Women complain of too much sex from Viagra-popping partners

Viagra is giving older men a new lease on sex - but many wives are upset about it.

A $600,000 study paid for by the Health Research Council (N Zealand) has found that many women blame doctors for giving their husbands the erection-producing drug without considering its effects on them.

They say men's clinics use the health drug as a quick-fix for men instead of helping couples with other problems in their relationship or simply accepting that older people do not need sex as often.

The study is based on interviews with 27 women with an average age of 53, and 33 men, who responded to advertisements throughout the country in 2001. It is believed to be the world's first publicly funded research project on the social effects of the drug.

Viagra manufacturer Pfizer says more than 15 million people around the world have taken the drug since it was released in 1998, despite a price which is now around $100 for a packet of four pills. Each pill can have an effect for up to 12 hours.

Lead researcher Dr Annie Potts, a research fellow in gender studies at Canterbury University at the time, said about a quarter of the women came forward because they wanted to talk about the detrimental effects of the drug.

The other three-quarters, who often said the drug had allowed them to have sex again, included many who personally 'don't necessarily want sex as much as they are getting now'.

'Even women who had a generally positive narrative about Viagra explained that a 'downside' or 'drawback' could be an undesired increased frequency of intercourse, because of pressures coming from the desire not to waste a tablet,' the study says.

A 51-year-old woman told the researchers that she sometimes felt pressure to have sex both at night and the next morning so that her husband could 'get in two for the price of one'.

A 48-year-old said: 'It had such a powerful effect that ... this made sex inevitable. Sometimes there was no discussion about whether ... the sex act was going to take place, so it would be ... 'I've taken the pill, okay's, let's go.' '

She commented: 'It took away the whole notion of any kind of ... spontaneity or you know, the reason for the actual boning. I mean, you know, you like to think it's an act of love, rather than just lust.'

Some older women were in pain during sex because of post-menopausal vaginal dryness, even when they used lubricants.

Another 51-year-old said she consented to sex even when she was in pain because she had heard that older men needed to keep having it or they might 'lose the art'.

Some feared that Viagra would drive their partners to other women. Five of the 33 men confirmed that they had been unfaithful since taking the drug.

The study concluded that women as well as men should take part in doctors' consultations and decisions about erectile problems.

'Men talked about how easy it was to get the drug. Even men who were not experiencing erectile problems found it was easy to go in and get the drug,' Dr Potts said.

A 60-year-old woman told the researchers: 'We weren't interviewed together ... because they seem to have this idea that this is a man's problem. But it's not a man's problem, it's a couple's problem, and how the woman feels about it should come into it too.'

Other women complained about doctors' 'clinical coldness'. But the head of the Medical Association's General Practitioners' Council, Hawks Bay GP Peter Foley, said that when male patients asked for Viagra, doctors could not force them to talk to their partners first.

Viagra chewing gum is on the way

A new supercharged Wrigley's chewing gum may one day be on the market - containing the active ingredient in the sex-enhancing health drug Viagra.
It emerged yesterday that the Chicago-based Wm Wrigley Jr Co, whose slogan is 'Double Your Pleasure', has filed a patent to sell Viagra in gum form.

According to the application, gum would have to be chewed for a period of at least two minutes around half an hour before sex. Each stick would contain from 5mg to 100mg of Viagra's active ingredient, sildenafil citrate.

However the new chewing gum will not be available any time soon. Pfizer's patent on Viagra runs until 2011. Wrigley would only be able to enter the market after that date, when generic versions of the drug can also be marketed.

The patent application, filed in November 2000, was one of many that Wrigley routinely seeks for products that might eventually be a hit with consumers.

'We file dozens of patents every year with interesting or intriguing concepts,' Christopher Perille, a Wrigley spokesman, said. 'But there's a huge difference between filing for a patent and actually developing a product, and finding one that's exactly right for commercialization.'

The application suggests that Wrigley believes that chewing gum might be a better vehicle to deliver the drug to the bloodstream, as it would release the drug more gradually. The pills in which Viagra is now sold have caused gastrointestinal problems for some men.

Viagra may help children With PAH (Pulmonary Arterial Hypertension)

Researchers found the active ingredient in Viagra, also known as sildenafil, helped children with pulmonary arterial hypertension (PAH) walk farther and breathe easier when taken over the course of a year. Viagra was first approved by the U.S. Food and Drug Administration in 1998. Over 130 clinical trials were used to test the drug's safety. Physicians all over the world have found that the health drug sildenafil may help children suffering from pulmonary arterial hypertension. This research is reported in the June 14, 2005 issue of Circulation: Journal of the American Heart Association.

Currently, inhaled nitric oxide (iNO) is used to treat PAH patients by relaxing the arteries in the lungs. "In many respects, Viagra is superior, since it enhances overall cardiac performance more than iNO," said Dr. Evangelos Michelakis, professor of cardiology at the U of A., who led the research team along with Dr. Stephen Archer, director of the U of A Division of Cardiology in a news article published on the University of Alberta website. "These findings are particularly important because currently iNO can only be given in intensive care units and, furthermore, its price has recently increased dramatically."

"Active ingredient in Viagra, sildenafil, compared favorably to the drugs used now and had far fewer side effects," said senior study author Ian Adatia, Ch.B., M.B, associate professor of pediatrics at the University of California San Francisco Children's Hospital. What is PAH

Pulmonary arterial hypertension (PAH) is continuous high blood pressure in the pulmonary artery. The average blood pressure in a normal pulmonary artery is about 14 mm Hg when the person is resting. In PAH, the average is usually greater than 25 mm Hg.

The disease, which has no cure, causes continuous high blood pressure in the artery that carries blood from the heart to small vessels in the lungs. The vessels narrow, leaving less room for blood to flow. The heart can't keep up if the pressure gets too high, and excessively high pressure in the pulmonary artery can cause liquid to leak through the capillary walls and into the lungs. That causes symptoms including fatigue, dizziness, shortness of breath, and have frequent fainting spells, eventually heart failure and death. PAH can be inherited, or result from another chronic heart or lung disease. The exact cause of PAH is still a mystery, although it is often associated with such diseases as congenital heart disease, rheumatoid diseases or HIV infection. Currently, the disease is often fatal within months of diagnosis.

Viagra works by relaxing the smooth muscle that lines blood vessels, so it is able to treat PAH. PAH is a serious condition for which there are treatments but no cure, and treatment benefits many patients.

Case Study how Viagra Help

Adatia conducted the study while he was director of the Childhood Pulmonary Hypertension Clinic at Toronto's Hospital for Sick Children. He worked with Tilman Humpl, M.D., the clinic's present director, and Janette Reyes, R.N., pulmonary hypertension nurse practitioner at the hospital.

"Untreated, children usually die within one year of diagnosis," Adatia said. "And even with the best therapy - continual intravenous infusion of the drug prostacyclin that helps lower the pressure in the pulmonary arteries - few patients live five years past diagnosis." Adatia added that the prostacyclin treatment is also burdensome: children must always carry an infusion pump, and their parents must mix the drug daily. There are also a host of unpleasant side effects, including jaw and muscle pain and facial flushing, he said.

The study gave 14 children with pulmonary hypertension various doses of the impotence pill for a year.

Viagra May Accelerate Recovery From Jet lag

Scientists in Argentina have shown that low doses of sildenafil (more commonly known as the brand Viagra) helped hamsters' circadian rhythms to adapt more quickly to a new day-night pattern similar to eastbound jet lag.

