Start Sex Education Earlier

Children should be getting sex education lessons when they start school, according to a leading medical figure.

The call comes amid fears that many teenagers are exposing themselves to risk because the safe sex message is being left too late.

Dr Charles Saunders, chairman of the British Medical Association's Scottish consultants' committee, also says secondary schools should hand out condoms and other forms of contraception to older children.

Saunders, a consultant in public health medicine at NHS Fife, told the Scotland on Sunday newspaper: "It needs to start at quite an early age, because if you leave it until they are 12 it is too late because some are already experimenting.

"It probably needs to be started off when children start school. You need to start laying the groundwork to help them and empower them to make decisions and turn things down."

Scotland's sexual health record is one of the poorest in the western world. Teenage pregnancies are on the rise with 9,040 in 2005, the latest year for which figures are available, compared with 8,891 in 2004. Cases of sexually-transmitted diseases are also rising.

Dr Saunders said that lessons could start off with "simple concepts" in the same way as other subjects, adding: "It could start off with how babies are made and progress from there. Basically sex education needs to be a whole lot better."

As well as the dangers of infection, lessons should also cover the pros and cons of having sex or waiting.

Dr Saunders added that particularly in rural areas, schools may well be the only way that pupils can access contraception. "It may well be that as time goes on it would make sense to have emergency contraception in schools," he said.

The Scottish Government allows local authorities and head teachers to set their own sex education policies, but most children do not learn about sex until Primary Six or Seven, when they are 10 or 11.

Super Size Orgasms?

Recently I listened to an Australian radio program called The Orgasmic Brain, hosted by Natasha Mitchell. One of the guests on the program was Gert Holstege, a Dutch scientist who has begun mapping events in the brain during orgasm using brain scans of the event. At the very end of their interview, Dr. Holstege said:

We are addicted to sex as you know, as everybody is. It is the orbital frontal cortex that is controlling whether we can do it or not. And for example people that don't have this part of the brain - and these people exist - these people really go for orgasm all the time.

Ms. Mitchell then ran out of time and did not ask about the significance of the addictiveness of sex for our intimate relationships. Questions certainly could be asked.

Dr. Holstege - in his findings released a couple of years ago-compared the scans of men during orgasm to scans of people shooting heroin. Alas, sometimes the most obvious questions are overlooked or ignored - even by excellent journalists like Ms. Mitchell. In biology, what goes up must come down as the body seeks to rebalance itself.

Talking With Your Healthcare Provider About Sexual Difficulties

Women who have had success with treatment for sexual health problems have spoken about the inner resolve they needed to seek professional help. None of us found it easy to take this step. Each of us felt very much alone, although this was not the case. As many as 43% of American women have experienced sexual difficulties, according to a survey published in the 1999 Journal of the American Medical Association.

Although women's sexuality and health has been studied for many decades, the scientific study of women's sexual health in the field called sexual medicine is only about 5 years old. Since medical schools are just beginning to consider including sexual medicine in their coursework, your physician may or may not be aware of the latest research or even how to effectively evaluate your sexual health difficulty.

Women can increase the chances of getting the best possible care by being aware of their own sexual health and available treatment options. It is for this reason that we have come up with the following recommendations, based on the shared experiences of many women.

Step One: Find an understanding and knowledgeable healthcare provider

Some women prefer female doctors or nurse practitioners, but the important issue is finding a provider who has the expertise to help you.

Two New ED Drugs: How They Measure Up Against Viagra?

Two New ED Drugs: How They Measure Up Against Viagra?

Since Viagra was approved by the FDA in 1998, the number of men diagnosed with erectile dysfunction in the United States has increased by 250 percent. So there is no wonder why two new drugs for the condition have recently hit the market. The January issue of Harvard Health Letter examines Levitra and Cialis and assesses how these drugs measure up against the groundbreaking Viagra. Levitra offers a much smaller dose, 10 milligrams (mg), compared with the usual starting dose of 50 mg for Viagra. Levitra may also work faster- 25-30 minutes compared with an hour for Viagra. Cialis, on the other hand, stays active in the body much longer than the other two drugs 24-36 hours-compared to 4-5 hours for Viagra and Levitra.

The January Harvard Health Letter also examines the three drugs' similarities:

• They all work by relaxing smooth muscle cells, thereby widening blood vessels.
• None of the drugs automatically produce an erection. Rather, they make an erection possible with sexual arousal.
• Resulting side effects are comparable and may include headaches, heartburn, and flushing.
• The FDA advises against mixing these drugs with alpha blockers and nitrate medications.

