Common Sexually Transmitted Diseases

Gonorrhea

Gonorrhea is an infection caused by the Gonococcus bacterium. In men, it is marked by a thick, white discharge from the penis and a burning pain when urinating.

In women, gonorrhea may infect the cervix. There may be mild pain and a discharge. If the urethra is infected, there may be a burning sensation during urination. However, women's symptoms are most often mild or simply unnoticeable. Even so, it is important to treat the infection because gonorrhea can lead to pelvic inflammatory disease.

When gonorrhea is transmitted during anal or oral sex, painful infection of the rectum or throat may occur in both men and women.

Chlamydia

Infection by the Chlamydia tracheotomy bacterium is the leading cause of nongonococcal urethritis in men. This condition consists of pain or burning during urination, a thin discharge from the penis, and staining on underwear. Chlamydiae infection may also inflame the sperm-collecting tubules in the scrotum and eventually cause sterility. A man infected with chlamydia may be infected simultaneously with Urea plasma urealyticum, which also causes urethritis.

In women, a chlamydial infection may cause a thin vaginal discharge, pain during urination, or pain in the lower abdomen about 10 to 20 days after exposure. However, women often do not notice any early symptoms. Chlamydia may also lead to pelvic inflammatory disease.

Pelvic Inflammatory Disease

Pelvic inflammatory disease (PID) is an infection of the uterus, fallopian tubes, or ovaries and usually results from either gonorrhea or chlamydia infection.

The disease typically develops in two stages. First the infection attacks the cervix (the lower part of the uterus). It then spreads to the uterus, fallopian tubes, and ovaries. Sometimes PID starts directly within the uterus when germs gain entry following childbirth, abortion, or the insertion of an intrauterine contraceptive device (IUD). This, however, is rare.

Since PID causes scar tissue to form, there is up to a 25 percent risk of infertility. PID is also the single most common cause of tubal pregnancy, in which a fertilized egg begins to grow while still in the fallopian tube, instead of the uterus. If the tube bursts, the woman could die.

Genital Warts

Genital warts (condyloma) are caused by the human papillomavirus (HPV) and look much like other warts. They usually occur near the tip of the penis in men. In women, the warts appear on the vulva, in the vagina, on the cervix of the uterus, or near the anus.

Genital warts are flat, hard, and painless when they first appear. If allowed to grow, however, they develop a "cauliflower" appearance and hurt when pressed. Genital warts tend to get bigger during pregnancy. In rare instances, very large warts may interfere with childbirth, making a cesarean section necessary.

There are several types of HPV. Some types can cause precancerous cell changes in the tissues of a woman's vulva, anus, cervix, or vagina. An invasive cervical cancer can be fatal, which is why women with genital warts should have a Pap test at least once a year.

Viagra competitor coming soon

Viagra has been the most-talked-about prescription drug since the birth-control pill.
And with this week's U.S. debut of rival impotence drug Levitra - and with another competitor on the horizon - the talk is only going to get louder.
Levitra's makers, Bayer AG and Glaxo Smith Kline Plc., have promised lots of advertising. They have signed a three-year sponsorship deal with the National Football League and hired Mike Ditka, the former Chicago Bears coach, as a Levitra spokesman.
'You couldn't ask for a better audience,' said Michael Fleming, Glaxo Smith Kline's director of product communications. 'You want to reach out to men where they are. One hundred twenty million people watch the games every week - that's 100 million men.'

Another Viagra rival is just months away from store shelves. Like Levitra, Cialis (made by Eli Lilly & Co. and Icos Corp.) made its European debut months ago. Cialis is expected to gain FDA approval by the end of this year. Paul Newman has been mentioned as a potential spokesman.

A loud, chest-thumping contest seems inevitable as the rivals put forward competing claims about the three drugs' relative benefits. GlaxoSmithKline and Bayer assert that Levitra acts more quickly than Viagra, which Pfizer disputes.

