THE 2002 OFFICIAL PATIENT’S SOURCEBOOK
on
MPOTENCE J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS
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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright Ó2002 by ICON Group International, Inc. Copyright Ó2002 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1
Publisher, Health Care: Tiffany LaRochelle Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher’s note: The ideas, procedures, and suggestions contained in this book are not intended as a substitute for consultation with your physician. All matters regarding your health require medical supervision. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation, in close consultation with a qualified physician. The reader is advised to always check product information (package inserts) for changes and new information regarding dose and contraindications before taking any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960The 2002 Official Patient’s Sourcebook on Impotence: A Revised and Updated Directory for the Internet Age/James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary and index. ISBN: 0-597-83220-X 1. Impotence-Popular works. I. Title.
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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem or as a substitute for consultation with licensed medical professionals. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors or authors. ICON Group International, Inc., the editors, or the authors are not responsible for the content of any Web pages nor publications referenced in this publication.
Copyright Notice If a physician wishes to copy limited passages from this sourcebook for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications are copyrighted. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs or other materials, please contact us to request permission (e-mail:
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Dedication To the healthcare professionals dedicating their time and efforts to the study of impotence.
Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this sourcebook which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which directly or indirectly are dedicated to impotence. All of the Official Patient’s Sourcebooks draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this sourcebook. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany LaRochelle for her excellent editorial support.
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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for the Official Patient’s Sourcebook series published by ICON Health Publications.
Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for the Official Patient’s Sourcebook series published by ICON Health Publications.
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About ICON Health Publications In addition to impotence, Official Patient’s Sourcebooks are available for the following related topics: ·
The Official Patient's Sourcebook on Cystocele
·
The Official Patient's Sourcebook on Glomerular Disease
·
The Official Patient's Sourcebook on Goodpasture Syndrome
·
The Official Patient's Sourcebook on Hematuria
·
The Official Patient's Sourcebook on Hemochromatosis
·
The Official Patient's Sourcebook on Immune Thrombocytopenic Purpura
·
The Official Patient's Sourcebook on Interstitial Cystitis
·
The Official Patient's Sourcebook on Kidney Failure
·
The Official Patient's Sourcebook on Kidney Stones
·
The Official Patient's Sourcebook on Lupus Nephritis
·
The Official Patient's Sourcebook on Nephrotic Syndrome
·
The Official Patient's Sourcebook on Peyronie
·
The Official Patient's Sourcebook on Polycystic Kidney Disease
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The Official Patient's Sourcebook on Prostate Enlargement
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The Official Patient's Sourcebook on Prostatitis
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The Official Patient's Sourcebook on Proteinuria
·
The Official Patient's Sourcebook on Pyelonephritis
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The Official Patient's Sourcebook on Renal Osteodystrophy
·
The Official Patient's Sourcebook on Renal Tubular Acidosis
·
The Official Patient's Sourcebook on Simple Kidney Cysts
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The Official Patient's Sourcebook on Urinary Incontinence
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The Official Patient's Sourcebook on Urinary Incontinence for Women
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The Official Patient's Sourcebook on Urinary Incontinence with Children
·
The Official Patient's Sourcebook on Urinary Tract Infection in Children
·
The Official Patient's Sourcebook on Urinary Tract Infections in Adults
·
The Official Patient's Sourcebook on Vasectomy
·
The Official Patient's Sourcebook on Vesicoureteral Reflux
To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes & Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health
Contents vii
Table of Contents INTRODUCTION ................................................................................................................................. 1 Overview ....................................................................................................................................... 1 Organization ................................................................................................................................. 3 Scope.............................................................................................................................................. 3 Moving Forward............................................................................................................................ 4 PART I: THE ESSENTIALS ............................................................................................................. 7 CHAPTER 1. THE ESSENTIALS ON IMPOTENCE: GUIDELINES ........................................................... 9 Overview ....................................................................................................................................... 9 What Is Impotence? ..................................................................................................................... 11 How Does an Erection Occur?.................................................................................................... 11 What Causes Impotence?............................................................................................................. 12 How Is Impotence Diagnosed? .................................................................................................... 13 How Is Impotence Treated? ......................................................................................................... 15 What Will the Future Bring? ...................................................................................................... 19 Points to Remember..................................................................................................................... 19 For More Information.................................................................................................................. 19 More Guideline Sources .............................................................................................................. 20 Vocabulary Builder...................................................................................................................... 34 CHAPTER 2. SEEKING GUIDANCE ................................................................................................... 41 Overview ..................................................................................................................................... 41 Associations and Impotence......................................................................................................... 41 Finding More Associations ......................................................................................................... 43 Finding Doctors........................................................................................................................... 45 Finding a Urologist ..................................................................................................................... 46 Selecting Your Doctor ................................................................................................................. 47 Working with Your Doctor ......................................................................................................... 47 Broader Health-Related Resources .............................................................................................. 49 Vocabulary Builder...................................................................................................................... 49 PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL ........................... 51 CHAPTER 3. STUDIES ON IMPOTENCE............................................................................................. 53 Overview ..................................................................................................................................... 53 The Combined Health Information Database .............................................................................. 53 Federally-Funded Research on Impotence ................................................................................... 60 E-Journals: PubMed Central ....................................................................................................... 69 The National Library of Medicine: PubMed................................................................................ 70 Vocabulary Builder...................................................................................................................... 71 CHAPTER 4. PATENTS ON IMPOTENCE ........................................................................................... 79 Overview ..................................................................................................................................... 79 Patents on Impotence................................................................................................................... 80 Patent Applications on Impotence............................................................................................... 94 Keeping Current .......................................................................................................................... 95 Vocabulary Builder...................................................................................................................... 95 CHAPTER 5. BOOKS ON IMPOTENCE ............................................................................................... 99 Overview ..................................................................................................................................... 99 Book Summaries: Federal Agencies ............................................................................................. 99 Book Summaries: Online Booksellers ........................................................................................ 109 The National Library of Medicine Book Index........................................................................... 113 Chapters on Impotence .............................................................................................................. 116 Directories ................................................................................................................................. 128
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General Home References .......................................................................................................... 129 Vocabulary Builder.................................................................................................................... 129 CHAPTER 6. MULTIMEDIA ON IMPOTENCE .................................................................................. 135 Overview ................................................................................................................................... 135 Video Recordings....................................................................................................................... 135 Audio Recordings ...................................................................................................................... 140 Bibliography: Multimedia on Impotence ................................................................................... 142 Vocabulary Builder.................................................................................................................... 144 CHAPTER 7. PERIODICALS AND NEWS ON IMPOTENCE ............................................................... 147 Overview ................................................................................................................................... 147 News Services & Press Releases ................................................................................................ 147 Newsletters on Impotence.......................................................................................................... 155 Newsletter Articles .................................................................................................................... 156 Academic Periodicals covering Impotence................................................................................. 158 Vocabulary Builder.................................................................................................................... 161 CHAPTER 8. PHYSICIAN GUIDELINES AND DATABASES .............................................................. 163 Overview ................................................................................................................................... 163 NIH Guidelines ......................................................................................................................... 163 NIH Databases .......................................................................................................................... 164 Other Commercial Databases .................................................................................................... 171 The Genome Project and Impotence .......................................................................................... 171 Specialized References ............................................................................................................... 176 Vocabulary Builder.................................................................................................................... 177 CHAPTER 9. DISSERTATIONS ON IMPOTENCE .............................................................................. 179 Overview ................................................................................................................................... 179 Dissertations on Impotence ....................................................................................................... 179 Keeping Current ........................................................................................................................ 181 PART III. APPENDICES .............................................................................................................. 183 APPENDIX A. RESEARCHING YOUR MEDICATIONS ..................................................................... 185 Overview ................................................................................................................................... 185 Your Medications: The Basics ................................................................................................... 186 Learning More about Your Medications ................................................................................... 187 Commercial Databases............................................................................................................... 189 Contraindications and Interactions (Hidden Dangers)............................................................. 196 A Final Warning ....................................................................................................................... 197 General References..................................................................................................................... 198 Vocabulary Builder.................................................................................................................... 199 APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE ............................................................... 203 Overview ................................................................................................................................... 203 What Is CAM? .......................................................................................................................... 203 What Are the Domains of Alternative Medicine? ..................................................................... 204 Can Alternatives Affect My Treatment?................................................................................... 207 Finding CAM References on Impotence.................................................................................... 208 Additional Web Resources......................................................................................................... 216 General References..................................................................................................................... 232 APPENDIX C. RESEARCHING NUTRITION..................................................................................... 235 Overview ................................................................................................................................... 235 Food and Nutrition: General Principles .................................................................................... 236 Finding Studies on Impotence ................................................................................................... 240 Federal Resources on Nutrition................................................................................................. 244 Additional Web Resources......................................................................................................... 244 Vocabulary Builder.................................................................................................................... 247 APPENDIX D. FINDING MEDICAL LIBRARIES ............................................................................... 249
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Overview ................................................................................................................................... 249 Preparation ................................................................................................................................ 249 Finding a Local Medical Library ............................................................................................... 250 Medical Libraries Open to the Public ........................................................................................ 250 APPENDIX E. NIH CONSENSUS STATEMENT ON IMPOTENCE ..................................................... 257 Overview ................................................................................................................................... 257 Abstract ..................................................................................................................................... 258 What Is Impotence? ................................................................................................................... 258 Prevalence and Association with Age........................................................................................ 260 Clinical, Psychological, and Social Impact ................................................................................ 261 Physiology of Erection ............................................................................................................... 262 Erectile Dysfunction.................................................................................................................. 263 Evaluation and Diagnosis ......................................................................................................... 265 Treatment Considerations ......................................................................................................... 269 Improving Public and Professional Knowledge about Impotence ............................................. 274 Directions for Future Research.................................................................................................. 276 Conclusions ............................................................................................................................... 278 Vocabulary Builder.................................................................................................................... 279 ONLINE GLOSSARIES ............................................................................................................... 281 Online Dictionary Directories................................................................................................... 284 IMPOTENCE GLOSSARY........................................................................................................... 287 General Dictionaries and Glossaries ......................................................................................... 312 INDEX.............................................................................................................................................. 314
Introduction
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INTRODUCTION Overview Dr. C. Everett Koop, former U.S. Surgeon General, once said, “The best prescription is knowledge.”1 The Agency for Healthcare Research and Quality (AHRQ) of the National Institutes of Health (NIH) echoes this view and recommends that every patient incorporate education into the treatment process. According to the AHRQ: Finding out more about your condition is a good place to start. By contacting groups that support your condition, visiting your local library, and searching on the Internet, you can find good information to help guide your treatment decisions. Some information may be hard to find—especially if you don’t know where to look.2 As the AHRQ mentions, finding the right information is not an obvious task. Though many physicians and public officials had thought that the emergence of the Internet would do much to assist patients in obtaining reliable information, in March 2001 the National Institutes of Health issued the following warning: The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading.3
Quotation from http://www.drkoop.com. The Agency for Healthcare Research and Quality (AHRQ): http://www.ahcpr.gov/consumer/diaginfo.htm. 3 From the NIH, National Cancer Institute (NCI): http://cancertrials.nci.nih.gov/beyond/evaluating.html. 1 2
2
Impotence
Since the late 1990s, physicians have seen a general increase in patient Internet usage rates. Patients frequently enter their doctor’s offices with printed Web pages of home remedies in the guise of latest medical research. This scenario is so common that doctors often spend more time dispelling misleading information than guiding patients through sound therapies. The Official Patient’s Sourcebook on Impotence has been created for patients who have decided to make education and research an integral part of the treatment process. The pages that follow will tell you where and how to look for information covering virtually all topics related to impotence, from the essentials to the most advanced areas of research. The title of this book includes the word “official.” This reflects the fact that the sourcebook draws from public, academic, government, and peerreviewed research. Selected readings from various agencies are reproduced to give you some of the latest official information available to date on impotence. Given patients’ increasing sophistication in using the Internet, abundant references to reliable Internet-based resources are provided throughout this sourcebook. Where possible, guidance is provided on how to obtain free-ofcharge, primary research results as well as more detailed information via the Internet. E-book and electronic versions of this sourcebook are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). Hard copy users of this sourcebook can type cited Web addresses directly into their browsers to obtain access to the corresponding sites. Since we are working with ICON Health Publications, hard copy Sourcebooks are frequently updated and printed on demand to ensure that the information provided is current. In addition to extensive references accessible via the Internet, every chapter presents a “Vocabulary Builder.” Many health guides offer glossaries of technical or uncommon terms in an appendix. In editing this sourcebook, we have decided to place a smaller glossary within each chapter that covers terms used in that chapter. Given the technical nature of some chapters, you may need to revisit many sections. Building one’s vocabulary of medical terms in such a gradual manner has been shown to improve the learning process. We must emphasize that no sourcebook on impotence should affirm that a specific diagnostic procedure or treatment discussed in a research study, patent, or doctoral dissertation is “correct” or your best option. This sourcebook is no exception. Each patient is unique. Deciding on appropriate
Introduction
3
options is always up to the patient in consultation with their physician and healthcare providers.
Organization This sourcebook is organized into three parts. Part I explores basic techniques to researching impotence (e.g. finding guidelines on diagnosis, treatments, and prognosis), followed by a number of topics, including information on how to get in touch with organizations, associations, or other patient networks dedicated to impotence. It also gives you sources of information that can help you find a doctor in your local area specializing in treating impotence. Collectively, the material presented in Part I is a complete primer on basic research topics for patients with impotence. Part II moves on to advanced research dedicated to impotence. Part II is intended for those willing to invest many hours of hard work and study. It is here that we direct you to the latest scientific and applied research on impotence. When possible, contact names, links via the Internet, and summaries are provided. It is in Part II where the vocabulary process becomes important as authors publishing advanced research frequently use highly specialized language. In general, every attempt is made to recommend “free-to-use” options. Part III provides appendices of useful background reading for all patients with impotence or related disorders. The appendices are dedicated to more pragmatic issues faced by many patients with impotence. Accessing materials via medical libraries may be the only option for some readers, so a guide is provided for finding local medical libraries which are open to the public. Part III, therefore, focuses on advice that goes beyond the biological and scientific issues facing patients with impotence.
Scope While this sourcebook covers impotence, your doctor, research publications, and specialists may refer to your condition using a variety of terms. Therefore, you should understand that impotence is often considered a synonym or a condition closely related to the following: ·
Impotence
·
Male Erectile Disorder
·
Sexual Dysfunction (a Nonspecific Term)
4
Impotence
In addition to synonyms and related conditions, physicians may refer to impotence using certain coding systems. The International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) is the most commonly used system of classification for the world’s illnesses. Your physician may use this coding system as an administrative or tracking tool. The following classification is commonly used for impotence:4 ·
302 sexual disorders
·
302.7 psychosocial dysfunction
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302.70 psychosocial dysfunc nos
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302.71 inhibited sexual desire
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302.72 inhibited sex excitement
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302.79 psychosocial dysfunc nec
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302.8 psychosocial dis nec
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302.89 psychosexual dis nec
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302.9 psychosexual dis nos
·
607.84 impotence, organic origin
For the purposes of this sourcebook, we have attempted to be as inclusive as possible, looking for official information for all of the synonyms relevant to impotence. You may find it useful to refer to synonyms when accessing databases or interacting with healthcare professionals and medical librarians.
Moving Forward Since the 1980s, the world has seen a proliferation of healthcare guides covering most illnesses. Some are written by patients or their family members. These generally take a layperson’s approach to understanding and coping with an illness or disorder. They can be uplifting, encouraging, and highly supportive. Other guides are authored by physicians or other healthcare providers who have a more clinical outlook. Each of these two styles of guide has its purpose and can be quite useful. 4 This list is based on the official version of the World Health Organization’s 9th Revision, International Classification of Diseases (ICD-9). According to the National Technical Information Service, “ICD-9CM extensions, interpretations, modifications, addenda, or errata other than those approved by the U.S. Public Health Service and the Health Care Financing Administration are not to be considered official and should not be utilized. Continuous maintenance of the ICD-9-CM is the responsibility of the federal government.”
Introduction
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As editors, we have chosen a third route. We have chosen to expose you to as many sources of official and peer-reviewed information as practical, for the purpose of educating you about basic and advanced knowledge as recognized by medical science today. You can think of this sourcebook as your personal Internet age reference librarian. Why “Internet age”? All too often, patients diagnosed with impotence will log on to the Internet, type words into a search engine, and receive several Web site listings which are mostly irrelevant or redundant. These patients are left to wonder where the relevant information is, and how to obtain it. Since only the smallest fraction of information dealing with impotence is even indexed in search engines, a non-systematic approach often leads to frustration and disappointment. With this sourcebook, we hope to direct you to the information you need that you would not likely find using popular Web directories. Beyond Web listings, in many cases we will reproduce brief summaries or abstracts of available reference materials. These abstracts often contain distilled information on topics of discussion. While we focus on the more scientific aspects of impotence, there is, of course, the emotional side to consider. Later in the sourcebook, we provide a chapter dedicated to helping you find peer groups and associations that can provide additional support beyond research produced by medical science. We hope that the choices we have made give you the most options available in moving forward. In this way, we wish you the best in your efforts to incorporate this educational approach into your treatment plan. The Editors
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PART I: THE ESSENTIALS
ABOUT PART I Part I has been edited to give you access to what we feel are “the essentials” on impotence. The essentials of a disease typically include the definition or description of the disease, a discussion of who it affects, the signs or symptoms associated with the disease, tests or diagnostic procedures that might be specific to the disease, and treatments for the disease. Your doctor or healthcare provider may have already explained the essentials of impotence to you or even given you a pamphlet or brochure describing impotence. Now you are searching for more in-depth information. As editors, we have decided, nevertheless, to include a discussion on where to find essential information that can complement what your doctor has already told you. In this section we recommend a process, not a particular Web site or reference book. The process ensures that, as you search the Web, you gain background information in such a way as to maximize your understanding.
Guidelines
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CHAPTER 1. THE ESSENTIALS ON IMPOTENCE: GUIDELINES Overview Official agencies, as well as federally-funded institutions supported by national grants, frequently publish a variety of guidelines on impotence. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. The great advantage of guidelines over other sources is that they are often written with the patient in mind. Since new guidelines on impotence can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.
The National Institutes of Health (NIH)5 The National Institutes of Health (NIH) is the first place to search for relatively current patient guidelines and fact sheets on impotence. Originally founded in 1887, the NIH is one of the world’s foremost medical research centers and the federal focal point for medical research in the United States. At any given time, the NIH supports some 35,000 research grants at universities, medical schools, and other research and training institutions, both nationally and internationally. The rosters of those who have conducted research or who have received NIH support over the years include the world’s most illustrious scientists and physicians. Among them are 97 scientists who have won the Nobel Prize for achievement in medicine.
5
Adapted from the NIH: http://www.nih.gov/about/NIHoverview.html.
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There is no guarantee that any one Institute will have a guideline on a specific disease, though the National Institutes of Health collectively publish over 600 guidelines for both common and rare diseases. The best way to access NIH guidelines is via the Internet. Although the NIH is organized into many different Institutes and Offices, the following is a list of key Web sites where you are most likely to find NIH clinical guidelines and publications dealing with impotence and associated conditions: ·
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
·
National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines available at http://www.nlm.nih.gov/medlineplus/healthtopics.html
·
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm
Among these, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) is particularly noteworthy. The NIDDK’s mission is to conduct and support research on many of the most serious diseases affecting public health.6 The Institute supports much of the clinical research on the diseases of internal medicine and related subspecialty fields as well as many basic science disciplines. The NIDDK’s Division of Intramural Research encompasses the broad spectrum of metabolic diseases such as diabetes, inborn errors of metabolism, endocrine disorders, mineral metabolism, digestive diseases, nutrition, urology and renal disease, and hematology. Basic research studies include biochemistry, nutrition, pathology, histochemistry, chemistry, physical, chemical, and molecular biology, pharmacology, and toxicology. NIDDK extramural research is organized into divisions of program areas: ·
Division of Diabetes, Endocrinology, and Metabolic Diseases
·
Division of Digestive Diseases and Nutrition
·
Division of Kidney, Urologic, and Hematologic Diseases
The Division of Extramural Activities provides administrative support and overall coordination. A fifth division, the Division of Nutrition Research Coordination, coordinates government nutrition research efforts. The Institute supports basic and clinical research through investigator-initiated This paragraph has been adapted from the NIDDK: http://www.niddk.nih.gov/welcome/mission.htm. “Adapted” signifies that a passage is reproduced exactly or slightly edited for this book. 6
Guidelines 11
grants, program project and center grants, and career development and training awards. The Institute also supports research and development projects and large-scale clinical trials through contracts. The following patient guideline was recently published by the NIDDK on impotence.
What Is Impotence?7 Impotence is a consistent inability to sustain an erection sufficient for sexual intercourse. Medical professionals often use the term “erectile dysfunction” to describe this disorder and to differentiate it from other problems that interfere with sexual intercourse, such as lack of sexual desire and problems with ejaculation and orgasm. This fact sheet focuses on impotence defined as erectile dysfunction. Impotence can be a total inability to achieve erection, an inconsistent ability to do so, or a tendency to sustain only brief erections. These variations make defining impotence and estimating its incidence difficult. Experts believe impotence affects between 10 and 15 million American men. In 1985, the National Ambulatory Medical Care Survey counted 525,000 doctor-office visits for erectile dysfunction. Impotence usually has a physical cause, such as disease, injury, or drug sideeffects. Any disorder that impairs blood flow in the penis has the potential to cause impotence. Incidence rises with age: about 5 percent of men at the age of 40 and between 15 and 25 percent of men at the age of 65 experience impotence. Yet, it is not an inevitable part of aging. Impotence is treatable in all age groups, and awareness of this fact has been growing. More men have been seeking help and returning to near-normal sexual activity because of improved, successful treatments for impotence. Urologists, who specialize in problems of the urinary tract, have traditionally treated impotence--especially complications of impotence.
How Does an Erection Occur? The penis contains two chambers, called the corpora cavernosa, which run the length of the organ (see figure 1). A spongy tissue fills the chambers. The corpora cavernosa are surrounded by a membrane, called the tunica Adapted from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK): http://www.niddk.nih.gov/health/urolog/pubs/impotnce/impotnce.htm. 7
12 Impotence
albuginea. The spongy tissue contains smooth muscles, fibrous tissues, spaces, veins, and arteries. The urethra, which is the channel for urine and ejaculate, runs along the underside of the corpora cavernosa. Erection begins with sensory and mental stimulation. Impulses from the brain and local nerves cause the muscles of the corpora cavernosa to relax, allowing blood to flow in and fill the open spaces. The blood creates pressure in the corpora cavernosa, making the penis expand. The tunica albuginea helps to trap the blood in the corpora cavernosa, thereby sustaining erection. Erection is reversed when muscles in the penis contract, stopping the inflow of blood and opening outflow channels.