Even with the introduction of these two new drugs, the decision to medicate erectile dysfunction should be carefully considered with a physician and will vary among male patients.

Sex Education in Schools May Help Delay Teen Sex

Sex education in school may encourage teenagers to put off having sexual intercourse, the results of a U.S. government study suggests.

The study, published Wednesday in the Journal of Adolescent Health, did not whether the type of program matters - that is, abstinence-only versus more-comprehensive programs.

However, the findings do suggest that having some form of sex education helps delay teen sex, according to the researchers, from the Centers for Disease Control and Prevention (CDC) in Atlanta.

In a national survey of more than 2,000 adolescents between 15 and 19 years old, the researchers found that teens who had sex ed in school were more likely to put off sex until at least age 15. Furthermore, boys who received sex ed were less likely to have started having sex at all.

"Sex education seems to be working," lead researcher Dr. Trisha E. Mueller, an epidemiologist with the CDC, said in a statement.

Review Of Fibric Acid Derivatives In Primary and Secondary Prevention Of Coronary Heart Disease

The fibric acid derivatives, also known as fibrates, are well established as effective agents for managing dyslipidemia, in particular elevated concentrations of triglyceride-rich very-low-density lipoprotein (VLDL) and VLDL remnants and low levels of high-density lipoprotein cholesterol (HDLC) that are typically associated with the dyslipidemia characteristic of type 2 diabetes and the metabolic syndrome. Clofibrate has been discontinued in the United States since it has been associated with cholangiocarcinoma and other gastrointestinal cancers ¹. Other fibrates that are available worldwide include bezafibrate and ciprofibrate.

Fibrates are indicated for the treatment of hypercholesterolemia, hypertriglyceridemia, and as adjunctive therapy to diet to reduce elevated total cholesterol, low-density lipoprotein cholesterol (LDLC), triglycerides, and apolipoprotein-B (apo-B), and to increase HDL-C in adult patients with primary hypercholesterolemia or mixed dyslipidemia. ² The use of fibric acid derivatives has decreased over the years because of unimpressive results in major clinical trials, safety concerns, and the emergence of HMG-CoA reductase inhibitors, more commonly known as statins. While statins are considered firstline therapy for dyslipidemia based on their efficacy in reducing levels of LDL-C, they exhibit only modest effects by decreasing triglycerides about 15-35% and increasing HDL up to 15% ³. The safety and efficacy of fibrates have been reviewed in six major clinical trials during the past 30 years. The results have generated mixed findings when evaluating overall mortality, cardiovascular events, and adverse effects. The inconsistent outcomes may be a result of differences among individual fibrates and highly varied study populations. In this article, the pharmacology of the fibrates is discussed along with evaluating their role in the primary and secondary prevention of coronary heart disease (CHD).

Mechanism of Action

Fibrates have a complex mechanism of action, involving several steps in the metabolism of lipoproteins. Primarily, fibrates affect the peroxisome proliferator activated receptor (PPAR)-α (Table 1) ⁴. The PPARs are a group of nuclear receptors predominantly expressed in tissues, such as the liver, kidney, heart and muscle, that metabolize fatty acids ⁵. On activation by binding of the fibrate, PPAR-α binds as heterodimers with a retinoid X receptor (RXR), which then recognizes and binds to specific PPAR-α response elements leading to expression modulation of the target genes ⁵. In particular, the activity of lipoprotein lipase is increased and synthesis of apoC-III is decreased, which both enhance the clearance of circulating triglyceride-rich lipoproteins ⁶. PPAR-α activation regulates gene expression involved in metabolic pathways including lipid metabolism, thereby reducing triglyceride concentrations and increasing HDL concentrations.

Pepsi makes the right choice on HIV/AIDS

Beverages major, Pepsico, has joined hands with NGOs Bhoruka Public Welfare Trust and Durbar in Kolkata to spread awareness on AIDS/HIV and popularise the use of condoms among local people.

According to Sanjiv Saxena, director-east of PepsiCo, "Pepsi's biggest consumers are people between 18 and 35 years of age. This age group is also most vulnerable to diseases like AIDS. So we thought of reaching out to the masses with the help of local NGOs in creating AIDS awareness as part of our corporate social responsibility."

Since 2005, Pepsi has been engaged in training its own employees, factory workers and the truck-drivers who carry Pepsi's stocks, in AIDS awareness programmes and condom usage.

