, in...

Club Drugs

Although MDMA was first synthesized in 1912, its use among youth and gay men has increased greatly only in recent years. One study from Seattle indicated that 41 of gay men aged 20 to 29 years surveyed used Ecstasy at some time in their lives (Community Epi-demiologic Work Group, 2000). MDMA seems to achieve its effects by flooding the brain with serotonin. Similar to methamphetamine, it both stimulates the release of serotonin and then inhibits its uptake. It may also be taken along with sildenafil to overcome side effects of sexual dysfunction (to promote sex-tasy''), and there has been increasing concern about unsafe sexual activity associated with MDMA and an increase in HIV transmission. Although MDMA is considered a benign drug by many, there are now numerous reports of severe toxic, sometimes fatal, reactions (McCann et al., 1996). Chronic use may lead to mood instability and cognitive impairment, which are particular problems for people with HIV (Bolla et al., 1998 McCann and...

Geriatrics

Normal sexual function changes in men elderly men take longer to get an erection and have an increased refractory period (after ejaculation it takes longer before the patient can have another erection). Delayed ejaculation is common, and the patient may ejaculate only 1. of every 3 times that he has sex. impotence and lack of sexual desire are not normal and should be investigated. Look for psychological (depression) as well as physical causes. Medications, especially antihypertensives, are notorious culprits.

Spinal Cord Lesion

Spinal Cord Lesions

Flaccid paralysis of bladder and bowel, loss of erectile function 1 Spinal cord level (not the same as vertebral level). 2 See p. 32ff. 3 Disturbance of bladder, bowel, rectal, and erectile function, sweating, and blood pressure regulation p. 140ff. 4 High cervical cord lesion. 5 Low cervical cord lesion. 6 Epiconus. 7 Conus medullaris.

Abt724

Penile erection is a spinal reflex under CNS (supraspinal) inhibitory control. Visual, tactile, olfactory, and imaginative stimuli from the higher cortical areas of the brain are integrated in the medial preoptical area of the hypothalamus via dopaminergic and oxytocinergic neuronal systems. These elicit the release of NO from 'nitrergic neurons' in the corpus cavernosum of the penis that then activates soluble guanylyl cyclase (sGC) in smooth muscle producing vasodilation and venoocclusion with engorging of the penis resulting in rigidity and erection. 6.23.5.1.1 Centrally acting treatments for erectile dysfunction Injection of DA D2 agonists into the rat medial preoptic area of the hypothalamus can induce penile erections. Apomorphine (17), a centrally acting agent, is a nonselective DA D2 agonist approved for use in Europe and Japan for the treatment of ED. The lack of DA receptor selectivity is associated with an emetic response, which to some patients has represented an...

New Avenues

For existing products there is a trend toward new formulations such as extended-release doxazosin, which has the same clinical benefits as the standard preparation but with less need for dose-titration, and the use of these medications in comorbid conditions. In a recent study of BPH patients with comorbid sexual dysfunction, doxazosin extended-release 4 or 8 mg or doxazosin standard 1-8 mg were given to patients for 13 weeks. The study showed that sexual function improved after treatment with both formulations as shown by the International Index of Erectile Function questionnaire.58

Sexual Function

Psychological Factors Sexuality

The genital organs receive sympathetic (T11-L2), parasympathetic (S2-S4), somatic motor (Onuf's nucleus), and somatosensory innervation (S2-S4) and are under supraspinal control, mostly through hypothalamic projections to the spinal cord. Hormonal factors also play an important role (p. 142). Neurological disease often causes sexual dysfunction (erectile dysfunction, ejaculatory dysfunction) in combination with bladder dysfunction. Isolated sexual dysfunction is more often due to psychological factors (depression, anxiety), diabetes mellitus, endocrine disorders, and atherosclerosis.

Other Target Classes

Moving beyond cancer, new targets in the 1980s included phosphodiesterases (PDE). Who could have predicted that PDE inhibitors, which were studied extensively in the 1980s for heart failure (e.g., inhibitors of type 3 cAMP PDE, like amrinone),451 and later as antidepressants (e.g., rolipram),452 would ultimately yield billion dollar products for erectile dysfunction (e.g., inhibitors of type 5 cGMP PDE, such as sildenafil (Viagra)). This shift in emphasis raises other questions, though. A society that shifts its attention to ''desires rather than diseases'' is a society gone off

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