What Causes Impotence? Since an erection requires a sequence of events, impotence can occur when any of the events is disrupted. The sequence includes nerve impulses in the brain, spinal column, and area of the penis, and response in muscles, fibrous tissues, veins, and arteries in and near the corpora cavernosa.
Guidelines 13
Damage to arteries, smooth muscles, and fibrous tissues, often as a result of disease, is the most common cause of impotence. Diseases--including diabetes, kidney disease, chronic alcoholism, multiple sclerosis, atherosclerosis, and vascular disease--account for about 70 percent of cases of impotence. Between 35 and 50 percent of men with diabetes experience impotence. Surgery (for example, prostate surgery) can injure nerves and arteries near the penis, causing impotence. Injury to the penis, spinal cord, prostate, bladder, and pelvis can lead to impotence by harming nerves, smooth muscles, arteries, and fibrous tissues of the corpora cavernosa. Also, many common medicines produce impotence as a side effect. These include high blood pressure drugs, antihistamines, antidepressants, tranquilizers, appetite suppressants, and cimetidine (an ulcer drug). Experts believe that psychological factors cause 10 to 20 percent of cases of impotence. These factors include stress, anxiety, guilt, depression, low selfesteem, and fear of sexual failure. Such factors are broadly associated with more than 80 percent of cases of impotence, usually as secondary reactions to underlying physical causes. Other possible causes of impotence are smoking, which affects blood flow in veins and arteries, and hormonal abnormalities, such as insufficient testosterone.
How Is Impotence Diagnosed? Patient History Medical and sexual histories help define the degree and nature of impotence. A medical history can disclose diseases that lead to impotence. A simple recounting of sexual activity might distinguish between problems with erection, ejaculation, orgasm, or sexual desire. A history of using certain prescription drugs or illegal drugs can suggest a chemical cause. Drug effects account for 25 percent of cases of impotence. Cutting back on or substituting certain medications often can alleviate the problem.
14 Impotence
Physical Examination A physical examination can give clues for systemic problems. For example, if the penis does not respond as expected to certain touching, a problem in the nervous system may be a cause. Abnormal secondary sex characteristics, such as hair pattern, can point to hormonal problems, which would mean the endocrine system is involved. A circulatory problem might be indicated by, for example, an aneurysm in the abdomen. And unusual characteristics of the penis itself could suggest the root of the impotence--for example, bending of the penis during erection could be the result of Peyronie’s disease.
Laboratory Tests Several laboratory tests can help diagnose impotence. Tests for systemic diseases include blood counts, urinalysis, lipid profile, and measurements of creatinine and liver enzymes. For cases of low sexual desire, measurement of testosterone in the blood can yield information about problems with the endocrine system. Other Tests Monitoring erections that occur during sleep (nocturnal penile tumescence) can help rule out certain psychological causes of impotence. Healthy men have involuntary erections during sleep. If nocturnal erections do not occur, then the cause of impotence is likely to be physical rather than psychological. Tests of nocturnal erections are not completely reliable, however. Scientists have not standardized such tests and have not determined when they should be applied for best results.
Psychosocial Examination A psychosocial examination, using an interview and questionnaire, reveals psychological factors. The man’s sexual partner also may be interviewed to determine expectations and perceptions encountered during sexual intercourse.
Guidelines 15
How Is Impotence Treated? Most physicians suggest that treatments for impotence proceed along a path moving from least invasive to most invasive. This means cutting back on any harmful drugs is considered first. Psychotherapy and behavior modifications are considered next, followed by vacuum devices, oral drugs, locally injected drugs, and surgically implanted devices (and, in rare cases, surgery involving veins or arteries).
Psychotherapy Experts often treat psychologically based impotence using techniques that decrease anxiety associated with intercourse. The patient’s partner can help apply the techniques, which include gradual development of intimacy and stimulation. Such techniques also can help relieve anxiety when physical impotence is being treated. Drug Therapy Drugs for treating impotence 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 approved sildenafil citrate (marketed as Viagra), the first oral pill to treat impotence. Taken 1 hour before sexual activity, sildenafil works by enhancing the effects of nitric oxide, a chemical that relaxes smooth muscles in the penis during sexual stimulation, allowing increased blood flow. While sildenafil improves the response to sexual stimulation, it does not trigger an automatic erection as injection drugs do. The recommended dose is 50 mg, and the physician may adjust this dose to 100 mg or 25 mg, depending on the needs of the patient. The drug should not be used more than once a day. Oral testosterone can reduce impotence in some men with low levels of natural testosterone. Patients also have claimed effectiveness of other oral drugs--including yohimbine hydrochloride, dopamine and serotonin agonists, and trazodone--but no scientific studies have proved the effectiveness of these drugs in relieving impotence. Some observed improvements following their use may be examples of the placebo effect, that is, a change that results simply from the patient’s believing that an improvement will occur.
16 Impotence
Many men gain potency by injecting drugs into the penis, causing it to become engorged with blood. Drugs such as papaverine hydrochloride, phentolamine, and alprostadil (marked 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, sometimes can enhance erection when rubbed on the surface of the penis. A system for inserting a pellet of alprostadil into the urethra is marketed as MUSE. The system uses a pre-filled applicator to deliver the pellet about an inch deep into the urethra at the tip of the penis. An erection will begin within 8 to 10 minutes and may last 30 to 60 minutes. The most common side effects of the preparation are aching in the penis, testicles, and area between the penis and rectum; warmth or burning sensation in the urethra; redness of the penis due to increased blood flow; and minor urethral bleeding or spotting. Research on drugs for treating impotence is expanding rapidly. Patients should ask their doctors about the latest advances. Vacuum Devices Mechanical vacuum devices cause erection by creating a partial vacuum around the penis, which draws blood into the penis, engorging it and expanding it. The devices have three components: a plastic cylinder, in which the penis is placed; a pump, which draws air out of the cylinder; and an elastic band, which is placed around the base of the penis, to maintain the erection after the cylinder is removed and during intercourse by preventing blood from flowing back into the body (see figure 2). One variation of the vacuum device involves a semirigid rubber sheath that is placed on the penis and remains there after attaining erection and during intercourse.
Guidelines 17
Surgery Surgery usually has one of three goals: ·
To implant a device that can cause the penis to become erect,
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To reconstruct arteries to increase flow of blood to the penis,
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To block off veins that allow blood to leak from the penile tissues.
Implanted devices, known as prostheses, can restore erection in many men with impotence. Possible problems with implants include mechanical breakdown and infection. Mechanical problems have diminished in recent years because of technological advances. Malleable implants usually consist of paired rods, which are inserted surgically into the corpora cavernosa, the twin chambers running the length of the penis. The user manually adjusts the position of the penis and, therefore, the rods. Adjustment does not affect the width or length of the penis.
18 Impotence
Inflatable implants consist of paired cylinders, which are surgically inserted inside the penis and can be expanded using pressurized fluid (see figure 3). Tubes connect the cylinders to a fluid reservoir and pump, which also are surgically implanted. The patient inflates the cylinders by pressing on the small pump, located under the skin in the scrotum. Inflatable implants can expand the length and width of the penis somewhat. They also leave the penis in a more natural state when not inflated.
Surgery to repair arteries can reduce impotence caused by obstructions that block the flow of blood to the penis. The best candidates for such surgery are young men with discrete blockage of an artery because of an injury to the crotch area or fracture of the pelvis. The procedure is less successful in older men with widespread blockage. Surgery to veins that allow blood to leave the penis usually involves an opposite procedure--intentional blockage. Blocking off veins (ligation) can reduce the leakage of blood that diminishes rigidity of the penis during erection. However, experts have raised questions about this procedure’s long-term effectiveness.
Guidelines 19
What Will the Future Bring? Advances in suppositories, injectable medications, implants, and vacuum devices have expanded the options for men seeking treatment for impotence. These advances also have helped increase the number of men seeking treatment. An oral form of the drug phentolamine may soon join sildenafil in the armamentarium of noninvasive treatments for impotence. Other treatments in the experimental stages include reconstruction surgery for damaged veins and arteries in the penis. Whether or not this method proves to be safe and effective, ongoing improvements in traditional methods should continue to create more successful and widespread treatment of impotence.
Points to Remember ·
Impotence is a consistent inability to sustain an erection sufficient for sexual intercourse.
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Impotence affects 10 to 15 million American men.
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Impotence usually has a physical cause.
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Impotence is treatable in all age groups.
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Treatments include psychotherapy, drug therapy, vacuum devices, and surgery.
For More Information For more information, contact: Impotence Information Center P.O. Box 9 Minneapolis, MN 55440 1-800-843-4315 Sexual Function Health Council American Foundation for Urologic Disease 300 West Pratt Street Suite 401 Baltimore, MD 21201 1-800-242-2383
20 Impotence
The Geddings Osbon, Sr. Foundation P.O. Drawer 1593 Augusta, GA 30903-1593 1-800-433-4215 National Kidney and Urologic Diseases Information Clearinghouse 3 Information Way Bethesda, MD 20892-3580 E-mail: National Kidney and Urologic Diseases Information Clearinghouse The National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The NIDDK is part of the National Institutes of Health under the U.S. Public Health Service. Established in 1987, the clearinghouse provides information about diseases of the kidneys and urologic system to people with kidney and urologic disorders and to their families, health care professionals, and the public. NKUDIC answers inquiries; develops, reviews, and distributes publications; and works closely with professional and patient organizations and Government agencies to coordinate resources about kidney and urologic diseases. Publications produced by the clearinghouse are carefully reviewed for scientific accuracy, content, and readability.
More Guideline Sources The guideline above on impotence is only one example of the kind of material that you can find online and free of charge. The remainder of this chapter will direct you to other sources which either publish or can help you find additional guidelines on topics related to impotence. Many of the guidelines listed below address topics that may be of particular relevance to your specific situation or of special interest to only some patients with impotence. Due to space limitations these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly.
Topic Pages: MEDLINEplus For patients wishing to go beyond guidelines published by specific Institutes of the NIH, the National Library of Medicine has created a vast and patient-
Guidelines 21
oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages.” You can think of a health topic page as a guide to patient guides. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following as being relevant to impotence: ·
Guides On impotence Impotence http://www.nlm.nih.gov/medlineplus/impotence.html
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Other Guides Male Genital Disorders http://www.nlm.nih.gov/medlineplus/malegenitaldisorders.html
Within the health topic page dedicated to impotence, the following was recently recommended to patients: ·
General/Overviews Endocrinology and Impotence (Erectile Dysfunction) Source: Endocrine Society http://www.endosociety.org/pubrelations/patientInfo/impotence.htm Erectile Dysfunction Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=DS00162
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Diagnosis/Symptoms Testosterone Test Source: American Association for Clinical Chemistry http://labtestsonline.org/understanding/analytes/testosterone/glan ce.html
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Treatment Erectile Dysfunction - Viagra Source: Patient Education Institute http://www.nlm.nih.gov/medlineplus/tutorials/erectiledysfunction viagraloader.html
22 Impotence
Testosterone Replacement Therapy - Many Effective Treatments Available Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=MC00004 Viagra Online: Is It Safe? Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?objectid=6BAEB2AA-EF224F04-B949E11FD66D6F8A&locID= Viagra: Proper Use Can Restore Erections Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=MC00011 ·
Coping Where to Seek Professional Help: Sexuality and Cancer Source: American Cancer Society http://www.cancer.org/eprise/main/docroot/MIT/content/MIT_7 _2X_Where_To_Seek_Professional_Help_Women
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Specific Conditions/Aspects Erectile Dysfunction and Diabetes: Many Possible Solutions Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=DA00045 Male Sexual Problems Source: American Association for Marriage and Family Therapy http://www.aamft.org/families/Consumer_Updates/MaleSexualPr oblems.htm Patient's Guide to Low Testosterone Source: Endocrine Society, Hormone Foundation http://www.medem.com/medlb/article_detaillb.cfm?article_ID=ZZ ZO7PDVDLC&sub_cat=57 Truth about Impotence Treatment Claims Source: Federal Trade Commission http://www.ftc.gov/bcp/conline/pubs/alerts/impoalrt.htm
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·
From the National Institutes of Health Impotence Source: National Institute of Diabetes and Digestive and Kidney Diseases http://www.niddk.nih.gov/health/urolog/pubs/impotnce/impotnc e.htm
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Latest News Company Touts New Erectile Drug Source: 05/27/2002, Associated Press http://www.nlm.nih.gov/medlineplus/news/fullstory_7788.html Gene Therapy May Offer Long-term Impotence Remedy Source: 05/29/2002, Reuters Health http://www.nlm.nih.gov/medlineplus/news/fullstory_7819.html Viagra Alternative Shows Promise Source: 05/28/2002, Reuters Health http://www.nlm.nih.gov/medlineplus/news/fullstory_7796.html
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Organizations American Foundation for Urologic Disease http://www.afud.org/ Directory of Kidney and Other Urologic Diseases Organizations Source: National Institute of Diabetes and Digestive and Kidney Diseases http://www.niddk.nih.gov/health/kidney/pubs/kuorg/kuorg.htm National Institute of Diabetes and Digestive and Kidney Diseases http://www.niddk.nih.gov/
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Pictures/Diagrams Overview of the Male Anatomy Source: University of Utah, Health Sciences Center http://www.uuhsc.utah.edu/healthinfo/adult/Men/maleanat.htm
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Research Regular Cycling Can Improve Sexual Function in Men With Heart Failure Source: American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=11999
24 Impotence
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Statistics JAMA Patient Page: Sexual Dysfunction -- Silence About Sexual Problems Can Hurt Relationships Source: American Medical Association http://www.medem.com/MedLB/article_detaillb.cfm?article_ID=Z ZZSAC20NAC&sub_cat=2 Kidney and Urologic Disease Statistics for the United States Source: National Kidney and Urologic Diseases Information Clearinghouse http://www.niddk.nih.gov/health/kidney/pubs/kustats/kustats.ht m
If you do not find topics of interest when browsing health topic pages, then you can choose to use the advanced search utility of MEDLINEplus at http://www.nlm.nih.gov/medlineplus/advancedsearch.html. This utility is similar to the NIH Search Utility, with the exception that it only includes material linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search.
The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on impotence and related conditions. One of the advantages of CHID over other sources is that it offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: ·
[Geddings Osbon, Sr. Foundation Information Packet] Source: Augusta, GA: Geddings Osbon Sr. Foundation. 1995. [70 p.]. Contact: Available from Geddings Osbon Sr. Foundation. P.O. Box 1593, Augusta, GA 30903. (800) 433-4215. Price: Single copy free. Summary: This information packet from the Geddings D. Osbon, Sr. Foundation contains information about impotence. Included are two
Guidelines 25
booklets on male impotence, one a treatment guide written for men, the other a woman's perspective on the problem of male impotence. Also included are fact sheets on the Foundation and its work; diabetes and erectile dysfunction; heart disease and erectile dysfunction; impotence statistics and facts; and the 1992 NIH Consensus Development Conference on impotence. A recommended patient management algorithm for erectile dysfunction is also included. The materials are presented in a printed folder. ·
Diabetes [Equals] Impotence? Source: Minnetonka, MN: American Medical Systems. 1998. [4 p.]. Contact: Available from American Medical Systems. 10700 Bren Road West, Minnetonka, MN 55343. (800) 843-4315 or (800) 328-3881. Fax (612) 930-6157. Website: www.VisitAMS.com. Price: Single copy free. Order number 21600014D. Summary: This article uses a question and answer format to explain how diabetes is related to erectile dysfunction (ED) and what treatment options are available. ED, a condition in which a man is not able to have an erection that is firm enough or that lasts long enough to have successful sexual intercourse, is one of the most common problems men with diabetes may experience. Although the cause of the high prevalence of ED among men with diabetes is unknown, it is possible that the nerves or blood vessels that control the flow of blood to the penis may become permanently damaged as a result of diabetes. Treatment options include keeping diabetes in tight control; receiving counseling from a qualified psychologist, psychiatrist, or sex therapist; taking oral medications; using intra-urethral suppositories, injection therapy, or vacuum erection devices; and undergoing vascular surgery.
·
Diabetes and Male Impotence: Information and Treatment Guide Source: Augusta, GA: Geddings Osbon Sr. Foundation. 1995. 2 p. Contact: Available from Geddings Osbon Sr. Foundation. P.O. Box 1593, Augusta, GA 30903. (800) 433-4215. Price: Single copy free. Summary: This brochure provides an overview of diabetes and male erectile dysfunction (impotence). The brochure defines impotence and encourages readers who are experiencing impotence to seek health care advice. The brochure addresses common myths and provides facts in the areas of impotence and aging, the diagnosis of impotence, and impotence as a key indicator of total health. The brochure then focuses on treatment, emphasizing the importance of choosing a treatment that is right for both the patient and his partner. The brochure concludes with a brief
26 Impotence
description of presently available treatments for impotence, including counseling or sex therapy, topical vasodilators, oral medications, hormone replacement therapy, external vacuum therapy, penile injection therapy, penile prostheses, and penile reconstruction and venous ligation procedures. ·
Your Question and Answer Guide for Impotence Treatment Source: Augusta, GA: Osbon Medical Systems. 1995. 8 p. Contact: Available from Osbon Medical Systems. 1253 Broad Street, Augusta, GA 30903. (800) 438-8592 or (706) 821-6879. Price: Single copy free; bulk orders available to health professionals. Summary: This booklet provides basic information about impotence, or male erectile dysfunction. Topics include a definition of impotence; causes; treatment options and health care providers who treat impotence; and choosing the treatment option that is best for each individual. Treatment options include sex counseling or sex therapy, yohimbine, hormone replacement therapy, external vacuum therapy, penile injection therapy, and penile implant surgery. The booklet emphasizes the use of external vacuum therapy, including detailed illustrations of how the system works. The final page of the booklet provides a quick reference guide to the medical and surgical treatment alternatives for impotence and the advantages and disadvantages of each. 8 figures.
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Impotence: You Can Do Something About It! Source: Santa Barbara, CA: Mentor Urology. 1994. 11 p. Contact: Available from Mentor Urology. 5425 Hollister Avenue, Santa Barbara, CA 93111. (800) 235-5731 or (805) 681-6000. Fax (805) 967-7108. Price: Single copy free. Summary: This brochure is designed to help readers better understand erectile dysfunction (impotence) and its causes and to become more comfortable with the subject. The brochure stresses that a consultation with a urologist who is experienced in evaluating and treating impotence is the best source of information. Written in a question and answer format, the booklet discusses the physiology of erection, some of the potential causes of impotence, psychological versus physical impotence, diagnostic tests used to confirm physical impotence, and treatment options including counseling, drug therapy, vacuum erection devices, penile injection therapy, vascular reconstructive surgery, venous ligation, and penile implants. The brochure concludes with a brief discussion of insurance considerations. 4 references.
Guidelines 27
·
Male Impotence: A Treatment Guide Source: Augusta, GA: Geddings Osbon Sr. Foundation. 1993. 23 p. Contact: Available from Geddings Osbon Sr. Foundation. P.O. Box 1593, Augusta, GA 30903. (800) 433-4215. Price: Single copy free; bulk orders for physicians available at $1.00 per booklet. Summary: This booklet is a general guide for men who are impotent. It is designed to help men understand erectile dysfunction (impotence), what causes it, and what treatments are available. The booklet is written to help patients be more comfortable discussing impotence with their physicians and, along with their partners, in choosing a treatment best suited for their own needs. Topics include the evaluation of erectile dysfunction; causes of erectile dysfunction; working with health care providers; impotence treatments, including counseling, topical vasodilators, oral medications, hormone replacement therapy, external vacuum therapy, penile injection therapy, penile prosthesis, and penile reconstruction and venous ligation; and cost and insurance issues. 6 figures.
·
Male Impotence: A Woman's Perspective Source: Augusta, GA: Geddings Osbon Sr. Foundation. 1993. 25 p. Contact: Available from Geddings Osbon Sr. Foundation. P.O. Box 1593, Augusta, GA 30903. (800) 433-4215. Price: Single copy free; bulk orders for physicians available at $1.00 per booklet. Summary: This booklet, written from the woman's perspective, is a general guide for those in a relationship with a partner who suffers from erectile dysfunction (impotence). The booklet discusses impotence, what causes it, what treatments are available, and its psychological impact on the couple. The booklet is written to encourage discussion of impotence with a physician and to help men, along with their partners, choose the best treatment for their needs. Topics include the effects of impotence on a relationship; how erectile dysfunction is diagnosed; causes of erectile dysfunction; working with health care providers; impotence treatments, including counseling, oral medications, hormone replacement therapy, external vacuum therapy, penile injections, penile implants, and vascular reconstructive surgery; premature ejaculation; and the importance of effective communication between partners. 8 figures.
·
Patient's Guide for the Treatment of Impotence Source: Augusta, GA: Geddings Osbon Sr. Foundation. 1993. 33 p.
28 Impotence
Contact: Available from Geddings Osbon Sr. Foundation. P.O. Box 1593, Augusta, GA 30903. (800) 433-4215. Price: Single copy free; bulk orders for physicians available at $1.00 per booklet. Summary: This booklet is a general guide to the treatment options available for men who are impotent. It is designed to help men understand erectile dysfunction (impotence) and its treatments. The booklet is written to help patients be more comfortable discussing impotence with their physicians and, along with their partners, choose the best treatment for their own needs. Topics include the evaluation of erectile dysfunction; causes of erectile dysfunction; working with health care providers; impotence treatments, including sex counseling and therapy, Yohimbine tablets, hormone replacement therapy, external vacuum therapy, penile injection therapy, penile prosthesis, and vascular surgery; choosing a treatment; and cost and insurance issues. One chart summarizes the advantages and disadvantages of each of the treatment choices. 11 figures. 1 table. ·
Impotence: A Guide for Men With Diabetes Source: Minnetonka, MN: American Medical Systems, Inc. 1993. 4 p. Contact: Available from Impotence Information Center, American Medical Systems, Inc. P.O. Box 9, Minneapolis, MN 55440. (800) 843-4315. Price: Single copy free. Order number 21600022. Summary: This brochure, written for men with diabetes, outlines the condition of impotence (erectile dysfunction), why it occurs, and the treatment options available. The brochure notes that the overall incidence of impotence in men with diabetes is two to five times higher than it is in the general male population. However, this does not mean that impotence is inevitable or permanent in these men. Written in a question and answer format, the brochure defines impotence, covers the physical and psychological factors that can contribute to impotence, considers the impact of diabetes on erectile function, notes the diagnostic tests used to confirm a diagnosis of impotence, and outlines treatment options. The brochure stresses that problems with physical impotence may be minimized by keeping diabetes in tight control. This means keeping blood sugar levels within normal ranges as much as possible. Treatment options covered include counseling, medication, vacuum devices, injection therapy, vascular surgery, and penile prostheses. The brochure encourages readers to work closely with their health care providers to diagnose and treat any impotence problems.