Pepsi has reached out to over 1000 truckers and employees in Kolkata with its AIDS awareness programmes. "So far, our activities were restricted to our eastern India factory at Sonarpur. But now we plan to reach out to more local people in Kolkata," Saxena said.

According to BPWT project manager Ishita Majumdar, corporate partnerships like the one with Pepsico will ease the NGO's work as Pepsi already enjoys a high brand recall .

"We will have to make less efforts to make people listen to us if a big name like Pepsi is associated with the activity," feels Majumdar.

Losing Virginity Early Or Late Tied To Health Rrisks

People who start having sex at a younger or older than average age appear to be at greater risk of developing sexual health problems later in life, a new study suggests.

The findings, according to researchers, cast some doubts on the benefits of abstinence-only sexual education that has been introduced in U.S. public schools.

Using data from a 1996 cross-sectional survey of more than 8,000 U.S. adults, the researchers found that those who started having sex at a relatively young age were more likely to have certain risk factors for sexually transmitted diseases (STD) — including a high number of sexual partners and a history of having sex under the influence of alcohol.

On the other hand, both "early" and "late" starters were at increased risk of problems in sexual function. This was true primarily of men, whose problems included difficulty maintaining an erection and reaching orgasm.

The findings are published in the American Journal of Public Health.

It's not clear from the survey why both early and late starters tend to have more sexual dysfunction, according to the researchers, led by Dr. Theo G.M. Sandfort of Columbia University in New York City.

Health Chiefs Supply The Morning-After Pill To Girls Under 16

Campaigners have accused health chiefs in Suffolk and Essex of promoting a casual attitude to sex by supplying the morning-after pill to girls under the age of 16. In a new report, published today, the Family Education Trust says 128 primary care trusts across the country are authorising the supply of the emergency pill to girls under 16.

Of this number, 70% are also prepared to insist on provision of the drug to underage girls as a condition of granting a pharmacy licence, it says.

The trust, which researches the causes and consequences of family breakdown, describes the policy as "misguided" and claims it is born out of the "blind ideology" that it will contribute to lower teenage pregnancy rates.

But PCTs in Suffolk and Essex have hit back at the claims, saying although they work hard to make youngsters aware of the consequences of unprotected sex, some girls will ignore advice and go ahead with it anyway.

The trust obtained data under the Freedom of Information Act to discover how many PCTs operated the policy.

Its research found Suffolk PCT, Mid-Essex PCT and Great Yarmouth and Waveney PCT were among those issuing girls under 16 with the morning-after pill, the latter only in the Waveney area.

The Rapid Test Offers New Weapon Against Chlamydia

A new rapid test for chlamydia, the world's most common sexually transmitted infection, has proved successful in trials and could help rein in a worrying rise in the disease, British scientists said on Friday.

The test is able to detect chlamydia in less than 30 minutes — and often much faster.

Its speed could also mean it becomes a vital diagnostic tool in the developing world where chlamydia, which can cause infertility, is a largely hidden menace.

The new Chlamydia Rapid Test (CRT) detects bacteria from self-collected vaginal swabs, which are much simpler to obtain than cervical swabs required by existing rapid tests. It is also up to twice as accurate.

"The speed of the CRT means that we can provide a 'test and treat' strategy, offering immediate clinical care to the patient," said Helen Lee of the University of Cambridge, whose research team developed the test.

That could make it particularly useful in mobile clinics or amongst difficult-to-reach populations in the developing world, where high-risk groups such as female sex workers frequently carry the disease undetected.

Chlamydia is easily cured with antibiotics, but often goes undiagnosed. When untreated, it can cause severe health consequences, particularly for women, such as pelvic inflammatory disease, ectopic pregnancy and infertility.

The test will be made available by a university spinout company Diagnostics for the Real World in early 2008. The firm plans to provide the test at virtually cost price to the public sector in developing countries.

An evaluation of the test in three British clinics was reported in the British Medical Journal.

Women With AIDS Face Cervical Cancer Threat

According to a recent report by UNAIDS, access to antiretroviral therapy is beginning to reduce AIDS mortality worldwide. But Dr. Groesbeck Parham, gynecologic oncologist and Director of the Cervical Cancer Prevention Program at the Center for Infectious Disease Research in Zambia (CIDRZ) warns that women being treated for AIDS could end up dying of cervical cancer unless they have access to screening and treatment.

"We are saving women's lives by treating them with antiretroviral therapy, but we could lose a high percentage of them to cervical cancer," said Parham.

