What is a vasectomy?

A vasectomy is an operation that makes a man permanently unable to get a woman pregnant. It involves cutting the 2 tubes called as deferents so that sperm can no longer get into the semen.


How is a vasectomy done?
A vasectomy is usually done in your doctor's office or in an outpatient surgery center. The operation takes about half an hour. You'll be awake during the procedure. Your doctor will give you a local anesthetic to numb your scrotum.

After you're numb, your doctor will cut a small opening (an incision) on one side of your scrotum and pull out part of the as deferents on that side. You may feel some tugging and pulling. A small section of the as deferents is removed. The ends of the as deferents will be sealed by stitching them shut, by searing them shut with heat, or by using another method. Your doctor will then do the same thing on the other side.

Your doctor will close the 2 openings in your scrotum with stitches. After 3 to 10 days, the stitches will disappear by themselves.

What is no-scalpel vasectomy?
The no-scalpel vasectomy involves making a very small puncture (a hole) in the scrotum instead of an incision. The puncture is so small that it heals without stitches.

How effective is vasectomy in preventing pregnancy?
Vasectomy may be the safest, most effective kind of birth control. Only about 15 out of 10,000 couples get pregnant the first year after a vasectomy.

Are there any reasons I shouldn't have a vasectomy?
Don't have a vasectomy unless you're sure you don't want to have children in the future. You may need to wait to have a vasectomy, or may not be able to have one, if you have an infection on or around your genitals, or you have a bleeding disorder.

What are the risks of a vasectomy?
Problems that might occur after your vasectomy include bleeding, infection and a usually mild inflammatory reaction to sperm that may have gotten loose during the surgery (called sperm granuloma). Call your doctor if you notice any of the signs in the box below.
Another risk is that the ends of the as deferents may find a way to create a new path to one another. This doesn't occur very often. But if it does, you could be able to cause a pregnancy.

Call your doctor if:

* You have a fever.
* You have swelling that won't go down or keeps getting worse.
* You have trouble urinating.
* You can feel a lump forming in your scrotum.
* You have bleeding from an incision that doesn't stop even after you've pinched the site between 2 gauze pads for 10 minutes

How is erectile dysfunction treated?

Most physicians suggest that treatments proceed from least to most invasive. For some men, making a few healthy lifestyle changes may solve the problem. Quitting smoking, losing excess weight, and increasing physical activity may help some men regain sexual function.
Cutting back on any drugs with harmful side effects is considered next. For example, drugs for high blood pressure work in different ways. If you think a particular drug is causing problems with erection, tell your doctor and ask whether you can try a different class of blood pressure medicine.
Psychotherapy and behavior modifications in selected patients are considered next if indicated, followed by oral or locally injected drugs, vacuum devices, and surgically implanted devices. In rare cases, surgery involving veins or arteries may be considered.
Psychotherapy

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

Drugs for treating ED can be taken orally, injected directly into the penis, or inserted into the urethra at the tip of the penis. In March 1998, the Food and Drug Administration (FDA) approved Viagra, the first pill to treat ED. Since that time, vardenafil hydrochloride (Levitra) and tadalafil (Cialis) have also been approved. Additional oral medicines are being tested for safety and effectiveness.
Viagra, Levitra, and Cialis all belong to a class of drugs called phosphorescence (PDE) inhibitors. Taken an hour before sexual activity, these drugs work by enhancing the effects of nitric oxide, a chemical that relaxes smooth muscles in the penis during sexual stimulation and allows increased blood flow.
While oral medicines improve the response to sexual stimulation, they do not trigger an automatic erection as injections do. The recommended dose for Viagra is 50 mg, and the physician may adjust this dose to 100 mg or 25 mg, depending on the patient. The recommended dose for either Levitra or Cialis is 10 mg, and the physician may adjust this dose to 20 mg if 10 mg is insufficient. A lower dose of 5 mg is available for patients who take other medicines or have conditions that may decrease the body's ability to use the drug. Levitra is also available in a 2.5 mg dose.
None of these PDE inhibitors should be used more than once a day. Men who take nitrate-based drugs such as nitroglycerin for heart problems should not use either drug because the combination can cause a sudden drop in blood pressure. Also, tell your doctor if you take any drugs called alpha-blockers, which are used to treat prostate enlargement or high blood pressure. Your doctor may need to adjust your ED prescription. Taking a PDE inhibitor and an alpha-blocker at the same time (within 4 hours) can cause a sudden drop in blood pressure.
Oral testosterone can reduce ED in some men with low levels of natural testosterone, but it is often ineffective and may cause liver damage. Patients also have claimed that other oral drugs—including yohimbine hydrochloride, dopamine and serration agonizes, and trapezoid—are effective, but the results of scientific studies to substantiate these claims have been inconsistent. Improvements observed following use of these drugs may be examples of the placebo effect, that is, a change that results simply from the patient's believing that an improvement will occur.
Many men achieve stronger erections by injecting drugs into the penis, causing it to become engorged with blood. Drugs such as papaverine hydrochloride, phentolamine, and alprostadil (marketed as Caverject) widen blood vessels. These drugs may create unwanted side effects, however, including persistent erection (known as priapism) and scarring. Nitroglycerin, a muscle relaxant, can sometimes enhance erection when rubbed on the penis.
A system for inserting a pellet of alprostadil into the urethra is marketed as Muse. The system uses a p refilled applicator to deliver the pellet about an inch deep into the urethra. An erection will begin within 8 to 10 minutes and may last 30 to 60 minutes. The most common side effects are aching in the penis, testicles, and area between the penis and rectum; warmth or burning sensation in the urethra; redness from increased blood flow to the penis; and minor urethral bleeding or spotting.
Research on drugs for treating ED is expanding rapidly. Patients should ask their doctor about the latest advances.

