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Between 15 and 30 million American men suffer from erectile dysfunction or impotence. Erectile dysfunction refers to an ongoing inability to get or maintain an erection. Impotence includes other sexual health problems such as a lack of sexual desire, or problems with ejaculation.
In the original clinical trials involving more than 3000 male subjects, the incidence of myocardial infarction and myocardial ischemia was not significantly different between those who took a placebo and those who took sildenafil. The same was true when postural hypotension was evaluated. Exertion associated with sexual activity has been documented to increase the chances of ischemic events and myocardial infarction. Men with ischemic heart disease who do not take sildenafil have as much as a 2-fold increase in cardiac events compared with healthy men.
The Latin term impotentia coeundi describes simple inability to insert the penis into the vagina. It is now mostly replaced by more precise terms. The study of erectile dysfunction within medicine is covered by andrology, a sub-field within urology.
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"Men can develop erectile dysfunction after sitting on a hard bicycle seat for many hours because they compress an area of the anatomy known as the perineum," explains Ken Taylor, MD, a former assistant clinical professor of family medicine at UCSD and a co-researcher in the 1999 cycling-impotence study. The perineum is the area between the anus and the scrotum.
Several other, more invasive options exist for patients who do not respond to PDE-5 inhibitor therapy or in whom it is contraindicated. Alprostadil (prostaglandin E1) causes smooth-muscle relaxation and subsequent vasodilation by acting on adenylate cyclase to increase the intracellular cyclic adenosine monophosphate (cAMP) concentration. Prostaglandin E1 may be administered intraurethrally, where it is absorbed and transported throughout the erectile bodies. The reported efficacy of intraurethral alprostadil therapy is variable. Padma-Nathan and colleagues59 reported a response rate of 65.9%. Fulgham and associates60 noted improvement in 30% of patients; however, this study has been criticized for inadequate dose titration.61 The most common side effect of intraurethral alprostadil therapy is local penile pain caused by drug-mediated sensitization of nerve fibres.60
"What is clear is that we need much greater public awareness of the risks of buying counterfeit drugs, as lives are at risk.
The penis contains two chambers called the corpora cavernosa, which run the length of the organ (see figure 1). A spongy tissue fills the chambers. The corpora cavernosa are surrounded by a membrane, called the tunica albuginea. The spongy tissue contains smooth muscles, fibrous tissues, spaces, veins, and arteries. The urethra, which is the channel for urine and ejaculate, runs along the underside of the corpora cavernosa and is surrounded by the corpus spongiosum.
The potential effects of prolonged PDE-5 inhibition on spermatogenesis were evaluated by Hellstrom and colleagues55 in a large cohort of men given daily doses of 10 and 20 mg of tadalafil who were followed up for 6 months. They found no significant effect of the drug on reproductive hormones or sperm parameters.
The issue of male enhancement products is a highly private topic, since it is one which many men feel difficulty in talking about. But most men want to have a more sustained sexual experience, even if they do not wish to talk about it.Male enhancemen t is very helpful to men suffering from diminished sex drive, early ejaculation, weak or short-term erections, lack of pleasurable sensation, and lack of overall confidence about their sexual selves. A host of products are available in the market to improve male enhancement. Most of these products drastically and efficiently add to male enhancement.The common methods that are used for male enhancement include psychotherapy, devices such as penis prosthesis and vacuum constriction, drugs including Viagra, Cialis and Levitra, and surgery like implantation of devices, neurosurgery and vacuum constriction.
About a month later, the tissue began to reconstitute itself, forming new blood vessel structures necessary for proper functioning, while nerves from the existing penile tissue integrated into the new tissue. In time, Atala said, the collagen structure was reabsorbed, and the cells built their own collagen structure.
The medication, in addition to its use as a popular treatment for impotence, has already been approved by the U.S. Food and Drug Administration for the treatment of the chronic version of such blood pressure spikes, known as pulmonary arterial hypertension (PAH). The drug has been marketed specifically for this purpose under the trade name Revatio. Another drug -- bosentan -- is also approved for similar purposes.
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Penile erection is a behavioral response that occurs in response to the administration of N-methyl-D-aspartic acid (NMDA) within the PVN. At the same time, inhibition of NO synthase with NG-monomethly-L-argining (L-NMMA) prevents NMDA-induced erection. The researchers hypothesized that the blunted NMDA mediated responses in diabetes reflects an impaired NO mechanism within the PVN. The involvement of an NO mechanism in the NMDA mediated behavioral response was also explored.
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