Guidelines 29
·
Impotence: Causes and Treatments Source: Minneapolis, MN: American Medical Systems. 1991. 8 p. Contact: Available from American Medical Systems. Pfizer Hospital Products Group. 1101 Bren Road East, Minnetonka, MN 55343. (800) 3283881. Price: Free. Publication No. 10313. Order Number 21000435. Summary: This pamphlet explains penile/erectile physiology, the psychological and physical causes of impotence, and the diagnosis and treatment of impotence. Treatments discussed include the use of penile implants, especially the American Medical System (AMS) malleable semirigid rod prosthesis and the AMS inflatable penile prosthesis.
·
Diabetes and Impotence Source: Lenexa, KS: Diagnostic Center for Men, Integrated Medical Resources, Inc. 199x. 2 p. Contact: Available from Diagnostic Center for Men, Integrated Medical Resources, Inc. 8326 Melrose Drive, Lenexa, KS 66214. (800) 331-4636 or (913) 894-0591. Price: Single copy free. Summary: This brochure provides general information about erectile dysfunction (impotence) in men with diabetes. The brochure is designed to help readers feel more comfortable with the subject and to better understand the causes and treatments of this common health problem. Written in a question and answer format, the brochure defines impotence and discusses how diabetes may cause impotence. Also reviewed are diagnostic tests used to confirm impotence, and treatment options, including counseling, drug therapy, external vacuum devices, and surgery. The brochure concludes with a brief discussion of costs and insurance coverage.
·
Understanding Erectile Dysfunction (Impotence): A Common and Treatable Problem. [Como Entender Mejor Los Trastornos de la Ereccion: Un Problema Comun Que Puede Tratarse] Source: San Bruno, CA: StayWell Company. 1999. 15 p. Contact: Available from StayWell Company. Order Department, 1100 Grundy Lane, San Bruno, CA 94066-9821. (800) 333-3032. Fax (650) 2444512. E-mail:
[email protected]. Website: www.staywell.com. Price: $1.35 plus shipping and handling. Summary: This patient education brochure offers a guide to erectile dysfunction (ED, or impotence). The brochure emphasizes that ED is a common problem and that most men can be helped with medical treatment or counseling. Diagnosis begins with a thorough history,
30 Impotence
physical exam, and lab tests. The psychological causes of ED include depression, stress, performance anxiety, and misinformation about sexuality. The physical causes of ED include drug effects (very common), blood flow abnormalities (including those caused by systemic diseases such as diabetes mellitus or hardening of the arteries), nerve impulse abnormalities, and hormonal abnormalities. The brochure reviews the anatomy and physiology of erection, with labeled illustrations showing the flaccid (soft) penis, the tumescent (swollen) penis, and the erect (rigid) penis, and describes the normal changes that occur as the man ages. The brochure outlines the types of questions that will be asked during the patient history taking, including in the areas of medical history, sexual history, and psychological history. The physical examination will include laboratory tests, penile blood flow studies, sleep monitoring, rectal examination, and tests for genetic abnormalities (such as Peyronie's disease). The brochure then describes the nonsurgical treatments available, including medications, vacuum erection therapy, transurethral therapy, and penile self injection; and surgical options (penile implants), including malleable implants, self contained inflatable implants, and fully inflatable implants. The brochure concludes with general suggestions for improved sex and intimacy, in the areas of sharing and relaxing, relapse exercises, tips for better physical intimacy, and the importance of good general health. The brochure is illustrated with full color line drawings. The brochure is available in English or Spanish. 32 figures.
The National Guideline Clearinghouse™ The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search their site located at http://www.guideline.gov by using the keyword “impotence” or synonyms. The following was recently posted: ·
AACE clinical practice guidelines for the evaluation and treatment of hypogonadism in adult male patients. Source: American Association of Clinical Endocrinologists/American College of Endocrinology.; 1996; 28 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 0454&sSearch_string=impotence
Guidelines 31
·
ACR Appropriateness Criteria™ for thrombolysis for lower extremity arterial and graft occlusions. Source: American College of Radiology.; 1996 (revised 1999); 14 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1725&sSearch_string=impotence
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Benign prostatic hyperplasia. Source: Finnish Medical Society Duodecim.; 2001 April 30; Various pagings http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 2081&sSearch_string=impotence
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Diagnosis and management of hypertension in the primary care setting. Source: Department of Defense/Veterans Health Administration.; 1999 May; Various pagings http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1805&sSearch_string=impotence
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Drug treatment for hyperlipidaemias. Source: Finnish Medical Society Duodecim.; 2001 April 4; Various pagings http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1837&sSearch_string=impotence
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Herniated disc. In: North American Spine Society phase III clinical guidelines for multidisciplinary spine care specialists. Source: North American Spine Society.; 2000; 104 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 2029&sSearch_string=impotence
32 Impotence
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Massachusetts guidelines for adult diabetes care. Source: Massachusetts Department of Public Health, Bureau of Family and Community Health, Diabetes Control Program.; 1999 June; Various pagings http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1389&sSearch_string=impotence
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Pharmacologic treatment of acute major depression and dysthymia. Source: American College of Physicians-American Society of Internal Medicine.; 2000; 5 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1773&sSearch_string=impotence
Healthfinder™ Healthfinder™ is an additional source sponsored by the U.S. Department of Health and Human Services which offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: ·
Confronting Erectile Dysfunction as a Team Summary: This fact sheet seeks to answer some of your questions about erectile dysfunction (ED), also known as impotence. Source: American Foundation for Urologic Disease http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=3949
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FAQ - About Viagra Summary: In response to numerous inquiries, the FDA answers your questions online concerning Viagra, the first oral pill approved to treat impotence. Source: Center for Drug Evaluation and Research, U.S. Food and Drug Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=2266
Guidelines 33
·
Impotence Summary: Impotence is a consistent inability to sustain an erection sufficient for sexual intercourse. This fact sheet focuses on impotence defined as erectile dysfunction. Source: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=827
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Impotence Resource Web Site Summary: This web site is designed to provide both consumers and medical professionals with reliable information about impotence. Source: American Foundation for Urologic Disease http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=3948
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International Journal of Impotence Research Summary: This publication is designed to assist Urologists, impotence specialists, vascular surgeons, sex therapists and psychiatrists in keeping abreast of new developments in the treatment of impotence. Source: Commercial Entity--Follow the Resource URL for More Information http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=1949
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The Truth About Impotence Treatment Claims Alert Summary: Tips for evaluating claims concerning healthcare or medical products that promises a miracle cure for impotence. Source: Federal Trade Commission http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=4506
The NIH Search Utility After browsing the references listed at the beginning of this chapter, you may want to explore the NIH Search Utility. This allows you to search for
34 Impotence
documents on over 100 selected Web sites that comprise the NIH-WEBSPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to impotence. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html.
Additional Web Sources A number of Web sites that often link to government sites are available to the public. These can also point you in the direction of essential information. The following is a representative sample: ·
AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats
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drkoop.comÒ: http://www.drkoop.com/conditions/ency/index.html
·
Family Village: http://www.familyvillage.wisc.edu/specific.htm
·
Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/
·
Med Help International: http://www.medhelp.org/HealthTopics/A.html
·
Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/
·
Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/
·
WebMDÒHealth: http://my.webmd.com/health_topics
Vocabulary Builder The material in this chapter may have contained a number of unfamiliar words. The following Vocabulary Builder introduces you to terms used in this chapter that have not been covered in the previous chapter: Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally
Guidelines 35
stimulated by naturally occurring substances. [EU] Alprostadil: A potent vasodilator agent that increases peripheral blood flow. It inhibits platelet aggregation and has many other biological effects such as bronchodilation, mediation of inflammation, etc. [NIH] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Aneurysm: A sac formed by the dilatation of the wall of an artery, a vein, or the heart. The chief signs of arterial aneurysm are the formation of a pulsating tumour, and often a bruit (aneurysmal bruit) heard over the swelling. Sometimes there are symptoms from pressure on contiguous parts. [EU]
Antidepressant: An agent that stimulates the mood of a depressed patient, including tricyclic antidepressants and monoamine oxidase inhibitors. [EU] Antihistamine: A drug that counteracts the action of histamine. The antihistamines are of two types. The conventional ones, as those used in allergies, block the H1 histamine receptors, whereas the others block the H2 receptors. Called also antihistaminic. [EU] Anxiety: The unpleasant emotional state consisting of psychophysiological responses to anticipation of unreal or imagined danger, ostensibly resulting from unrecognized intrapsychic conflict. Physiological concomitants include increased heart rate, altered respiration rate, sweating, trembling, weakness, and fatigue; psychological concomitants include feelings of impending danger, powerlessness, apprehension, and tension. [EU] Atrophy: A wasting away; a diminution in the size of a cell, tissue, organ, or part. [EU] Biopsy: The removal and examination, usually microscopic, of tissue from the living body, performed to establish precise diagnosis. [EU] Cimetidine: A histamine congener, it competitively inhibits histamine binding to H2 receptors. Cimetidine has a range of pharmacological actions. It inhibits gastric acid secretion, as well as pepsin and gastrin output. It also blocks the activity of cytochrome P-450. [NIH] Cirrhosis: Liver disease characterized pathologically by loss of the normal microscopic lobular architecture, with fibrosis and nodular regeneration. The term is sometimes used to refer to chronic interstitial inflammation of any organ. [EU] Distention: The state of being distended or enlarged; the act of distending. [EU]
Ejaculation: A sudden act of expulsion, as of the semen. [EU] Elastic: Susceptible of resisting and recovering from stretching, compression or distortion applied by a force. [EU]
36 Impotence
Endocrinology: A subspecialty of internal medicine concerned with the metabolism, physiology, and disorders of the endocrine system. [NIH] Enzyme: A protein molecule that catalyses chemical reactions of other substances without itself being destroyed or altered upon completion of the reactions. Enzymes are classified according to the recommendations of the Nomenclature Committee of the International Union of Biochemistry. Each enzyme is assigned a recommended name and an Enzyme Commission (EC) number. They are divided into six main groups; oxidoreductases, transferases, hydrolases, lyases, isomerases, and ligases. [EU] Erection: The condition of being made rigid and elevated; as erectile tissue when filled with blood. [EU] Extraction: The process or act of pulling or drawing out. [EU] Extremity: A limb; an arm or leg (membrum); sometimes applied specifically to a hand or foot. [EU] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH] Ferritin: An iron-containing protein complex that is formed by a combination of ferric iron with the protein apoferritin. [NIH] Fibrosis: The formation of fibrous tissue; fibroid or fibrous degeneration [EU] Flaccid: Weak, lax and soft. [EU] Hematology: A subspecialty of internal medicine concerned with morphology, physiology, and pathology of the blood and blood-forming tissues. [NIH] Hyperlipidaemia: A general term for elevated concentrations of any or all of the lipids in the plasma, including hyperlipoproteinaemia, hypercholesterolaemia, etc. [EU] Hyperplasia: The abnormal multiplication or increase in the number of normal cells in normal arrangement in a tissue. [EU] Hypertension: Persistently high arterial blood pressure. Various criteria for its threshold have been suggested, ranging from 140 mm. Hg systolic and 90 mm. Hg diastolic to as high as 200 mm. Hg systolic and 110 mm. Hg diastolic. Hypertension may have no known cause (essential or idiopathic h.) or be associated with other primary diseases (secondary h.). [EU] Hypogonadism: A condition resulting from or characterized by abnormally decreased functional activity of the gonads, with retardation of growth and sexual development. [EU] Impotence: The inability to perform sexual intercourse. [NIH] Invasive: 1. having the quality of invasiveness. 2. involving puncture or
Guidelines 37
incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU] Jaundice: A clinical manifestation of hyperbilirubinemia, consisting of deposition of bile pigments in the skin, resulting in a yellowish staining of the skin and mucous membranes. [NIH] Ligation: Application of a ligature to tie a vessel or strangulate a part. [NIH] Lipid: Any of a heterogeneous group of flats and fatlike substances characterized by being water-insoluble and being extractable by nonpolar (or fat) solvents such as alcohol, ether, chloroform, benzene, etc. All contain as a major constituent aliphatic hydrocarbons. The lipids, which are easily stored in the body, serve as a source of fuel, are an important constituent of cell structure, and serve other biological functions. Lipids may be considered to include fatty acids, neutral fats, waxes, and steroids. Compound lipids comprise the glycolipids, lipoproteins, and phospholipids. [EU] Membrane: A thin layer of tissue which covers a surface, lines a cavity or divides a space or organ. [EU] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Nitroglycerin: A highly volatile organic nitrate that acts as a dilator of arterial and venous smooth muscle and is used in the treatment of angina. It provides relief through improvement of the balance between myocardial oxygen supply and demand. Although total coronary blood flow is not increased, there is redistribution of blood flow in the heart when partial occlusion of coronary circulation is effected. [NIH] Oral: Pertaining to the mouth, taken through or applied in the mouth, as an oral medication or an oral thermometer. [EU] Orgasm: The apex and culmination of sexual excitement. [EU] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the islets of langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Papaverine: An alkaloid found in opium but not closely related to the other opium alkaloids in its structure or pharmacological actions. It is a directacting smooth muscle relaxant used in the treatment of impotence and as a vasodilator, especially for cerebral vasodilation. The mechanism of its pharmacological actions is not clear, but it apparently can inhibit phosphodiesterases and it may have direct actions on calcium channels. [NIH]
38 Impotence
Penis: The male organ of copulation and of urinary excretion, comprising a root, body, and extremity, or glans penis. The root is attached to the descending portions of the pubic bone by the crura, the latter being the extremities of the corpora cavernosa, and beneath them the corpus spongiosum, through which the urethra passes. The glans is covered with mucous membrane and ensheathed by the prepuce, or foreskin. The penis is homologous with the clitoris in the female. [EU] Phentolamine: A nonselective alpha-adrenergic antagonist. It is used in the treatment of hypertension and hypertensive emergencies, pheochromocytoma, vasospasm of Raynaud's disease and frostbite, clonidine withdrawal syndrome, impotence, and peripheral vascular disease. [NIH]
Porphyria: A pathological state in man and some lower animals that is often due to genetic factors, is characterized by abnormalities of porphyrin metabolism, and results in the excretion of large quantities of porphyrins in the urine and in extreme sensitivity to light. [EU] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Priapism: Persistent abnormal erection of the penis, usually without sexual desire, and accompanied by pain and tenderness. It is seen in diseases and injuries of the spinal cord, and may be caused by vesical calculus and certain injuries to the penis. [EU] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Prosthesis: An artificial substitute for a missing body part, such as an arm or leg, eye or tooth, used for functional or cosmetic reasons, or both. [EU] Psychotherapy: A generic term for the treatment of mental illness or emotional disturbances primarily by verbal or nonverbal communication. [NIH]
Radiology: A specialty concerned with the use of x-ray and other forms of radiant energy in the diagnosis and treatment of disease. [NIH] Rectal: Pertaining to the rectum (= distal portion of the large intestine). [EU] Relaxant: 1. lessening or reducing tension. 2. an agent that lessens tension. [EU]
Rigidity: Stiffness or inflexibility, chiefly that which is abnormal or morbid; rigor. [EU] Sclerosis: A induration, or hardening; especially hardening of a part from inflammation and in diseases of the interstitial substance. The term is used
Guidelines 39
chiefly for such a hardening of the nervous system due to hyperplasia of the connective tissue or to designate hardening of the blood vessels. [EU] Siderosis: The deposition of iron in a tissue. In the eye, the iron may be deposited in the stroma adjacent to the Descemet's membrane. [NIH] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Spotting: A slight discharge of blood via the vagina, especially as a sideeffect of oral contraceptives. [EU] Topical: Pertaining to a particular surface area, as a topical anti-infective applied to a certain area of the skin and affecting only the area to which it is applied. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Transurethral: Performed through the urethra. [EU] Ulcer: A local defect, or excavation, of the surface of an organ or tissue; which is produced by the sloughing of inflammatory necrotic tissue. [EU] Urinalysis: Examination of urine by chemical, physical, or microscopic means. Routine urinalysis usually includes performing chemical screening tests, determining specific gravity, observing any unusual color or odor, screening for bacteriuria, and examining the sediment microscopically. [NIH] Urinary: Pertaining to the urine; containing or secreting urine. [EU] Urology: A surgical specialty concerned with the study, diagnosis, and treatment of diseases of the urinary tract in both sexes and the genital tract in the male. It includes the specialty of andrology which addresses both male genital diseases and male infertility. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Withdrawal: 1. a pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) a substancespecific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU] Yohimbine: A plant alkaloid with alpha-2-adrenergic blocking activity. Yohimbine has been used as a mydriatic and in the treatment of impotence. It is also alleged to be an aphrodisiac. [NIH]
Seeking Guidance 41
CHAPTER 2. SEEKING GUIDANCE Overview Some patients are comforted by the knowledge that a number of organizations dedicate their resources to helping people with impotence. These associations can become invaluable sources of information and advice. Many associations offer aftercare support, financial assistance, and other important services. Furthermore, healthcare research has shown that support groups often help people to better cope with their conditions.8 In addition to support groups, your physician can be a valuable source of guidance and support. Therefore, finding a physician that can work with your unique situation is a very important aspect of your care. In this chapter, we direct you to resources that can help you find patient organizations and medical specialists. We begin by describing how to find associations and peer groups that can help you better understand and cope with impotence. The chapter ends with a discussion on how to find a doctor that is right for you.
Associations and Impotence As mentioned by the Agency for Healthcare Research and Quality, sometimes the emotional side of an illness can be as taxing as the physical side.9 You may have fears or feel overwhelmed by your situation. Everyone has different ways of dealing with disease or physical injury. Your attitude, your expectations, and how well you cope with your condition can all Churches, synagogues, and other houses of worship might also have groups that can offer you the social support you need. 9 This section has been adapted from http://www.ahcpr.gov/consumer/diaginf5.htm. 8
42 Impotence
influence your well-being. This is true for both minor conditions and serious illnesses. For example, a study on female breast cancer survivors revealed that women who participated in support groups lived longer and experienced better quality of life when compared with women who did not participate. In the support group, women learned coping skills and had the opportunity to share their feelings with other women in the same situation. In addition to associations or groups that your doctor might recommend, we suggest that you consider the following list (if there is a fee for an association, you may want to check with your insurance provider to find out if the cost will be covered): ·
American Foundation for Urologic Disease Address: American Foundation for Urologic Disease 1128 North Charles Street, Baltimore, MD 21201 Telephone: (410) 468-1800 Toll-free: (800) 242-2383 Fax: (410) 468-1808 Email:
[email protected] Web Site: http://www.afud.or Background: The American Foundation for Urologic Disease (AFUD) is a national not-for-profit health organization dedicated to the prevention and cure of urologic diseases through the expansion of medical research and the education of health care professionals and the public. Such urologic diseases include bladder cancer, urinary incontinence, urinary tract disorders, interstitial cystitis, kidney stones, benign prostatic hyperplasia, prostate cancer, prostatitis, and sexual dysfunction. Established in 1987, the Foundation sponsors a Research Scholars Program to encourage physicians to conduct research into urologic diseases, provides appropriate referrals, engages in patient advocacy, and offers networking services. AFUD also offers a variety of educational materials including brochures, pamphlets, and a quarterly magazine entitled 'Family Urology.' In addition, the Foundation has a web site on the Internet at http://www.afud.org. Relevant area(s) of interest: Impotence, Interstitial Cystitis, Kidney Stones, Prostatitis
·
LEMS Update Address: LEMS Update 2016 Willamette View Court, West Linn, OR 97068 Telephone: (503) 657-4592 Email:
[email protected]
Seeking Guidance 43
Web Site: http://www.europa.com/~clark Background: 'LEMS Update' is a newsletter dedicated to disseminating information and promoting awareness of Lambert-Eaton Myasthenic Syndrome (LEMS). LEMS, or Eaton-Lambert Syndrome, a rare neuromuscular disorder, is suspected to be an autoimmune disease. Major symptoms include muscle weakness and fatigue especially of the pelvic and thigh muscles. Other symptoms may include dryness of the mouth, impotence, pain in the thighs, and a pricking, tingling, or creeping sensation on the skin (paresthesias) around the affected areas. 'LEMS Update' endeavors to provide current information on treatments and studies and to answer questions about this disorder. 'LEMS Update' also maintains a site on the World Wide Web at http://www.europa.com/~clarkc.
Finding More Associations There are a number of directories that list additional medical associations that you may find useful. While not all of these directories will provide different information than what is listed above, by consulting all of them, you will have nearly exhausted all sources for patient associations. The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about impotence. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797.
DIRLINE A comprehensive source of information on associations is the DIRLINE database maintained by the National Library of Medicine. The database comprises some 10,000 records of organizations, research centers, and government institutes and associations which primarily focus on health and biomedicine. DIRLINE is available via the Internet at the following Web site: http://dirline.nlm.nih.gov/. Simply type in “impotence” (or a synonym) or the name of a topic, and the site will list information contained in the database on all relevant organizations.
44 Impotence
The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “impotence”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” By making these selections and typing in “impotence” (or synonyms) into the “For these words:” box, you will only receive results on organizations dealing with impotence. You should check back periodically with this database since it is updated every 3 months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by specific diseases. You can access this database at the following Web site: http://www.rarediseases.org/cgi-bin/nord/searchpage. Select the option called “Organizational Database (ODB)” and type “impotence” (or a synonym) in the search box.
Online Support Groups In addition to support groups, commercial Internet service providers offer forums and chat rooms for people with different illnesses and conditions. WebMDÒ, for example, offers such a service at their Web site: http://boards.webmd.com/roundtable. These online self-help communities can help you connect with a network of people whose concerns are similar to yours. Online support groups are places where people can talk informally. If you read about a novel approach, consult with your doctor or other healthcare providers, as the treatments or discoveries you hear about may not be scientifically proven to be safe and effective. The following Internet sites may be of particular interest: ·
About Impotence and Erectile Dysfunction http://www.aboutimpotencetherapies.com
Seeking Guidance 45
·
Impotence Support Group http://cpmcnet.columbia.edu/dept/urology/ events/impsupport.html
·
MD Advice http://www.mdadvice.com/topics/impotence
Finding Doctors One of the most important aspects of your treatment will be the relationship between you and your doctor or specialist. All patients with impotence must go through the process of selecting a physician. While this process will vary from person to person, the Agency for Healthcare Research and Quality makes a number of suggestions, including the following:10 ·
If you are in a managed care plan, check the plan’s list of doctors first.
