Thursday, November 2, 2006

Impotence Among Men with Diabetes

Impotence is a common complaint among men with diabetes. In order to
understand it, first we have to see what is involved in a normal
erection. I'll try to explain what it takes to have a normal erection.
Remember here the differences between impotence and lack of libido (sex
drive). In true impotence, the libido is normal but there is no
erection and therefore no performance. In decreased libido, there is
decreased interest in sex (so there are usually no erections), but the
person is not concerned about it.

The majority of erections appear when one is sexually aroused, but
erections are also common during sleep. For that reason, it is not
uncommon for a man to wake up with an "unprovoked" erection two or
three times a week. This is a good sign that helps us to know if the
pathways of an erection are functioning well or not.

To have an erection, several ingredients are required:

- A normal brain, the most important sexual organ
- Normal hormones
- Normal circulation to the pelvic and genital areas
- Normal nerve terminals

A "normal brain" means that, emotionally, one should feel very good
about himself. The most common causes of impotence are psychogenic
("psychogenic impotence") and are due to stress, too much work, not
enough sleep, and, particularly, depression. Less common are phobias
and long-term psychological trauma. In cases of psychogenic impotence,
the onset of impotence is usually sudden, and these persons have normal
erections when they first get up in the morning two-three times a week.

Normal hormones. You need to have normal function of the pituitary
gland and the testes to maintain a good level of circulating
testosterone (the "macho" hormone). An excessive amount of female
hormones may also have an effect similar to low testosterone. Male
hormones are necessary, but they are NOT a sine qua non for erections.
There are persons with low testosterone who are able to have erections,
although at a decreased frequency, because very often low testosterone
is associated with low libido. Treatment with testosterone injections
restores this function. On the other hand, to give testosterone
injections in any other form of impotence is not justified, and it's
even contraindicated because it may increase libido without increasing
performance.

Normal circulation. Erections are a "hydraulic" phenomenon that occurs
involuntarily. Nobody can will an erection! Blood supply to the area
increases by a factor of 15 - 20 because of dilatation of the arteries.
At the same time, the veins close, and this pools the blood in the
organ, increasing the pressure and causing the hardness. If there are
blockages (atherosclerosis of pelvic arteries), blood flow does not
increase, and therefore the hydraulic pressure inside of the penis does
not raise and there is less or no hardness.

Normal nerve terminals. If there is blockage of the "electrical"
connections between the brain and the penis because the "wires"
(nerves) are not normal, the orders to cause an erection do not reach
the area, and these hydraulic changes do not occur. The messages from
the brain do not arrive to the area. It may happen at times with
lesions in the spinal cord, such as in persons with multiple sclerosis,
or more commonly with abnormalities in the peripheral nerves
(neuropathy) like it's seen in diabetes.

Blood pressure medications. All the medications that lower blood
pressure tend to cause impotence because an erection is basically a
hydraulic phenomenon. The blood supply increases to the corpora
carvenosa, which dilate, and the veins close so that there is pooling of
blood with pressure. If you lower the blood pressure, there is less
pressure to send more blood into the penis. Of all the blood pressure
medications, ACE inhibitors are amongst the ones that cause less
impotence because they do not seem to decrease blood flow as much.

Finally, it's not uncommon that impotence is due to several factors
acting together (decreased circulation and abnormal nerves).

Remember that every person is different. You have to analyze with your
doctor the reasons for this problem. Do not be afraid to bring it up.
At times, doctors are afraid to talk about it, but then they feel much
better if you tell them about it.

The treatments vary according to the cause. If it is psychogenic, the
treatment is mostly psychiatric. In cases of permanent and organic
impotence, several modalities of treatment may be considered:

a) Vacuum pumps. They consist of a tube placed outside the penis that
creates a vacuum and increases the blood flow. Once the blood is pooled,
a rubber band is applied to the base of the organ to maintain the blood
and the erection. These devices are inexpensive and work for some, but
they tend to be anticlimactic because you have to stop and get the pump,
then pump, then get the rubber band, and so on.

b) Injections in the penis. There are two different products. The
newest, by Upjohn, is a prostaglandin. Using an insulin syringe, the
medication is applied, and this causes an erection for about 2 to 4
hours. Side effects are rare (plaques of scar-fibrosis if you use them
too much; prolonged, painful erections - this is called priapism).

c) Surgery. A rigid, plastic prosthesis is inserted inside of the penis,
permanently giving the organ enough rigidity to be used at any time. I
prefer the implants because they are simple and effective, and they are
usually covered by insurance. You forget you have the problem, and you
can use it any time you want without having to make any stops.

Dealing With Male Impotence

WARNING: The information presented in this document is not
intended to serve as a clinical diagnosis or treatment of male
impotence. The information contained in this paper should be
considered only as anecdotal and informational in nature. The
author does not endorse any specific brands of described items.

"I was first diagnosed as being diabetic in 1987. One of the
problems men with diabetes must face, besides the life-long need
to control their diabetic condition, is male impotence. This was
not a problem until I began regular injections of insulin
in 1992.

I discussed the problem of impotence with my endocrinologist.
First, he recommended a serum testosterone test. The results
showed I was thirty-five percent deficient for a 43 year old
male. I began Depo-testosterone (testosterone cypionate)
injections. The results, in my case, were remarkable!

As a result of the testosterone injections, I was able to
maintain a full erection for as long as forty-five minutes!
Also, I gained the endurance to exercise on a treadmill, at three
miles per hour, thirty minutes per day! For the first time in my
life I had the stamina and endurance to exercise on a daily
basis! My glyco-hemoglobin test results improved (from 11.7 in
1992 to 6.00 in 1994). And I required less insulin.