Parham and his team have tested more than 10,000 Zambian women in the largest cervical cancer screening program targeting HIV-infected women in the developing world. In a study published last year in the journal Gynecologic Oncology, he reported that 90 percent of HIV-infected women presenting for antiretroviral therapy also harbor cervical cell abnormalities, conditions that left untreated can develop into cervical cancer.

"Before having access to antiretroviral medications, women living in developing nations who had AIDS typically succumbed to it before they could develop cervical cancer," said Parham.

Currently, 80 percent of new cases of cervical cancer and 80 percent of the annual deaths occur in women who live in developing countries. Few women in poor countries have access to cervical cancer screening or treatment.

"As funds are allocated for HIV/AIDS care and treatment, we need to make sure that women's other health issues are not swept under the carpet," said Dr. Mulindi Mwanahamuntu, Co-Director of the CIDRZ Cervical Cancer Prevention Program.

In sub-Saharan Africa, cervical cancer is the most common female cancer and the most common cause of cancer-related death. When cervical lesions are discovered in pre-cancer stage the cure rates are high.

In the CIDRZ program, women are examined by nurses trained in a low-tech, low-cost screening protocol that allows them to identify precancerous or suspected cancer within minutes instead of waiting for results from a pap test. The women can then be treated immediately.

ScienceDaily

Alcoholism & Conduct Disorder Contribute To Having A High Number Of Sex Partners

Previous studies have linked heavy drinking and conduct disorder to high-risk sexual behaviors that can, in turn, lead to unintended pregnancies, infection, and damage to reproductive health. A new study has linked the clinical diagnoses of alcohol dependence and conduct disorder among 18-to-25-year-olds to the risk of having a high number of sexual partners.

"Our study is the first of its kind to link problematic drinking and alcohol dependence with a high number of sex partners," said Patricia A. Cavazos-Rehg, research instructor in the Department of Psychiatry at Washington University School of Medicine and corresponding author for the study. "We have moved beyond self-reports of heavy and/or frequent drinking to utilizing a clinical diagnosis of alcohol dependence in order to improve understanding of how alcohol use influences risky sexual behaviors."

"The relationship between risky sexual behavior and conduct disorder has been well documented, especially among young women," added Denise Hallfors, senior research scientist at the Pacific Institute for Research and Evaluation. "What was not known was whether alcohol dependence and conduct disorder independently contribute to the number of sexual partners. Previous studies tended to look at either alcohol dependence and conduct disorder, or conduct disorder and sexual risk, or heavy drinking and sexual risk, but not at all three behaviors together."

IHT Examines Efforts Aimed at Providing Prison Inmates With Condoms to Reduce of HIV

The AP/International Herald Tribune on Monday examined nationwide efforts to provide prison inmates with condoms in an attempt to reduce the spread of HIV and other sexually transmitted infections. According to the AP/Herald Tribune, efforts by HIV/AIDS and prisoners' rights advocates to distribute condoms in prisons have gone "almost nowhere" because some prison officials and politicians argue that they encourage sexual activity among inmates and can be used to hide drugs.

Vermont and five other cities in the U.S. allow inmates regular access to condoms, the AP/Herald Tribune reports. Vermont's Department of Corrections has provided condom access in prisons since 1992 even though prison regulations ban sexual activity. The program provides inmates one condom at a time if they request it from a health worker. "It's a courageous position that Vermont took then and continues to have now," the corrections department's health services director, Dolores Burroughs-Biron, said, adding that there have been no reports of security problems as a result of the program.

Female Sexual Dysfunction: A Case Study of Disease Mongering and Activist Resistance

The creation and promotion of "female sexual dysfunction" is a textbook case of disease mongering by the pharmaceutical industry and by other agents of medicalization, such as health and science journalists, healthcare professionals, public relations and advertising firms, contract research organizations, and others in the "medicalization industry." Whether one relies on Lynn Payer's original definition of disease mongering ("trying to convince essentially well people that they are sick, or slightly sick people that they are very ill"), her checklist, or the analysis of our pill-popping society that was recently offered by Greg Critser, the sequence of events and cast of participants involved in FSD matches the classic disease-mongering tactics.

Professor Sparks Debate On Treatment Of Sexual Dysfunction

Over the past decade, a little blue pill has transformed how sexual disorders are perceived by doctors, sex therapists and the public at large. But while a Valparaiso University psychologist and leading sex disorder researcher says looking at sexual dysfunction as a medical problem has helped some people seeking help, too often the behavioral and social factors underlying individuals' sexual problems are being ignored.