·
Ask doctors or other health professionals who work with doctors, such as hospital nurses, for referrals.
·
Call a hospital’s doctor referral service, but keep in mind that these services usually refer you to doctors on staff at that particular hospital. The services do not have information on the quality of care that these doctors provide.
·
Some local medical societies offer lists of member doctors. Again, these lists do not have information on the quality of care that these doctors provide.
Additional steps you can take to locate doctors include the following: ·
Check with the associations listed earlier in this chapter.
·
Information on doctors in some states is available on the Internet at http://www.docboard.org. This Web site is run by “Administrators in Medicine,” a group of state medical board directors.
·
The American Board of Medical Specialties can tell you if your doctor is board certified. “Certified” means that the doctor has completed a training program in a specialty and has passed an exam, or “board,” to assess his or her knowledge, skills, and experience to provide quality patient care in that specialty. Primary care doctors may also be certified as specialists. The AMBS Web site is located at
10
This section is adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm.
46 Impotence
http://www.abms.org/newsearch.asp.11 You can also contact the ABMS by phone at 1-866-ASK-ABMS. ·
You can call the American Medical Association (AMA) at 800-665-2882 for information on training, specialties, and board certification for many licensed doctors in the United States. This information also can be found in “Physician Select” at the AMA’s Web site: http://www.amaassn.org/aps/amahg.htm.
Finding a Urologist The American Urological Association (AUA) provides the public with a freeto-use “Find A Urologist” service to help patients find member urologists in their area. The database can be searched by physician name, city, U.S. State, or country and is available via the AUA’s Web site located at http://www.auanet.org/patient_info/find_urologist/index.cfm. According to the AUA: “The American Urological Association is the professional association for urologists. As the premier professional association for the advancement of urologic patient care, the AUA is pleased to provide Find A Urologist, an on-line referral service for patients to use when looking for a urologist. All of our active members are certified by the American Board of Urology, which is an important distinction of the urologist’s commitment to continuing education and superior patient care.”12 If the previous sources did not meet your needs, you may want to log on to the Web site of the National Organization for Rare Disorders (NORD) at http://www.rarediseases.org/. NORD maintains a database of doctors with expertise in various rare diseases. The Metabolic Information Network (MIN), 800-945-2188, also maintains a database of physicians with expertise in various metabolic diseases.
11 While board certification is a good measure of a doctor’s knowledge, it is possible to receive quality care from doctors who are not board certified. 12 Quotation taken from the AACE’s Web site: http://www.aace.com/memsearch.php.
Seeking Guidance 47
Selecting Your Doctor13 When you have compiled a list of prospective doctors, call each of their offices. First, ask if the doctor accepts your health insurance plan and if he or she is taking new patients. If the doctor is not covered by your plan, ask yourself if you are prepared to pay the extra costs. The next step is to schedule a visit with your chosen physician. During the first visit you will have the opportunity to evaluate your doctor and to find out if you feel comfortable with him or her. Ask yourself, did the doctor: ·
Give me a chance to ask questions about impotence?
·
Really listen to my questions?
·
Answer in terms I understood?
·
Show respect for me?
·
Ask me questions?
·
Make me feel comfortable?
·
Address the health problem(s) I came with?
·
Ask me my preferences about different kinds of treatments for impotence?
·
Spend enough time with me?
Trust your instincts when deciding if the doctor is right for you. But remember, it might take time for the relationship to develop. It takes more than one visit for you and your doctor to get to know each other.
Working with Your Doctor14 Research has shown that patients who have good relationships with their doctors tend to be more satisfied with their care and have better results. Here are some tips to help you and your doctor become partners: ·
You know important things about your symptoms and your health history. Tell your doctor what you think he or she needs to know.
·
It is important to tell your doctor personal information, even if it makes you feel embarrassed or uncomfortable.
13 This
section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm. 14 This section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm.
48 Impotence
·
Bring a “health history” list with you (and keep it up to date).
·
Always bring any medications you are currently taking with you to the appointment, or you can bring a list of your medications including dosage and frequency information. Talk about any allergies or reactions you have had to your medications.
·
Tell your doctor about any natural or alternative medicines you are taking.
·
Bring other medical information, such as x-ray films, test results, and medical records.
·
Ask questions. If you don’t, your doctor will assume that you understood everything that was said.
·
Write down your questions before your visit. List the most important ones first to make sure that they are addressed.
·
Consider bringing a friend with you to the appointment to help you ask questions. This person can also help you understand and/or remember the answers.
·
Ask your doctor to draw pictures if you think that this would help you understand.
·
Take notes. Some doctors do not mind if you bring a tape recorder to help you remember things, but always ask first.
·
Let your doctor know if you need more time. If there is not time that day, perhaps you can speak to a nurse or physician assistant on staff or schedule a telephone appointment.
·
Take information home. Ask for written instructions. Your doctor may also have brochures and audio and videotapes that can help you.
·
After leaving the doctor’s office, take responsibility for your care. If you have questions, call. If your symptoms get worse or if you have problems with your medication, call. If you had tests and do not hear from your doctor, call for your test results. If your doctor recommended that you have certain tests, schedule an appointment to get them done. If your doctor said you should see an additional specialist, make an appointment.
By following these steps, you will enhance the relationship you will have with your physician.
Seeking Guidance 49
Broader Health-Related Resources In addition to the references above, the NIH has set up guidance Web sites that can help patients find healthcare professionals. These include:15 ·
Caregivers: http://www.nlm.nih.gov/medlineplus/caregivers.html
·
Choosing a Doctor or Healthcare Service: http://www.nlm.nih.gov/medlineplus/choosingadoctororhealthcareserv ice.html
·
Hospitals and Health Facilities: http://www.nlm.nih.gov/medlineplus/healthfacilities.html
Vocabulary Builder The following vocabulary builder provides definitions of words used in this chapter that have not been defined in previous chapters: Cystitis: Inflammation of the urinary bladder. [EU] Incontinence: Inability to control excretory functions, as defecation (faecal i.) or urination (urinary i.). [EU] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Neuromuscular: Pertaining to muscles and nerves. [EU] Prostatitis: Inflammation of the prostate. [EU]
You can access this information at: http://www.nlm.nih.gov/medlineplus/healthsystem.html.
15
51
PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL
ABOUT PART II In Part II, we introduce you to additional resources and advanced research on impotence. All too often, patients who conduct their own research are overwhelmed by the difficulty in finding and organizing information. The purpose of the following chapters is to provide you an organized and structured format to help you find additional information resources on impotence. In Part II, as in Part I, our objective is not to interpret the latest advances on impotence or render an opinion. Rather, our goal is to give you access to original research and to increase your awareness of sources you may not have already considered. In this way, you will come across the advanced materials often referred to in pamphlets, books, or other general works. Once again, some of this material is technical in nature, so consultation with a professional familiar with impotence is suggested.
Studies 53
CHAPTER 3. STUDIES ON IMPOTENCE Overview Every year, academic studies are published on impotence or related conditions. Broadly speaking, there are two types of studies. The first are peer reviewed. Generally, the content of these studies has been reviewed by scientists or physicians. Peer-reviewed studies are typically published in scientific journals and are usually available at medical libraries. The second type of studies is non-peer reviewed. These works include summary articles that do not use or report scientific results. These often appear in the popular press, newsletters, or similar periodicals. In this chapter, we will show you how to locate peer-reviewed references and studies on impotence. We will begin by discussing research that has been summarized and is free to view by the public via the Internet. We then show you how to generate a bibliography on impotence and teach you how to keep current on new studies as they are published or undertaken by the scientific community.
The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and impotence, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the
54 Impotence
format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type in “impotence” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is a sample of what you can expect from this type of search: ·
Impotence Treatment Update Source: Diabetes Self-Management. 17(4): 110-111. July-August 2000. Contact: Available from R.A. Rapaport Publishing, Inc. 150 West 22nd Street, New York, NY 10011. (800) 234-0923. Website: www.diabetes-selfmgmt.com. Summary: This article provides updated information on treatments for erectile dysfunction. Many different factors can disrupt the process of male sexual arousal, including psychological barriers, heart disease, excess alcohol consumption, and diabetes. The latter contributes to erectile dysfunction because men who have diabetes are more likely to develop atherosclerosis, which makes it harder for blood to flow into the penis, and to have nerve damage, which can prevent normal transmission of nerve signals from the brain to the penis. When the drug sildenafil, commonly known as Viagra, was introduced to the United States in 1998, it was an immediate hit because it was the first impotence treatment to come in pill form. Despite its popularity, sildenafil can have dangerous and even fatal side effects, mainly when it interacts with nitrate-containing heart drugs. A second oral impotence treatment, apomorphine, may soon receive Food and Drug Administration approval. This drug, marketed under the brand name Uprima, is placed under the tongue and allowed to dissolve. The drug works by stimulating a chemical in the brain called dopamine that helps initiate erections. However, this drug also has side effects, including nausea and vomiting, dizziness, and fainting.
·
Treating Impotence Source: Diabetes Self-Management. 15(5): 37, 41-43, 46-47. SeptemberOctober 1998. Contact: Available from R.A. Rapaport Publishing, Inc. 150 West 22nd Street, New York, NY 10011. (800) 234-0923. Summary: This review article examines the relationship between impotence and diabetes. It begins by explaining the physiological aspects
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of a normal erection and defining impotence. The article then discusses the ways impotence can result as a complication of diabetes. First, accelerated arteriosclerosis restricts blood flow to the penis, and, second, nerve damage prevents the normal transmission of nerve impulses to the blood vessels in the penis. Good blood sugar control may prevent or slow down the onset of complications related to diabetes, including erectile dysfunction. The article continues with information on the diagnosis and treatment of impotence as a complication of diabetes. An evaluation by a physician usually involves a review of a man's medical history, a physical examination, and laboratory tests. A nocturnal penile tumescence test may also be used to evaluate erectile dysfunction. A variety of options are available to treat impotence, including oral drugs such as Viagra, penile suppositories, penile injection therapy, external vacuum devices, penile implant surgery, vascular surgery, testosterone supplements, yohimbine extract, and counseling. In addition, several drugs are under investigation as treatments for impotence, including apomorphine, phentolamine, and prazosin. The article recommends that a man work with his partner in overcoming his impotence. 1 figure. ·
Impotence in Older Patients with Diabetes Source: Practical Diabetology. 10(4): 8-10, 12-13. July-August 1991. Summary: Diabetes, as a specific disease entity, is the most common organic cause of impotence, resulting in approximately two million cases in the United States. This article discusses impotence in older patients with diabetes. Topics include the health problems, sexual activity, and sexual changes in older men with diabetes; etiologies of impotence, including psychogenic, vasculogenic, neurogenic causes, diabetic cavernous muscle myopathy, and endocrine abnormalities; the evaluation of impotence; medical treatment; external vacuum erection assistance devices; intracavernous pharmacotherapy; surgical treatment, including vascular surgery, and implantation of penile prostheses; and sex therapy and psychotherapy. 1 figure. 10 references.
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Relationship of Psychiatric Illness to Impotence in Men With Diabetes Source: Diabetes Care. 13(8): 893-895. August 1990. Summary: This article reports on a review of clinical data from 37 adult males with diabetes mellitus who had undergone psychiatric diagnosis and peripheral nerve conduction studies to determine whether psychiatric illness was significantly related to complaints of sexual dysfunction. Main-effects testing revealed that impotence was associated with both neuropathy and psychiatric illness. These data allow for the hypothesis that psychiatric illness may be an important contributor to
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impotence in men with diabetes, as it is in men who do not have diabetes, even when neuropathic complications of the disease are present. 1 table. 11 references. (AA-M). ·
Long-Term Followup of Treatment for Peyronie's Disease: Modeling the Penis Over an Inflatable Penile Prosthesis Source: Journal of Urology. 165(6): 825-829. March 2001. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-3030 or (301) 714-2334. Fax (301) 824-7290. Summary: Peyronie's disease is a benign condition characterized by the formation of fibrotic plaques in the corpora cavernosa of the penis. Patients may present with painful erection, palpable penile plaque, or penile curvature. The authors of this article originally reported on the use of inflatable penile implants used to treat erectile dysfunction (ED, formerly called impotence) in patients with Peyronie's disease (Wilson et al, 1993). In this article, the authors present a historical prospective study of 104 patients in whom the modeling procedure was used to correct Peyronie's curvature after implantation with the Mentor Alpha 1 and AMS 700CX penile prostheses. The authors compared revision free survival experience of these implants with 905 similar implants in men with non Peyronie's disease. The reasons for revision were classified as mechanical failure, patient dissatisfaction, infection and medical causes, including reoperation for straightening. Maximum followup was more than 12 years (average followup was more than 5 years). No significant difference in device survival was observed in the two study cohorts in 5 years. Similarly, each prosthesis provided the same permanent straightening without the need for revision. In Peyronie's disease cases, mechanical survival of the Mentor Alpha 1 was superior to that of the AMS 700CX. There was no significant difference in mechanical reliability of the devices in non Peyronie's disease cases. 5 figures. 3 tables. 10 references.
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Quality of Life in Men with Urinary Incontinence After Prostate Cancer Surgery Source: Journal of WOCN. Journal of Wound, Ostomy and Continence Nurses. 27(3): 174-178. May 2000. Contact: Available from Journal of WOCN, Mosby-Year Book, Inc. 11830 Westline Industrial Drive, St. Louis, MO 63146. (800) 453-4351. Summary: Quality of life assessment is significant to health care providers because it helps them to understand the experience of well
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being as it relates to an illness and its severity. Attempting to deduce the influence of illness on quality of life is complex; however, this area of research has demonstrated that the measurement of quality of life is as important in providing comprehensive care as the treatment itself. This article considers quality of life in men with urinary incontinence (UI) after surgery for prostate cancer. Prostate cancer is the most prevalent cancer in American men and radical prostatectomy (removal of the prostate) is frequently considered the treatment of choice for localized prostate cancer. Despite its widespread use, considerable morbidity exists, including erectile dysfunction (ED, formerly called impotence) and UI. Although not all men who undergo radical prostatectomy will experience UI, those who do find that it influences their daily lives, affecting the clothes they wear, their activities, sleep patterns, social relationships, and self esteem. The severity of voiding symptoms seems to be a major factor in determining the effect of radical prostatectomy on quality of life (QOL). The response of health care professionals to men before and after prostatectomy also influences their QOL. Despite this link between information, appraisal, and coping, few studies have focused on the informational needs of patients with treatment related morbidities. The author concludes by discussing the implications of these findings on the care offered by WOC (wound, ostomy and continence) nurses. Nursing interventions likely to improve QOL in patients undergoing treatment for prostate cancer include providing accurate information about what to expect after surgery and about treatment for postoperative UI. 31 references. ·
Asthma and Impotence: The Story of an Unexpected Connection Source: JAAPA. Journal of the American Academy of Physician Assistants. 13(6): 59-60, 62, 68, 70. June 2000. Contact: Available from Medical Economics. 5 Paragon Drive, Montvale, NJ 07645. (800) 432-4570. Fax (201) 573-4956. Summary: In this case report, the author describes a man who was seeking relief of a debilitating respiratory illness (asthma) who also told his primary care clinician that he was deeply concerned about his erectile dysfunction (ED, formerly called impotence). The author explores the etiology (causes) of ED, including vascular, endocrinologic, neurologic, drug induced, psychological, or traumatic. The author notes that, in retrospect, it was clearly inappropriate to refer this patient to an internist. Instead, the primary care clinician should have taken a complete history and performed a physical examination. The workup for ED is fairly straightforward and can be started by a primary care provider. The workup should include history, physical examination, and laboratory
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tests, as well as investigation of the patient's relationship with his sexual partner. Many treatment options are available, including systemic drug therapy or adjustment of ongoing drug therapy, surgical intervention, and mechanical devices to simulate physiologic erections. In the patient described in the case report, it was concluded that primary hypogonadism was the patient's underlying condition. The methylprednisolone prescribed for his asthma probably activated the androgen receptors, and this improved his ED. 3 tables. 19 references. ·
[What is Impotence? Is Viagra a Viable Treatment for Dialysis Patients?] Source: Renalife. 14(4): 22-23. Winter 1999. Contact: Available from American Association of Kidney Patients (AAKP). 100 South Ashley Drive, Suite 280, Tampa, FL 33602. (800) 749AAKP or (813) 223-7099. E-mail:
[email protected]. Website: www.aakp.org. Summary: This entry on Viagra (sildenafil) is one from a regular column that provides readers with an opportunity to submit renal related health questions to health care professionals. This column answers a reader's question about Viagra and its use as a treatment option for erectile dysfunction in patients on dialysis. The author notes that a loss of interest in sexual activity is common in patients with progressive kidney failure. Coping with the stress of an abdominal or vascular access for dialysis, surviving the usual muscle loss, and accommodating to drugs given to control hypertension, phosphate overload, and other components of uremia poses adjustment stresses that place sex at a relatively low priority. The author notes that recent publicity over Viagra has opened doors for more frank discussion between health care providers and patients regarding erectile dysfunction. The author briefly reviews four steps in the evaluation and treatment of erectile dysfunction: identify and correct all correctable medical problems; review all prescribed medications to check for any impact on sexual function; inspect all aspects of life quality, particularly those contributing to exhaustion, conflict, and psychological factors; and a comprehensive urologic evaluation. The author concludes that sildenafil (Viagra) may be an appropriate drug therapy for men on dialysis, but only after going through the steps noted above. The author cautions that men who have angina under treatment with nitroglycerine or similar drugs may be at extra risk of sudden death from a heart attack when treated with Viagra. However, this risk has not been confirmed and should be now classified as a worry rather than a reality.
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Role of Viagra in the Treatment of Male Impotence in ESRD Source: ANNA Journal. American Nephrology Nurses Association Journal. 26(2): 242. April 1999. Contact: Available from American Nephrology Nurses' Association. Box 56, East Holly Avenue, Pitman, NJ 08071. (609) 256-2320. Summary: This brief article, from a regular column called Clinical Consult, reviews the role of Viagra (sildenafil) in the treatment of erectile dysfunction (impotence) in men with end-stage renal disease (ESRD). The article emphasizes a treatment process that begins with the least invasive treatment. After a thorough medical evaluation, treatment options should be counseling, if appropriate; external vacuum devices; oral medication (sildenafil, yohimbine, testosterone); urethral suppositories; penile injection; penile implant surgery; and vascular surgery. Sildenafil is indicated for erectile dysfunction only; it does not increase libido or enhance performance. In clinical trials with over 3,000 subjects with erectile dysfunction ranging from mild to severe, the success rate for sildenafil was 65 to 85 percent compared to 39 percent of placebo subjects. Main adverse reactions to Viagra are headache (16 percent), flushing (10 percent), and dyspepsia (7 percent). Less than 4 percent of subjects experienced nasal congestion, urinary tract infection, abnormal pain, blue green vision, diarrhea, and dizziness. Viagra is contraindicated in persons using any form of nitrates. The use of Viagra may be problematic for ESRD patients in several areas. Hemodialysis patients are prescribed an average of 8 medications, and at least 75 percent of hemodialysis patients and 81 percent of peritoneal dialysis patients use at least one antihypertensive medication. These statistics increase the probability of drug interactions. 3 references.
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Prevalence and Etiology of Impotence in 101 Male Hypertensive Outpatients Source: American Journal of Hypertension. 12(3): 271-275. March 1999. Contact: Available from Elsevier Science, Inc. 655 Avenue of the Americas, New York, NY 10010. (888) 4ES-INFO or (212) 633-3680. Email:
[email protected]. Summary: Erectile dysfunction (impotence) has a high prevalence among men with hypertension. Whether this relates mainly to specific drug side effects or to primary pathogenic disorders is unknown. This article reports on a study of 101 male patients from an outpatient hypertension clinic who answered detailed questionnaires about hypertension and sexual function. Patients with perceived impotence were offered a thorough penile evaluation and examination performed by specialists in
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the urology department. Twenty seven (27 percent) men had impotence. The main cause of impotence was an arterial dysfunction (89 percent). The prevalence of impotence was related to the degree of secondary organ manifestation, reflected by World Health Organization (WHO) classification I through III. Intermittent claudication and ischemic heart disease were the best determinants in these respect. Twelve patients with impotence (44 percent) ascribed onset of impotence to drug initiation. A variety of drugs were implicated in the occurrence of drug induced impotence. The authors summarize that their results indicate impotence in men with hypertension is caused mainly by penile arterial vascular changes, probably atherosclerosis. Drug induced impotence could well be the result of blood pressure reduction itself and not specific drug side effects. 5 tables. 9 references.
Federally-Funded Research on Impotence The U.S. Government supports a variety of research studies relating to impotence and associated conditions. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.16 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally-funded biomedical research projects conducted at universities, hospitals, and other institutions. Visit the CRISP Web site at http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket. You can perform targeted searches by various criteria including geography, date, as well as topics related to impotence and related conditions. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally-funded studies use animals or simulated models to explore impotence and related conditions. In some cases, therefore, it may be difficult to understand how some basic or fundamental research could eventually translate into medical practice. The following sample is typical of the type of information found when searching the CRISP database for impotence:
16 Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).