Lilly says Cialis is effective for 36 hours, instead of four to five hours for Viagra and Levitra. In Europe, it's called 'the weekend pill' because a Friday-night dose lasts until Sunday.

The stakes of the ad battle will be huge. Despite Viagra's success (sales were $1.7 billion last year), nine of 10 men with erectile dysfunction don't get treatment.

In the United States, an estimated 32 million men (about half of men over 40) are affected, and many of them are still too embarrassed to bring up the subject with a doctor.

But although many men may not want to talk about it, they'll be hearing about it. A lot. Think Viagra advertising times three.

So far, Viagra ads have tried to break through men's reluctance to address the issue by using celebrity spokesmen who embody respectability (Bob Dole); athleticism (NASCAR driver Mark Martin, Brazilian soccer star Pele and Texas Rangers baseball player Rafael Palmeiro); and virility (Hugh Hefner).

Altogether, Pfizer has spent more than $100 million on endorsements, television advertising, online marketing and sports event sponsorship.

The celebrities encourage men to fix the problem - as they would fix heartburn with Nexium or arthritis with Celebrex.

The campaign has earned Viagra brand-name recognition approaching that of Coca-Cola and has led to a saturation of Viagra jokes and spam e-mails.

(At online marketing firm Opt In Real Big, one of Viagra's marketers, CEO Scott Richter estimates that online pharmacies collectively spend from $200,000 to $300,000 per week on mass e-mails for Viagra.)

Men are getting the message
'It comes up for refills, it comes up for new prescriptions. It is a daily event,' said West Palm Beach urologist Murray G. Goldberg. 'Some people come in asking for Viagra; other people come in for what seems like an unrelated thing, then they say, 'Oh, by the way....' You come back and say, 'Is that the reason you came in?' And they say, 'Yeah.' '
A sexual and social landmark
Viagra's prevalence also has created a shift in the way we view men's sexuality.
Start with the change in terminology. The issue is no longer 'impotence,' and it's no longer shameful.
It's 'erectile dysfunction' or 'ED.' It's nobody's fault. And it's treatable.
'Obviously (Viagra) is a relief for a lot of men; it really gives the man confidence,' says Palm Beach Gardens certified sex therapist Nicholas S. Aradi. 'It has been a very positive thing that has brought a lot of couples together. It has been very effective.'
But not every problem can be fixed with a pill. And if men take the drug for the wrong reason, a relationship can suffer.
'It has made sex more goal-oriented,' Aradi said. 'For women in particular, they prefer more intimacy, communication. And the man is thinking he's going to take the pill an hour before bed and - boom.'

Without communication, he said, the drugs can introduce even more tension into a relationship. And there's a wide-ranging mis perception that Viagra will increase a man's libido.
'If the interest is not there, Viagra is not going to bring it about. The most powerful sex organ is between our ears, not between our legs.'
Miriam Davis, a West Palm Beach-based sex therapist and licensed mental health counselor, says Viagra is helpful in cases where there is a clear medical problem - and when asking about it is a joint decision. But she worries that some couples use it as a way to avoid dealing with important issues.
'If anything, I think it's made people think we don't need to solve any problems, that it's OK not to bridge the intimacy problems,' she said. 'For a lot of women, it makes it nice and quick and it's done. It doesn't put any pressure on them.'
Another concern: Although Viagra can make sex physically successful, it can't guarantee emotional satisfaction. Some couples who have solved the erectile dysfunction problem with Viagra suddenly find themselves facing other challenges in the bedroom.

'A lot of people forget that just getting an erection is not enough to have satisfying sex,' Davis said. 'It's no magic bullet. It's not going to bridge emotional distance.'

With new drugs that work faster and last longer than Viagra, she added, it will be even easier to lose sight of that distinction. 'You have this medication that bypasses all the communication. It has made it easier for people not to interact.'

The challengers' claims

The competitors, which are getting a positive response in Europe, each claim their own edge over Viagra -and in both cases it's an edge with emotional appeal.