An article by psychology professor Dr. David Rowland in the newest edition of the Journal of Sex and Marital Therapy outlines the negative impacts of an increasing reliance on medication to solve sexual disorders and calls for more comprehensive assessment of those disorders.

Dr. Rowland's article "Will Medical Solutions to Sexual Problems Make Sexological Care and Science Obsolete?" is the lead article in the journal, with the rest of the issue 16 commentaries by international experts in sexual medicine responding to it.

Vacuum Constriction Devices

The curative application of negative pressure was well established in 19th century medicine. M. Junod used a "Vacuum Exhausting Receiver" to apply negative suction to different areas of the human body including the extremities in order to heal conditions like headache, vertigo or menstruation problems.

By stating that "the glass exhauster should be carefully applied to the part, once a day" the American physician John King was the first to suggest a contnuous and repeated application of a vacuum device to the penis for the cure of impotence in 1874. The Viennese physician Otto Lederer made the signficant improvement of adding a compression ring to the use of the vacuum device to facilitate an odemand erection. His "device for the artificial eretion of the penis" was patented in Germany in 1913 and four years later in the US a patent was issued.

The Future Of Male Contraception

For decades, pundits have predicted new contraceptives for men within the next 5 to 10 years. Are we really getting any closer? Judging from work presented at the second "Future of Male Contraception" conference, the answer may finally be yes.

But will men actually use a new method if researchers make one? Elaine Lissner, director of the nonprofit Male Contraception Information Project, says demand is the least of the problems. "You'll never have all men interested, but attitudes have really changed - studies consistenly show a majority of men would consider it. You have to remember, between condoms and vasectomy, men in the U.S. are already taking care of a third of contraception. Just imagine if they had another non-permanent option."

Hormone Therapy Has No Consequence On Women's Memory

Hormone therapy interpreted inch the world-class few years after menopause does not appear to affect a woman's memory, but may lead to increased sexual interest, according to a study published in the September 25, 2007, offspring of Neurology, the medical journal of the American Academy of Neurology.

The bailiwick, the largest to see examining the effects of hormone therapy IN early post-menopausal women, tangled 180 women between the ages of 45 and 55 who had finished their final menstrual cycle in the past unitary to three years. The women were randomly tending placebo or hormone therapy consisting of day-after-day estrogen and progesterone for four months. The women also underwent tests on memory, attention, cognitive run, worked up condition, sexuality, and sleep.

10% Of Women Infected With Human PapillomaVirus

A new study by the Health protection Agency estimates at least 10% of untried women in England have been infected with unrivalled or more strains of the human papillomavirus (HPV) by the historic period of 16. The study will be discussed on the net twenty-four hour period of the Health Protection Agency annual conference inward Warwick.

The examine, the 1st of its tolerant in England , investigated the proportion of women of age 10-29 old who had antibodies indicating they had been septic with HPV. Researchers tried and true blood samples from 1483 girls and women for types of HPV that terminate do genital warts and cervical Crab. Results evidence that from the age of 14, the risk of HPV infection increases precipitously.

Or So HPV infections sack do cervical cancers in women and genital warts in both women and men, although about infections with HPV cause no symptoms and exculpated on their own.

Pathophysiology Of Erectile Dysfunction

Given the complexity of the system, it is not surprising that a wide variety of diverse disorders may result in erectile dysfunction. Often, the cause is multifactorial, but vasculogenic causes are the most commonly implicated.

Because the development and maintenance of a rigid erection depend on achieving a high intracavernosal pressure, it is not surprising that disorders affecting the peripheral arterial blood flow are strongly associated with erectile dysfunction.

The most common cause is atheroma involving either the common or internal iliac arteries or their more distal branches. The risk factors for this are similar to those for coronary artery disease (including smoking, hypertension, hyperlipidemia, diabetes mellitus and obesity).

Risk Factors For Erectile Dysfunction

Risk factors for organic erectile dysfunction mainly stem from the fact that the erectile mechanism is a vasodilatory response dependent on smooth muscle function under neurogenic control. Aging, which has the strongest association with erectile dysfunction, probably exerts its effects mainly through impaired vasodilatory and venoocclusive mechanisms.

Atheroma of the internal iliac arteries and their pudendal branches may be one factor, but age-related degeneration of intracorporeal smooth muscle mechanisms is probably more important.

Venous leakage, another age-related phenomenon, may in itself be a manifestation of deterioration of intracorporeal smooth muscle function.