Since secondary male impotence (the kind I have) is often
controllable, I researched other things that would maintain and
enhance male sexual performance. Here is what I found:

ADDENDUM: A recent Discovery Network television show "Assault on
the Male" indicated that phenol based products tends to feminize
(de-masculinize) males. The need for avoidance of refined and
processed foods (yes, even the lining of canned foods) becomes
important in that phenol based products invade every facet of our
male lives (cologne, foods, cosmetic products, etc.). Phenol-
based products mimic estrogen (the female hormone) and readily
bond to estrogen receptors in the nucleus of both male and female
tissue cells. The end result is that males may possess male
appendages (a penis) but may, due to estrogenic activity of
phenol based products and others, exhibit female characteristics
and tenancies. I shall let the reader further explore and
interpret the obvious repercussions of this information.

Prescription Drugs

-Testosterone Cypionate. This is a class three (C3) regulated
drug (Anabolic Steroids Control Act). You need a prescription.
Also, you need a three cubic centimeter (3CC) syringe and a one
and one-half inch long needle (needless to say, another
prescription). There is no such thing as a normal dose of
testosterone. I started at 100 milligrams (.5 CC) and progressed
Prescription Drugs (continued)

to 500 milligrams (2.5 CCs) twice per month before my serum
testosterone "normalized" for my "male" age of 43 years.

Administration: This is a deep gluteal (hip) upper/outer
quadrant injection. Once you get over the initial shock of that
1.5 inch long cannula (needle) poised over your hip and give
yourself that first injection, it gets easier. I self-inject
twice a month. If you do take this drug, make sure you read and
understand the pharmacological description that comes with it.
There is a "patch" on the market but it requires daily
application to your "dry shaved" scrotum (forget-it!).

Benefits: If it works for you like it works for me (evidently,
men respond differently to the treatment): An achievable and
maintainable full erection and increased physical endurance and
stamina.

Side effects: In my case, acne and profuse night sweats. There
are other side effects, too. According to the literature these
injections cause the same symptoms as going through puberty.
They minimize as the body becomes acclimated to the dosage.

-Prozac (antidepressant). This is a controversial prescription
drug. Some antidepressants delay sexual orgasm (in both males
and females) and they are sometimes used to control premature
ejaculation. Read all the literature on Prozac before you decide
to take it. The reason I am taking Prozac is due to a clinical
diagnosis of mild depression (diabetics tend toward a depressive
state). I personally find Prozac to be beneficial in not only
controlling depression but in maintaining mental alertness.
Also, it helps control ejaculation for as long as forty-five
minutes, even during direct physical stimulation.

Administration: Orally, once per day.

Benefits: Already described.

Side effects: Read the literature on Prozac. I personally have
not experienced any negative side effects.

Non Prescription Drugs

-Exercise! Just Do It! Do at least twenty minutes per day of
vigorous exercise or one hour of non-vigorous exercise.
Remember: Sexual performance is diminished if you are
overweight!

-Excessive use of tobacco and alcohol. These are probably the
two primary causes of temporary male impotence. Enough said!

-Pumpkin Seed Oil. This is a standard treatment for prostate
disorders in Europe. Most of the claims about pumpkin seed oil
Non Prescription Drugs (continued)

I have read about are anecdotal. I take it because as a diabetic
I am on a low/no fat diet and some essential fatty acid (EFA)
foods are needed by the prostate for maintenance. Other EFA
sources are olive oil, fish oil, and evening primrose oil.
Remember! One out of eleven men will develop prostate cancer.
Take care of you prostate and it will take care of you!

-Water. Drink eight to ten eight ounce glasses of water each
day. Again, Just Do It! I do it because I have already had two
kidney stones removed (no fun at all!).

-Vitamin and Mineral supplements: Vitamin C, E, and zinc are
needed by the prostate for proper maintenance and for the
formation of seminal fluid. Also, I take B vitamins and
magnesium.

-Homeopathic Remedies. There is not enough room in this paper to
fully describe homeopathic remedies. Buy a book or go to the
library if you don't know what these are. There are several
remedies for male sexual problems (including impotence) described
in homeopathic literature. I am taking these remedies with
positive results.

-Herbal Remedies. One herbal remedy I use is yohimbe bark (the
unrefined bark of the yohimbe tree). There are pharmacologically
pure preparations of yohimbe but they can cause a lot of side
effects (you should not take refined yohimbe hydrochloride if you
are taking antidepressants). You can buy the bark preparation
from companies that sell health supplements.

What it does: The bottom line is that yohimbe reportedly
increases the flow of blood to the penis, and decreases the
outflow from an erect penis. Also, retromission (the time after
orgasm to gain another full erection) is reduced. The literature
I have read states that yohimbe may act as an aphrodisiac.
Enough said!

The only other herbal I use is panax ginseng (specifically
Manchurian Ginsing). This herbal can give you a real power boost
if you take it prior to a workout. I have read that too much
ginseng can cause headaches and skin problems. The primary
effect of ginseng, as an adaptogen, is on the adrenal gland. You
can buy this preparation from companies that sell health
supplements.

-Raw testicular concentrate. Again, the claims about glandular
therapy I have read are anecdotal rather than clinical.
Evidently, the raw glandular tissue formulation has an affinity
for similar living tissue. One of the components of the raw
testicular concentrate, testosterone, acts to boost the level of
serum testosterone. How much you need to take will vary. Based
on the literature I have read, the half-life of testosterone is
short (somewhere between 10 and 100 minutes). It is rapidly
metabolized and 90% of an oral dose doesn't even make it through
the digestive system. You can buy this preparation from
companies that sell health supplements.

Final Note

These things work for me. You may want to consider some or all
of the above if an active sex life, and physical strength and
endurance, are important to you as a male. If you are a male
diabetic you are probably already familiar with the problem of
impotence: Anything that helps to diminish impotence is
welcomed!"