Levitra takes effect in about half the time, making it more spontaneous -- a plus for couples who dislike the hour-in-advance planning Viagra requires. Cialis, which lasts for 36 hours, might appeal to men who feel hurried with Viagra.

'Men tell us that, when they take other pills, they feel like they're on a stopwatch, and that adds to the pressure they already feel,' Carole Copeland, a spokeswoman for Cialis-maker Eli Lilly, told The New York Times. 'They would like a treatment that would disconnect taking a tablet from intimacy.'

(As with Viagra, sexual stimulation is also necessary for both drugs to work).

Glaxo Smith Kline will place its Levitra ads inside a larger education program called 'Tackling Men's Health,' said communication director Fleming.

Although the ads will target football fans, some see the fans' wives as key. Women are much more likely than men to go to the doctor and seek treatment. Might they be important in urging men to get help?

'Women do have a critical role in motivating their partners,' Fleming acknowledged, but there won't be any ads in women's magazines or on Lifetime. At least, not yet.

Meanwhile, 'there are a lot of women who do watch football,' he pointed out. No matter what the advertising venue, the new drugs face a tough battle against Viagra's established name and familiar faces.

But they'll have the luxury of appealing to a public already inured to frank talk about a subject that was taboo just five years ago.

Adrienne Merrill, communications director for the Sexuality Information and Education Council of the United States, notes a different side to the new treatments.

From a women's health and family planning perspective, she said, the publicity around Viagra has been an unexpected boon.

When Viagra was approved, health insurers were quick to include it in their prescription drug coverage. 'It set off a firestorm. Even the Defense Department was covering Viagra,' she said.

But many of the same insurers didn't cover contraceptives for women -- and the discrepancy created an outcry. As a result, 21 states have since passed legislation requiring health insurers to include birth control in their prescription drug coverage.

Viagra, in some cases, takes effect in 14 minutes

Viagra (R) 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 (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 dilatory 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 dilatory 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.

Natural Viagra?

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 and a potential for fewer side effects because it targeted the protein more precisely than sildenafil.

About Viagra

Viagra is a prescription medication indicated for the treatment of ED. 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.

Patients should discuss their general health status with their doctors to ensure that they are healthy enough to engage in sexual activity. If patients experience pain, nausea, or any other discomfort during sex, or an erection that lasts longer than four hours, they should seek medical help.

The most common side effects of Viagra(reg) (sildenafil citrate) are headache, facial flushing and upset stomach. Less commonly, bluish vision, blurred vision or sensitivity to light may briefly occur.

Patients with recent serious cardiovascular events, hypertension or controlled hypertension or retinues pigmentation did not participate in pre-approval clinical trials. In these patients, physicians should prescribe Viagra with caution. The use of Viagra offers no protection against sexually transmitted diseases, including human immunodeficiency virus (HIV).

Discovered and developed by Pfizer, Viagra is the breakthrough oral treatment for erectile dysfunction that is found to be effective and well tolerated in more than 130 completed and ongoing clinical studies. Viagra has been approved by regulatory authorities in more than 123 countries around the world and is among the most widely prescribed medications, with more than 130 million prescriptions written for 23 million men worldwide.

Pfizer Inc discovers, develops, manufactures and markets leading prescription medications for humans and animals and many of the world's best-known consumer products.

Sildenafil (oral)

Do not take sildenafil if you are also using a nitrate drug for chest pain or heart problems. This includes nitroglycerin (Nitrostat, Nitrolingual, Nitro-Dur, Nitro-Bid, and others), isosorbide dinitrate (Dilatrate-SR, Isordil, Sorbitrate), and isosorbide mono nitrate (Imdur, ISMO, Monoket). Nitrates are also found in some recreational drugs such as amyl nitrate or nitrite ("poppers"). Taking sildenafil with a nitrate medicine can cause a serious decrease in blood pressure, leading to fainting, stroke, or heart attack.

During sexual activity, if you become dizzy or nauseated, or have pain, numbness, or tingling in your chest, arms, neck, or jaw, stop and call your doctor right away. You could be having a serious side effect of sildenafil.