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Project Title: Prevention and Treatment of Impotence Principal Investigator & Institution: Lue, Tom F.; Professor of Urology; Urology; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 94143 Timing: Fiscal Year 2000; Project Start 1-AUG-1994; Project End 1-DEC2001 Summary: This is a competitive renewal application in which the authors have found that growth hormone significantly facilitated the regeneration of nitric oxide synthase containing nerves after cavernous nerve injury in a group of young rats. The authors propose to examine and compare the response to cavernous nerve injury in a group of both young and old rats and to study the effect of growth hormone and its mediator insulin-like growth factor system on the erectile mechanism. If proved beneficial in the proposed experiments, clinical application of growth hormone or IGF could become an important preventative and therapeutic manure for neurogenic impotence in humans. The specific aims are: 1: To test the hypothesis that injury to the cavernous nerve has different effects on the nonadrenergic noncholinergic vasodilator system in young and old rats. 2: To test the hypothesis that the cellular and molecular mechanisms of impotence associated with cavernous nerve injuries are due to altered gene and protein expression of NOS, TGF, NGF, IGF, FGF and adrenoreceptor in young and old rats. 3: To test the hypothesis that growth hormone facilitates regeneration of the cavernous nerve in both young and old rats. 4: To test hypothesis that the mechanism of facilitated NANC and parasympathetic nerve regeneration by growth hormone is due to production of IGF and IGFBBPs. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
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Project Title: Diabetes and Erectile Function Principal Investigator & Institution: Dahiya, Rajvir; Professor and Director; Northern California Institute Res & Educ for Research and Education San Francisco, Ca 94121 Timing: Fiscal Year 2000; Project Start 0-SEP-1998; Project End 1-AUG2003 Summary: (adapted from the application) The long term goal of this application is to investigate the cellular and molecular mechanisms of diabetic impotence. Based on prior publications and preliminary data, we hypothesize that diabetic impotence is associated with alterations in signaling pathways of noradrenergic non-cholinergic (NANC) neurotransmission adenosine 3', 5' cyclic monophosphate (cAMP), guanosine 3', 5' cyclic monophosphate (cGMP), nitric oxide synthase
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(NOS), adrenoreceptor alpha, and growth factors (TGFa, TGFb1, TGFb2, TGFb3, IGF, and NGF). We will induce diabetes in Fisher rats by streptozotocin (35 mg /kg) and pursue the following experiments to test our hypothesis: In Specific Aim 1, we will test the hypothesis that streptozotocin-induced diabetes will alter NANC vasodilator system in rats. Under this aim we will analyze intracavernous pressure (functional assessment) of penile erection in streptozotocin-induced diabetic (2, 4, 6, 8 weeks) rats. Immunohistochemical examination (NADPH diaphorase and NOS antibodies staining) of NOS-containing neurons and nerve fibers of the following sites: major pelvic ganglion and intra-penile nerves (dorsal, cavernous and spongiosal) and endothelium in early and late diabetic rats. In Specific Aim 2, we will test the hypothesis that the cellular and molecular mechanisms of impotence associated with streptozotocin-induced diabetes are due to altered gene and protein expression of NOS, transforming growth factor (TGF), nerve growth factor (NGF), insulin like growth factor (IGF), and adrenoreceptor in rats. Under this specific aim, we will analyze NOS activity by enzymatic assay, NOS gene expression by Norther blot, cAMP, cGMP by radioimmunoassay in diabetic rats. The protein and gene expression for adrenoreceptor, NOS, TGFa, TGFb, NGF, and IGF-I will be done by immunohistochemistry/ Western blotting and Norther blot / reverse transcription/polymerase chain reaction (RT-PCR), respectively. In Specific Aim 3, we will test the hypothesis that insulin treatment can alter diabetes induced cellular and molecular mechanisms of importance in rats. Under this we will first induced diabetes in rats (streptozotocin injection/35 mg/kg i.p., for 2, 4, 6, and 8 weeks, and then treat them with insulin 915 IU/Kg wt, subcutaneous injection). We will study: (1) functional assessment of penile erection, (2) immunohistochemical parameters (NADPH diaphorase and NOS antibodies staining) of NOS containing neurons and nerve fibers, and (3) protein and gene expression for adrenoreceptor, NOS, TGFa, TGFb, NGF, and IGF-I will be done by immunohistochemistry/ Western blotting and Norther blot / RT-PCR, respectively. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Hormones and Erectile Dysfunction in Aging Men Principal Investigator & Institution: Mckinlay, John B.; Senior Vice President and Director; New England Research Institutes, Inc. 9 Galen St Watertown, Ma 02472 Timing: Fiscal Year 2001; Project Start 9-MAY-1995; Project End 1-AUG2005
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Summary: (provided by applicant): The Massachusetts Male Aging Study (MMAS) is considered a landmark research effort in the fields of aging, urology, and endocrinology. It employs a random sample of communitydwelling men (not a convenience sample of patient volunteers). Its size permits estimation of even relatively rare phenomena (e.g., hypogonadism). It is longitudinal (intra-subject variation) not crosssectional (inter-subject variation) and has successfully followed a cohort from 987-89 (T1) through 1995-97 (T2). Worldwide, it remains the largest male endocrine database. It is the first and still the only major longitudinal study of ED. It is multidisciplinary. The MMAS team has been extraordinarily productive. Emphasis has been given to the practical clinical applications of scientific findings. The proposed project ("Epidemiology Of Hormones And Erectile Dysfunction In Aging Men") is designed to extend the highly productive MMAS by following a projected 800 already participating subjects through a third wave (T3). Building directly on earlier work we will: continue investigation of lifespan changes in 14 carefully selected hormones in the same subjects; precisely delineate any hypogonadal syndrome and its major correlates; continue pioneering work on erectile dysfunction (ED) and its various predictors; precisely measure the hypothesized relation between ED (sentinel event) and subsequent CVD; extend knowledge concerning EDrelated utilization behavior and quality of life in older men; and assess the validity of the single question measure of ED against a clinical urologic examination by a nationally-respected urologist blinded to subjects' self-reported ED status. Methods of data collection will be identical to those used previously for the MMAS. The proposed research will continue to provide the most comprehensive and reliable information available on ED, life-span hormonal changes and their physiological, psychosocial, anthropometric, and behavioral predictors in normally aging men. Prior to the MMAS there was: (a) no well-designed prospective study describing life span changes in endocrine functioning (hormones) in normally aging men; and (b) no definitive populationbased study of ED and its biobehavioral correlates. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Male Urogenital Function and Chronic Spinal Cord Injury Principal Investigator & Institution: Hubscher, Charles H.; Assistant Scientist; Physiological Sciences; University of Florida Gainesville, Fl 32611 Timing: Fiscal Year 2000; Project Start 8-SEP-2000; Project End 1-AUG2003
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Summary: The neural mechanisms involved in the control/coordination of urogenital functions is poorly understood, making restoration of function following traumatic spinal cord injury a difficult task. In humans, spinal cord injury occurs predominantly in young males, compromises sexual function, and leaves most patients infertile because of an inability to ejaculate. Moreover, bladder voiding dysfunction is common due to bladder-sphincter dyssynergia. Incoordination of perineal motoneuron circuits, resulting from spinal cord injury-induced changes in non-locomotor segmental reflex circuits involved in male reproductive function and micturition, likely contributes to these complications. Since normal ejaculation and micturition require both an intact segmental reflex arc and brainstem integration, we have, in recent years, developed and characterized an in vivo brainstem-spinal cord electrophysiological animal model to study the neurological causes of sexual dysfunction following severe midthoracic spinal cord injury. Our previous studies with this model have shown that chronic bilateral lesions of the dorsal 3/5 of T8 spinal cord is correlated with (i) impaired bladder/sexual reflexes, (ii) changes in lumbosacral neural circuits mediating perineal muscle function and (iii) loss of ascending and descending connections between the distal urogenital tract and the medullary reticular formation (ii/iii - as determined in terminal electrophysiological experiments). The overall aim of the proposed research is to use this spino-bulbo-spinal model to address important questions regarding the neural control/coordination of smooth and striated muscles subserving sexual and bladder functions in male rats following chronic spinal cord injury. A unique benefit of our model lies in our ability to focus on the integration of information from multiple pelvic viscera. The knowledge gained from these basic scientific experiments will more specifically ascertain the spinal cord regions and the specific neural circuitry which should be targeted for therapeutic interventions designed to improve the control/coordination of sexual, bladder and bowel functions following chronic spinal cord injury. Parallel electrophysiological, behavioral and neuroanatomical studies are proposed. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Mechanisms of Muscle Sensory Recovery Principal Investigator & Institution: Cope, Timothy C.; Professor; Emory University 1380 S Oxford Rd Atlanta, Ga 30322 Timing: Fiscal Year 2000; Project Start 1-JUL-2000; Project End 0-JUN2005
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Summary: (Applicant's abstract): Despite the capacity of peripheral nerves to regenerate after injury or disease, functional recovery of the sensory system is only partially realized. The broad objective of this proposal is to determine the cellular mechanisms that constrain recovery of the sensory restoration of normal movement, and its profound ineffectiveness, even long after a cut peripheral nerve has regenerated into its original muscle, results in persistent motor disability. The impotence of sensory feedback from muscle is likely to be explained by limitations in the recovery of sensory transduction in the muscle and possibly by a diminished strength of central synaptic transmission are accounted for, as commonly accepted, by the inability of the sensory nerves to reconnect with their cognate muscle receptors. The absence of direct evidence for and the presence of strong challenges to this premise lead us to hypothesize that simple failure of a muscle afferent to reconnect with the appropriate muscle receptor is neither necessary nor sufficient to explain sensory dysfunction. This central hypothesis will be tested through combined electrophysiological and immunohistological studies of sensory nerves supplying long-term reinnervated muscles in living adult rats and cats. Three specific aims are proposed to determine whether the reconnection with a muscle receptor fully explains: (1) the normal response properties of some muscle afferents, (2) the abnormal response properties of others, and (3) the central synaptic constraints on recovery of sensory function under conditions in which sensory neuropathies, e.g. Guillain-Baree syndrome, diabetic neuropathy, or chronic inflammatory demyelinating polyneuropathy. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Regulation of PDE 5 in Human Penile Smooth Muscle Cells Principal Investigator & Institution: Kim, Noel N.; Urology; Boston University 121 Bay State Rd Boston, Ma 02215 Timing: Fiscal Year 2000; Project Start 1-SEP-1999; Project End 1-JUL-2002 Summary: The nitric oxide/cGMP signalling pathway is a major regulator of penile vascular smooth muscle tone and plays a critical role in erection. Phosphodiesterases, enzymes which hydrolyze cyclic nucleotides, are an integral part of this signalling pathway. Phosphodiesterase type 5 (PDE 5) is one of the main phosphodiesterases expressed in penile corpus cavernosum smooth muscle. Sildenafil, a reversible PDE 5 selective inhibitor, has been successfully utilized in the clinical treatment of erectile dysfunction. The efficacy of this inhibitor in ameliorating erectile function in men with impotence, resulting from a broad range of etiologies, emphasizes the crucial aspect which PDE5
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plays in regulating penile smooth muscle tone. Yet the regulation of PDE 5 expression or activity is not well understood and the consequences of prolonged inhibition of this enzyme are unknown. Fundamental knowledge of the cellular and molecular mechanisms which regulate PDE 5 expression and/or activity is important to the understanding of erectile function. The novel perspective that intracellular cGMP levels are actively regulated by PDE 5 broadens our understanding of the cGMP signalling pathway and the integrated mechanisms which control penile trabecular smooth muscle tone. Thus, in this study we will investigate potential regulatory mechanisms which may alter the expression and/or activity of PDE 5 in human penile corpus cavernosum smooth muscle. We will utilize primary cultures of human penile trabecular smooth muscle cells to study and characterize mechanisms of PDE 5 regulation without disrupting the intracellular regulatory pathways which are under investigation. Using cyclic nucleotide radioimmunoassays, Northern and Western blot analyses, and enzyme activity assays, we will investigate: 1) the effects of nitric oxide and cGMP on PDE 5 expression and/or activity; 2) the effects of cAMP and agonists which stimulate adenylate cyclase on PDE 5 expression and/or activity; 3) the effects of cAMP and agonists which stimulate adenylate cyclase on PDE 5 expression and/or activity; 4) cross-talk regulation between cyclic nucleotides and their respective protein kinases, and estrogen and testosterone signalling pathways. This investigation of multiple signalling systems and their influence on PDE 5 will increase our current understanding of the extensive nature by which distinct signalling pathways can interact and provide integrated regulation of smooth muscle tone. This work will provide new and useful information on regulation of PDE5 which will improve treatment strategies for management o erectile dysfunction. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Sonic Hedgehog, a Morphogen in Penile Development Principal Investigator & Institution: Podlasek, Carol A.; Urology; Northwestern University 303 E Chicago Ave Chicago, Il 60611 Timing: Fiscal Year 2002; Project Start 6-MAR-2002; Project End 1-JAN2004 Summary: (provided by applicant): The proposed research will examine the role of Sonic hedgehog (Shh) in penile development and the dysregulation of this pathway in diabetes induced erectile dysfunction. Shh is a secreted glycopeptide that is critically relevant in mesenchymalepithelial interaction in developing tissues. We will show preliminary evidence that Shh signaling in the corpora is neurally regulated during
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penile development and in the adult, and propose to determine the impact of diabetic neuropathy on the expression and activity of Shh in corporal bodies. Diabetes mellitus is a common risk factor for erectile dysfunction, which is a devastating pathologic development that effects 10-30 million American men and costs in excess of $150 million for inpatient urologic care alone (1985 dollars). Although angiopathy and neuropathy are frequent complications in the natural history of DM, the precise cause of diabetic impotence remains unknown. We will examine the hypothesis that neural Shh signaling is elemental in establishing and maintaining normal penile morphology and that erectile dysfunction associated with diabetic neuropathy results from disruption of the homeostatic functions of the Shh pathway. The power of this proposal is its potential to provide novel and critically important insight into the mechanism of diabetes induced erectile function. This may provide the basis for new treatments to prevent or treat this complication and may provide collateral insights into other neurovascular complications of diabetes. The proposed experiments are ideally suited to satisfy the goals of this RFA since novel and innovative technology is utilized to advance our current understanding of one aspect of urogenital development, specifically how neural Shh signaling during postnatal morphogenesis of the penis establishes corporal cavernosal integrity required for erection. Re-establishment of this signaling pathway offers great promise for erectile dysfirnction treatment. Knowledge gained in these studies may be applied to investigate the role of neural input in establishing tissue identity and examining the function of neuropathy in disease. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Urological Research Training Grant Principal Investigator & Institution: Coffey, Donald S.; Professor; Urology; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2002; Project Start 1-MAY-1987; Project End 0-APR2007 Summary: (provided by applicant): Genitourinary diseases cover abnormal development and growth, benign tumors and malignant cancers, abnormalities in kidney function and stone formation, infections, micturition, impotence and reproductive failure, as well as the neurological and endocrine control of the sex systems. This represents colossal medical problems requiring expertise in many areas of research. There is a critical shortage of trained research scientists in the field of urology. This research training program trains highly qualified young physician scientists for academic careers in urological research and
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develops young basic scientists (Ph.D. or M.D./Ph.D.) to pursue careers in urological research. Trainees function side-by-side in modern urology research laboratories occupied by 5 full-time Ph.D. basic scientists plus 6 M.D./Ph.D. and 10 M.D. clinical research investigators. These laboratories carry out major funded research programs in the physiology of the smooth muscle of the genitourinary tract, biochemical and physiological studies on benign prostatic hyperplasia, endocrine studies on male secondary sex characteristics, cell biology and structure, mechanisms of action of steroid hormones, genetic studies, neurotransmitter and receptor studies of genitoruinary tissues, reproductive physiology; and basic and clinical studies on cancer. Each trainee participates in a research training program that is customized for his/her particular needs and interests and includes courses in molecular biology, biostatistics, endocrinology, pathology and physiology. The six research trainees are comprised of three types: 1.) Postresident physician scientists - completed residency training, spending an additional 1-2 years in research, 2.) M.D. Urological Research Fellows will spend 1 or more years in full time research, and 3.) Postdoctoral Research Fellows Ph.D. or M.D./Ph.D., in full time research, who have already completed graduate training in a basic science discipline, plus 4.) Predoctoral Trainees, Ph.D. graduate program students carrying out thesis research in the urology labs who are not funded by this grant but who form part of the research-training environment. Each of these four components of our urological training program enriches and contributes to the success of each part. A multidisciplinary environment of graduate students, postdoctorals, postresidency, M.D.'s all doing research within the same environment has proven to be synergistic. The ability to understand the biology of the disease and to work on human pathological material with the application of precise molecular and pathological techniques that are now forthcoming provides a rich environment for future research leaders to study the major medical problems within the field of urology. Past successes of these laboratories in bridging clinical and basic research has produced a large number of scientists and physician scientists who are dedicated to solving urological diseases. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
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E-Journals: PubMed Central17 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).18 Access to this growing archive of e-journals is free and unrestricted.19 To search, go to http://www.pubmedcentral.nih.gov/index.html#search, and type “impotence” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for impotence in the PubMed Central database: ·
Cardiovascular events in users of sildenafil: results from first phase of prescription event monitoring in England by Saad A W Shakir, Lynda V Wilton, Andrew Boshier, Deborah Layton, and Emma Heeley; 2001 March 17 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=26545
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Cost utility analysis of sildenafil compared with papaverinephentolamine injections by Elly A Stolk, Jan J V Busschbach, Max Caffa, Eric J H Meuleman, and Frans F H Rutten; 2000 April 29 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=27357
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Erectile dysfunction in cyclic GMP-dependent kinase I-deficient mice by Petter Hedlund, Attila Aszodi, Alexander Pfeifer, Per Alm, Franz Hofmann, Marianne Ahmad, Reinhard Fassler, and Karl-Erik Andersson; 2000 February 29 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=15804
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Gene transfer of endothelial nitric oxide synthase to the penis augments erectile responses in the aged rat by H. C. Champion, T. J. Bivalacqua, A. L. Hyman, L. J. Ignarro, W. J. G. Hellstrom, and P. J. Kadowitz; 1999 September 28 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=18088
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Lifestyle drugs: issues for debate by Joel Lexchin; 2001 May 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=81072&ren dertype=external
Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html. 18 With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 19 The value of PubMed Central, in addition to its role as an archive, lies the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print. 17
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Sexual dysfunction in men after treatment for lower urinary tract symptoms: evidence from randomised controlled trial by Sara T Brookes, Jenny L Donovan, Tim J Peters, Paul Abrams, and David E Neal; 2002 May 4 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=104331
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Sildenafil: from the bench to the bedside by Evangelos Michelakis, Wayne Tymchak, and Stephen Archer; 2000 October 31 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=80254&ren dertype=external
The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine. The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to the public.20 If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with impotence, simply go to the PubMed Web site at www.ncbi.nlm.nih.gov/pubmed. Type “impotence” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for “impotence” (hyperlinks lead to article summaries): ·
100 cases of impotence treated by acupuncture and moxibustion. Author(s): Wu JZ, Zhang Q, Wu WC, Guo ZH, Yin FX, Yan CH, Zhou RL, Zhu LX. Source: J Tradit Chin Med. 1989 September; 9(3): 184-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2615452&dopt=Abstract
PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.