-- Submitted by John

What Every Man Should Know About Feminist Issues: Rape Women as property

One bad idea pop-feminists promote is that men's abhorrence of rape begins with property ownership: "The essence of rape was theft of or damage to another man's property, be it the father or the husband. As a result, rape was originally connected to property, the seizing and devaluing of a possession." (Women on Rape, Jane Dowdeswell, p 43)

This ignores the historical dynamics between women and men. In the past, to be eligible for marriage, men often had to prove themselves able to provide a wife with food and shelter. In a sense, a woman didn't marry a man, but his livelihood. In every essential respect, he was as much her property as she was his.

It also demeans modern men. Historically, rape may have been about property. But that does not dictate what is presently true. Do most mothers consider their children chattel? Are kids no more than property to moms? Would torturing a woman's children be, to her, nothing more than vandalizing her property?

Of course not. Nor is the rape of a man's wife mere "defilement" of a valued possession. The conduit of his love may be occluded by his anguished I-should- have-been-there-to-defend-her shame, but no matter what reasons individual men may have for wishing no harm for their wives, one thing very clear is that most men feel almost as much concern for the safety of most women as they do for their own mothers, wives and sisters. When pop-feminists disparage this genuine concern, they do more than harm men, they hurt women, too.

When the bonds of love are severed by cut-throat commentators, what's left? For men today, it's quickly becoming a matter of self-preservation. No where is this so evident as in the discussions over date rape and responsibility.

What if your date tells you she wants to have sex with you, then when you're in bed about to "do it," she says, "no." If you keep going, is it rape? What if you're already humping away and she says, "I've changed my mind, stop" seconds before you orgasm, if you orgasm, is it rape? The best answer in every case is: Assume it is, get the hell out of there, warn all of your friends she's a rape waiting to happen, and never have anything to do with her again. Always take no for an answer. The less you have to do with women who play such games, the better.

Isn't this being paranoid? Yes, and men have good reason to be paranoid. Pop- feminists are teaching most women, and college students in particular, that even reluctant sex is rape. (Time, June 3, 1991, p 53)

Even though most accusations of rape are dropped, a false charge can destroy a man's career, ruin his reputation, and leave his life in shambles. What do pop- feminists have to say about that? A woman who levels false charges of rape has her "reasons." (Time, June 3, 1991, p 51)

When is it rape, and when is it something else? Susan Brownmiller argues that rape is "a crime of violence and power over women" rather than a sex crime: "It is nothing more or less than a conscious process of intimidation, by which all men keep all women in a state of fear." (Against Our Will, Susan Brownmiller, p 5)

We should welcome such a broad definition since it allows us to look beyond the limited idea of rape as a crime committed only by men against women. Realistically, rape is an obsolete term that should be replaced with a non-gender specific term, such as Sexual Violence. Indirectly, pop-feminists even admit the whole concept of rape has as much to do with subjective social attitudes as with any objective characteristics of the crime:

Men can never be raped by a woman in the same way a woman can be raped by a man -- or a man can be by another man -- since cultural symbols do not allow female sexual aggression to be humiliating to a man. -- The Hite Report on Male Sexuality, Ballantine Books Edition, Sixth Printing, 1989, Shere Hite, p 794

If rape wholly depends upon what kinds of sexual aggression cultural symbols cause to be humiliating, then women are raping men at breakneck speed. By their own logic, every woman who has ever sneered at and spurned a "nerd's" request for a dance or a date is guilty of rape. Everytime a woman fakes orgasm, she rapes. And every woman who has ever scorned a man's sexual performance has raped, because most men find these forms of female sexual cruelty both hurtful and humiliating.

Despite this, pop-feminists cling to their anachronistic concept like Crusaders of olde swashing their bucklers because, without the means to deny by definition that men can be sexually victimized by women, they would lose the primary basis upon which they persecute men. Consequently, they cannot accept that rape sometimes results from an over-excited libido.

Rape, or sexual violence, is not always about sex. But women who assert it's never about sex just don't get it.

But when rape isn't about sex, it can be, as Brownmiller argues, "a deliberate, hostile, violent act of degradation and possession on the part of a would-be conqueror, designed to intimidate and inspire fear ..." (Against Our Will, Susan Brownmiller, p 439) So, if it's not about sex, but power and control, then clearly millions of women are guilty of raping men. This is a crime pop-feminists encourage and perpetuate.

They are successfully using rape and many other "feminist" issues, for example, as a "conscious process of intimidation, by which all (women) are putting all (men) in a state of fear" by terrorizing men with the threat of being accused of rape, sex discrimination, a sexual thought, or sexual harassment for any act that the "victim" may believe or say occurred: "Men, too, should be aware that if walking behind a woman, she may assume she is being followed. They should cross over or take a different route." (Women on Rape, Jane Dowdeswell, p 53)

By pop-feminist definition, men are guilty, period. "All men are rapists, that's all they are," pop-feminists say. The corollary to this, which most rightly ridicule, is "all women want to be raped."

Presuming a universal perversity among men is acceptable to many, but Brownmiller asserts our adherence to this absurd notion of human sexuality is in men's best interest: "There is good reason for men to hold tenaciously to the notion that 'All women want to be raped.' Because rape is an act that men do in the name of their masculinity, it is in their best interest to believe that women also want rape done, in the name of femininity." (Against Our Will, Susan Brownmiller, p 346) The problem with this is, the two go hand in hand. If "all men are rapists," then "all women
want to be raped." They are inseparable propositions, each lending life and
logic to the other.