What Everyone Should Know about Generic Drugs

NAPS — an estimated half of all prescriptions in the United States are filled with generic drugs. These products carry all the medicinal qualities (and side effects) of their brand-name counterparts, but generics tend to have one additional benefit: lower cost.

According to the U.S. Food and Drug Administration [FDA], a generic drug is a copy that is identical to a brand-name drug in dosage, refuge, strength, how it is interpreted, quality, performance and intended manipulation. New drugs, like other new products, are developed under patent protection. The patent protects the investment—including research, development, marketing and promotion—by giving the company the sole right to sell the drug while the patent is in effect. When patents or other periods of exclusivity on brand-name drugs are near expiry, manufacturers can apply to the FDA to sell generic versions.

Penile Implants for Erectile Dysfunction

Penile implants were introduced into the marketplace over 30 years ago with the marketing of the three piece inflatable and the semi rigid rod almost simultaneously. Prior to that time, there was little interest in erectile dysfunction, little was known of the causes and epidemiology, and the treatments which were prescribed were in most cases unsuccessful. The rudimentary implants used prior to that time simply acted as inadequate splints, attempting to maintain the penis in a rigid state.

The French surgeon Ambroise Pare suggested an "artificial penis" made of wooden pipe or tube for patients after traumatic penile amputation in order to facilitate a proper micturition in the standing position. Although not intended for sexual activities, one might call this device a 16th century "penile prosthesis". As per definition a prosthesis replaced the whole organ or part of the body. On the other hand on should always confine to the term "penile implant" when referring to the modern devices discussed.

Canada's Drug Price Paradox 2007

Canadians pay much more than Americans for generic drugs because government policies in Canada distort the market for prescription medicines. Canadian government policies insulate generic drug companies and pharmacy retailers from normal market forces that would put downward pressure on prices for generic drugs.

This study compares prices for generic and brand-name drugs in Canada and the United States for the year 2006. Differences between the economics and public policy of the two countries theoretically explain the observed variation in prices for identical drugs. This study estimates the effect on total retail-drug expenditures from price distortions caused by Canadian public policies.

Canadian data

The main Canadian data set used for this study included three lists of drug products.

1. The 100 most commonly prescribed brand-name drug products in Canada in 2006, ranked by the number of prescriptions dispensed. This sample represents 69% of the total number of brand-name prescriptions dispensed in the Canadian market in 2006.
2. The 100 most commonly prescribed generic drug products in Canada in 2006, ranked by the number of prescriptions dispensed. This sample represents 57% of the total number of generic prescriptions dispensed in the Canadian market in 2006.
3. All manufacturers in the Canadian generic market for each of the 100 most commonly prescribed generic drug products in 2006 and their associated market shares defined by the number of prescriptions dispensed for each product in 2006.

Effect Of Premature Menopause On Sexuality

Premature menopause, that is, menopause – spontaneous or iatrogenic – occurring at or before the age of 40 years, affects sexual identity, sexual function and sexual relationships. The woman's health, wellbeing and achievement of life's goals may be variably impaired.

Factors modulating the individual's sexual outcome after premature menopause include: etiological heterogeneity of premature menopause and associated medical and sexual comorbidities; psychosexual vulnerability to premature menopause and associated infertility in survivors of childhood and adolescent cancers; impact of premature menopause on women's sexual identity, sexual function – particularly the biological basis of desire, arousal, orgasm and vaginal receptivity – and sexual relationships; partner-related factors; fertility issues; and preventive/therapeutic measures.

Hormone therapy is indicated but long-term safety data are lacking. An interdisciplinary medical and psychosexual approach comprises appropriate counseling, fertility protection, when
feasible, individualized hormone therapy and specific psychosexual treatment(s). Further research on fertility protection and the safety of long-term hormone therapy after premature menopause is needed.

Epidemiology of Erectile Dysfunction

Ever since the ground-breaking work of Kinsey, the prevalence of erectile dysfunction has been a subject of debate. Although it is certain that many millions of men are affected by the condition, there is a surprising dearth of high-quality epidemiological data with which to quantify accurately the extent of the problem. A figure of one man in ten has often been quoted as an estimate of the prevalence of erectile dysfunction, but the frequency and severity of the disorder vary markedly with age. Erectile dysfunction is uncommon in young men (with the exception of intermittent psychogenic problems), becomes more common in middle age, and is highly prevalent in men more than 60 years of age. Thus, to some extent, erectile dysfunction is a natural expression of aging, but one that men are increasingly less willing to accept without seeking treatment. As the world’s population ages over the next few decades (Figure 1), the number of men who will suffer erectile dysfunction seems certain to rise.