Do not take sildenafil more than once a day. Allow 24 hours to pass between doses.

Contact your doctor or seek emergency medical attention if your erection is painful or lasts longer than 4 hours. A prolonged erection (prismatic) can damage the penis.

Sildenafil can decrease blood flow to the optic nerve of the eye, causing sudden vision loss. This has occurred in a small number of people taking sildenafil, most of whom also had heart disease, diabetes, high blood pressure, high cholesterol, or certain preexisting eye problems, and in those who smoke or are over 50 years old. It is not clear whether sildenafil is the actual cause of vision loss.

Stop using sildenafil and get emergency medical help if you have sudden vision loss.

What is sildenafil?

Sildenafil relaxes muscles and increases blood flow to particular areas of the body.

Sildenafil under the name Viagra is used to treat erectile dysfunction (impotence) in men. Another brand of sildenafil is Revatio, which is used to treat pulmonary arterial hypertension and improve exercise capacity in men and women.

Sildenafil may also be used for other purposes not listed in this medication guide.

What should I discuss with my health care provider before taking sildenafil?

Do not take sildenafil if you are also using a nitrate drug for chest pain or heart problems. This includes nitroglycerin (Nitrostat, Nitrolingual, Nitro-Dur, Nitro-Bid, and others), isosorbide dinitrate (Dilatrate-SR, Isordil, Sorbitrate), and isosorbide mono nitrate (Imdur, ISMO, Monoket). Nitrates are also found in some recreational drugs such as amyl nitrate or nitrite ("poppers"). Taking sildenafil with a nitrate medicine can cause a serious decrease in blood pressure, leading to fainting, stroke, or heart attack.

Before taking sildenafil, tell your doctor if you are allergic to any drugs, or if you have:

* heart disease or heart rhythm problems;
* a recent history (in the past 6 months) of a heart attack, stroke, or heart rhythm disorder;
* congestive heart failure;
* high or low blood pressure;
* coronary artery disease;
* liver disease;
* kidney disease;
* a blood cell disorder such as sickle cell anemia, multiple myeloma, or leukemia;
* a bleeding disorder such as hemophilia;
* a stomach ulcer;
* retinues pigmentation (an inherited condition of the eye);
* a physical deformity of the penis (such as Peyronie's disease); or
* if you have been told you should not have sexual intercourse for health reasons.

If you have any of these conditions, you may need a dose adjustment or special tests to safely take sildenafil.
Sildenafil can decrease blood flow to the optic nerve of the eye, causing sudden vision loss. This has occurred in a small number of people taking sildenafil, most of whom also had heart disease, diabetes, high blood pressure, high cholesterol, or certain preexisting eye problems, and in those who smoke or are over 50 years old. It is not clear whether sildenafil is the actual cause of vision loss. Stop using sildenafil and get emergency medical help if you have sudden vision loss.

FDA pregnancy category B: This medication is not expected to be harmful to an unborn baby. Do not use sildenafil without telling your doctor if you are pregnant or plan to become pregnant during treatment.

It is not known if sildenafil passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

Younger men lead surge in Viagra

The use of Viagra(R) (sildenafil) has grown more than three- fold among younger men since it entered the market, according to a study published today in the International Journal of Impotence Research. The study is the first to profile trends in the use of Viagra using prescription claim information from a random, nationwide sample.

The study by Express Scripts examined Viagra use among more than 5 million commercially insured adult beneficiaries 18 years and older from 1998 to 2002. The fastest growing segments of users were found to be men 18 to 45 years and 46 to 55 years, who experienced increases in use of 312% and 216%, respectively, over the study period. In addition, use for an underlying medical reason declined in all age groups over the five years. These findings suggest increased use of Viagra as an enhancement or recreational agent.

Overall, use increased from 0.8% of the sample population in 1998 to 1.4% in 2002, an 84% increase. Men 56 years and older continued to receive the majority of Viagra prescriptions. In contrast with greater use among younger men, growth in use slowed among women and older men.