20
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·
Marital crisis intervention: hypnosis in impotence-frigidity cases. Author(s): Levit HI. Source: Am J Clin Hypn. 1971 July; 14(1): 56-60. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=5163567&dopt=Abstract
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Validation of a psychophysiological waking erectile assessment (WEA) for the diagnosis of male erectile disorder. Author(s): Janssen E, Everaerd W, Van Lunsen RH, Oerlemans S. Source: Urology. 1994 May; 43(5): 686-95; Discussion 695-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8165769&dopt=Abstract
Vocabulary Builder Adenosine: A nucleoside that is composed of adenine and d-ribose. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA. Adenosine itself is a neurotransmitter. [NIH] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Anthropology: The science devoted to the comparative study of man. [NIH] Antihypertensive: An agent that reduces high blood pressure. [EU] Antioxidant: One of many widely used synthetic or natural substances added to a product to prevent or delay its deterioration by action of oxygen in the air. Rubber, paints, vegetable oils, and prepared foods commonly contain antioxidants. [EU] Apomorphine: A derivative of morphine that is a dopamine D2 agonist. It is a powerful emetic and has been used for that effect in acute poisoning. It has also been used in the diagnosis and treatment of parkinsonism, but its adverse effects limit its use. [NIH] Arginine: An essential amino acid that is physiologically active in the Lform. [NIH] Arthralgia: Pain in a joint. [EU] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Bethanidine: A guanidinium antihypertensive agent that acts by blocking adrenergic transmission. The precise mode of action is not clear. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or
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involving chemical reactions in living organisms. [EU] Calmodulin: A heat-stable, low-molecular-weight activator protein found mainly in the brain and heart. The binding of calcium ions to this protein allows this protein to bind to cyclic nucleotide phosphodiesterases and to adenyl cyclase with subsequent activation. Thereby this protein modulates cyclic AMP and cyclic GMP levels. [NIH] Cardiomegaly: Cardiac hypertrophy. [EU] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Conduction: The transfer of sound waves, heat, nervous impulses, or electricity. [EU] Congestion: Excessive or abnormal accumulation of blood in a part. [EU] Contractility: stimulus. [EU]
Capacity for becoming short in response to a suitable
Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Debrisoquin: An adrenergic neuron-blocking drug similar in effects to guanethidine. It is also noteworthy in being a substrate for a polymorphic cytochrome P-450 enzyme. Persons with certain isoforms of this enzyme are unable to properly metabolize this and many other clinically important drugs. They are commonly referred to as having a debrisoquin 4hydroxylase polymorphism. [NIH] Desensitization: The prevention or reduction of immediate hypersensitivity reactions by administration of graded doses of allergen; called also hyposensitization and immunotherapy. [EU] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Dizziness: An imprecise term which may refer to a sense of spatial disorientation, motion of the environment, or lightheadedness. [NIH] Dorsal: 1. pertaining to the back or to any dorsum. 2. denoting a position more toward the back surface than some other object of reference; same as posterior in human anatomy; superior in the anatomy of quadrupeds. [EU] Dyspepsia: Impairment of the power of function of digestion; usually applied to epigastric discomfort following meals. [EU]
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Electrophoresis: An electrochemical process in which macromolecules or colloidal particles with a net electric charge migrate in a solution under the influence of an electric current. [NIH] Electrophysiological: Pertaining to electrophysiology, that is a branch of physiology that is concerned with the electric phenomena associated with living bodies and involved in their functional activity. [EU] Endoscopy: Visual inspection of any cavity of the body by means of an endoscope. [EU] Endothelium: The layer of epithelial cells that lines the cavities of the heart and of the blood and lymph vessels, and the serous cavities of the body, originating from the mesoderm. [EU] Enterotoxins: Substances that are toxic to the intestinal tract causing vomiting, diarrhea, etc.; most common enterotoxins are produced by bacteria. [NIH] Fatal: Causing death, deadly; mortal; lethal. [EU] Filtration: The passage of a liquid through a filter, accomplished by gravity, pressure, or vacuum (suction). [EU] Flushing: A transient reddening of the face that may be due to fever, certain drugs, exertion, stress, or a disease process. [NIH] Frigidity: Coldness; especially, lack of sexual response in the female. [EU] Ganglion: 1. a knot, or knotlike mass. 2. a general term for a group of nerve cell bodies located outside the central nervous system; occasionally applied to certain nuclear groups within the brain or spinal cord, e.g. basal ganglia. 3. a benign cystic tumour occurring on a aponeurosis or tendon, as in the wrist or dorsum of the foot; it consists of a thin fibrous capsule enclosing a clear mucinous fluid. [EU] Gastritis: Inflammation of the stomach. [EU] Gastroduodenal: Pertaining to or communicating with the stomach and duodenum, as a gastroduodenal fistula. [EU] Genitourinary: Pertaining to the genital and urinary organs; urogenital; urinosexual. [EU] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Guanabenz: An alpha-2 selective adrenergic agonist used as an antihypertensive agent. [NIH] Helicobacter: A genus of gram-negative, spiral-shaped bacteria that is pathogenic and has been isolated from the intestinal tract of mammals, including humans. [NIH] Hepatomegaly: Enlargement of the liver. [EU]
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Homeostasis: A tendency to stability in the normal body states (internal environment) of the organism. It is achieved by a system of control mechanisms activated by negative feedback; e.g. a high level of carbon dioxide in extracellular fluid triggers increased pulmonary ventilation, which in turn causes a decrease in carbon dioxide concentration. [EU] Hormones: Chemical substances having a specific regulatory effect on the activity of a certain organ or organs. The term was originally applied to substances secreted by various endocrine glands and transported in the bloodstream to the target organs. It is sometimes extended to include those substances that are not produced by the endocrine glands but that have similar effects. [NIH] Immunohistochemistry: Histochemical localization of immunoreactive substances using labeled antibodies as reagents. [NIH] Implantation: The insertion or grafting into the body of biological, living, inert, or radioactive material. [EU] Infarction: 1. the formation of an infarct. 2. an infarct. [EU] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Innervation: 1. the distribution or supply of nerves to a part. 2. the supply of nervous energy or of nerve stimulus sent to a part. [EU] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulindependent diabetes mellitus. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Lesion: Any pathological or traumatic discontinuity of tissue or loss of function of a part. [EU] Libido: Sexual desire. [EU] Locomotor: Of or pertaining to locomotion; pertaining to or affecting the locomotive apparatus of the body. [EU] Malaise: A vague feeling of bodily discomfort. [EU] Malignant: Tending to become progressively worse and to result in death. Having the properties of anaplasia, invasion, and metastasis; said of tumours. [EU] Mediator: An object or substance by which something is mediated, such as
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(1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Medullary: Pertaining to the marrow or to any medulla; resembling marrow. [EU] Microsomal: Of or pertaining to microsomes : vesicular fragments of endoplasmic reticulum formed after disruption and centrifugation of cells. [EU]
Morphogenesis: The development of the form of an organ, part of the body, or organism. [NIH] Mutagenesis: Process of generating genetic mutations. It may occur spontaneously or be induced by mutagens. [NIH] Myopathy: Any disease of a muscle. [EU] Nausea: An unpleasant sensation, vaguely referred to the epigastrium and abdomen, and often culminating in vomiting. [EU] Nephrology: A subspecialty of internal medicine concerned with the anatomy, physiology, and pathology of the kidney. [NIH] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neuropathy: A general term denoting functional disturbances and/or pathological changes in the peripheral nervous system. The etiology may be known e.g. arsenical n., diabetic n., ischemic n., traumatic n.) or unknown. Encephalopathy and myelopathy are corresponding terms relating to involvement of the brain and spinal cord, respectively. The term is also used to designate noninflammatory lesions in the peripheral nervous system, in contrast to inflammatory lesions (neuritis). [EU] Neurotransmitter: Any of a group of substances that are released on excitation from the axon terminal of a presynaptic neuron of the central or peripheral nervous system and travel across the synaptic cleft to either excite or inhibit the target cell. Among the many substances that have the properties of a neurotransmitter are acetylcholine, norepinephrine, epinephrine, dopamine, glycine, y-aminobutyrate, glutamic acid, substance P, enkephalins, endorphins, and serotonin. [EU] Nitrates: Inorganic or organic salts and esters of nitric acid. These compounds contain the NO3- radical. [NIH] Osteoarthritis: Noninflammatory degenerative joint disease occurring chiefly in older persons, characterized by degeneration of the articular
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cartilage, hypertrophy of bone at the margins, and changes in the synovial membrane. It is accompanied by pain and stiffness, particularly after prolonged activity. [EU] Outpatients: Persons who receive ambulatory care at an outpatient department or clinic without room and board being provided. [NIH] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of YEASTS. [NIH] Pigmentation: 1. the deposition of colouring matter; the coloration or discoloration of a part by pigment. 2. coloration, especially abnormally increased coloration, by melanin. [EU] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Prazosin: A selective adrenergic alpha-1 antagonist used in the treatment of heart failure, hypertension, pheochromocytoma, Raynaud's syndrome, prostatic hypertrophy, and urinary retention. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychosomatic: Pertaining to the mind-body relationship; having bodily symptoms of psychic, emotional, or mental origin; called also psychophysiologic. [EU] Receptor: 1. a molecular structure within a cell or on the surface characterized by (1) selective binding of a specific substance and (2) a specific physiologic effect that accompanies the binding, e.g., cell-surface receptors for peptide hormones, neurotransmitters, antigens, complement fragments, and immunoglobulins and cytoplasmic receptors for steroid hormones. 2. a sensory nerve terminal that responds to stimuli of various kinds. [EU] Reflex: 1; reflected. 2. a reflected action or movement; the sum total of any particular involuntary activity. [EU] Regeneration: The natural renewal of a structure, as of a lost tissue or part. [EU]
Reoperation: A repeat operation for the same condition in the same patient. It includes reoperation for reexamination, reoperation for disease
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progression or recurrence, or reoperation following operative failure. [NIH] Resorption: The loss of substance through physiologic or pathologic means, such as loss of dentin and cementum of a tooth, or of the alveolar process of the mandible or maxilla. [EU] Serine: A non-essential amino acid occurring in natural form as the Lisomer. It is synthesized from glycine or threonine. It is involved in the biosynthesis of purines, pyrimidines, and other amino acids. [NIH] Serum: The clear portion of any body fluid; the clear fluid moistening serous membranes. 2. blood serum; the clear liquid that separates from blood on clotting. 3. immune serum; blood serum from an immunized animal used for passive immunization; an antiserum; antitoxin, or antivenin. [EU] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Sphincter: A ringlike band of muscle fibres that constricts a passage or closes a natural orifice; called also musculus sphincter. [EU] Symptomatic: 1. pertaining to or of the nature of a symptom. 2. indicative (of a particular disease or disorder). 3. exhibiting the symptoms of a particular disease but having a different cause. 4. directed at the allying of symptoms, as symptomatic treatment. [EU] Synaptic: Pertaining to or affecting a synapse (= site of functional apposition between neurons, at which an impulse is transmitted from one neuron to another by electrical or chemical means); pertaining to synapsis (= pairing off in point-for-point association of homologous chromosomes from the male and female pronuclei during the early prophase of meiosis). [EU] Synergistic: Acting together; enhancing the effect of another force or agent. [EU]
Threonine: An essential amino acid occurring naturally in the L-form, which is the active form. It is found in eggs, milk, gelatin, and other proteins. [NIH]
Tyrosine: A non-essential amino acid. In animals it is synthesized from phenylalanine. It is also the precursor of epinephrine, thyroid hormones, and melanin. [NIH]
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CHAPTER 4. PATENTS ON IMPOTENCE Overview You can learn about innovations relating to impotence by reading recent patents and patent applications. Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.21 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available to patients with impotence within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available to patients with impotence. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information.
21Adapted
from The U. S. Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.
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Patents on Impotence By performing a patent search focusing on impotence, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an example of the type of information that you can expect to obtain from a patent search on impotence: ·
Male impotence diagnostic ultrasound system Inventor(s): Hovland; Claire T. (Minnetonka, MN), Abrams; Jerome H. (St. Paul, MN), Wons; Edward J. (Minnetonka, MN) Assignee(s): UroMetrics Inc. (St. Paul, MN) Patent Number: 6,251,076 Date filed: August 1, 1997 Abstract: An apparatus for diagnosing male impotence by measuring blood velocity in a cavernosal artery of a male penis includes at least one transducer for transmitting/receiving energy and reading corresponding Doppler effect to detect blood velocity in the cavernosal artery, a transducer housing for supporting the transducer in a substantially fixed orientation with respect to the penis as the transducer measures blood velocity in the cavernosal artery, and a fixing device, mechanically coupled to the transducer housing, to substantially mechanically fix the transducer housing in place with respect to the penis and hold the at least one transducer in a substantially constant angular orientation with respect to the cavernosal artery during an impotence diagnostic procedure. Corresponding methods are also disclosed. Excerpt(s): Male impotence is defined as the chronic inability to attain and/or maintain an erection of sufficient rigidity for sexual intercourse. This problem affects approximately 10 million American men, with increasing incidence in those of advanced age. Impotence is a source of great anxiety for many and is the subject of many thousands of visits to physicians and other medical professionals every year. ... During a normal erection, neurochemical stimulation causes penile arterial inflow to increase in the paired cavernosal arteries. The result is increased blood flow into the corpora cavernosa. The subtunical venus plexus is compressed against the tunica albuginea, and venous outflow is reduced
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to trap blood in the corpora cavernosa. This combination of increased inflow and decreased outflow results in vascular congestion of the penis, tumescence, and rigidity sufficient for sexual intercourse. It is believed that abnormal reduction of blood flow to the cavernosal arteries and/or excess venal outflow, i.e. corporal venous leakage, are the primary physical causes of impotence. These abnormal blood flow characteristics to and from the cavernosal arteries can be caused by a number of factors, for example atherosclerotic vascular disease, traumatic arterial occlusive disease, or defective venoocclusive mechanisms. ... Quam, J.P., et al., "Duplex and Color Doppler Sonographic Evaluation of Venogenic Impotence," AJR, 1989; 159:1141-7. Web site: http://www.delphion.com/details?pn=US06251076__ ·
Powered external vacuum appliance for the treatment of impotence Inventor(s): Gamper; Steven C. (Atlanta, GA), Rowley; David S. (Smyrna, GA), Flynn; Stephen J. (Peachtree City, GA), Moore; Devin L. (Decatur, GA), McMillan; John A. (Atlanta, GA), Mitchell; John M. (Martinez, GA), Carroll; Maureen (Atlanta, GA) Assignee(s): Timm Medical Technologies, Inc. (Eden Prairie, MN) Patent Number: 6,248,059 Date filed: May 3, 1996 Abstract: Pump assisted vacuum therapy impotence treatment apparatus may be provided in either electric or manually operated embodiments. The axis of a pump housing affixed to a vacuum chamber via an elastomeric coupler is at an angle to the vacuum chamber axis, and turned towards a user's torso to be drawn into the user's body for better vacuum sealing. The pump cylinder of a manual embodiment has an enlarged annular rest area for receiving a resilient skirt around the piston head during nonuse of the pump. This prevents compression set of the resilient skirt, for more reliable subsequent use of the pump. The vacuum chamber is tapered and transitions from a relatively smaller round end for receipt of a male sex organ to a relatively larger oval shaped end for bayonet mounting on the resilient coupler. A pair of sizing inserts adjusts the vacuum chamber end which receives the male sex organ. The smaller of the two inserts recesses into the larger insert, which improves the vacuum seal formed with the larger insert. The inserts help reduce scrotal tissue intake. Excerpt(s): The present invention relates in general to improved impotence treatment appliances and, in particular to pump assisted vacuum therapy impotence treatment technology improved for
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reliability, performance, and user controlled convenience. ... The medical condition of male impotence (i.e., the inability to achieve adequate penile erection for sexual intercourse) has been the subject of significant medical and scientific attention. Various therapies, both surgical and nonsurgical, have been previously made available for treating male impotence. One nonsurgical therapy generally involves the therapeutic use of a vacuum chamber for producing penile engorgement by drawing blood into the erectile bodies of the user's male sex organ, i.e., penis, by using a vacuum. The user's penis is placed within a vacuum chamber or cylinder. With a relative vacuum seal established between the user's body and such vacuum chamber, negative pressure or vacuum is produced within the chamber, leading to vacuum induced engorgement. An elastic cincture band or similar device is then used to secure the engorged condition of the male sex organ. ... Because vacuum therapy impotence treatment requires some physical manipulations, the user's dexterity and strength are inherently involved in the process. With some patients, particularly if advanced age, disease, or other degenerative physical condition is involved, the physical aspects of the therapy may be more significant than with other more generally fit or capable patients. Because of the sensitive nature of the therapy involved, the reliability of any system or technology and its ease of use can be other significant factors in the overall success of the therapy for a given patient. Web site: http://www.delphion.com/details?pn=US06248059__ ·
Use of cGMP-phosphodiesterase compositions to treat impotence
inhibitors
in
methods
and
Inventor(s): Daugan; Alain Claude-Marie (Les Ulis, FR) Assignee(s): ICOS Corporation (Bothell, WA) Patent Number: 6,140,329 Date filed: March 10, 1998 Abstract: The use of (6R,12aR)-2,3,6,7,12,12a-hexahydro-2-methyl-6-(3,4methylenedioxyphenyl)-p yrazino[2',1':6,1]pyrido[3,4-b]indole-1,4-dione, (3S 6R,12aR)-2,3,6,7,12,12a-hexahydro-2,3-dimethyl-6-(3,4methylenedioxyhenyl) -pyrazino[2',1':6,1]pyrido[3,4-b]indole-1,4-dione, and physiologically acceptable salts and solvates thereof, in methods and compositions for the treatment of impotence. Excerpt(s): This invention relates to the use of tetracyclic derivatives which are potent and selective inhibitors of cyclic guanosine 3',5'monophosphate specific phosphodiesterase (cGMP specific PDE) in the treatment of impotence. ... Impotence can be defined as a lack of power,
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in the male, to copulate and may involve an inability to achieve penile erection or ejaculation, or both. More specifically, erectile impotence or dysfunction may be defined as an inability to obtain or sustain an erection adequate for intercourse. Its prevalence is claimed to be between 2 and 7% of the human male population, increasing with age, up to 50 years, and between 18 and 75% between 55 and 80 years of age. Web site: http://www.delphion.com/details?pn=US06140329__ ·
Composition for treating impotence in men containing dried roe and yohimbine Inventor(s): Omar; Lotfi Ismail (P.O. Box F396, Kew Gardens, NY 11415) Assignee(s): none reported Patent Number: 6,086,884 Date filed: February 7, 1998 Abstract: A composition for treating impotence in human males contains a synergistic mixture of dried sturgeon roe and yohimbine hydrochloride wherein the weight percent ratio of said dried sturgeon roe:yohimbine hydrochloride is from about 25:1 to 1000:1, with an optimum ratio of about 132:1. The roe can be dried via either lyophilization or air drying under ambient temperature and pressure with reduced environmental humidity. A method of treating impotence in human males includes administration of such compositions containing the synergistic mixture of roe and yohimbine. Also, a method of treating impotence in human males by administration of dried roe in doses of from 300 to 900 mg. The roe is prepared either via lyophilization or air drying under ambient temperature and pressure with reduced environmental humidity. Excerpt(s): The instant invention relates generally to a composition for treating impotence in men that relieves erectile dysfunction and enhances sexual desire, and specifically to a composition for treating impotence by using fish roe either alone or in combination with yohimbine. The invention relates also to methods of preparing fish roe for use as a pharmaceutical product to treat impotence and for incorporation into the compositions of the present invention. ... Therapies for treating impotence are known in the art. These include the compositions and treatment methods described below. ... Testosterone and its derivatives are obtained only by prescription. They are administered orally or via injection, buccal tablets or other pharmaceutical dosage forms. The main use is for hypogonadism, male climactric and impotence. Testosterone also has other applications in medicine. As with other hormonal treatments, during administration of exogenous testosterone,
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endogenous testosterone release is inhibited through the negative feedback mechanism of pituitary lutenizing hormone (LH, or lutropin). Web site: http://www.delphion.com/details?pn=US06086884__ ·
Compositions for topical treatment of erectile impotence Inventor(s): Curri; Sergio (Milan, IT) Assignee(s): Inpharma S.A. (Lugano, CH) Patent Number: 6,013,277 Date filed: March 8, 1996 Abstract: Description of pharmaceutical or cosmetic compositions aimed at improving the local microcirculation of the penis for chronic topical treatment of vascular impotence due to vascular causes, with main impairment of the arterial-arteriolar afferents of the cavernous bodies. The new pharmacological properties of the complex between PGE1 and/or Troxerutine with Phosphatidylcholine are administered locally on the skin of the penis; the activity is obtained using the T.E.B. system according to Curri. Excerpt(s): This invention refers in general to pharmaceutical or cosmetic compositions aimed at improving local microcirculation of the penis in conditions such as erectile impotence of vascular origin in which the cause of the dysfunction is attributable to a deficiency in blood flow to the cavernous bodies. ... It is known that during the last few years the pathogenetic question as to the real cause of erectile impotence has continued to place ever increasing emphasis on the vascular origin of the problem rather than on the psychological causes. This is due to the continuous improvement of the instrumental techniques available for diagnosis. In a consistent number of cases of impotence it is, therefore, now possible to identify the organic (and not simply functional) origin of the affliction. ... This obviously means that medical treatment of impotence reverts less to psychotherapy, favouring drugs or methods that enable adequate treatment of local vascular deficiencies. Web site: http://www.delphion.com/details?pn=US06013277__
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·
Method for counteracting vasospasms, ischemia, renal failure, and treating male impotence using calcitonin gene related peptide Inventor(s): Wimalawansa; Sunil J. (907 Laurel Field, Friendswood, TX 77546) Assignee(s): none reported Patent Number: 5,958,877 Date filed: May 18, 1995 Abstract: The present invention provides a method for counteracting vasospasms and treating male impotence using calcitonin gene-related peptide (CGRP). CGRP is a naturally occurring substance in the human body. As such, CGRP does not have the same toxicity and allergy problems as the foreign substances that currently are used for similar purposes. When locally applied or infused, the effects of CGRP are limited to a local vascular area. Virtually no systemic effects are induced, making CGRP extremely safe and effective. Excerpt(s): The present invention relates to the local administration of calcitonin gene-related peptide (CGRP) to treat male impotence, and to prevent vasospasms induced by vasoconstrictor peptides, particularly during angioplasty or to prevent reocclusion of blood vessels during and/or after either angioplasty, stent insertion, or the implantation of a vascular graft. ... The present invention provides a method for counteracting vasospasms and treating male impotence using calcitonin gene-related peptide (CGRP). CGRP is a naturally occurring vasodilator substance in the human body. As such, CGRP does not have the same toxicity and allergy problems as the foreign substances that currently are used for similar purposes. When locally applied or infused, the effects of CGRP are limited to a local vascular area. Virtually no systemic effects are induced, making CGRP extremely safe and effective. ... Where CGRP is used to treat impotence, topical application directly on the penis in the form of a cream is preferred. Any pharmaceutically acceptable preparation may be used, in particular a preferred cream being Aquaphore, which is commercially available from Beiersdorf Inc., Norwalk, Conn. The concentration of CGRP in the cream should range from about 1-3 nmol, and in one preferred embodiment be about 2.5 nmol/ml. In a preferred embodiment, the CGRP is conjugated to linolenic acid--a naturally occurring polyunsaturated fatty acid--as an ester. (Acetoxymethyl acetate or acetoxymethyl esters can also be used for this purpose instead of linolenic acid.) This CGRP ester (conjugate) may be prepared using an automated peptide synthesizer and known methods. Alternately, the CGRP ester may be prepared by reacting the
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CGRP and linolenic acid using carbodiimide, glutaraldehyde, or a similar compounds, as a coupling agent. Web site: http://www.delphion.com/details?pn=US05958877__ ·