Every time a pop-feminist denounces all men as rapists, or as potential rapists, she also brands women as real or potential masochistic matrons of perfidiousness. They do try, however, to obscure the connection by assiduously asserting the former while vehemently denying the latter: It is in their best interests to sell the idea all men are potential rapists.

Until recently, rape was defined as a crime no woman could commit: "rape is the only crime in which by law the victim is female and the offender is male." (Against Our Will, Susan Brownmiller, p 413) This ignores that women can be guilty of statutory rape. Have sex with anyone too young and, male or female, the act is, by law, rape. In this context, women can be rapists, too. But are they likely to be charged with rape? Rarely, because "our society mistakenly believes that 'girls get raped and hate it, but boys are seduced and love it.'" (Abused Boys, Mic Hunter, pp 25 - 26)

Why is a girl a "victim" but a boy is "lucky"? Because, no less than the men whom they accuse of sexism, women objectify themselves as sex-objects. Thinking in terms of supply and demand, they see themselves as suppliers of sex and men as consumers. Thus, a boy who is "given" sex to "consume" is lucky, while a girl who "gives" of her "supply" is, by sexist logic, a victim of theft. Objectified by her own gender, her pleasure is made a commodity she must hang onto and exchange for power over men.

For this reason, as "suppliers of sex" all women are subject to victimization, while all men, as "consumers of sex," are like thieves in the night whom pop-feminists prejudge guilty by virtue of being men.

This is particularly evident in Brownmiller's assessment of the predicament of groupies, who find themselves "coerced" into giving away their sex: "(T)he glamour attached to cultural heroes, such as a movie star, sports figure, rock singer or respected-man-in-the-community, provides a psychologic edge that lessens the need for physical coercion until it is too late for the victim to recognize her predicament." (Against Our Will, Susan Brownmiller, p 283) Personifying men as success objects, these frequently young women pursue the attentions of rich, powerful, sometimes famous walking wallets with a fervor matched only by some young men's pursuit of sexually objectified women.

Recognizing the sexual power these men have, Brownmiller labels them "rapists" who "operate within an emotional setting or within a dependent relationship that provides a hierarchical, authoritarian structure of its own that weakens a victim's resistance, distorts her perspective and confounds her will." (Against Our Will, Susan Brownmiller, p 283) As most men can confirm, an attractive woman has an almost identical effect on men. Does that mean all attractive women are rapists? If a man's career success makes him a rapist because it gives him a sexual "edge," then shouldn't the same be true of a woman whose carnal success gives her a competitive edge of her own? Just who are the real victims, here?

Pop-feminists assert most women are victims of rape. That it is both common and under-reported. In Great Britain, the 1984 Women's Safety Survey concluded one in six women had been raped. (Women on Rape, Jane Dowdeswell, p 16) In the U.S., Brownmiller asserts "one in five (female) rapes, or possibly one in twenty, may actually be reported." (Against Our Will, Susan Brownmiller, p 190) Their numbers may be true. But ignoring how women victimize men, they are certainly biased.

Do women sexually violate men as often as men sexually violate women? Not according to police statistics. But do those numbers accurately portray reality?

Probably not: Most cases of reported spouse battering, for example, involve a man attacking a woman. Yet surveys conducted independently of reported cases (i.e., police records), show that, in 1975, five husbands were battered for every four battered wives. Ten years later, that increased to more than seven battered husbands for every four battered wives. (Handbook of Family Violence, Susan K. Steinmetz and Joseph S. Lucca, p 237)

Despite this, police statistics show between twelve and fourteen cases of wife battering are reported for every case of husband battering. In other words, only one case out of between seventeen and twenty occurrences of husband battering is reported. If this ratio holds true with rape, then it's possible that, in 1985, perhaps one in three men were raped, but only one in 29 were reported.

This is not as far-fetched as it may sound: Statutory rapes of male victims are seldom reported. What's more, the 1991 study suggesting a new category of rape defined by reluctant consent, found that more male than female college students said they had engaged in sexual intercourse when they really didn't want to. (Time, June 3, 1991, p 53) If reluctant consent sex is rape, then the rape of men may be the most under-reported crime of all. But, all of this begs the question if men cannot, by definition, be victims of rape.

Treatment For Erectile Dysfunction

Treatment Options
Successful erections require the coordinated actions of a healthy brain, pliable blood vessels, fully functional nerves and certain hormones. Erotic or manual stimulation, triggered by the five senses or by memory, begins the erectile process. The nervous system responds by sending chemical messages to and from the pelvic area.

These messages cause the smooth muscle tissue inside the penis to relax. The blood vessels dilate, allowing more blood to flow into the corpora cavernosa, the two erectile bodies within the penis.

Like sponges, they capture more blood, swelling and lengthening the penis. When all of the spaces are occupied with blood, the organ becomes rigid. The enlarged corpora cavernosa take up so much space inside the penis that strong pressure is exerted against the penile veins, greatly reducing the outflow of blood, which allows the penis to stay rigid.

At this point, the erect penis contains seven to eight times more blood than the same flaccid, or non-erect, penis. As long as the sexual stimulation is continued, an erect stage can be maintained until orgasm and ejaculation.

Some patients can achieve an erection naturally, but cannot maintain it long enough for normal sexual activity. This situation is sometimes referred to as "venous leak." A non-invasive, prescription product called StayErec may be able to help with venous leak.

It is your doctor's job to help you determine what is causing your problem and which treatment option is best for you. All physicians will first record your medical history, including psychological and sexual aspects. They may ask about stress and fatigue and about the relationship between you and your partner. Some questions may be very personal, but your doctor needs to know about your present sexual functioning in order to treat your impotence. So, be honest with your answers.

One common question is, "Do you wake up in the morning with an erection?" If you always wake up with an erection, your physical system works, and the impotence may be psychological. If you never wake up with an erection, it suggests a physical problem with blood vessels or nerves.