Premature Ejaculation

International experts from ten countries have teamed up to develop the first ever evidence-based definition of lifelong premature ejaculation (PE) in the hope that it will aid future diagnosis, treatment and research.

The results of their in-depth study, conducted by the Standards Committee of the International Society for Sexual Medicine, have just been published online by two leading Wiley-Blackwell publications, the urology journal BJU International and The Journal of Sexual Medicine.

They developed their definition after lengthy critical evaluation of the evidence presented in more than 100 studies on PE published over the last 65 years. It was unanimously agreed by the experts that the definition of lifelong PE should be a combination of three key factors:

* "Ejaculation which always or nearly always occurs prior to or within about one minute of vaginal penetration."

* "The inability to delay ejaculation on all or nearly all vaginal penetrations."

* "Negative personal consequences such as distress, bother, frustration and/or the avoidance of sexual intimacy."

However, the team have concluded that at the moment there is insufficient evidence to develop an evidence-based definition of acquired PE, which develops at a stage in a man's life rather than being a life-long problem.

They have also stressed that more research is needed into the PE issues faced by homosexual men as there is also insufficient evidence to develop a definition for this patient group.

The multi-disciplinary team was made up of 21 experts from the USA, UK, Singapore, Argentina, France, Egypt, Denmark, The Netherlands, Australia and Germany.

It included urologists, psychologists, psychiatrists, a sexual health physician, a primary care physician, a neuro-urology researcher, a clinical pharmacologist, an endocrinologist and a radiation oncologist.

"PE has been a recognised condition for many years and the first topical anaesthetic cream to delay ejaculation was described as far back the 1930s" explains co-author Dr Chris G McMahon, Associate Professor at the University of Sydney and Director of the Australian Centre for Sexual Health in Sydney.

"The premise that PE is a psychosomatic disturbance was first suggested in 1943 and men with PE were recommended to try various treatments such as the stop-start method.

"Various drug treatments have been developed over the last 30 years and in the past 15 years an increasing number of well-controlled, evidence-based studies have demonstrated the effectiveness and safety of selective serotonin reuptake inhibitor drugs in delaying ejaculation.

"More recently clinicians and the pharmaceutical industry have been paying more attention to the psychosocial consequences of PE.

"But what has been lacking is a consensus on how lifelong PE should be defined. As a result everyone - from urologists and clinicians working in sexual medicine to the pharmaceutical industry - have been working to different parameters.

"That is why the International Society for Sexual Medicine felt it was vital to bring together international experts to look at the wealth of published data and formulate an evidence-based definition of lifelong PE."

Men with lifelong PE suffer from a cluster of core symptoms, including early ejaculation nearly every time they have intercourse. Approximately 90 per cent ejaculate within 30 to 60 seconds of vaginal penetration and the remaining 10 per cent within one to two minutes.

The definition developed by the Society does not cover men with acquired PE, which develops in men who have previously had normal ejaculatory experiences. This may be due to psychological or relationship problems, erectile dysfunction, an inflamed prostate gland or thyroid dysfunction.

Because the definition has not been put into practice yet, it is not possible to quantify retrospectively how many men fall into the lifelong PE category based on the new evidence-based definition. However, previous research has suggested that as many as 35 per cent men suffer from premature ejaculation of some kind, making it even more common than erectile dysfunction (ED). Unlike ED, which increases with age, PE affects men more or less equally across all age ranges.

"Numerous organisations have tried to define lifelong PE but this is the first evidence-based definition to be developed" stresses Dr McMahon. "It is a vital step forward for men with PE and the clinicians who treat them as it can be used to provide consistent diagnosis and treatment and enable the results of any clinical trials to be compared."

Erectile Dysfunction Causes

Erectile dysfunction (ED) is one of the most common sexual problems and affects nearly 50% of all men over the age of 40 at some stage. This problem becomes even more common and more severe as men grow older. There are many causes of ED and it is thought that 70% of cases have physical causes and 30% psychological causes although often there are both physical and psychological reasons for the condition.