Their findings are published in the early on line edition of the US journal Proceedings of the National Academy of Sciences.

The research was conducted by Patricia Agosto and colleagues from the Laboratory de Microbiological (Chronology Laboratory), Departmental de Ciencia y Technology (Department of Science and Technology), University National DE Quilter, Buena Aires, Argentina. Microbiologists study the biological rhythms of organisms.

Mammals have a biological master clock that controls their circadian rhythm (sleep-wake cycle). The master clock is located in the brain, inside the hypothalamus in a region called the supranationalism nucleus (SCN). The SCN controls the release of hormones and neurotransmitters that regulate a multitude of body and brain functions over a 24 hour period.

Light-activated brain signals play an important role in "training" the master clock to keep time.

Agostino and colleagues already knew that the master clock could be trained to a different 24 hour cycle, for instance as when people gradually adapt to being in London as opposed to New York, but they did not know exactly how the mechanism worked. They had a hunch that it depended on triggering an enzyme to make cg Mp (cyclic guano sine mono phosphate) and its related protein kinase PKG.

And they also knew that sildenafil (Viagra) enhanced the effect of cGMP by stopping it from being broken down by the enzyme phosphodiesterase 5 (PDE5).

So they injected low doses of sildenafil (Viagra) in hamsters and trained them to get used to an earlier daytime by switching lights on 6 hours earlier (like someone in London waking up before someone in New York).

The found that the hamsters who had the sildenafil (Viagra) adapted more quickly to the earlier daylight, for instance they were more active, as they would have been in real day time. It did not work for the reverse, in other words the equivalent of having jet lag from flying west, from London to New York for example.

They also showed that the SCN of the hamsters contained PDE5, leading them to surmise that the effect of sildenafil (Viagra) was to inhibit PDE5 which in turn increased cGMP and its related protein kinase PKG, thereby suggesting that they play a role in the speed with which the master clock adapts to environmental change.

Agostino and colleagues concluded that:

"These results suggest that sildenafil may be useful for treatment of circadian adaptation to environmental changes, including trans meridian eastbound flight schedules."

There is a suggestion that these findings could point research in the direction of other drugs that affect cg Mp levels, and one day they could be used to help shift workers, airline crew, and long-haul travelers or anyone who needs to adapt quickly to new time-shifts.

There is no suggestion that people start taking the currently available sildenafil (Viagra) (health drugs)for any other use except that for which it has been approved.

Viagra, in some cases, takes effect in 14 minutes

Viagra can take effect in as little as 14 minutes in many men, study shows New York, NY, September 9, 2003 -A study of men with erectile dysfunction (ED) found that within 14 minutes more than one third of those taking Viagra is health drugs (sildenafil citrate) 100 mg achieved an erection that resulted in successful sexual intercourse. Results of the study were published in the current issue of Urology.

"Onset-of-action speed is only one factor to consider when choosing a therapy for ED," said Dr. Harin Padma-Nathan, clinical professor of urology at the University of Southern California Keck School of Medicine.

"But in that context, it's important for patients and their physicians to note that no published studies show any oral therapy for ED has a faster onset of action than Viagra."

In the double-blind, placebo-controlled study, 228 men successfully treated with Viagra (100 mg) for ED for at least two months were randomly assigned to receive either Viagra (100 mg) or placebo for four weeks.

Study participants averaged 60 years of age, had ED for an average of seven years, and a majority had moderate to severe ED.

Results showed that within 20 minutes, more than half of men taking Viagra had erections that resulted in successful intercourse.

The study also found that Viagra was well tolerated, with no patients discontinuing treatment because of side effects.

Funding for this study was provided by Pfizer.Viagra is a prescription medication indicated for the treatment of ED. It is important to note that Viagra can be taken with or without food.

Viagra is available only from health care providers and should always be used in accordance with its approved labeling. Viagra is contraindicated in patients who use nitrates in any form at any time.

Before treating ED, physicians should consider the impact of resuming sexual activity and the mild and transient vasodilatory effects of Viagra on blood pressure.

Physicians should carefully consider whether patients with underlying cardiovascular disease or other more unusual conditions could be adversely affected by vasodilatory effects, especially in combination with sexual activity.

The most common side effects of Viagra are headaches, flushing and dyspepsia. Adverse events, including visual effects, were generally transient and mild to moderate.

Discovered and developed by Pfizer, Viagra is a breakthrough oral treatment for erectile dysfunction that has been found to be effective and well tolerated in over 130 completed and ongoing clinical studies.

Viagra has been approved by regulatory authorities in over 120 countries around the world and is among the most widely prescribed medications, with over 130 million prescriptions written for more than 20 million men worldwide.

Depression and mens health

In some men, depression can accompany the condition of erectile dysfunction (ED). It is common for men with ED to feel angry, frustrated, sad, or unsure of themselves. Men may feel less “manly” because of ED. Such feelings may lead to a lack of self-esteem and eventually to depression.

What is depression?

Depression is an illness marked by persistent sadness, feelings of hopelessness, and a pessimistic outlook.
The most common symptoms of depression include:

• low self-esteem
• loss of interest in formerly pleasurable activities
• fatigue
• changes in appetite
• sleep disturbances
• apathy

Depression affects the way one feels about oneself and the way one thinks about things. People who are depressed cannot simply “pull themselves together” and get better. Depression is not a sign of personal weakness.
Without treatment, symptoms of depression can last indefinitely. Appropriate treatment, however, can help most people who suffer from depression.

Depression is not a “woman’s disease”

Depression is found in men and women, even though men account for only one in 10 diagnosed cases of depression. Depression once was considered a “woman’s disease” that was linked to hormones and premenstrual syndrome (PMS). This lingering stereotype of the disease may prevent some men from recognizing its symptoms and seeking appropriate treatment.

Depression in men may not be recognized

In American culture, expressing emotion is largely considered a feminine trait. Depression in males may go unrecognized because:

• Men tend to deny having problems because they are supposed to “be strong.”
• Men who are depressed are more likely to talk about the physical symptoms of depression, such as feeling tired, rather than about actual emotions.
• Outward symptoms of male depression are not always understood. Men are less likely than women to show “typical” signs of depression, such as crying, sadness, or loss of interest in activities they used to enjoy.
• Men are more likely than women to keep their feelings hidden, but they may become more irritable and aggressive.

For these reasons, many men—as well their health care professionals—fail to recognize depression.

Diagnosing depression in men with ED

The diagnosis of depression begins with a physical exam and interview by a health care professional, who likely will ask about issues including family history and chemical dependency. There is no single test that can diagnose depression; however, there are certain patterns that health care professionals look for in order to make a proper diagnosis. These patterns may include overall sadness, irritability, and withdrawal from everyday activities.

Treating depression in men with ED

Treatment for depression may include antidepressant medications, psychotherapy (talk therapy), or a combination of both.

• Antidepressants: Many different drugs, including Prozac, Zoloft, Ellaville, and Wellbutrin, are used to treat depression. Note that some antidepressants can worsen ED. Health care providers can recommend antidepressants that are appropriate for men with ED.
• Talk therapy: During therapy, a person with depression talks to a licensed and trained mental health care professional who helps the person identify and work through issues related to depression. Types of talk therapy include couples therapy, individual therapy, and group therapy.
• For the treatment of such diseases using different healthy drugs that help reduce the occurrence of disease in the future.