A new impotence screening device called Inform(TM) is a simple, inexpensive, at-home erection test. Inform provides an easy, cost-effective method of determining whether your impotence is physical or psychological. Your doctor may use the information provided by Inform to decide on further testing with a more sophisticated testing device, the RigiScan monitor. For more information on ordering the Inform nighttime erection test, see our on-line Inform order form or call Osbon Medical Systems’ Customer Service department at 1-800-438-8592.

Whether you start treatment with your family doctor or a urologist, the initial approach will probably be conservative. Conservative, non-surgical treatments for impotence have proven very successful, and most patients find surgical treatment unnecessary.

If your family doctor is not comfortable with treating impotence, he or she may refer you to a urologist, who may prescribe any of the known treatments for impotence. He or she may also do all the examining and testing already mentioned, if not done by your family doctor. The urologist will conduct additional, more sophisticated tests if you are thinking about a surgical correction for your impotence.

A panel of experts met in Washington, D.C. in December 1992 to assess current knowledge of the diagnosis and treatment of impotence. They recommended that "as a general rule, the least invasive treatments should be tried first." The statement of the National Institutes of Health (NIH) Consensus Panel suggested the staging of treatments from the least to most invasive in a sequence such as the following:


External vacuum devices (ErecAid® System)
Penile injection therapy (InjecAid System)
Penile implant surgery (Dura-II)
Vascular surgery

Sexual therapy or counseling - In November of 1996, the American Urological Association (AUA) issued the first official guidelines for the treatment of erectile dysfunction. The guidelines confirm and reinforce the NIH recommendations on the staging of impotence treatment, adding that the three safe and effective treatments today are external vacuum therapy, penile injection therapy and implant surgery. The guidelines further declare that vacuum therapy is almost always helpful as an adjunct therapy and may be used concurrently with any treatment.

Some men may be helped by taking an oral drug like yohimbine, but its effects have been determined to be largely placebo effects and any results are usually weeks away. A small percentage may also benefit from taking hormone medications, but unless the hormone deficiency is severe, this treatment may not help.

Vacuum therapy with ErecAid® System, the original external vacuum device, is probably the most widely recognized first-step treatment since it works for all types of impotence and has minimal side effects. Even if other non-invasive treatments like yohimbine or counseling are tried first, vacuum treatment can be applied concurrently to get immediate results. Vacuum therapy is widely prescribed, safe and 90% effective.

Penile injections have been used for over a decade with about a 70% success rate, but many men reject this treatment when they learn that it involves putting a needle into the penis. However, many impotence clinics specialize in this common, effective therapy. More recently developed is a method of delivering a drug through insertion of a pellet into the urethra

Implanted devices, of course, involve surgery. Experts now believe that this treatment, once considered the "gold standard" therapy, should only be done as a last resort, if and when less invasive treatments have failed. The placement of an implant permanently alters the interior structure of the penis and precludes successful use of other therapies or the return of natural function. Consider that when a pill is finally discovered to restore potency, it will surely require healthy corpora cavernosa in order to work.

External Vacuum Therapy - This treatment is a simple, non-invasive method of producing a quality erection. The external vacuum device was created by Geddings Osbon in the early 1960s to solve his own impotence problem. He created the ErecAid® System, based on negative pressure and tension, to achieve and maintain a near-natural erection any time one was desired.

ErecAid® System consists of a clear plastic cylinder, a manual pump or battery pump and a patented pressure-point tension ring. The user loads the tension ring around the open end of the cylinder, then inserts his penis into that end. Holding the device firmly against his body to form an airtight seal, he uses the pump to remove air from inside the cylinder. This creates a partial vacuum around the penis, causing the body’s blood to enter the corpora cavernosa. This fills the penis with blood in a way similar to a natural erection.

To maintain the erection, it is necessary to reduce the outflow of blood from the penis. Therefore, while the penis is still under vacuum pressure, the tension ring is moved from the cylinder onto the base of the penis. The cylinder and pump are then removed and laid aside. The user can maintain an erection for up to 30 minutes wearing only the tension ring. This method of creating an erection takes about two minutes and may be used as often as desired.

ErecAid® System has consistently proven effective for over 90% of its 450,000 users, regardless of the cause or origin of their impotence. It is often prescribed following prostate surgery and has even been successfully used by men who have had a penile implant removed. Also, because of its non-invasive nature, ErecAid® System may be used as an adjunct to other therapies.

One of the most significant advantages of the ErecAid® System is that it works immediately, without requiring surgery or a healing period. The erections are of high quality, last longer than natural ones and do not usually disappear after orgasm. Though it is recommended that the ring be removed within 30 minutes. Also, once the Osbon Technique has been learned, the patient can achieve reliable, consistent erections whenever he wishes.

Another advantage is cost. The ErecAid® System has a one time cost of $400 to $500. Most other impotence treatments have a continuing cost for duration of use. Medicare and most private insurers cover the cost of ErecAid® System. To further protect you, the major components of ErecAid® System have lifetime replacement guarantees.

Side effects of vacuum therapy are minor and rarely require treatment. Some men experience petechiae and ecchymosis. Reddish pinpoint-size dots (petechiae) may appear on the surface of the penis. They are often caused by placing the penis under negative pressure too rapidly. Ecchymosis is a bruise caused by the penis being held under vacuum pressure too long. Neither condition is painful or serious and does not need treatment. They stop happening after a few uses. No major injuries have ever been reported by users of the ErecAid® System, and side effects rarely require treatment.

This device may not be an appropriate treatment for men who have sickle cell anemia or a history of spontaneous priapism (extended erections). It has been determined that men on blood thinners like coumadin may safely use the device by pumping more slowly. Proper use of ErecAid® System requires some manual dexterity and hand strength though the newer battery powered model minimizes that requirement.