The shaft of the penis has two chambers that fill up with blood during sexual arousal. Sexual thoughts are transmitted though the nerves to the genitals. These nerves cause the relaxing of the muscle cells in the walls of the blood vessels entering the penis. The increased blood flow fills up the two chambers in the shaft of the penis forming an erection. Therefore any condition or disease which affects either the blood flow to the penis or the nerves to the genital area can cause erectile dysfunction.

Such conditions or diseases are:

Physical Health problems such as:
- Diabetes can be the cause of ED in more than 50% of men (3 times as high as non diabetic men).
- Vascular disease can lead to a narrowing of vessels carrying blood to the penis and other areas.
- Nonexclusive disease can cause problems keeping the blood within the penis.
- MS, spinal cord injury and Parkinson's disease are all conditions where the nervous system can affect transmission of signals from the brain to the blood vessels in the penis.
- Damage from surgery to the pelvic area such as in prostrate gland surgery.
- Psychological problems such as anxiety and guilt, relationship issues, stress, depression, boredom and sexual orientation.

Medicines: the side effect of some treatments for high blood pressure as well as for heart disease, depression, peptic ulcers and cancer, can cause ED. Medicines can also affect sexual drive and desire (libido) or even cause problems with ejaculation and orgasm. So if you have a problem and are on medication, check out whether there are any ED side effects.

Lifestyle: alcohol and drugs commonly affect the ability to get and maintain an erection and in the long term, interfere with the production of the male hormone testosterone. Nicotine damages the circulation in the body thereby increasing the risk of erection problems. In addition, smoking constricts the blood vessels and is a major cause of damage to the arteries leading to the penis. Being physically inactive contributes to poor cardiovascular fitness. Lean, physically active men are less likely to have problems with ED than obese couch potatoes.

Premature ejaculation is one of man's most common underestimated sexual problems

Is one of man's most common, underestimated sexual problems: Ejaculating earlier than desired. More common than erectile dysfunction, this condition can affect men at any point in their lives, and one in four men experience poor control over ejaculation on a frequent basis.

According to published research, 20%-30% of men worldwide are commonly affected by premature ejaculation (PE), yet this medical condition remains a taboo subject in virtually every culture. Two presentations at this week's 99th Annual Meeting of the American Urological Association (AUA) are helping to increase understanding and discussion of this common male sexual condition.

"Premature ejaculation is a frequent and distinct medical condition that can severely impact quality of life, affecting the physical and emotional well-being of patients and their partners," says James H. Barada, M.D., urologist at the Center for Male Sexual Health, Albany, NY, and board member of the Sexual Medicine Society of North America (SMSNA). "But most men are reluctant to talk about it with their partners or physicians."

To address whether renaming the condition would help increase awareness of, and discussion about, premature ejaculation, and reduce the stigma associated with it, the SMSNA has established a Scientific Working Group.

The working group undertook a review of recent research and a representative research study, sponsored by Johnson & Johnson Pharmaceutical Research & Development, L.L.C. At the AUA, Dr. Barada presented the recommendations of the working group.

The working group found that the term premature ejaculation was universally recognized and accurately understood by men with the condition and their partners, and concluded that changing the name may have the opposite effect, resulting in confusion and requiring extensive re-education. In the research study, which included 61 healthcare professionals, 75 men with premature ejaculation and 48 partners, other terms that also were occasionally used by physicians to describe the condition like "rapid ejaculation", were not as well understood by the study participants.

Most significantly, the results of the study highlight that the stigma is not associated with the name, but with the condition. The SMSNA Scientific Working Group recommends continued use of the term premature ejaculation to describe the condition, and in a move to minimize the stigma, calls on medical professionals to encourage communication about sexual health and the medical causes of premature ejaculation.

Why is premature ejaculation so stigmatized considering it is a well-known condition?

Further research reported at the AUA by Andrew R. McCullough, M.D., Director of Male Sexual Health, Fertility and Microsurgery at the New York University Medical Center suggests that one of the reasons might be the broad impact that premature ejaculation has on many aspects of a man's life, leaving him with feelings of embarrassment and inadequacy.

Dr. McCullough's analysis shows that men with poor control over ejaculation tend to be less satisfied with sexual intercourse and their sexual relationship, and may suffer more difficulties with sexual anxiety and arousal compared to non-sufferers (P <> 6 months) heterosexual relationships and answered 31 questions regarding overall and sexual health. These included questions about ejaculatory control that were primarily based on DSM-IV premature ejaculation criteria.

According to these criteria, 32% of surveyed men identified themselves as sufferers, which is consistent with prevalence estimates in the literature. Of these, 189 men identified themselves as "probable" premature ejaculation sufferers, and a further 188 as "possible" sufferers.

Premature ejaculation is defined as persistent or recurrent ejaculation with minimal sexual stimulation before, upon, or shortly after penetration, or before the person wishes, causing distress and embarrassment to one or both partners, potentially affecting sexual relationships and overall well-being.