Figure 1. The projected world population pyramid for 2002 (green) and 2025 (white) demonstrating how many more older people will be around to be affected by erectile dysfunction.

The Male Genital System Illustrated

(Items in bold correspond to the drawing)

The bladder is emptied by way of the urethra, a tube passing through the prostate gland. The main function of the prostate is to supply fluid for sperm that has been collected in the seminal vesicles. Ejaculation is when the seminal vesicles and prostate empty.

The seminal vesicles are supplied by the vas deferens from the epididymis, a tightly coiled, tube next to the testicle that provides for the storage, transmission, and maturation of sperm.

Before ejaculation, the Cowper's glands secrete an alkaline fluid that neutralizes any urine that may be left in the urethra. The fluid also has a lubricating quality. Because these glands are often spared in a prostatectomy, they may continue to function, even though there is no ejaculate.

Online Sexuality And Online Sexual Problems: Skating On Thin Ice

Observations about obsessional love and compulsive sexual behaviors are not new. Since human beings began to express themselves on granite walls and clay scrolls, there has been a fascination with sexuality. Secular and religious literature, oral history, art and music were all replete with both overt and oblique references to the power sex holds. About 4,000 years ago, the Sumarians wrote about the sexual conquests of the warrior Gilgamesh in The Epic of Gilgamesh which describes his behavior and reputation: "His lust leaves no virgin to her lover, neither the warrior's daughter nor the wife of the nobleman." Forty centuries later the Internet burst upon the world and has given us yet another outlet for the expression of sexuality. Its potential seems infinite, frightening and wondrous all at the same time.

In May 1997, theWall Street Journal ran a story about a stripper, Danni Ashe, who was able to use her business skills to market sexually explicit images of herself and other models on the Internet. Lane (2001) reports how the journalist, Thomas E. Weber described how Ashe's site, Danni's Hard Drive, was "bring [ing] in so much revenue that she has given up the stage and nude photo shoots... Now the pay site boasts 17,000 members, putting Ms. Ashe on pace for more than $2 million in revenue [in 1997]... " (Lane, 2001, p. XIII).

Mechanisms Of Erection

Intracavernosal smooth muscle tone is by far the most important determinant of intracavernosal blood flow. Approximately half of the cavernosal volume is composed of smooth muscle, with the remainder consisting of either lacunar spaces or collagen. Collagen fibers are largely responsible for the passive mechanical properties of cavernosal tissue. In contrast, active contraction of cavernosal smooth muscle is dependent upon a number of factors, including the level of agonists (neurotransmitters, hormones and endothelium-derived factors), adequate expression of receptors, integrity of transduction mechanisms, calcium homeostasis, interaction of contractile proteins, and intimate intracellular communication between smooth muscle cells (gap junctions).

Cavernosal smooth muscle cells contain abundant amounts of the contractile proteins, actin and myosin. Following phosphorylation of myosin by adenosine triphosphate (ATP), attachments (crossbridges) form between the light chains of these two proteins and these attachments provide the mechanism for contractile tone of smooth muscle. The expenditure of energy for maintaining this state of tone is almost zero, but there is an absolute requirement for a high concentration of cytoplasmic free calcium.

How to Use Viagra and Other Erection Drugs

The world of erection impairment changed dramatically on March 27, 1998—the day the Food and Dose Administration approved the little blasphemous pill. Viagra is used for treatment of erection impairment, at present medically called erectile dysfunction (ED). Viagra was not the outset drug treatment for erection impairment (see Yohimbine below), but it was the one that captured the public’s imagination. Viagra took the U.S.—and the world—by storm. During its number 1 month of availability, American doctors wrote more than 300,000 prescriptions, making Viagra the fastest-selling new drug in history. Inside six months, repeat prescriptions were being written at the rate of 100,000 per calendar month. Today, Viagra is one of the most successful drugs always marketed. More than 10 meg men have taken more than 125 million tablets. Annual gross sales approach $2 billion. And with millions of male Baby Boomers in their 50s, the future of the little blue pill—and other erection medications—looks bright.

1. Step One

Be aware the erection medication is not the answer to every man’s erection problem, though erection medication certainly has a place in treatment of ED. Many erection difficulties are caused by sexual anxiety, and resolve when men learn more about sexual activity, relax about it, and espouse a less penis-centered, holistic and sensual approach to lovemaking. Other erection difficulties are caused by medical problems and resolve when the illnesses are treated. Many erection problems are caused by drugs (notably alcohol and cigarettes) and drug side effects and can be helped by cutting back on alcohol, quitting smoke, or tinkering with prescriptions.