Some of the drawbacks mentioned by users involve the initial minor discomfort of the tension ring or a perceived loss of spontaneity in lovemaking. Both of these concerns appear to resolve with regular use of the device. Becoming comfortable with ErecAid® System is comparable to becoming comfortable with eyeglasses or a hearing aid during the first few weeks of use. Most couples believe that the learning period is well worth the effort for the return of a fuller, happier life. For more information on the ErecAid® System, please call or e-mail the Osbon Medical Systems’ Customer Service department at 1-800-435-6780.

Penile Injection Therapy - Self injection should be done near the base of the penis and at a specific angle. Physicians learned in the early 1980s that some medications injected directly into the corpora cavernosa would produce an erection within a few minutes. Urologists now routinely use this method to treat men by teaching them self-injection techniques to use at home.

Currently three medications are used for penile injection, though only one - Prostaglandin E¹ (alprostadil) - has received permission to market under FDA guidelines. The first injections were typically of papaverine alone; the alpha blocker phenlatahine was sometimes added to papaverine as well as prostaglandin E¹.

Diabetic needles (27 or 28 gauge, a half-inch long) are used for these injections. The patient must learn to inject the base of the penis at a specific angle, usually using less than 1 cc. Either corpus cavernosum may be injected but not the urethra. Hand pressure is applied afterward to the injection site for 2-3 minutes to prevent bleeding. Ideally, erections will last 30-60 minutes and will become more rigid if stimulation occurs.

With injection treatment, high quality erections are available on demand, and they last longer than natural ones. The erection does not always disappear at orgasm or ejaculation. Injections work in about 70% of all cases. The 30% failure is often due to poor blood flow, venous leakage or severe scarring of the penile tissues.

There are concerns with injections. The key ones are priapism, pain, dropout rate, and cost. "Priapism" is an unwanted, prolonged erection. Injecting too much of the drug may cause an erection which lasts much longer than intended. After four hours, men should seek medical help for reversal of the erection. This is done by injecting an adrenaline-like drug into the penis.

Any pain from injecting is primarily from the needle puncture. Many men are frightened to think of injecting the penis with a needle, though the needless are a very fine gauge and many report the injection to be painless. This apprehension may account for the high dropout rate for men on injections. A 1990 study (University of Chicago) showed that 51% of the group dropped out after receiving only a test injection. The average patient stayed in the study group for seven months before leaving it. Other men, however, have injected successfully for years.

Depending on the exact mix of the drugs, one injection will cost from about $5 to $32. If a man is sexually active twice a week, the annual cost will range from $520 to $2080. Reimbursement is available for prostaglandin drugs only.




Implant Therapy - In 1972-73, physicians began doing penile implants to help with lost potency. Today, surgeons implant about 20,000 of these devices per year into American men who choose this treatment. Semi-rigid rods account for about 30%; multi-component inflatable implants are thought to be 50% of the total; and self-contained devices make up the last 20%. In all cases, two synthetic cylinders are surgically placed inside the corpus cavernosum of the penis. After a 4-6 week healing period, a man is usually ready to engage in sexual intercourse.

These devices are either mechanical, inflatable, or hydraulic. Their implementation permanently alters the corpora cavernosa, ending the possibility of the return of natural erections, so this treatment should be considered a final step, not an early one. All surgery carries a risk of infection and eventual malfunction or deterioration of the device may require other surgeries.

Semi-Rigid Rods (Penile Prosthesis or Dura-II) - A pair of semi-rigid rods implanted in the penis is bendable. Two bendable rods have an outer coating of silicone and inner, parallel, silver or stainless steel wires or interlocking plastic joints held together by a cable. With this rod, the penis is always erect, but can be bent down. To prepare for intercourse, the man simply bends the penis to a "ready" angle.

The rate of complication is low and many of these rods are inserted as an outpatient procedure with a local anesthetic. The surgeon’s skill is important since he has to properly "size" the implant to your penis. Cost is approximately $6,000-$10,000, including the surgery.

Disadvantages are: Because the penis is always erect, it is difficult to hide under a swimsuit or tight-fitting clothes; the erection is due to metal and silicone, not the flow of blood into the penis; and, finally, the surgery is not reversible.

Multi-Component Inflatable Implants - This implant has two or three components. Inflatable cylinders are placed in the corpora, a fluid reservoir goes into the abdomen (or scrotum) and the pump is placed in the scrotum. Squeezing on the pump moves fluid from reservoir to cylinders, causing rigidity. A squeeze of the pump release valve reverses this process.

Self-Contained Inflatable Implants - Two cylinders are placed inside the penis. Each one contains a pump, fluid, and release valve. A squeeze of the head of the penis forces a fluid transfer to the forward chamber, causing rigidity. A simple bend of the penis causes fluid to flow back into the storage area, ending the erection.

Vascular Reconstructive Surgery - Penile surgery of this type is similar to heart bypass surgery, which reroutes the blood supply around blockages. Fewer than 1% of impotent men are candidates for this procedure, which is still considered experimental. The failure rate is high.

Venous ligation is a penile surgical procedure in which the surgeon attempts to repair the veins causing venous leak. This procedure was popular until physicians began to realize that it offered only a temporary solution, as many patients required another operation within a few years.

These surgeries cost about $15,000-$20,000 and should only be performed by surgeons experienced with the procedures, preferably in an investigations setting. Complications may include permanent numbness near the incision and scar tissue which may shorten or "torque" the penis. Also, the surgery may need to be repeated.

What are the odds of re-operation?
Ask your physician about the odds of having repeat surgeries. Ask about the failure rate of the implant he is recommending. Ask about the failure rate of the various vascular surgeries.