External device for eluding masculine impotence Inventor(s): Vergara; Roberto Jose Romero (Turina 10-1o., 47006 Valladolid, ES) Assignee(s): none reported Patent Number: 5,928,134 Date filed: January 30, 1997 Abstract: An external device for eluding masculine impotence, comprising: (A) SUPPORT, with a rigid core and a softer lining, it lies along the penis, to which it communicates its rigidity, since both are enveloped in a preservative. To avoid tautness, rubbing and pinching, the inner side of the preservative is previously wetted with an aqueous type lubricant. (B) FASTENER, made of rigid material, is attached to said support by means of two hinges, thus maintaining the support in its proper place despite the effort exerted during its use. (C) TIE, made of soft, flexible material, maintains the fastener well tightened to the body by pulling from it from the front and rear. It is useful for coitus performance when the erection is nonexistent or insufficient in intensity or duration. Excerpt(s): Masculine impotence is the male's inability to achieve and maintain an erection to a sufficient degree for full coitus performance. ... The rigidity in a normal erection is caused by the swelling of the cavernous bodies: two erectile tubes contained in the penis which are attached to the pubic bone by the penis' suspensory ligament. In order to maintain an erection, a 40 to 60 milliliter/minute blood flow is necessary. The length of an erect penis normally varies from 8 to 16 centimeters; its circumference perimeter, from 8 to 11 centimeters. However, impotence is a matter of rigidity, not size: the penetrating force in the vagina under normal circumstances is approximately 5 newtons (i.e. half a kilo), an exercise which is possible only if the penis acquires a sufficient rigidity; simply increasing the size is not enough. ... The majority of men are said to suffer an erectile disfunction at some time in their lives. However, a severe condition arises on reaching a 20% failure index. The causes of impotence can be: a) Of a psychic or mental source, such as life traumas, sense of guilt, apprehension of failure, etc., and generally any emotionally stressing condition, including a subconscious one. b) Of a physical or organic source, such as certain ailments, medicines,
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alcoholism, drug addiction, neurological, hormonal and vascular problems (blood irrigation), and sequelae from traumatisms, malformations, etc., namely deriving from anatomic and metabolic alterations. Causes of a psychic and organic nature can be simultaneously present in one same individual. Web site: http://www.delphion.com/details?pn=US05928134__ ·
Transurethral administration of vasoactive agents to treat peripheral vascular disease, related vascular diseases, and vascular impotence associated therewith Inventor(s): Place; Virgil A. (Kawaihae, HI), Hanamoto; Mark S. (Belmont, CA), Doherty, Jr.; Paul C. (Cupertino, CA), Spivack; Alfred P. (Menlo Park, CA), Gesundheit; Neil (Los Altos, CA), Bennett; Sean R. (Denver, CO) Assignee(s): VIVUS, Inc. (Mountain View, CA) Patent Number: 5,919,474 Date filed: October 28, 1997 Abstract: A method for treating peripheral vascular disease (PVD), related vascular diseases, and vascular impotence associated with such diseases, is provided. The method involves transurethral administration of a pharmaceutical formulation containing a selected vasoactive agent within the context of an effective dosing regimen. Preferred vasoactive agents are vasodilating agents selected from the group consisting of naturally occurring prostaglandins, synthetic prostaglandin derivatives, and combinations thereof. The pharmaceutical formulations used in conjunction with the novel method may also contain enzyme inhibitors, transurethral permeation enhancers, carriers, preservatives, surfactants, and the like. Kits and pharmaceutical formulations are provided as well. Excerpt(s): In addition, atherosclerotic PVD, involving the distal aortoiliac arteries and trauma to those vessels, are thus a common cause of vascular impotence. Individuals suffering from such vascular impotence generally have diminished or substantially absent femoral pulses, and generally present with Leriche's syndrome, although claudication may be absent in some cases. Furthermore, atherosclerotic macro- and microvascular disease are major factors contributing to erectile dysfunction in from 30 to 50 per cent of diabetic men who develop impotence. ... The present invention is directed to a novel method of treating the aforementioned vascular diseases as well as a novel method for treating vascular impotence as may be associated with such diseases. The treatment involves transurethral administration of a
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vasoactive agent, particularly a vasodilating agent, as will be described in detail herein. ... Transurethral administration of pharmacologically active agents has been described. For example, U.S. Pat. No. 4,478,822 to Haslam et al. relates to a controlled release, thermosetting gel formulation for delivering drugs into a body cavity such as the urethra. Also, U.S. Pat. No. 4,610,868 to Fountain et al. describes a biodegradable lipid matrix composition for administering a drug, wherein the composition is stated to be deliverable through the urethra. Basile et al. (1994), "Medical Treatment of Neurogenic Impotence," Sexual Disabilities 12(1):81-94 describes the intraurethral administration of drugs. PCT Publication No. WO91/16021, U.S. Pat. No. 4,801,587 to Voss et al., and U.S. Pat. No. 5,242,391 to Place et al. relate to the treatment of erectile dysfunction by administration of vasoactive agents into the male urethra. While these references mention urethral drug delivery, the potential importance of administering specific drugs in this manner to induce a desired local or systemic effect has only recently been recognized. Further, applicant is unaware of any art disclosing the effectiveness of transurethral administration of vasoactive agents in the treatment of PVD or PVD-associated vascular impotence. Web site: http://www.delphion.com/details?pn=US05919474__ ·
Device for percutaneous administration of medicaments for treating male impotence Inventor(s): Millot; Philippe (Dijon, FR), Lamoise; Michel (Bessey-lesCiteaux, FR) Assignee(s): Laboratoires D'Hygiene et de Dietetique (L.H.D.) (Paris, FR) Patent Number: 5,899,875 Date filed: May 12, 1997 Abstract: A device for the percutaneous administration of a medicament for treating male impotence comprises two reservoirs (1,2) hydratable with a medicament solution and intended to be applied to the skin of the penis. The reservoirs are mounted on substantially cylindrical braceletshaped means (8) with an elastically expansible diameter to support and press the reservoirs (1,2) against said skin during the treatment. The device includes a sensor which is fixed on the bracelet and is sensitive to the expansion of the bracelet in order to deliver a signal to the user. Excerpt(s): The present invention relates to a device for percutaneous administration of a medicament for treating male impotence and, more particularly, to such a device comprising at least one reservoir which can be moisturized with a solution of the medicament and is designed to bear
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on the skin of the penis. ... Organic male impotence, that is to say erectile dysfunction, is in most cases of iatrogenic, hormonal, vascular or psychologic origin. Attempts have hitherto been made to treat this condition in some cases by injecting papaverine into the cavernous bodies of the penis. This technique presents various disadvantages. The administration of papaverine by injection is on the one hand painful and on the other hand dangerous. This is because it can result, in the long term, in irreversible lesions, such as the appearance of fibrous plates or nodules in the cavernous bodies. It sometimes also causes excessively prolonged erections, which have to be treated with other injections in order to reduce them. It has also been proposed to treat erectile dysfunction by purely mechanical means consisting of a pneumatic vacuum device which is fitted around the penis in order to provoke its erection. A ring then blocks any escape of blood from the cavernous bodies. ... The present invention therefore has the aim of making available a device for treating male impotence which does not have any of these disadvantages and which thus ensures that this condition is treated in a manner which is painless, straightforward and without danger. Web site: http://www.delphion.com/details?pn=US05899875__ ·
Use of odorants to treat male impotence, and article of manufacture therefor Inventor(s): Hirsch; Alan R. (180 E. Pearson #4702, Chicago, IL 60611) Assignee(s): none reported Patent Number: 5,885,614 Date filed: February 23, 1996 Abstract: A method is provided for inducing or enhancing penile erection through the delivery of odorants for inhalation. The administration of odorants provides an increase in blood flow to the penis, and a therapeutic aid to stimulate sexual activity and alleviate male vasculogenic impotence. Excerpt(s): Male erectile dysfunction, or impotence, is the inability to achieve or sustain an erection of sufficient rigidity to have sexual intercourse. The causes of impotence are psychological and/or organic (i.e., endocrinologic, neurogenic and vasculogenic). Ten to fifteen percent of male impotence is organic in nature. Organic causes can be from local lesions of the genitalia, endocrine diseases, organic lesions of the nervous system, and/or vasculogenic impotence from reduced blood flow is the most common organic cause usually seen in diabetes. Impotence may be
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a side effect of a therapeutic drug or associated with a disease such as multiple sclerosis, diabetes and sickle cell anemia, and can be exacerbated by smoking, inadequate diet among other factors. Emotional disturbances, including stress, fatigue or distraction, can also cause impotence. ... Alteration of blood flow to and from the penis is considered to be the most frequent organic cause of impotence. Vasculogenic impotence results from either arterial occlusion, i.e., the obstruction of adequate blood flow to the penile arteries, or excess venal outflow (cavernovenous leaking). ... Treatment of impotence can include counseling directed toward dealing with the male's insecurities and feelings to reduce fears of sexual performance. Treatments for male impotence include surgery, penile prostheses implants including flexible rods and inflatable balloons, drugs such as vasodilators given to induce an erection as an ointment for topical application or a solution for transurethral injection, and external aids such as penile splints to support the penis or constricting rings to alter the blood flow through the penis. A drawback of those systems is their invasiveness, unwanted side effects, cost, inconvenience, and complexity. Web site: http://www.delphion.com/details?pn=US05885614__ ·
Use of 5HT.sub.3 antagonist to treat impotence Inventor(s): Nomura; Kazuhiko (Tsukuba, JP), Yamaguchi; Isamu (Kawanishi, JP) Assignee(s): Fujisawa Pharmaceutical Co., Ltd. (Osaka, JP) Patent Number: 5,750,537 Date filed: March 17, 1997 Abstract: An impotence remedy containing a 5HT.sub.3 antagonist as the active ingredient. Excerpt(s): The present invention relates to a therapeutic agent for impotence which comprises a 5HT.sub.3 antagonist as the active ingredient, and is useful in the medical field. ... Recently, the need for a therapeutic agent for impotence has been growing clinically. Although there is a therapeutic method for impotence in which vasoactive drugs such as papaverine or PGE1 are injected directly in corpus cavernosum, this method is not desirable because of some undesirable side effects or the methodology. Consequently, the development of an effective oral therapeutic agent for impotence has been needed. Up to the present, however, the effects of conventional oral drugs which were considered to be beneficial for impotence has been proved to be unsatisfactory, because of their poor efficacy, their safety, or undesirable side effects. ... The object
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of the present invention is to provide a novel and effective medicine for the treatment of impotence. Web site: http://www.delphion.com/details?pn=US05750537__ ·
Medication for impotence containing lyophilized roe and a powdered extract of Ginkgo biloba Inventor(s): Omar; Lotfy Ismail (P.O. Box F396, Kew Gardens, NY 11415) Assignee(s): none reported Patent Number: 5,730,987 Date filed: June 10, 1996 Abstract: A composition for treating impotence in human males is disclosed, which includes a mixture of lyophilized roe and a dry powdered extract from leaves of Ginkgo biloba. The lyophilized roe is obtained from a species of Sturgeon. The dry powdered extract is standardized to include flavonoid glycosides and terpenes. The mixture preferably provides lyophilized roe to lyophilized Ginkgo biloba in the ratio of approximately 12.33:1. The composition is preferably encapsulated and orally given to patients. A process for producing the composition is also provided. Excerpt(s): The instant invention relates generally to a medication for impotence that relieves erectile dysfunction and enhances a man's sexual desire. ... Caverject is a brand name marketed and available only by prescription. It is the synthetic version of alprostadil (prostaglandin E) which the body uses to help produce an erection. The medication is to be injected directly into the penis shortly before intercourse. It relaxes smooth muscle tissue in the penis which in turn enhances blood flow to the penis and causes erection. Caverject is often effective for men whose impotence is due to diabetic complications, anxiety or radical prostatectomy. One of the major drawbacks of caverject is that the subject, after injection, may have long lasting painful erection (priapism), which may last more than 6 hours and cause serious and permanent damage to the delicate spongy structure of the penis which may never again function properly. ... It is, therefore, an object of the present invention to provide a medication for impotence which will achieve positive effects on the libido and the penile erection, both of which are necessary to result in successful copulation. Web site: http://www.delphion.com/details?pn=US05730987__
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·
Treatment of male impotence with s-nitrosylated compounds Inventor(s): Stamler; Jonathan (Boston, MA), Loscalzo; Joseph (Dedham, MA), Slivka; Adam (Randolph, MA), Simon; Daniel (Waban, MA), Brown; Robert (Natick, MA), Drazen; Jeffrey (Winchester, MA) Assignee(s): Brigham & Women's Hospital (Boston, MA) Patent Number: 5,648,393 Date filed: August 29, 1994 Abstract: Methods of relaxing corpus cavernosum smooth muscle, treating disease states responsive to prevention or relaxation of undesirable contractions of corpus cavernosum smooth muscle and of treating male impotence by administering an S-nitrosothiol such as a low molecular weight S-nitrosothiol, S-nitroso-ACE-inhibitor or S-nitrosoprotein. Excerpt(s): This invention relates to the use of low molecular weight Snitrosothiols, such as S-nitroso-N-acetylcysteine, S-nitroso-glutathione, Snitroso-homocysteine, S-nitroso-cysteine, S-nitroso-penicillamine and Snitroso-captopril, to relax non-vascular smooth muscle. Types of smooth muscle include airway, gastrointestinal, bladder uterine, and corpus cavernosum. The invention also relates to the use of S-nitrosothiols for the treatment or prevention of disorders which involve non-vascular smooth muscle, such as respiratory disorders, gastrointestinal disorders, urological dysfunction, impotence, uterine dysfunction or premature labor. The invention also relates to the use of S-nitrosothiols or ameliorate smooth muscle contraction or spasm and thus, facilitate diagnostic or therapeutic procedures, such as bronchoscopy, endoscopy, laparoscopy, and cystoscopy. S-nitrosothiols may also be used to increase hemoglobinoxygen binding, and thus enhance oxygen transport to bodily tissues. ... In summary, the relaxation kinetics of non-vascular smooth muscle are very important in numerous physiological system. Moreover, a variety of significant clinical disorders occur, which involve contraction, spasm, or failure to achieve the necessary relaxation of smooth muscle. Examples of such disorders include airway obstruction (i.e., asthma, bronchitis and emphysema), bladder dysfunction, gastrointestinal muscle spasm (i.e., irritable bowel syndrome, achalasia, dumping disorders), and impotence. Thus, a clinical need exists for pharmacological agents which can treat or prevent such disorders by inducing relaxation of the affected smooth muscle. ... The invention is also directed to the use of S-nitrosothiols for the treatment or prevention of disorders associated with relaxation of smooth muscle, such as airway obstruction, gastrointestinal spasm, bladder dysfunction and impotence. The invention is also directed to the use of S-nitrosothiols to alleviate smooth muscle contraction and spasm,
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and thus facilitate procedures involving diagnostic instrumentation such as endoscopy and bronchoscopy. Web site: http://www.delphion.com/details?pn=US05648393__ ·
Methods for treating erectile impotence Inventor(s): Kral; John G. (23 Prospect Ave., Larchmont, NY 10538) Assignee(s): none reported Patent Number: 5,583,144 Date filed: February 24, 1995 Abstract: The present invention relates to methods of relieving erectile impotence in a human male. The method comprises administering to the male an erectile impotence relieving amount of piperoxan and the compositions include an erectile impotence relieving amount of piperoxan or the pharmaceutically acceptable acid addition salts thereof optionally in combination with a pharmaceutically acceptable carrier. Excerpt(s): The present invention relates to compositions and methods for treating male erectile impotence and more particularly to pharmaceutical compositions comprising erection enhancing compounds and methods of their use for the treatment of human erectile impotence. ... Impotence is the inability to obtain and sustain an erection sufficient for intercourse. Erection is achieved as a result of arterial inflow into the corpus cavernosum of the penis, which produces engorgement of the corpus cavernosum, and subsequent penile erection. According to a 1993 National Institutes of Health Consensus Panel, it is estimated that as many as 30 million American men experience some degree of erectile dysfunction, the prevalence of which increases with age (NIH Consensus Statement, Vol 10(4): 1-31, (1992)). Fifteen to twenty-five percent of all men 65 years and older suffer from some sort of erectile dysfunction, but the disease is also experienced by as many as five percent of men age 40 years. Half of diabetic men exhibit erectile dysfunction. An increased prevalence of the disease is also associated with hypogonadism, hypertension, high blood cholesterol, drugs, neurogenic disorders, Peyronie's disease, priapism, depression, and renal failure (NIH Consensus Statement, Vol 10(4):1-31, (1992)). ... The causes of impotence are usually divided into two subcategories a) organic and b) psychological. The organic aspects of impotence are caused by underlying vascular disease such as that associated with hypertension, diabetes mellitus, and prescription medications. Conservative estimates indicate that half of all cases of impotence are of vascular origin. Because the physiologic process of erection is initiated by an increase in blood
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flow through the penile arteries and shunting of blood into the vascular spaces of the corpus cavernosum, erectile dysfunction can result from vasculogenic disorders. Since erection necessarily involves vasodilation of the arteries of the penis, the pathophysiologic basis of impotence can be contributed to the inability of the arteries of the penis to vasodilate, thereby inhibiting the flow of blood into the erectile tissue. Web site: http://www.delphion.com/details?pn=US05583144__
Patent Applications on Impotence As of December 2000, U.S. patent applications are open to public viewing.22 Applications are patent requests which have yet to be granted (the process to achieve a patent can take several years). The following patent applications have been filed since December 2000 relating to impotence: ·
Method of treating for impotence and apparatus particularly useful in such method Inventor(s): Sheinman, Shuki ; (Raanana, IL), Sidi, Abraham Ami ; (Ramat Gan, IL), Yacobi, Yacov ; (Kiryat Ono, IL) Correspondence: Birch Stewart Kolasch & Birch; PO Box 747; Falls Church; VA; 22040-0747; US Patent Application Number: 20010007080 Date filed: February 22, 2001 Abstract: A method and apparatus for treating a male for impotence, i.e., for enabling, or improving the ability of, the male to achieve or maintain a penile erection of adequate rigidity for sexual intercourse, by applying monochromatic light radiation, preferably low-power laser radiation of a wavelength of 440 nm, to the penis of the male, sufficient to induce relaxation of the walls of the blood vessels supplying blood to the corpora cavernosa of the penis. Excerpt(s): The invention relates to a method of treating a male for impotence, namely a male's inability to achieve or maintain a penile erection of adequate rigidity for sexual intercourse. The invention also relates to apparatus for irradiating an object with monochromatic light, preferably a laser beam, which apparatus is particularly useful in such method. ... erectile tissue disfunction impotence, secondary to fibrosis, trauma, diabetes, tumor infiltration and others. ... An object of the present invention is to provide a novel method of treating a male for impotence,
22
This has been a common practice outside the United States prior to December 2000.
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i.e., for enabling, or improving the ability of, the male to achieve penile erection of adequate rigidity for sexual intercourse, which method has advantages in one or more of the above respects. Another object of the invention is to provide apparatus for irradiating an object with light radiation, preferably laser radiation, which apparatus is particularly useful in the above method but could conceivably be used in other applications. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
Keeping Current In order to stay informed about patents and patent applications dealing with impotence, you can access the U.S. Patent Office archive via the Internet at no cost to you. This archive is available at the following Web address: http://www.uspto.gov/main/patents.htm. Under “Services,” click on “Search Patents.” You will see two broad options: (1) Patent Grants, and (2) Patent Applications. To see a list of granted patents, perform the following steps: Under “Patent Grants,” click “Quick Search.” Then, type “impotence” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on impotence. You can also use this procedure to view pending patent applications concerning impotence. Simply go back to the following Web address: http://www.uspto.gov/main/patents.htm. Under “Services,” click on “Search Patents.” Select “Quick Search” under “Patent Applications.” Then proceed with the steps listed above.
Vocabulary Builder Acetylcysteine: The N-acetyl derivative of cysteine. It is used as a mucolytic agent to reduce the viscosity of mucous secretions. It has also been shown to have antiviral effects in patients with HIV due to inhibition of viral stimulation by reactive oxygen intermediates. [NIH] Angioplasty: Endovascular reconstruction of an artery, which may include the removal of atheromatous plaque and/or the endothelial lining as well as simple dilatation. These are procedures performed by catheterization. When reconstruction of an artery is performed surgically, it is called endarterectomy. [NIH] Aqueous: Watery; prepared with water. [EU] Arteriolar: Pertaining to or resembling arterioles. [EU]
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Bronchitis: Inflammation of one or more bronchi. [EU] Bronchoscopy: Endoscopic examination, therapy or surgery of the bronchi. [NIH]
Buccal: Pertaining to or directed toward the cheek. In dental anatomy, used to refer to the buccal surface of a tooth. [EU] Calcitonin: A peptide hormone that lowers calcium concentration in the blood. In humans, it is released by thyroid cells and acts to decrease the formation and absorptive activity of osteoclasts. Its role in regulating plasma calcium is much greater in children and in certain diseases than in normal adults. [NIH] Captopril: A potent and specific inhibitor of peptidyl-dipeptidase A. It blocks the conversion of angiotensin I to angiotensin II, a vasoconstrictor and important regulator of arterial blood pressure. Captopril acts to suppress the renin-angiotensin system and inhibits pressure responses to exogenous angiotensin. [NIH] Coitus: Sexual connection per vaginam between male and female. [EU] Conjugated: Acting or operating as if joined; simultaneous. [EU] Copulation: Sexual contact of a male with a receptive female usually followed by emission of sperm. Limited to non-human species. For humans use coitus. [NIH] Cystoscopy: Direct visual examination of the urinary tract with a cystoscope. [EU] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Emphysema: A pathological accumulation of air in tissues or organs; applied especially to such a condition of the lungs. [EU] Endogenous: Developing or originating within the organisms or arising from causes within the organism. [EU] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Femoral: Pertaining to the femur, or to the thigh. [EU] Glycoside: Any compound that contains a carbohydrate molecule (sugar), particularly any such natural product in plants, convertible, by hydrolytic cleavage, into sugar and a nonsugar component (aglycone), and named specifically for the sugar contained, as glucoside (glucose), pentoside (pentose), fructoside (fructose) etc. [EU] Iatrogenic: Resulting from the activity of physicians. Originally applied to disorders induced in the patient by autosuggestion based on the physician's
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examination, manner, or discussion, the term is now applied to any adverse condition in a patient occurring as the result of treatment by a physician or surgeon, especially to infections acquired by the patient during the course of treatment. [EU] Infiltration: The diffusion or accumulation in a tissue or cells of substances not normal to it or in amounts of the normal. Also, the material so accumulated. [EU] Inhalation: The drawing of air or other substances into the lungs. [EU] Irrigation: Washing by a stream of water or other fluid. [EU] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Kinetic: Pertaining to or producing motion. [EU] Laparoscopy: Examination, therapy or surgery of the abdomen's interior by means of a laparoscope. [NIH] LH: A small glycoprotein hormone secreted by the anterior pituitary. LH plays an important role in controlling ovulation and in controlling secretion of hormones by the ovaries and testes. [NIH] Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU] Malformation: A morphologic defect resulting from an intrinsically abnormal developmental process. [EU] Medicament: A medicinal substance or agent. [EU] Microcirculation: The flow of blood in the entire system of finer vessels (100 microns or less in diameter) of the body (the microvasculature). [EU] Penicillamine: 3-Mercapto-D-valine. The most characteristic degradation product of the penicillin antibiotics. It is used as an antirheumatic and as a chelating agent in Wilson's disease. [NIH] Percutaneous: Performed through the skin, as injection of radiopacque material in radiological examination, or the removal of tissue for biopsy accomplished by a needle. [EU] Piperoxan: A benzodioxane alpha-adrenergic blocking agent with considerable stimulatory action. It has been used to diagnose pheochromocytoma and as an antihypertensive agent. [NIH] Plexus: A network or tangle; a general term for a network of lymphatic vessels, nerves, or veins. [EU] Prostaglandins: A group of compounds derived from unsaturated 20carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway. They are extremely potent mediators of a diverse group of physiological processes. [NIH]
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Psychic: Pertaining to the psyche or to the mind; mental. [EU] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Vasoactive: Exerting an effect upon the calibre of blood vessels. [EU] Venus: The second planet in order from the sun. It has no known natural satellites. It is one of the four inner or terrestrial planets of the solar system. [NIH]
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CHAPTER 5. BOOKS ON IMPOTENCE Overview This chapter provides bibliographic book references relating to impotence. You have many options to locate books on impotence. The simplest method is to go to your local bookseller and inquire about titles that they have in stock or can special order for you. Some patients, however, feel uncomfortable approaching their local booksellers and prefer online sources (e.g. www.amazon.com and www.bn.com). In addition to online booksellers, excellent sources for book titles on impotence include the Combined Health Information Database and the National Library of Medicine. Once you have found a title that interests you, visit your local public or medical library to see if it is available for loan.
Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go to http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “impotence” (or synonyms) into the “For these words:” box. You will only receive results on books. You should check back periodically with this database which is updated every 3 months. The following is a typical result when searching for books on impotence: ·
Live Now, Age Later: Proven Ways to Slow Down the Clock Source: New York, NY: Warner Books. 1999. 398 p.