Penis problems

If you're really worried that your penis is the wrong size, go and see your doctor.If you're not happy about consulting your GP on such an intimate matter, you could see one of the medics who spend their entire day checking men's penises.
You can find these doctors at:

• private 'well-man' clinics, but take care: a few of these are run by quacks
• NHS urology clinics
• NHS sexual medicine clinics
• NHS genitourinary medicine (GUM) clinics
• NHS family planning clinics, although these tend to be oriented towards women and don’t have much time to deal with males.
• Brook advisory clinics (for the under 25s).

What treatments are there to increase penis size? Many companies claim they know how to enlarge your penis - for a price.We have recently been to several medical conferences at which leading experts have spoken about penis size and penis enlargement.Their opinions on the various methods that are so widely advertised to the public can be summed up as follows.

• Pills or patches for increasing penis size: a complete waste of time.
• Penile enlargement surgery: of uncertain value and sometimes dangerous.
• Penile enlargement exercises: probably pretty futile.
• Penile suction devices: probably of little use.

Several European experts say that the relatively new stretcher or extender devices may sometimes be of value in giving a man a little extra length. Surgery to increase penis sizeA number of private clinics now offer operations that claim to make the penis look bigger. The expense of this type of surgery is very great and there is a risk of complications like bleeding, infection or deformity.One surgical procedure that has become popular since 2005 is slicing through the ligament that supports the penis.This makes the penis dangle more, so it looks longer when not erect. But it will make no difference to the size of your erection - and furthermore it won’t come up as high as it used to before the op.Another type of surgery involves injecting your own fat into your penis to make it more bulky. This may not work, and it can lead to complications.
Penis stretchers (extenders) Some urologists are beginning to use a special extending frame to try to stretch the penis.If you want something in the future doctor appoints healthy drugs for treatment.

These ‘stretchers’ are small rectangular frames that you wear on your penis for hours at a time, every day. They pull your organ out to its maximum length, and the idea is that it will gradually remain longer.The devices are said to be undetectable under trousers.There have been several reports from Italy and Spain by surgeons who claim a modest degree of improvement in length from this kind of traction.We don't think these devices are some sort of miracle discovery, but one surgeon reported that a group of men achieved an average increase in length of 1.8cm after using the device daily for four months. This is less than three-quarters of an inch, but for some men this would be significant.

Average size of erections

We've talked about the length of the penis in its ordinary non-erect state, but how long should it be when it's erect?Interestingly, most penises are very much the same size when erect.

• The man whose non-erect penis is smallish will usually achieve about a 100 per cent increase in length during sexual excitement.
• The man whose non-erect penis is on the largish size will probably manage about a 75 per cent increase.
• This means the great majority of penises measure between 15cm and 18cm (6-7 inches) when erect, with the average figure being about 16.5cm (6.5 inches).

So you can see that even if a man has got a 'small' penis, he's got a built-in compensating factor that will bring him up to about the same size as the guy who appears to be 'better equipped' in the shower room.Sex and women Virtually every man forgets that it doesn't matter how long or how short your penis is, because the vagina will accommodate itself to any length.

• The vagina of a woman who hasn't had a child is only 7.5cm (3 inches) long when she's not sexually excited. The figures for women who have had babies are only slightly different.
• Even when aroused, a woman's vagina usually extends only to a length of about 10cm (4 inches).

This means any man's penis will fill her vagina completely, unless you happen to be one of those rare guys with an erect penile length of less than four inches.You're probably now wondering how the average man with an erection of six inches manages to insert his penis into the vagina at all.The vagina has the most remarkable capacity for lengthening if something is introduced into it gradually.So the exceptional man whose erect penis is eight inches long can still make love to any woman, providing he excites her properly and introduces his organ very slowly. If he does this, her vagina will lengthen by 150 or 200 per cent to accommodate him. The main thing to remember, to avoid health problems need time to see a doctor, who will pick up your good health drugs.

A question of perspective

The trouble is that every man sees his own penis in a foreshortened view. The angle at which you look down inevitably makes your penis seem shorter than it is.
But when you glance at another man's organ, there's no such foreshortening effect, so very often it'll look as though the other guy is slightly better endowed.
A lifetime of comparison of this sort (and virtually every male does a quick mental check on each naked man he sees) can easily make you feel a bit inadequate. But it's important to realize the facts about penis length.
Average penis length
A non-erect penis usually measures between 8.5cm and 10.5cm (3-4 inches) from tip to base.
The average figure is about 9.5cm (3.75 inches), but this kind of precise measurement is rather valueless. Many factors can cause a temporary shrinkage of two inches or more, for instance cold weather or going swimming, so you needn't worry if you happen to fall short of the average figure.
Of course, it's true that some men have big penises and some have smaller ones, just as some men have small feet and some have big feet, but the measurement is not - repeat not - an index of virility.
Most people think that a tall man will usually have a large penis, but this is not entirely true. The distinguished American researchers Masters and Johnson measured the penile lengths of more than 300 men.

• The largest organ was 14 cm (5.5 inches) in the flaccid state. It belonged to a slim man who was 5' 7" tall (170 cm).
  
• The smallest penis measured 6cm (2.25 inches). It belonged to a fairly heavily built man of 5' 11" (180cm).
  

It's also worth pointing out that there is no correlation between penile size and race. The main thing to remember, to avoid health problems need time to see a doctor, who will pick up your good health drugs.

Facts about penise size

Even in this supposedly enlightened century, men fret about penis size. Though the vast majority of guys have more than enough bulk to perform well as lovers, there is a widespread masculine obsession that 'more would be better'.
We get a constant flow of emails and letters from males who are worried that they are 'too small'. Vast sums of money can be made by exploiting this obsession, but other than surgery, there is little that is clinically proved to increase penis size.
Any woman reading this article may find it puzzling that so many men are concerned about the length of their penis and wish they had 'just a couple of inches more'. But that's the way that a lot of men are.
Size matters
To the average man, his penis is, consciously or unconsciously, one of the most important things in the whole world. At an early age he discovers it and immediately becomes fascinated by it.
But then a note of uncertainty enters his mind: 'Isn't mine rather small?' Look at Dad's, look at big brother's, look at those in the men's changing room - and he asks himself if he will be as big as that.
And so he goes on through life, always a tiny bit sensitive about the size of his organ, always convinced that it would be nicer if it were just that little bit longer.
No matter how often it's written that penile size doesn't matter, and that women aren't attracted to a man because of the length of his organ, the average male continues to think the same way.
The average female cannot understand this obsession with penile measurement. So if you're a woman, never belittle a man's penis in bed, even as a joke, or say anything to indicate that you think it's small. The guy may take you seriously, and if he does, he'll be deeply hurt. The main thing to remember, to avoid health problems need time to see a doctor, who will pick up your good health drugs.

What is normal semen?

Semen is usually white or grey, but can occasionally appear yellowish. Pink or red semen suggests that blood is present. Although this is only rarely due to a serious health problem, men with semen that seems bloodstained should seek advice from their family doctor.
Semen clots almost immediately after ejaculation, forming a sticky, jelly-like liquid. It will liquefy again in 5 to 40 minutes. It is quite normal for semen to form jelly-like globules and this does not indicate any health or fertility problem. Failure of clotting and subsequent liquefaction can cause fertility problems.
The average volume of semen produced at ejaculation is 2 to 5ml. Volumes consistently less than 1.5ml (hypospermia) or more than 5.5ml (hypersphere) are probably abnormal. Lower volumes may occur after very frequent ejaculation and higher volumes are seen after prolonged abstinence.
The World Health Organization provides a definition of a 'normal' sperm count:

• the concentration of spermatozoa should be at least 20 million per ml.
  