With health care resources becoming more scarce, debate continues over the coverage of lifestyle medications such as Viagra. "Already concerned with the impact Viagra has had on their pharmacy budgets, health plan sponsors now face the prospect of increased use among a younger, healthier generation of patients," said Tom Delate, lead author of the study. "In addition, marketing approval of other erectile dysfunction drugs, such as Levitra(R) and Cialis(R), will likely increase utilization of such drugs."

The coverage of erectile dysfunction (ED) drugs by prescription benefit plans varies widely, with some plans having no restrictions on coverage, others requiring prior authorization for medical necessity or placing quantity limits, and others offering no coverage. In one finding, the use of quantity limits by plan sponsors can mitigate the effects of increased demand for ED drugs.

Viagra can cause permanent vision loss in some men

Ophthalmologists at the University of Minnesota say that a condition that causes permanent vision loss has been diagnosed in a small group of men who have taken the erectile dysfunction drug Viagra. The condition, noncritical chemic optic neuropathology (NAION), described as "stroke of the eye," occurs when blood flow is cut off to the optic nerve, which injures the nerve and results in permanent vision loss.

Seven patients, aged between 50 and 69 years, had typical features of NAION within 36 hours after ingestion of Viagra for erectile dysfunction. Seven similar cases have been previously reported.

"For years, we've known that some men who take Viagra will experience temporary color changes in their vision and see things as blue or green," said Howard Pomeranz, M.D., associate professor of ophthalmology at the University of Minnesota Medical School. "NAION is a much more serious condition because it can lead to permanent vision loss."

All of the patients had at least one arteriosclerotic risk factor, including hypertension, diabetes, hypercholesterolemia, or hyperlipidemia. All of the patients also had a low cup to disk ratio, which is a way doctors measure the small circular indentation where the optic nerve connects to the eyeball. The low cup to disk ratio means that the blood vessels and nerves are tightly bundled together into the small space in the back of the eye.

"Viagra regulates a chemical in the body to constrict the arteries. This constriction may cut off the blood flow to the optic nerve, especially in people with a low cup to disk ratio, where the blood vessels and nerves are tightly bundled provoking NAION," says Pomeranz.

The onset of NAION within hours after ingestion of Viagra in 14 patients supports an association between the use of the drug and NAION. Based on the fact that 14 cases of NAION have now been reported soon after the use of Viagra, the researchers believe that ophthalmologists should ask all men with NAION about the use of Viagra, and recommend that patients with a history of NAION in one eye be cautioned that Viagra may increase the risk of NAION in the fellow eye.

The Academic Health Center is home to the University of Minnesota's six health professional schools and colleges as well as several health-related centers and institutes. Founded in 1851, the University is one of the oldest and largest land grant institutions in the country. The AHC prepares the new health professionals who improve the health of communities, discover and deliver new treatments and cures, and strengthen the health economy.

Erectile Dysfunction and Cardiovascular Problems

For men, flagging potency can be a red flag that somethings not right in the cardiovascular system. And experts say men who rush to fix the problem with impotence drugs may be ignoring a bigger threat to their health.

"Erectile dysfunction [ED] is frequently a manifestation of underlying cardiovascular problems. It even precedes angina - it can be an early warning, in that respect," said Dr. Andrew McCullough, director of male sexual health, fertility and microsurgery at New York University School of Medicine in New York City.

The advent of Viagra, Cialis and Levitra has put the research spotlight back on ED, and a series of studies are suggesting that, for most men, the condition has physiological, not psychological, origins.

Early in 2004, researchers led by Dr. Alan Bank of the St. Paul Heart Clinic in Minnesota published a study showing that the arteries of men with ED expanded less efficiently than men without erectile difficulties - a possible sign of underlying heart disease.

McCullough likened ED to a common plumbing problem: "If you turn on your kitchen faucet and you don't get any flow, either the faucet's broken or the pipes are clogged."

For men with advanced heart disease, the clogged-pipe explanation probably holds true, since buildup of cholesterol in arteries can greatly reduce blood flow.