Hormone Medication - A serious deficiency of the male hormone, testosterone, can cause impotence. In these situations, treatment with hormone replacement can be effective. Only about 3-4% of the male population, however, has this problem and can benefit from the treatment.

The nature of the treatment is to administer an injection of testosterone into the arm or buttocks to raise the hormone to acceptable levels. Side effects of testosterone replacement therapy can be serious, and patients with a medical history that includes liver disease, heart disease, kidney problems or, especially, prostate cancer should avoid supplemental testosterone.

Yohimbine Tablets - This natural aphrodisiac from the bark of the yohimbehe tree is sometimes prescribed by doctors for men with intermittent erectile dysfunction. In most of these cases, the physician suspects a psychological problem, but cannot prove it. The drug is used to stimulate desire and improve the quality of the erection. Dispensed in tablet form and available only by prescription, yohimbine is taken three times a day for 4-6 weeks to test its effect. Costs are
about $40 a month. Even if the tablets work (which they do in 15-20% of patients) stopping the tablets may return the patient to his former state of impotence. Side effects may include headaches, sweaty palms, dizziness, and nausea. Men with ulcers or hypertension should take this drug with caution. The American Urology Association has determined that the benefit is largely a placebo effect.

Sex Counseling and Sex Therapy - Sex counseling refers to consultations with a qualified counselor who helps the couple to identify, understand and cope with their sexual concerns. Sex therapy is more structured in that it uses counseling, but also includes a time element and specific exercises for the couple. Exercises are meant to remove stress from areas of the relationship that influence sexual function. They may include sexual touching and other sexual exploration.

When the cause of impotence has a strong psychological involvement, sex counseling or therapy can be very effective. Many people feel that counseling can enhance the effects of other treatments as well. Couples should seek this therapy only from a trained professional with a good reputation. Best results occur when there is good partner cooperation and both patient and partner attend the counseling session.

Which Treatment Should I Choose?
You and your partner should thoroughly discuss the options and your habits. Go through this booklet together and visit the doctor together. Does your partner lean toward one treatment more than the others? Do you? Start with the simplest treatment that has the highest potential for success.

Treatment Sequence.
The best way to look at impotence therapy is that the simple, inexpensive, reversible treatments should be tried first, while the more complex, expensive, non-reversible treatments should be attempted later. ErecAid® System, yohimbine tablets, and sex therapy might be tried earliest since all are relatively inexpensive and reversible. Injections are next on the list, followed by implant surgery. The surgical procedures are the most invasive therapies and cause internal changes in the penis. If some new treatment appears in the future which requires the corpora cavernosa to be healthy, you may miss out on it if you have permanently altered the erectile bodies.

Financial considerations.
What is the out-of-pocket cost of the treatment selected? How much will health insurance pay for? What are the guarantees or warranties of the treatment chosen?

Maintenance costs. Ongoing costs for treatment must be identified. For example, yohimbine tablets have an ongoing cost, as do penile injections.

Safety and effectiveness.
Has the chosen therapy received FDA marketing approval? Have clinical studies been performed for this treatment? Is the treatment backed up by a reputable provider, with liability insurance?

Treatment Alert!
Unfortunately, perhaps due to the private nature of impotence, unethical advertising of sexual help products and miracle "cures" abounds. Many men do not seek medical treatment, but attempt instead to treat themselves with non-medical devices or unproved remedies. These so-called "cures" seldom work and can be potentially harmful.

Also, because impotence is often a symptom of more serious physical problems such as vascular disease or diabetes, it is extremely important for anyone experiencing impotence to see a qualified physician. Only after careful examination can a doctor determine the cause of impotence and recommend appropriate treatment.

Lastly, be wary of clinics that promote unnecessary and/or expensive testing when trying to determine the cause of impotence. Usually a detailed medical and sexual history will reveal a patient's predisposition to common, primary causes of impotence, such as diabetes.

Insurance Coverage - Insurance companies will generally pay for impotence treatment when the cause is physical. Your physician must specify on the claim form the physical cause of your impotence and that your treatment is "medically necessary."

Medicare coverage is divided into Medicare A, which covers surgeries, hospital stays and the more costly medical services; and Medicare B, which covers doctors’ office visits, medical devices and the less costly items and services. If you have Medicare, the person who sold you the System is required to file the claim for you. This may be your doctor, your pharmacist, medical supplier or Osbon Medical Systems. However, you are responsible for furnishing your Medicare number, date of birth, medical diagnosis, prescription and payment before a claim can be filed.

If you have FICA taxes deducted from your paycheck, you will be covered by Medicare A at no charge when you reach 65. Medicare B costs about $30 a month and may be deducted from your Social Security check.

Surgical treatments for impotence are covered by Medicare A in most states, as long as your doctor verifies a physical cause of the impotence and states that the treatment is "medically necessary." Vacuum devices are covered under Medicare B. Penile injection therapy is not covered by Medicare at this time.

With a valid prescription, you may obtain an ErecAid® System from your doctor, a pharmacy, a medical supplier or directly from Osbon Medical Systems

Monday, October 23, 2006

Impotence Common After Kidney Transplant

Sexual difficulties are among the 10 symptoms most frequently reported by men with kidney failure. These are caused by a combination of fatigue, hormonal changes, nerve damage and arterial disease. Of all the symptoms experienced before transplant, sexual difficulties are the only ones that don't improve afterwards.

A recent study in France reports that erectile dysfunction is surprisingly common in men who have had kidney transplants. Researchers gave a well-established questionnaire called the International Index of Erectile Function, or IIEF, to 271 men who had had kidney transplants and were sexually active. The men answered questions about five areas of their sexuality: erectile function, orgasm, sexual desire, satisfaction with intercourse, and overall satisfaction with their sex life. The researchers then compared this group of men with those that had been studied when the questionnaire was developed.