• the total volume of semen should be at least 2ml.
  
• the total number of spermatozoa in the ejaculate should be at least 40 million.
  
• at least 75 per cent of the spermatozoa should be alive (it is normal for up to 25 per cent to be dead).
  
• at least 30 per cent of the spermatozoa should be of normal shape and form.
  
• at least 25 per cent of the spermatozoa should be swimming with rapid forward movement.
  
• at least 50 per cent of the spermatozoa should be swimming forward, even if only sluggishly.
  

It is quite surprising how many dead and abnormal sperm can be present in a 'normal' sample.
Measuring sperm count is a very technical business and results can be affected by many factors, including the length of time between ejaculation and semen sample analysis, and how the sample is kept when being transported to the lab.
There can be enormous variation in sperm count in an individual, even over a few days. It is important that at least two, preferably three or more, samples are analyzed, each at least two to three weeks apart. A single sample is inadequate to assess semen quality.
Sperm count is only an indication of fertilising capacity and a normal count does not guarantee success. In addition, more is not necessarily better, as too high a sperm count can also result in fertility problems. The main thing to remember, to avoid health problems need time to see a doctor, who will pick up your good health drugs.

Low Testosterone May Cause Health Problems That Lead To Erectile Dysfunction

Men with erectile dysfunction should be examined for testosterone deficiency and the metabolic syndrome, because these conditions commonly occur together, a new study shows. The results will be presented at The Endocrine Society's 90th Annual Meeting in San Francisco.

"Erectile dysfunction is a portal into men's health," said the stud's senior author, Aksam Yassin, MD, PhD, of the Clinic for Urology and Andrology of the Segeberger Clinics in Norderstedt, Germany. "It is becoming clear that obesity, diabetes, high blood pressure, cholesterol problems and erectile difficulties are intertwined, and a common denominator is testosterone deficiency."

Yassin's research, performed with scientists from The Netherlands, Germany and the United Arab Emirates, aimed to determine in men with erectile dysfunction (ED) the prevalence of hypothyroidism, the scientific term for testosterone deficiency.

Over a two-year period the investigators studied 771 patients who sought treatment for ED. Their average age was 56. The patients received a comprehensive screening for low testosterone and indicators of the metabolic syndrome, a cluster of risk factors that increase the chances of developing heart and vascular disease and type 2 diabetes. Having three of the following five risk factors establishes the diagnosis of this syndrome: increased waist circumference (abdominal fat), low HDL ("good") cholesterol, high triglycerides (fats in the blood), high blood pressure, and high blood sugar.

Among the 771 men, 18.3 percent of the men (141 men) had testosterone deficiency, which had previously been undetected, the authors found. The prevalence of hypogonadism in the general population of men age 45 and older is about 12 percent, Yassin said.

Of all the men in the study, 270 (35 percent) had type 1 or type 2 diabetes; in eight of the men, diabetes was a new diagnosis, according to study data. High blood pressure was found in 239 men (31 percent), and 12 of these men had been unaware of it. Among the 162 men (21 percent) who had dyslipidemia abnormal cholesterol or triglycerides nine of them had not previously been diagnosed. And 108 men, or 14 percent, had varying degrees of coronary heart disease. Five of them received this diagnosis for the first time, Yassin said.

Men with ED especially older men should therefore receive evaluation not only for ED but also for testosterone deficiency and any underlying signs of the metabolic syndrome, he advised.

Yassin disclosed that he is on the speakers' bureau for Bayer Schering, which makes a brand of testosterone. And it is important to remember that it is not necessary to postpone the visit to the doctor, because only a good specialist can recommend the correct treatment and a healthy drug.

Male Cyclists Risk Sexual Problems If They Don't Choose The Right Bike

Men who take up cycling in an effort to stay fit, do their bit for the environment or avoid spiraling motoring costs, could be harming their health if they don't choose the right bicycle. That's the stark warning from consultant urological surgeon Mr Vinod Nargund from St Bartholomew's and Homerton Hospitals, London, in the urology journal BJU International.

He says that the problems to look out for include genital numbness, erection problems and soreness and skin irritations in the groin area.

Men who cycle a lot can also experience changes to their sperm function, because of the excessive heat generated in the pelvic area. No general link between cycling and male infertility has been established, but it is still recognized as a possible side effect and has been noted in a number of male cyclists.

Regular cyclists also run a higher risk of testicular damage and impaired testicular function.

Mountain bikers run a particular risk, says Mr Nargund, as studies have shown that they exhibit higher levels of scrotal abnormalities than on-road cyclists. "The bicycle saddle is in direct contact with the perineum and its underlying structures" he explains. "It makes contact just behind the scrotum where the nerves and blood vessels enter the back of the scrotum and penis.

"This area is sensitive, with hair follicles and sweat and sebaceous glands, which are all good breeding grounds for infection.

"Abrasions, chafing, damaged hair follicles and bruising are among the most traumatic cycling injuries. Sweating in this area can also cause soreness and skin problems."

He points out that more than 60 per cent of male cyclists who have taken part in research studies have reported genital numbness.

"Numbness is common because the pressure of the saddle can impair the blood supply to this area and put pressure on the nerves in the penis" says Mr Nargund. "This can also affect the man's ability to get an erection.

"There is a greater incidence of numbness and erectile problems in men who cycle regularly and over longer training distances. That is why it is important to rest intermittently during prolonged and vigorous cycling."

Choosing the right bike is essential, stresses Mr Nargund. "The male cyclist should know his bicycle well and a proper fit is particularly important for high-performance cycling" he says. "The level of pedal resistance is also very important, because riding a bike using too much resistance is a major cause of health problems in the groin area.

"Cyclists can also help to ease saddle-related injuries or skin irritations by adjusting the saddle height and fore and aft position. "Padding in the saddle and shorts are also important if cyclists want to avoid saddle related problems."

Mr Nargund's comment piece has been published on-line on the BJU International website in advance of its hard copy publication later this year. The main thing to remember, to avoid health problems need time to see a doctor, who will pick up your good health drugs.

Complications Of Penile Prosthesis Surgery

The overall satisfaction with penile implants in one study was 83%, compared to 51% for PDE5 inhibitors and about 30% for injection therapy. About a 10% mechanical failure rate can be expected at 10 years, although it may decrease with newer devices. There is good satisfaction by both the patient and partner with penile prosthetic devices. Dissatisfaction usually arises from loss of penile length, although data suggests that this is a patient perception and objective loss is only about 1cm. Having the patient stretch out his flaccid penis in the clinic prior to surgery will provide a realistic expectation of his post-operative erect length.

Dr. Mulcahy presented a case of a man with DM who had a 3-piece penile prosthetic device placed. 8 months later he presented with an infected implant. This scenario occurs in 1-3% of primary procedures and up to 10% of secondary implants. Antibiotic coated devices may decrease this problem. Infections often manifest over the pump or at the fossil navicularis. Antibiotics alone will not work in the presence of the foreign body due to a biofilm that develops over the penile prosthetic device. Options include removal of the implant or a salvage procedure. The latter involves removal of the penile prosthetic device, wound cleansing and placement of a new device. Success rates are about 84%. Vancomycin and gentamicin are given and washing solutions include beta dine and hydrogen peroxide. A water-pick is used to irrigate the wound. Most patients opt for the salvage procedure with the possible 16% failure rate. One benefit is that immediate replacement preserves penile length. Men with sepsis or ketoacidosis, genital necrosis, immunosuppression or bilateral urethral erosion of cylinders should not have a salvage procedure. Copious irrigation is a key to decreasing infections, he concluded.