But many men with ED aren't anywhere near this stage of cardiovascular deterioration. For them, the faucet - the vessels inside the penis and the smooth muscle around them -- may be broken on a biochemical level.

"We're learning that erectile dysfunction is largely due to reduced nitric oxide in the endothelial, the inner lining of blood vessels," explained Dr. David Gutterman, professor of medicine at the Medical College of Wisconsin in Milwaukee.

As blood flow demands increase (as happens during an erection), the endothelial releases nitric oxide to help trigger blood vessel expansion. "Nitric oxide is very important for normal erectile function," Gutterman said. "It's also - and here's the link to heart disease - very important as an anti-atherosclerosis agent, resisting 'hardening of the arteries.' "

In that sense, ED may serve as an early signal that blood vessels elsewhere in the body aren't expanding as they should, either.

It's no coincidence, then, that drugs such as Viagra - which helps increase nitric oxide levels in the endothelial - were first studied as possible treatments for cardiac trouble.

"However, it was found that these drugs do this better in some organs rather than others," Gutterman said. Looking at the problem from the other side, Bank's team is currently researching whether or not the statin family of cholesterol-lowering drugs might help fight ED.

"We do know that stating improve the function of the enzyme, nitric oxide syntheses, that produces nitric oxide inside the blood vessels," Gutterman pointed out. "That's probably related to the very mechanism that helps get rid of ED."

In the meantime, men with erectile difficulties should stop and consider the possible underlying cause of that dysfunction, McCullough said.

"Initially, when Viagra was first approved, there were all kinds of direct-to-consumer ads associating ED with a physiologic process, to convince men that it wasn't just psychological, and that it might be linked to underlying cardiovascular disease," he said.

"But now, there's a minimalization of all that in these ads. So guys who have these problems just say 'OK, I'll go online and get some Viagra,' " McCullough said.

But that type of attitude has its dangers, he said.

"One of the most serious things, in my mind, is the guy who fails Viagra, Cialis, Levitra. Because to me, that suggests he's got more serious underlying disease than some guy for whom it works," he said.

McCullough's advice? "Go see your doctor."

Gutterman agreed. "Some folks with undiagnosed heart disease might not get chest pain first, but they'll get erectile dysfunction. It's just another way of picking up on early coronary disease."

Alternative to infertility treatment

If you have had infertility problems and are thinking of adopting a child, consider the following while making your decision:

* Successful adoption and long-term parenting requires the commitment of both partners and a dependable support system. The need for a solid support system is even more important for a single adoptive parent.
* There are many adoption options available to Americans, both domestically and abroad. The Internet can be an efficient and useful tool for researching adoption information.
* The adoption application and placement process can be as time-consuming and expensive as infertility treatment. While a U.S. or international infant adoption can take a year or longer, a U.S. minority adoption can take less than a year.
* Some adoption agencies have parental age and other restrictions for infant adoption. If you are in your mid-30s and are considering infant adoption, you may have to weigh agency requirements against your own time line for starting an adoption process.

What are the risks of adopting?

As with parenting a biological child, raising an adopted child confronts you with a list of unknowns. Physical, intellectual, and mental health issues can unfold over time whether your child is biological or adopted.

Adoption poses its own risks and concerns, such as the possibility that an adoption process may not go through, unknowns about a child's genetic and health background, and attachment and behavior issues related to separation or neglect. The birth mother and father may have the legal right to change their minds about placing their child for adoption. In some states, relinquishment is final as soon as the legal papers are signed; and in other states, a period of time is allowed for the birth parents to change their minds.

Are you ready to adopt?

As you prepare for this possibility:

* Spend time exploring adoption options, costs, and time lines before you make a final decision to try or to discontinue infertility treatment.
* Think and talk about questions to consider about adoption.
* Be aware that one of you may be ready to adopt long before the other. Some couples report that it has taken months to years before they were both ready to start the adoption process.
* Before proceeding with an adoption, allow yourselves time to grieve your lost hopes for a biological child.