2. Step Two

Know how erection medications work. Currently there are four prescription drugs available for erection problems: Sildenafil, Levitra, Cialis and Yohimbine. They all essentially work the same way. Sexual arousal stimulates release of a compound, nitric oxide (NO), in the penis. Nitrous oxide, in turn, triggers synthesis of cGMP, which relaxes the penis’ smooth muscle tissue, and allows extra blood to flow into the organ’s spongy central erectile tissues. Erection drugs heighten this smooth muscle relaxation, prod greater blood flow into the penis.

When To Call a Doctor

Seek care immediately if you use medication to treat an erection problem (erectile dysfunction) and the erection lasts longer than 4 hours.

Do not use any form of nitroglycerin if you have chest pain and have taken Viagra, Levitra, or Cialis in the past 24 hours.

Call a health professional if erection problems occur with:

• Any type of injury to the back, legs, buttocks, groin, penis, or testicles.
• A loss of pubic or armpit hair and an enlargement of the breasts.

Viagra and other oral medications

Until the late 1990s, there were no truly effective oral medications for erectile dysfunction — the inability to achieve or sustain an adequate erection for sexual activity. The useful drugs that were available had to be injected into the penis or inserted into the urethra.

Treatment of erectile dysfunction is much easier now, thanks to a class of drugs called phosphodiesterase-5 (PDE-5) inhibitors. The medications — sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis) — all improve erectile function in the same basic way, but they differ in how quickly they take effect and how long their effects last.

Viagra, Levitra and Cialis: How they work

Viagra, Levitra and Cialis prevent the breakdown of nitric oxide, a chemical messenger that promotes relaxation and opening of the blood vessels that supply erectile tissue in the penis. Under the influence of nitric oxide, these vessels expand and stay dilated. Increased blood flow makes erectile tissue swell and compress the veins that carry blood out of the penis, resulting in a full erection.

Historical Highlights of Erectile and Sexual Dysfunction An Illustrated Chronology

Introduction

This short introductory chapter is to give very selected impressions on some historical milestones from the field of erectile and sexual function and dysfunction. These highlights are arranged in chronological order and are not including the developments of the most recent years.

The idea for this article was born by the author and Prof. Alain Jardin - both members of the Historical Committee of the European Association of Urology (EAU) - during the 2nd International Consultation held in Paris. The concept was immediately supported by the board of the consultation.

Every reader who is familiar with the history of sexual medicine will realize that many dates and names have not been mentioned in this brief overview. So hopefully, the 3rd International Consultation will come up with an extended and complete research of all fields and aspects of the history of sexual medicine and not only a collection of selected spotlights.

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.

Erectile Dysfunction Hits 18 Million

More than 18 million American hands suffer from erectile dysfunction, but help may not require a little pill.

A new study from Johns Hopkins' Bloomberg School of Public Health shows nearly one in five men experience erectile dysfunction, just simple lifestyle changes may be enough to ward off the problem.

Erectile dysfunction was much more rough-cut among men with diabetes or other risk factors for heart disease and those who were physically inactive, the researchers base.

"The associations of erectile dysfunction with diabetes and cardiovascular risk factors may serve as powerful motivators for men who need to make changes in their diet and lifestyle," says researcher Elizabeth Selvin, PhD, MPH, of the department of epidemiology at the Bloomberg School of Public Wellness, in Baltimore, in a news release.

About Erectile Dysfunction

Erectile dysfunction (ED or (male) impotence) is a sexual dysfunction characterized by the inability to develop or maintain an erection of the penis. There are various underlying causes, such as cardiovascular leakage and diabetes, many of which are medically treatable.

The causes of erectile dysfunction may be physiological or psychological. Physiologically, erection is a hydraulic mechanism based upon blood entering and being retained in the penis, and there are various ways in which this can be impeded, most of which are amenable to treatment. Psychological impotence is where erection or penetration fails due to thoughts or feelings (psychological reasons) rather than physical impossibility; this can often be helped. Notably in psychological impotence there is a very strong placebo effect.

Erectile dysfunction, tied closely as it is to cultural notions of potency, success and masculinity, can have devastating psychological consequences including feelings of shame, loss or inadequacy; often unnecessary since in most cases the matter can be helped. There is a strong culture of silence and inability to discuss the matter. In fact around 1 in 10 men will experience recurring impotence problems at some point in their lives.