A 57 year old man with ED and DM presented one year after removal of an infected penile prosthetic. He now has corporal fibrosis. Dr. Montague addressed this case. The tunic albugenia in this patient will have replacement of smooth muscle with fibrosis scar tissue. Corporeal excavation is performed via an extended corporately to develop a plane and mobilize the fibrotic core, which is then excised. A new PP cylinder can then be placed. In the scenario of distal erosion of the cylinder, the corpus cavernous is still present, but does not contain the cylinder. A ventral incision will provide exposure for removal of the cylinder. A transverse incision into the pseudo capsule is followed by dilation and the new cylinder placement. The false passage is then closed.

A man with semi-rigid penile prosthetic later presented with proximal perforation and erosion. Implant perforation can result from dilation of the corpora. There are many factors that contribute to penile prosthetic perforation. With proximal perforation, the cylinder can still be placed but with distal perforation the cylinder placement should be aborted and the contra lateral cylinder removed if already placed. For erosion, all components must be removed. He discussed penile shortening after radical prostate is further compounded by phallic shortening after PP device placement. Lengthening can be achieved using ventral phalloplasty with a wedge of skin mobilized to provide more penile tissue length. The main thing to remember, to avoid health problems need time to see a doctor, who will pick up your good health drugs.

Viagra-Like Effects From Watermelon

A cold slice of watermelon has long been a Fourth of July holiday staple. But according to recent studies, the juicy fruit may be better suited for Valentine's Day.

That's because scientists say watermelon has ingredients that deliver Viagra-like effects to the body's blood vessels and may even increase libido.

"The more we study watermelons, the more we realize just how amazing a fruit it is in providing natural enhancers to the human body," said Dr. Bhimu Patil, director of Texas A&M's Fruit and Vegetable Improvement Center in College Station.

"We've always known that watermelon is good for you, but the list of its very important healthful benefits grows longer with each study."

Beneficial ingredients in watermelon and other fruits and vegetables are known as phyto-nutrients, naturally occurring compounds that are bioactive, or able to react with the human body to trigger healthy reactions, Patil said.

In watermelons, these include lycopene, beta carotene and the rising star among its phyto-nutrients - citrulline - whose beneficial functions are now being unraveled. Among them is the ability to relax blood vessels, much like health dugs Viagra does.

Scientists know that when watermelon is consumed, citrulline is converted to arginine through certain enzymes. Arginine is an amino acid that works wonders on the heart and circulation system and maintains a good immune system, Patil said.

"The citrulline-arginine relationship helps heart health, the immune system and may prove to be very helpful for those who suffer from obesity and type 2 diabetes," said Patil. "Arginine boosts nitric oxide, which relaxes blood vessels, the same basic effect that Viagra has, to treat erectile dysfunction and maybe even prevent it."

While there are many psychological and physiological problems that can cause impotence, extra nitric oxide could help those who need increased blood flow, which would also help treat angina, high blood pressure and other cardiovascular problems.

"Watermelon may not be as organ specific as Viagra," Patil said, "but it's a great way to relax blood vessels without any drug side-effects."

The benefits of watermelon don't end there, he said. Arginine also helps the urea cycle by removing ammonia and other toxic compounds from our bodies.

Citrulline, the precursor to arginine, is found in higher concentrations in the rind of watermelons than the flesh. As the rind is not commonly eaten, two of Patil's fellow scientists, drs. Steve King and Hae Jeen Bang, are working to breed new varieties with higher concentrations in the flesh.

In addition to the research by Texas A&M, watermelon's phyto-nutrients are being studied by the U.S. Department of Agriculture's Agricultural Research Service in Lane, Oklahoma.

As an added bonus, these studies have also shown that deep red varieties of watermelon have displaced the tomato as the lycopene king, Patil said. Almost 92 percent of watermelon is water, but the remaining 8 percent is loaded with lycopene, an anti-oxidant that protects the human heart, prostate and skin health.

"Lycopene, which is also found in red grapefruit, was historically thought to exist only in tomatoes," he said. "But now we know that it's found in higher concentrations in red watermelon varieties."

Lycopene, however, is fat-soluble, meaning that it needs certain fats in the blood for better absorption by the body, Patil said.

"Previous tests have shown that lycopene is much better absorbed from tomatoes when mixed in a salad with oily vegetables like avocado or spinach," Patil said. "That would also apply to the lycopene from watermelon, but I realize mixing watermelon with spinach or avocados is a very hard sell."

No studies have been conducted to determine the timing of the consumption of oily vegetables to improve lycopodium absorption, he said.

"One final bit of advice for those Fourth of July watermelons you buy," Patil said. "They store much better uncut if you leave them at room temperature. Lycopodium levels can be maintained even as it sits on your kitchen floor. But once you cut it, refrigerate. And enjoy."

Men Treated For Prostate Cancer Experience High Levels Of Psychological Distress After Treatment

Men treated for prostate cancer have high levels of psychological distress and many suffer ongoing sexual dysfunction and lower urinary tract symptoms, according to a survey of men in England designed to explore their supportive care needs.

Prostate cancer is the commonest solid cancer in men, accounting for one in every four cancers diagnosed in males in England in 2004. Fortunately, the survival rate for this cancer is improving, reflecting the slow growing nature of the disease and its successful treatment in many men. Nearly three-quarters (71%) of men are still alive five years after being diagnosed with prostate cancer. The main thing to remember, to avoid health problems need time to see a doctor, who will pick up your good health drugs.

A range of treatment options - include surgery, radiotherapy and hormonal treatments - are available for prostate cancer, with the choice being determined by a man's age, the stage of his cancer and any other conditions that he has. Some of the treatments can have long-term effects on sexual and urological function.

The primary aim of treatment is to optimize cancer control, but some doctors also take into account a man's urological and sexual function before treatment and the patient's views on the balance of treatment efficacy against side-effects.

Relatively little is known about the support care needs - the requirements for care arising during illness and treatment to manage symptoms and side-effects - in men treated for prostate cancer. To find out more about how the disease and its treatment affects men, nursing researchers surveyed men with prostate cancer in six areas of England.

The researchers invited 1848 men who had been diagnosed with prostate cancer in the previous three to 24 months, from across six NHS Trusts (geographical regions in the National Health Service) to take part in the research study. Those who replied (820 men) were sent a postal questionnaire asking about their supportive care needs, prostate symptoms, quality of life, their cancer and its treatment; 741 were returned.

Three-quarters of the men taking part in the survey were 65 years old or over, Half (51%) had received hormonal therapy, one-quarter (25%) had radical prostatectomy and 28% had radiotherapy to the prostate. Just under half (46%) of the men said their cancer was in remission.

The survey revealed that the men had significant unmet supportive care needs. The areas of greatest need were related to psychological distress, sexuality-related problems and the management of enduring lowering urinary tract symptoms. The researchers noted: "High levels of psychological distress were reported, and those reporting psychological distress reported greater unmet supportive care needs."

Men who were uncertain of their remission status had higher levels of psychological need, while those not in remission were more likely to have needs for information.

Nearly one-third (30%) of the men taking part in the survey reported moderate or extreme anxiety or depression. A similar number had difficulty with undertaking usual activities. Some or extreme pain was reported by 26% of the men and 22% had problems with mobility.