"A significant decrease in erectile function and intercourse satisfaction was observed in male kidney transplant recipients compared to the controls. The prevalence of erectile dysfunction after renal transplantation was surprisingly high," according to Dr. Lionel Rostag of Hospital Rangueil in Toulouse, France, and colleagues, in the May issue of Transplantation. "Erectile dysfunction affected approximately every other sexually active patient (55.7 percent)." They note that among the general population, impotence affects only about one in 10 men.

The two aspects of sexuality that differed significantly between the transplant patients and the control group were the ability to achieve and sustain an erection and overall satisfaction with intercourse. The groups did not differ on interest in sex, ability to achieve orgasm or overall satisfaction with their sex life.

"Orgasmic function and most interestingly, overall satisfaction scorings were not affected," noted the researchers. They noted that while interest in sex is usually impaired in patients with kidney failure, the transplants restore patients' hormonal balance and this problem usually disappears.

Previous research had found that sexual dysfunction in both male and female patients was the only symptom that didn't improve significantly after kidney transplant, explained the researchers. However, they did not expect to find that over half of the men in their study reported difficulties, especially since the average age of this group as a whole (age 48) was younger than the control group (average age 55).

In the current study, the factors most closely related to sexual dysfunction in the transplant recipients were age, the amount of time they'd spent on dialysis before their transplants, and whether they'd had more than one transplant. Men who reported sexual difficulties were significantly older than those who didn't and had spent an average of almost eight years on dialysis -- compared to six years for those without difficulties. Twenty-one percent of those with sexual problems had had more than one transplant compared to just eight percent of those without problems.

Several factors could contribute to the sexual difficulties experienced by these men, Rostag and colleagues explained. In particular, kidney failure and dialysis both damage the blood vessels that lead to the penis as well as the tissues of the penis itself. The best way to avoid this damage, they concluded, is to do kidney transplants as soon as possible and reduce the amount of time on dialysis.

"Swift access to transplantation is widely recommended because it is more effective and less costly than dialysis," the researchers stated. "Another reason should be to preserve an intimate but very significant aspect of quality of life, i.e., sexuality."

In addition, specialists who work with kidney transplant patients should be aware of potential problems, evaluate them and be ready to help treat them, concluded the researchers.

"In view of the recent development of effective oral therapies for erectile dysfunction, nephrologists [kidney specialists] and transplant surgeons alike should be aware of the magnitude of patients' unexpressed expectations and of the means available for male patients to disclose these. In this respect, [the IIEF] could be used routinely for diagnosis and treatment evaluation."

Study Suggests Viagra Safe for Men Not Taking Nitrates

Taking a single dose of the popular impotence drug Viagra (sildenafil) caused no cardiovascular problems in 14 men who had severely clogged arteries, researchers report in the June 1, 2000, New England Journal of Medicine. Instead, Viagra decreased blood pressure slightly and boosted blood flow in coronary arteries, which is good for the heart.

"Viagra should be safe for many cardiovascular patients who are not on nitrates and who are capable of moderate activity," Dr. Howard C. Herrmann of the University of Pennsylvania in Philadelphia told HeartInfo/Mediconsult. Patients may want a stress test to make sure their heart can handle the exertion of intercourse, he said. Nitrates, a common heart medication taken for chest pain, are dangerous if used in combination with Viagra, studies have shown.

During the past couple of years, the Food and Drug Administration has raised concerns about Viagra by reporting that a significant number of men had heart attacks and cardiac arrests soon after taking the drug and before having intercourse. Researchers wondered if this was because many impotent men also have heart disease or if Viagra was dangerous to the heart.

Viagra works by inhibiting a type of enzyme in the penis, and similar enzymes are also found in the heart muscle. Researchers wondered if inhibiting the enzyme posed a cardiac risk, Dr. Herrmann explained.

As part of the open-label, non-blinded study, he and his colleagues gave 100 milligrams of the drug to 14 heart patients and then monitored their lung and heart function. All were
in their 50s and 60s and had at least one artery that was more than 70 percent blocked.

The men were on a variety of medications, but none were on nitrates. Almost half of the group had hypertension or diabetes, or were smokers. Before and 45 minutes after taking Viagra, the participants had their blood pressure, heart rate, and blood flow measured. The men did not have intercourse during the study, so it was not a test of the effects of Viagra on the heart during exertion.

On most measures of blood pressure and blood flow, Viagra did not appear to have any significant effect, the researchers report, "and it had no effect on pulmonary-capillary wedge pressure, right atrial pressure, heart rate, or cardiac output." There were no adverse effects on coronary blood flow. And none of the men in the study experienced any serious side effects, like low blood pressure or chest pain, that could be linked to Viagra, according to the authors.

"Our data support the consensus position of the American College of Cardiology and the American Heart Association that sildenafil is safe for patients with stable coronary artery disease who are not taking medications containing nitrates," the authors conclude.

Pfizer Inc, which makes Viagra, funded the study.

The American College of Cardiology and the American Heart Association recommend that patients with stable coronary disease who are not taking nitrates should consult their physician about the risks and benefits of taking Viagra. Those taking a combination of blood pressure-lowering drugs may be at increased risk for drug interactions, they note.

In addition, Dr. Andrew P. Levy, Medical Advisor for HeartInfo, cautions that "It is difficult to make many conclusions from such a small study. Men with heart disease should consult their doctor before taking Viagra. We don't yet understand why the drug may cause death, and this study is not definitive."

Erectile dysfunction affects up to 30 million men in the United States, and shares certain risk factors with heart disease, including age, diabetes, hypertension, hypercholesterolemia, and smoking.