Virtually all (97%) of the men reported that they had experienced lower urinary tract symptoms, including frequency or needing to urinate during the night, during the month before the survey. Urinary symptoms were affected by treatment, remission status and time since last treatment. They were least severe in men who were in remission, in those who had undergone radical prostatectomy and/or in those who had completed their treatment 19-24 months before the survey.

Unmet needs related to sexuality were more common in younger men and in those who had undergone radical prostatectomy.

The researchers, led by Emma Ream, from the Florence Nightingale School of Nursing and Midwifery, King's College London, UK, said: "The survey identified high levels of psychological distress within the sample, even though the majority had completed treatment over a year previously." They suggested that need for psychological care was particularly high in men not in remission or whose remission status was uncertain. "The need for systematic assessment and better management of psychological distress in men with prostate cancer was evident in this study," they concluded, adding that sexual dysfunction and lower urinary tract system symptoms also required greater attention by prostate services.

1 In 10 Men Suffer From Erectile Dysfunction Due To Work Related Stress

New research has shown that 1 in 10 men experience erectile dysfunction (ED) and as many as 1 in 5 men suffer a loss of libido, as a result of work-related stress. The main thing to remember, to avoid health problems need time to see a doctor, who will pick up your good health drugs.

These latest figures suggest that 90% of men have shown at least one clinical feature of stress due to work but only 54% of men know that stress from work may be the cause of their ED. Stress, either at work or home, is a known cause of ED and prolonged stress is associated with low testosterone levels.

Unfortunately 44% of men would not go to their GP if they experience erection problems, and those who do go to their GP about their ED wait on average 17 months before going for a consultation. But there's no need to delay - oral treatments for ED (PDE5 inhibitors), such as Levitra, Viagra and Cialis, have revolutionised the treatment of men with ED and are now widely prescribed as a first option for treatment.

Dr David Edwards, an Oxfordshire GP comments: "Work-place stress clearly has a strong impact on the incidence of ED in men. Men should think about the underlying cause of their ED, including how to combat their stress levels; not staying too late at work, a balanced and healthy diet, and regular exercise. We know that oral treatments usually work well for men with ED, but 1 in 3 men with ED are not able to have satisfactory sex the first time they take a tablet and consequently a third of them do not return to their doctor. These men could still be successfully treated by simply switching to a different tablet or increasing the dose, and should be encouraged to return to their GP."

Men have recently ranked 'high success rate with first tablet' as one of the most desirable attributes that a treatment can have. It is important for men with ED not to give up on their treatment too soon and return to their GP to ensure that they have tried the range of treatments available.

Low testosterone levels (which may be stress-related) can cause ED and also prevent PDE5 inhibitors working properly. All men with ED should ask their GP to test their testosterone levels. If low, this can be treated successfully alongside treatments for ED.

The SortED in 10 Campaign supported the research and highlighted that erection problems are very common, affecting half of all men between the age of 40 and 70. Given the range of oral treatments now available men should waste no time in asking their GP or nurse about what help is available.

Gene Determines Rapidity Of Ejaculation In Men

The rapidity of ejaculation in men is genetically determined. This is the result of research by Utrecht University. Neuropsychiatric Dr Marcel Waldinger and Pharmacological Researcher Paddy Jansen studied 89 Dutch men with premature ejaculation and will publish the results this week in the renowned International scientific journal the Journal of Sexual Medicine.

The participants in the study by Waldinger and Jansen were 89 Dutch men who suffer from the primary form of premature ejaculation, in other words, men who always had this problem. A control group of 92 men was also studied. For a month the female partners used a stopwatch at home to measure the time until ejaculation each time they had intercourse. 'This study applies to men who have always ejaculated prematurely from their first sexual contact onwards and not for men who started suffering from this later on in life,' Waldinger emphasizes.

Serotonin deficiency

In men who suffer from premature ejaculation, the substance serotonin appears to be less active between the nerves in the section of the brain that controls the ejaculation. Among other things, this substance is linked to sexual activity and appetite. It is a substance that transfers a signal from one neuron to another. Due to the low activity of serotonin, this signal transfer does not occur properly in men with the primary form of premature ejaculation.

Gene responsible

A gene which had already been discovered, namely 5-HTTLPR, appears to be responsible for the amount and activity of serotonin, which means that it controls the rapidity of ejaculation. Three types of the gene exist: LL, SL and SS. The study showed that the LL type causes a more rapid ejaculation. On average, men with LL ejaculate twice as quickly as men with SS, and also almost twice as quickly as men with SL. The researchers are currently also looking for other genes that are involved in ejaculation.

Not psychological

As long ago as 1998, researcher Marcel Waldinger predicted that both the rapidity with which men ejaculate and the primary form of premature ejaculation were genetically determined. 'This theory contradicts the idea, which has been common for years, that the primary form of premature ejaculation is a psychological disorder,' explains Waldinger. If you want something in the future doctor appoints healthy drugs for treatment.'The results of our research confirm the genetic theory and may contribute to possible gene therapy against premature ejaculation.'

Obstructive Sleep Apnea And Erectile Dysfunction: Still A Neglected Risk Factor?

Erectile dysfunction (ED) and sleep disordered breathing (SDB) have recently been correlated in a scientific manner. Previous attempts to link these two entities consisted mainly of case reports as well as observations of the impact of hypoxic conditions on erectile function.

The literature on this topic involves the review of early studies by Sir Edmund Hilary and his scientific team in the Himalayan expedition up to recent mice experiments performed in the lab. It appears that SDB and ED are implicated in more than one way creating difficulties identifying the leading and major pathway. Vasculogenic, neurogenic, hormonal, and psychogenic pathways as well as the effects of drugs and others factors have their roles in the development of ED. Most recent reports suggest that ED resulting from sleep apnea may involve the nitric oxide synthase and phosphodiesterase-mediated pathways targeted by tadalafil and similar agents (Erectile Dysfunction in a Murine Model of Sleep Apnea. Soukhova-O'Hare et al. Am. J. Respir. Crit. Care Med. 2008; 178: 644-650).

Regardless of the etiology or predominant pathways leading to the development of this condition, what is important is the potential of reversing ED by treating SDB. In many cases, this is the only treatment required and therefore may avert the need for testosterone replacement which is well known to cause worsening of SDB.

Since the majority of physicians who treat ED are unlikely to have expertise in SDB, and similarly those who treat SDB generally have little expertise in diagnosing or treating ED, it is the opinion of the authors that the potential impact each of these conditions may have on the other has been greatly underestimated. This review article attempts to alert physicians of the interaction between two apparently different disorders and give a more unified approach of ED and SDB.

Written by Sean Gilman, MD¹ and Nikolaos Zias, MD², as part of Beyond the Abstract on UroToday.com.

1 Department of Pulmonary and Critical Care Medicine, Beth Israel Deaconess Medical Center, Harvard University School of Medicine, Boston, Massachusetts, USA

2 Department of Pulmonary and Critical Care Medicine, Lahey Clinic Medical Center, Tufts University School of Medicine, Burlington, MA, USA,If required, the physicians to prescribe only healthy drugs, which do not hurt people.

UroToday - the only urology website with original content written by global urology key opinion leaders actively engaged in clinical practice.

Natural Viagra? "Horny Goat Weed" Shows Promise In Lab Studies

Move over,Viagra!
Researchers in Italy report that an ancient Chinese herbal remedy known as "horny goat weed" shows potential in lab studies as source for new future drugs to treat erectile dysfunction (ED). The study, which provides scientific evidence supporting the herb's well-known use as a natural aphrodisiac, is scheduled for the October 24 issue of ACS' Journal of Natural Products, a monthly publication.

In the new study, Mario Dell'Agli and colleagues point out that Viagra (sildenafil) and several other prescription drugs are now available for ED, or male impotence. ED affects an estimated 18 million men in the United States alone. Studies show, however, that these drugs may cause side effects such as headache, facial flushing, stomach upset, and visual disturbances.

To find better treatments, the scientists studied herbal extracts reputed to improve sexual performance. Scientists exposed the substances to an enzyme that controls blood flow to the penis and whose inhibition results in an erection. Of the extracts tested, "horny goat weed" was the most potent inhibitor of the enzyme. By chemical modification of icariin, the active ingredient purified from the extract, the scientists obtained a derivative with activity similar to Viagra (health drugs) and a potential for fewer side effects because it targeted the protein more precisely than sildenafil. - MTS

Viagra's Other Talents: To Help A 'Signaling' Protein Shield The Heart From High Blood Pressure Damage

Johns Hopkins and other researchers report what is believed to be the first direct evidence in lab animals that the erectile dysfunction drug sildenafil amplifies the effects of a heart-protective protein.

The team's findings, to be published in the Journal of Clinical Investigation on-line Jan. 5, helps explain why sildenafil, more widely known as Viagra, has already been shown to improve heart function and may one day have value in either treating or preventing heart damage due to chronic high blood pressure.

The key, investigators say, is sildenafil's effects on a single protein, RGS2, newly identified in the latest study as an essential link in the chain reactions that initially protect the body's main blood-pumping organ from spiraling into heart failure.

Experimenting in mice, the team of heart experts first established that after a week of induced high blood pressure, the hearts of animals engineered to lack RGS2, or regulator of G-protein signaling 2, quickly expanded in weight by 90 percent. Almost half the mice died of heart failure. In mice with RGS2, by contrast, the dangerous muscle expansion, known as hypertrophy, was delayed, growing only 30 percent, and no mice died.

Subsequent tests treating hypertensive mice that had RGS2 with sildenafil showed enhanced buffering, with less hypertrophy, stronger heart muscle contraction and relaxation, and as much as 10 times lower stress-related enzyme activity compared to their untreated counterparts. In mice lacking RGS2, sildenafil had no effect.

"Sildenafil clearly prolongs the protective effects of RGS2 in mouse hearts," says study senior investigator and cardiologist David Kass, M.D.

According to Kass, a professor at the Johns Hopkins University School of Medicine and its Heart and Vascular Institute, RGS2 is stimulated by an enzyme, protein kinase G, whose action is, in turn, raised by countering the activity of another enzyme, phosphodiesterase 5 (PDE5A). Sildenafil's ability to block PDE5A was shown by Kass and his team in 2005 to be responsible for blunting hypertrophy due to high blood pressure in mice and offsetting similar, adrenaline-stimulated heart stress in people.

Kass says RGS2 "acts like a short-term reset mechanism in the heart," recoupling G proteins that if left alone stimulate the heart's response to high blood pressure. And without the "reset," a cascade of reactions known as Gq signaling leads to scar tissue formation, hypertrophy and heart failure.

Currently, physicians use so-called ACE inhibitor and ARB inhibitor drugs to block Gq signaling. These classes of drugs are the most common treatment for heart failure, which afflicts more than 5 million Americans, killing over a quarter million of them each year.

"The evidence is piling up that unbridled Gq signaling is driving a central biological chain reaction in heart failure," says Kass, "and that by extending the protective effects of RGS2 or by developing a test for its presence, researchers can develop new therapies or improve existing ones, including ACE inhibitors and possibly sildenafil, for people with heart failure who will benefit most."

Until recently, scientists thought RGS proteins, which are found only in small quantities in the heart -- a thousand times less than other, more common proteins, such as myosin and metabolic proteins -- played no key role in heart function. Previous tests in mice, Kass says, had shown no harmful effects to the heart from knocking out production of RGS2, though the protein was known to have a role in maintaining smooth muscle function in blood vessels.

But studies by co-investigators at Tufts Medical Center in Boston had shown that RGS2 activity was upped by protein kinase G, leading Kass and others to look for stronger links between these biological pathways and hypertrophy.

The latest study involved more than a half-dozen experiments, all performed within the last three years and designed to zero in on the role played by RGS2 in stalling hypertrophy.

In one experiment for the current study, researchers artificially stimulated the Gq chemical pathway in mice lacking RGS2, worsening the effects of Gq signaling, including hypertrophy and widened heart chambers.

In another experiment in mice with and without RGS2, researchers analyzed the cardiac response to the physical stress of twice daily swimming exercises lasting 90 minutes each, a stress not known to affect Gq signaling. After six weeks of testing, both sets of mice showed similar increases, at 30 percent, in heart mass and no signs of impaired heart function.

Subsequent protein analysis for enzymatic action common to heart failure showed the same results for both sets of mice, confirming to researchers that RGS2 proteins were responsible for protecting the heart from hypertrophy linked to Gq signaling.

More tests with pressure overload showed that when RGS2 was stimulated by protein kinase G, both proteins moved together from inside the cell to its outer cell walls. This effect was then stabilized in RGS2 mice treated with sildenafil, solidifying evidence of the biological chain reactions between the drug and the protein.

"Our results offer among the first insights into the biology of the RGS2 protein in heart cells during hypertrophy," says study lead investigator Eiki Takimoto, M.D., Ph.D. If required, the physicians to prescribe only healthy drugs, which are not harmful to humans."This greatly expands our understanding of how high blood pressure affects the heart and helps break down the disease equation into its molecular components for subsequent clinical testing."

Takimoto, an assistant professor at Hopkins, says the team's next plans are to look at other potential consequences of increased RGS2 activity within the cell and to zero in on what other proteins or factors boost its action.

PDE5A is involved in the breakdown of a key molecule, cyclic guano sine mono phosphate, which helps control stresses and limit overgrowth in the heart. PDE5A is also the biological pathway blocked in the penis by sildenafil to promote the relaxation of blood vessels and maintain erections.

Funding for the reported study was provided by the National Institutes of Health, the Peter Belfer Laboratory Foundation, and the American Heart Association.

VIVUS Initiates Avanafil Phase 3 Trials For Males With Erectile Dysfunction

VIVUS, Inc. , a pharmaceutical company dedicated to the development and commercialization of novel therapeutic products, today announced it has initiated the first of several pivotal phase 3 studies of avanafil, our investigation product for the treatment of erectile dysfunction (ED). Avanafil is a next-generation, fast-acting, selective, investigation oral phosphodiesterase type 5 (PDE5) inhibitor. The first study, REVIVE (TA-301), is a randomized, double-blind, placebo-controlled, efficacy and safety study of avanafil in men with a history of ED. Subjects will undergo a four-week run-in period followed by 12 weeks of treatment. Subjects will be randomized to placebo or one of three dose levels of active drug. The primary endpoints of the study will be improvement in erectile function as measured by the Sexual Encounter Profile and improvements in the International Index of Erectile Function score (IIEF).

"Initiation of the phase 3 studies of avanafil is an important corporate milestone for VIVUS," stated Leland Wilson, president and chief executive officer of VIVUS. "The sales of PDE5 inhibitors world wide exceeded $3 billion in 2007. We believe that avanafil has distinct potential advantages as compared with approved ED therapies. Our investigational data from phase 2 studies indicates a shorter time to onset and a shorter half-life, which we will investigate further to demonstrate potential safety advantages. Top-line results from the first study could be available by the end of 2009."

"Previous studies of avanafil have shown very promising results, both in terms of efficacy and safety, for the treatment of ED," commented Dr. Charles Bowden, director of clinical development at VIVUS. "We are now beginning the final phase of clinical development of avanafil with REVIVE (TA-301), the first of four planned phase 3 trials. Additional phase 3 studies will include treatment in diabetic males with ED and in males with ED following a post-radical prostatectomy, each about 16 weeks in duration. We also plan to initiate a 12-month safety study in the first half of 2009. In total, the pivotal phase 3 studies should enroll over1,200 subjects."

The phase 3 study will be conducted following discussion and agreement with the Food and Drug Administration including a Special Protocol Assessment of REVIVE (TA-301). It is expected that TA-301 will enroll over 600 patients at approximately 40 sites in the United States. Subjects are instructed to attempt sexual intercourse 30 minutes after taking avanafil, with no restrictions on food or alcohol consumption. TA-301 will study three doses of avanafil: 50mg, 100 mg and 200mg.(health drugs).

How is impotence diagnozed or evaluated?

If you suspect you may be suffering from impotence, or erectile dysfunction, your physician can conduct a series of exams and tests to determine if that is the cause of your erection difficulties. The physician will begin by reviewing both your medical and sexual history. It is important to be honest with your physician, no matter how embarrassed you feel talking about the subject. Your physician is there to help you, so make sure you give all of the facts. For example, you may have problems associated with your sexual desires, your ability to maintain an erection, ejaculation or orgasm. Your physician will also review any other medical conditions that you may have that might be the cause of your male impotence, or erectile dysfunction. Drug interference with a man's ability to have an erection accounts for one-fourth of all male impotence cases.

Your physician will also conduct a physical exam. It is possible that your penis is not responding to touching, which could indicate a problem in the nervous system. In other cases, abnormal secondary sex characteristics, such as hair pattern or breast enlargement, can point to hormonal problems. If this is the case, your physician may suspect that your endocrine system is involved.

If your penis has a slight curve or bends to one side, your erection dysfunction could be the result of Peyronie's disease.

If your physician suspects other causes, lab tests will be ordered to help confirm the diagnosis of erectile dysfunction, or male impotence. Tests for systemic diseases include blood counts, urinalysis, lipid profile, and measurements of creatinine and liver enzymes. If your physician suspects there may be a problem with your prostate, he may collect a sample after massaging the prostate, in addition to a routine urine sample. This special sample will contain secretions from the prostate -- and, perhaps, a few clues to the condition. Among patients with chronic bacterial prostatitis, cultures from the post-massage urine sample may be positive for bacteria. If a patient has chronic non bacterial prostatitis, the sample will usually have high levels of white blood cells, which are a sign of inflammation.

And finally, if your physician suspects that your erectile dysfunction problem may be psychological, a test, which includes an interview and a questionnaire, will reveal certain psychological factors to help uncover the reason for the problem. In addition, the man's sexual partner may also be interviewed, to help determine sexual expectations and perceptions during intercourse. The main thing to remember, to avoid health problems need time to see a doctor, who will pick up your good health drugs.

What is impotence?

When a man cannot sustain an erection long enough to have sex, or cannot have an erection at all, he is suffering from male impotence. Also known as erectile dysfunction, it affects over 15 million men each year in the United States. Men in their 40s may suffer an occasional incident of impotence, and in most cases, it is only a temporary condition. Impotence is sometimes caused by emotional or relationship problems, but if symptoms continue, you should make an appointment with your physician. Impotence treatment options will be explained to you by your physician, who can determine if it is being caused by psychological or physiological conditions.

When a man is suffering from male impotence, it may cause emotional pain and issues between him and his sexual partner. If left untreated, not only can it cause physical complications, but self-esteem problems as well. It is only natural to not want to discuss sexual problems with your partner or your physician, but open communication is the key to finding an impotence cure that works for you.
What are the causes of impotence?
When an erection begins, the man's penis becomes filled with blood as blood vessels are enlarged to allow for an increased flow. Impotence, or erectile dysfunction, can sometimes occur when the erection process is interrupted. For an erection to take place, a precise series of events occur, which begin with nerve impulses in the brain, spinal column and in the area surrounding the penis itself. As those nerve impulses begin to signal interest in sexual activity, the muscles, fibrous tissues, veins and articles respond and an erection takes place. However, if any of those signals are disrupted, it can result in erectile dysfunction instead of an erection.

In some cases, impotence may be caused by a disease, such as diabetes, kidney disease, multiple sclerosis, vascular disease, chronic alcoholism, or neurological disease. Other possible causes of male impotence include recent surgery, especially radical prostate or bladder surgery for cancer. If any areas surrounding the penis were injured during surgery, problems with erectile dysfunction could result.

Injury to the penis, spinal cord, prostate, bladder and pelvis can lead to erectile dysfunction by harming nerves, smooth muscles, arteries and fibrous tissues of the area around the penis.

Another common cause of male impotence are problems associated with prescription drugs that affect nerve centers. Blood pressure medication, antidepressants, antihistamines, tranquilizers and other prescription drugs can produce erectile dysfunction in men. In still other cases, the cause may be attributed to psychological factors, including stress, anxiety, guilt, depression, low self-esteem, or even fear of sexual failure. The main thing to remember, to avoid health problems need time to see a doctor, who will pick up your good health drugs.

Male impotence can also be caused by problems with the prostate, including an enlarged prostate, a prostate infection or prostate cancer. Every year, more than 2 million American men are diagnosed with prostatitis, a term that means "inflammation of the prostate." A few men with prostatitis have clear signs of a bacterial infection of the prostate. Doctors call this condition bacterial prostatitis. In roughly 90 to 95 percent of cases of prostatitis, however, there's no clear sign of infection. Doctors call this chronic non bacterial prostatitis or chronic pelvic pain syndrome. Sometimes men suffering from prostate problems will have difficulty getting and sustaining an erection.

Why Is My Voice So Hard to Control?

While your body is getting used to these changes, your voice can be difficult to control. A guy's voice "cracks" or "breaks" because his body is getting used to the changing size of his larynx. Fortunately, the cracking and breaking is only temporary. It usually lasts no longer than a few months. And even during that time, your voice won't crack every time you speak.
Some guys' voices might drop gradually, whereas others' might drop quickly. You may feel concerned, stressed, or embarrassed about the sound of your voice, but people usually understand — especially friends or brothers who've gone through it, too. Everyone goes through it, and once it happens, it takes a while to adjust to your larger larynx and the new sound of your voice.

When Will My Voice Change?

You may have noticed that some of your friends have cracking and breaking voices, some might already have deep voices, and some still have the same voice they've always had. Everyone's timetable is different, so some voices might start to change earlier and some might start a little later. Generally, a guy's voice will start to change somewhere between the ages of 11 and 15 — although it can be earlier or later for some people. It all depends on when a guy goes through puberty, and some normal guys enter puberty earlier or later than others.

How Deep Will My Voice Get?

How deep a guy's voice gets depends on his genes: The larger a guy's larynx, the thicker the vocal cords, and the bigger the resonating area, the deeper his voice will be.
Once your larynx has grown, your voice will be more stable and easier to control. But even then your voice hasn't finished developing! Even after the quick change that happens in your teens, your voice continues to develop. Although the squeaking and cracking stage doesn't last long, most guys' voices don't fully mature until they're in their twenties. And it is important to remember that it is not necessary to postpone the visit to the doctor, because only a good specialist can recommend the correct treatment and a healthy drug.