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Contact: Available from Warner Books. 1271 Avenue of the Americas, New York, NY 10020. (800) 759-0190. E-mail:
[email protected]. Website: www.twbookmark.com. Price: $7.99 plus shipping and handling. Summary: This book offers practical strategies and healthy living advice for people who want to slow down their own aging process. The book is written in casual language with an emphasis on explaining medical and health issues for the general public. Twenty chapters cover Alzheimer's disease, cancer, constipation, depression, hearing loss, heart attacks, erectile dysfunction (impotence), insomnia, libido, menopause, osteoarthritis, osteoporosis, prostate enlargement, aging skin, stroke, diminished taste and smell, tinnitus, tooth loss, and loss of vision (macular degeneration, cataracts, glaucoma). Each chapter reviews the topic in question, risk factors, the type of symptoms that can be expected, diagnostic tests that are used to confirm the problem, treatment options, and prognosis. A final section offers general health guidelines that focus on the importance of positive thinking and healthy lifestyle choices. A subject index concludes the book. ·
Mayo Clinic on Managing Diabetes Source: Rochester, MN: Mayo Clinic. 2001. 194 p. Contact: Available from Mayo Clinic Health Information. 200 First Street, S.W., Fifth Floor Centerplace Building, Rochester, MN 55905. (800) 4309699. Website: www.mayoclinic.com. Price: $14.95 plus shipping and handling. ISBN: 1893005062. Summary: This book provides practical and easy to understand information on controlling diabetes and preventing complications of the disease. Part one provides facts about diabetes. Topics include types of diabetes, the signs and symptoms of diabetes, the risk factors for diabetes, and the criteria and tests for diagnosing diabetes. In addition, the issue of diabetic complications is addressed, focusing on hypoglycemia, diabetic hyperosmolar syndrome, diabetic ketoacidosis, neuropathy, nephropathy, retinopathy, heart and blood vessel disease, and increased risk of infection. Part two deals with the components involved in controlling the disease. Chapters discuss monitoring blood glucose, eating a healthy diet, getting daily exercise, and maintaining a healthy weight. Part three examines medical therapies for managing diabetes. Chapters provide information on the use of insulin to manage type 1 and type 2 diabetes; the use of sulfonylureas, meglinitides, biguanides, alpha glucosidase inhibitors, thiazolidinediones, and drug combinations to manage type 2 diabetes; and pancreas and islet cell transplantation as possible cures for diabetes. Part four addresses issues
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related to living well with diabetes. One chapter focuses on important tests every person who has diabetes should be getting, including the glycosylated hemoglobin test, lipid tests, the serum creatinine test, and the urine microalbumin test. Another chapter discusses self care issues, including having annual physical examinations, visiting a dentist regularly, caring for feet, avoiding smoking, monitoring blood pressure, and managing stress. A third chapter explores sexual health issues for both men and women. Topics include the affect of the menstrual cycle and menopause on blood glucose, hormone replacement therapy, pregnancy, and impotence. Each chapter concludes with a question and answer section. The book also includes a list of additional resources. 17 figures. 1 table. ·
Uncomplicated Guide to Diabetes Complications Source: Alexandria, VA: American Diabetes Association. 1998. 256 p. Contact: Available from American Diabetes Association, Inc. Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 442-9742. Website: www.diabetes.org. Price: $18.95 plus shipping and handling. ISBN: 0945448872. Order number 481401. Summary: This book uses a question and answer format to provide information on the symptoms, prevention, treatment, and self-care of diabetes complications. The information presented in the book is intended to help people who have diabetes cope with the uncertainty and fear of developing complications. Chapters cover all major complications: diabetic ketoacidosis, hyperglycemic hyperosmolar nonketotic coma, lactic acidosis, hypoglycemia, foot problems, eye disease and blindness, kidney and heart disease, hypertension and stroke, neuropathy and vascular disease, gastrointestinal problems, skin and dental problems, psychosocial complications, and impotence and other sexual disorders. Chapters also address special concerns such as hypoglycemia and obesity. Many chapters include a case study or studies to illustrate the complications of diabetes. The book concludes with a glossary and an index. 2 appendices. 33 figures. 32 tables.
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Foods That Harm, Foods That Heal: An A-Z Guide to Safe and Healthy Eating Source: Pleasantville, NY: Reader's Digest. 1997. 400 p. Contact: Available from Customer Service, Reader's Digest. Pleasantville, NY 10570. (800) 846-2100. Price: $30.00. ISBN: 0895779129. Summary: This nutrition reference book features more than 400 photographs and illustrations with more than 400 A to Z entries on a vast
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range of foods and health concerns, including caffeine, cancer, diabetes, fast food, garlic, heart disease, influenza, osteoporosis, pregnancy, sexually transmitted diseases, and vegetarianism. The book is designed to help families understand the close links between foods and wellness. Each food entry provides at-a-glance information of its nutrients (or lack of) and its benefits and drawbacks. Each ailment is accompanied by a list of foods and beverages that are considered safe, and what foods or beverages should be cut down or avoided altogether. Case studies help to illustrate various topics. There are special features on eating during different life stages, from infancy to old age, as well as such issues as genetically altered foods, irradiation, pesticides, and pollution. Other topics include how to cook foods to achieve maximum nutritional benefits; which dietary supplements really work; tips on exercise, food storage, and reading food labels; an instructive analysis of the most popular diet regimes; and controversial foods and additives such as eggs, nitrites, bran, cheese, milk, fat, wine, and alcohol. A glossary defines unfamiliar or technical terms; there is also a listing of organizations that can provide further information and resources. Topics specifically related to diabetes include atherosclerosis, basic food groups, blood pressure, carbohydrates, childhood and adolescent nutrition, cholesterol, convenience and fast foods, cravings, diabetes, dieting and weight control, exercise and diet to boost energy and lift mood, eye disorders, fats, fiber, heart disease, hypoglycemia, immune system, impotence, indigestion and heartburn, infertility, juicing, kidney diseases, malnutrition and dietary deficiencies, medicine-food interactions, menopause, minerals, neuralgia, obesity, organic foods, osteoporosis, pregnancy, preparation and storage of food, protein, restaurants and eating out, salt and sodium, sleep and diet, smoking and diet, sports nutrition, stress, stroke, sugar and other sweeteners, supplements, traveler's health, vegetarian diets, and vitamins. ·
Diabetic Man: A Guide to Health and Success in All Areas of Your Life, With Advice, Empathy, and Support for Those Who Have a Diabetic Man in Their Lives Source: Los Angeles, CA: Lowell House, and Chicago, IL: Contemporary Books. 1996. 348 p. Contact: Available from Contemporary Books. 2 Prudential Plaza, Suite 1200, Chicago, IL 60601. (800) 621-1918. Price: $15 (as of 1996). ISBN: 1565654390. Summary: This book, revised in 1996, is primarily addressed to men who have diabetes, but also offers several sections which address the concerns of the wives, partners, and families of men who have diabetes. Topics
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discussed in the book include the physical, psychological, emotional, and social effects and challenges of having diabetes; diet and nutrition; alcohol; sports and exercise; work, employment discrimination, military service, insurance, and government protection; sex and impotence; and travel. The book includes extensive lists of suggested reading and listening materials, several appendices, and a subject index. ·
Getting Help: A Patient's Guide for Men With Impotence Source: Lenexa, KS: Integrated Medical Resources, Inc. 1995. 48 p. Contact: Available from Integrated Medical Resources, Inc. 8326 Melrose Drive, Lenexa, KS 66214. (913) 894-0591. Price: $6.95. Summary: This handbook provides basic information about the diagnosis and treatment of male erectile dysfunction, or impotence. After introductory chapters defining impotence and discussing its causes, the author considers diagnostic issues, including the patient history and physical, specialized blood tests, erection monitoring during sleep, inoffice impotence testing, and other specialized tests. The next chapter outlines treatment options, including sexual counseling, oral medications, testosterone hormone replacement, penile injections, vacuum constriction devices, penile implant surgery, and corrective surgeries. Also included is a chapter on penile curvature and Peyronie's disease. The handbook concludes with two brief sections to help readers determine if they really have a problem and to encourage them to consult a health care provider. A brief index concludes the book. Simple line drawings illustrate many of the concepts.
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Living With Diabetic Complications: A Survival Guide for Patients by a Patient Source: Portland, OR: Outreach Enterprises. 1993. 294 p. Contact: Available from Outreach Enterprises. 2309 Southwest First Avenue, Suite 1842, Portland, OR 97201. (503) 224-9857. Price: $15.95 plus shipping and handling. ISBN: 1560435283. Summary: This book addresses the chronic complications of diabetes. The author discusses current treatments and offers practical living strategies and helpful advice on coping with the emotional and social impact of the complications of diabetes. The manual includes information on recent discoveries and medical advances in the treatment of vision impairment, kidney disease, neuropathy, impotence, heart disease, foot problems, and other chronic complications. The author also gives guidelines for cultivating faith and an optimistic attitude, retaining healthy relationships with family and friends, finding the right doctor, dealing
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with employment and insurance barriers, and enjoying many travel and recreational options. The book concludes with a detailed listing of organizations, publications, products and services and a bibliography of helpful books and articles. 80 references. (AA-M). ·
Diabetic Neuropathy Source: Somerset, NJ: John Wiley and Sons. 1990. 634 p. Contact: Available from John Wiley and Sons, Inc. 1 Wiley Drive, Somerset, NJ 08875. (201) 469-4400. Price: $135. ISBN: 0471924865. Summary: If one considers the unpleasant, painful sensory and muscle wasting syndromes, problems of the neuropathic foot, and the significant contribution to the development of impotence, then diabetic neuropathy must be regarded as the single most common clinical problem associated with complications of diabetes. This symposium report covers all aspects of current research on diabetic neuropathies. Seventy-one chapters are divided into eight sections: an introduction; morphology of human and animal nerve; aldose reductase; vascular factors in diabetic neuropathy; measurement, quantitation, and clinical assessment; autonomic neuropathy; other potential treatments of diabetic neuropathy; and the diabetic foot. Each chapter includes numerous tables, figures, and references for additional research. A detailed subject index is appended.
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Shy Bladder Syndrome: Your Step-by-Step Guide to Overcoming Paruresis Source: Oakland, CA: New Harbinger Publications, Inc. 2001. 147 p. Contact: Available from New Harbinger Publications, Inc. 5674 Shattuck Avenue, Oakland, CA 94609. (800) 748-6273 or (510) 652-2002. Fax (510) 652-5472. Website: www.newharbinger.com. Price: $13.95 plus shipping and handling. ISBN: 1572242272. Summary: This book provides a comprehensive overview of paruresis (shy bladder) and explains what it is, how the condition is diagnosed, and how it can be treated. The author notes that other than erectile dysfunction (impotence) and incontinence (involuntary loss of urine), shy bladder syndrome is perhaps the most embarrassing bodily dysfunction to discuss. The book includes eight chapters that cover a description of the condition and its symptoms; the physiology of the brain, bladder, and urination; determining the causes of bashful bladder syndrome; self treatment for paruresis; adjunct therapies, support groups and workshops; the medical community and paruresis; how family members, intimate partners, and friends can support the patient's recovery; and evolving legal ramifications, including those related to mandatory drug
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testing and the Americans with Disabilities Act (ADA). The book includes many personal stories from people who have shy bladder; these stories are taken from anonymous postings on the International Paruresis Association's (IPA) talk board or from personal communications with the authors. The authors recommend that readers use a journal when reading the book, to help identify and keep track of those issues that are important. Three appendices offer a literature review, a historical overview of the evolution of the bathroom, and resources for additional help. The book concludes with a list of references. 2 figures. 93 references. ·
20 Common Problems in Urology Source: New York, NY: McGraw-Hill, Inc. 2001. 335 p. Contact: Available from McGraw-Hill, Inc. 1221 Avenue of the Americas, New York, NY 10020. (612) 832-7869. Website: www.bookstore.mcgrawhill.com. Price: $45.00;plus shipping and handling. ISBN: 0070634130. Summary: This text on common problems in urology is designed for the primary care provider. The text covers both pediatric and adult conditions and features quick reference algorithms, charts and tables that organize presenting signs and symptoms, diagnostic tests, and treatments. Twenty chapters cover fetal and postnatal hydronephrosis (fluid accumulation in the kidneys), urinary tract infections (UTIs) in children, cryptorchidism (undescended testicles), circumcision, nocturnal enuresis (bedwetting), UTIs in adults, urethritis, urinary incontinence, interstitial cystitis, geriatric urology, hematuria (blood in the urine), prostate cancer screening, benign prostatic hyperplasia (BPH), scrotal mass and pain, genital skin rash, urinary calculi (stones), erectile dysfunction (impotence), male infertility, vasectomy, male menopause, and imaging studies (diagnostic tests). Most chapters define the condition and then discuss the differential diagnosis, the physical examination, recommended diagnostic tests, special considerations, treatment options, and patient care strategies. The text also offers practice advice on when to refer to a specialist and what to expect post-referral. The text concludes with a subject index and is illustrated with black and white photographs and diagrams.
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AAKP Patient Plan. Phase Three: Stabilization Source: Tampa, FL: American Association of Kidney Patients. 2000. 43 p. Contact: Available from American Association of Kidney Patients (AAKP). 100 South Ashley Drive, Suite 280, Tampa, FL 33602. (800) 749AAKP or (813) 223-7099. E-mail:
[email protected]. Website:
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www.aakp.org. Price: Single copy free. Also available for free at http://www.aakp.org/ppbk3.pdf. Summary: This booklet is the third in a four phase series of instructional materials for kidney patients. Published by the American Association of Kidney Patients (AAKP), the booklets are designed to address questions and concerns at various phases of the disease process. The four phases covered are diagnosis and treatment options, access and initiation, stabilization, and ongoing treatment. During each of these phases, the patient can keep control of his or her life by staying active and learning as much as possible about kidney disease and treatment. This third booklet introduces the reader to the idea of stabilization and the importance of continuing to learn about kidney disease. During this phase, the patient has settled into the routine of treatments and medications. The booklet covers optimal dialysis (dialysis adequacy); optimal transplant; family, friends, and social life; work, employment and volunteering; and legal responsibilities. Specific topics include hemodialysis adequacy, peritoneal dialysis adequacy, the importance of nutrition, anemia and how to treat it, the use of erythropoietin (EPO), the role of exercise, the symptoms of transplant rejection, the physical changes that may accompany transplant, how to handle stress, erectile dysfunction (impotence) and its treatment, how to talk about end stage renal disease (ESRD) in a new relationship, strategies to help the ongoing adjustment to ESRD, the Americans With Disabilities Act (ADA), the ESRD Networks and how they can help, and how to report a grievance to the Network. The booklet concludes with a glossary of terms and an appendix that lists information resources, ESRD networks, questions to ask the health care team, and forms to record important medical information. The booklet encourages readers to educate themselves and become active members of their own health care team. There are quotes and suggestions from other kidney patients sprinkled throughout the text. When readers are finished with the book, there is a postage paid card to send in to receive the fourth booklet. The booklet is illustrated with black and white photographs and tables. 3 figures. 8 tables. ·
Beyond Viagra: Plain Talk About Treating Male and Female Sexual Dysfunction Source: Montgomery, AL: Starrhill Press. 1999. 196 p. Contact: Available from Black Belt Press. P.O. Box 551, Montgomery, AL 36101. (800) 959-3245 or (334) 265-6753. Fax (334) 265-8880. Price: $13.95 plus shipping and handling. ISBN: 1573590142. Summary: This book discusses the drug sildenafil (Viagra) in the context of a larger discussion about sexuality and sexual dysfunction. Twenty-
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four chapters cover normal male sexual function, an overview of male sexual dysfunction, the causes of male erectile dysfunction, evaluating the male with erectile dysfunction, treatment strategies for metabolic disorders (including diabetes and prolactinoma), hormone replacement therapy, penile injections with vasoactive drugs, urethral suppository with vasoactive drugs, vacuum erection devices, vascular surgery for impotence, an overview of penile implants, treatment of Peyronie's disease, treatment of psychological impotence, the role of impotence support groups, herbal medicine for males, Viagra for male erectile dysfunction, Viagra in combination with injections or vacuum erection devices, Viagra in combination with penile implants, future treatments for erectile dysfunction, normal female sexual function, the causes and treatment of female sexual dysfunction, Viagra and apomorphine for females, herbal medicine for females, and healthy relationships and sexual function. The chapters are written in nontechnical language but include enough medical information to be of use to medical professionals wishing to learn more about sexual dysfunction. The book concludes with a list of resources and a subject index. 10 figures. 5 tables. 237 references. ·
Manual of Urology: Diagnosis and Therapy. 2nd ed Source: Hagerstown, MD: Lippincott Williams and Wilkins. 1999. 362 p. Contact: Available from Lippincott Williams and Wilkins. P.O. Box 1600, Hagerstown, MD 21741. (800) 638-3030 or (301) 714-2300. Fax (301) 8247390. Website: www.lww.com. Price: $37.95 plus shipping and handling. ISBN: 078171785X. Summary: This manual is designed to be used by the house officer and medical student responsible for urology patients. The related endoscopic, medical, and diagnostic procedures are well described. Twenty two chapters cover imaging of the genitourinary tract, radionuclide imaging, endoscopic instruments and surgery, nontraumatic genitourinary emergencies, fluid and electrolyte disorders, lower urinary tract symptoms, hematuria (blood in the urine) and other urine abnormalities, evaluation of renal mass lesions, surgical disorders of the adrenal gland, urinary calculi (stones) and endourology, the management of urinary incontinence, male erectile dysfunction (impotence), male reproductive dysfunction, neoplasms (cancerous and benign) of the genitourinary tract, the medical management of genitourinary malignancy (cancer), radiation therapy of genitourinary malignancy, genitourinary infection, management of genitourinary trauma, pediatric urology, neurourology and urodynamic testing, and renal (kidney) transplantation. Each chapter presents information in outline form, with numerous tables and
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diagrams, as necessary. Each chapter concludes with a list of suggested reading. The handbook concludes with two appendices, presenting the American Urological Association Symptom Score (for benign prostatic hyperplasia) and the staging of genitourinary tumors, as well as a subject index. ·
Medical Advisor Home Edition: The Complete Guide to Alternative and Conventional Treatments Source: Alexandria, VA: Time-Life Books. 1997. 960 p. Contact: Available from Time-Life Books. 400 Keystone Industrial Park, Dunsmore, PA 18512. Price: $20.00. ISBN: 0783552505. Summary: This book offers information about 300 health problems, ranging from relatively benign conditions to the most serious diseases. The book provides symptom charts that name several related problems and help readers decide which ailment entry to look up. Ailment entries provide a more complete list of symptoms, plus guidelines to discern whether the condition is potentially serious or requires a doctor's attention. Each entry describes the ailment and how it affects the body. Next, the entry outlines the underlying causes of the ailment and tests and procedures a doctor may use to confirm the diagnosis. The treatment segment presents conventional and alternative recommendations for curing the problem or alleviating the symptoms. Most ailment entries conclude with advice on preventive measures that can be used to maintain health. Alternative treatments described include bodywork, acupuncture and acupressure, herbal therapies, homeopathy, lifestyle changes, and nutrition and diet. The book begins with a section on emergency medicine. Also included is a visual diagnostic guide, an atlas to the body, a medicine chest section (describing herbs, homeopathic remedies, and over the counter drugs), a glossary, a subject index, a bibliography, and a list of health associations and organizations. Topics related to kidney and urologic diseases include AIDS, anemia, bedwetting, bladder cancer, bladder infections, diabetes, drug abuse, fluid retention, groin strain, impotence, incontinence, infertility, kidney cancer, kidney disease, kidney infections, kidney stones, penile pain, prostate cancer, prostate problems, sexual dysfunction, sexually transmitted diseases, testicle problems, testicular cancer, and urinary problems. The book is illustrated with line drawings and full color photographs.
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Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes & Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in PrintÒ). The following have been recently listed with online booksellers as relating to impotence (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): ·
Biopotency : A Guide in Sexual Success by Ricard Berger, Deborah Berger (1987); ISBN: 0878576568; http://www.amazon.com/exec/obidos/ASIN/0878576568/icongroupin terna
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Common Problems in Infertility and Impotence by Jacob Rajfer (1990); ISBN: 0815169914; http://www.amazon.com/exec/obidos/ASIN/0815169914/icongroupin terna
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Contemporary Management of Impotence and Infertility by Emil A. Tanagho, et al (1988); ISBN: 0683081012; http://www.amazon.com/exec/obidos/ASIN/0683081012/icongroupin terna
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Counterfeit Sex (1982); ISBN: 0808900552; http://www.amazon.com/exec/obidos/ASIN/0808900552/icongroupin terna
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Counterfeit Sex: Homosexuality Impotence Frigidity by Edmund Bergler (1982); ISBN: 0808900579; http://www.amazon.com/exec/obidos/ASIN/0808900579/icongroupin terna
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Damning the Innocent: A History of the Persecution of the Impotent in Pre-Revolutionary France by Pierre Darmon (1986); ISBN: 067080911X; http://www.amazon.com/exec/obidos/ASIN/067080911X/icongroupi nterna
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Diabetes and Impotence : A Concern for Couples by Priscilla Hollander (1985); ISBN: 0937721093; http://www.amazon.com/exec/obidos/ASIN/0937721093/icongroupin terna
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Diagnosis and Treatment of Erectile Disturbances: A Guide for Clinicians by R. Taylor Segraves, Harry W. Schoenberg (Editor) (1985); ISBN: 0306418711;
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http://www.amazon.com/exec/obidos/ASIN/0306418711/icongroupin terna ·
Disorders of Male Sexual Function by Drogo K. Montague (1988); ISBN: 0815159390; http://www.amazon.com/exec/obidos/ASIN/0815159390/icongroupin terna
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How to Eat Away Your Impotence by Marsh Morrison (1978); ISBN: 013405654X; http://www.amazon.com/exec/obidos/ASIN/013405654X/icongroupi nterna
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How to Win over Impotence-Frigidity by Salem Kirban (1981); ISBN: 0686803337; http://www.amazon.com/exec/obidos/ASIN/0686803337/icongroupin terna
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Impotence (1989); ISBN: 0933803079; http://www.amazon.com/exec/obidos/ASIN/0933803079/icongroupin terna
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Impotence and the Fountain of Youth by Robert W. Wilson (1989); ISBN: 0898657466; http://www.amazon.com/exec/obidos/ASIN/0898657466/icongroupin terna
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Impotence in the Male by Stekel (1971); ISBN: 0871400502; http://www.amazon.com/exec/obidos/ASIN/0871400502/icongroupin terna
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Impotence Is Always Having to Say You're Sorry by Jack S. Margolis (1975); ISBN: 0843103647; http://www.amazon.com/exec/obidos/ASIN/0843103647/icongroupin terna
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Impotence: How to Overcome It by Richard B. Manning (1989); ISBN: 0933803125; http://www.amazon.com/exec/obidos/ASIN/0933803125/icongroupin terna
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Impotence: Physiological, Psychological, and Surgical Diagnosis and Treatment by Gorm. Wagner (1982); ISBN: 0306407191; http://www.amazon.com/exec/obidos/ASIN/0306407191/icongroupin terna
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Impotence: Understanding the Problem and Its Treatment by Thomas J. Rohner (1986); ISBN: 0877624518;
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http://www.amazon.com/exec/obidos/ASIN/0877624518/icongroupin terna ·
It's Not All in Your Head : A Couple's Guide to Overcoming Impotence by Eileen MacKenzie, et al (1988); ISBN: 0525246495; http://www.amazon.com/exec/obidos/ASIN/0525246495/icongroupin terna
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It's Up to You : Overcoming Erection Problems by Williams Warwick (1989); ISBN: 072251915X; http://www.amazon.com/exec/obidos/ASIN/072251915X/icongroupi nterna
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It's Up to You: Self-Help for Men With Erection Problems by Warwick Williams (1986); ISBN: 0683121170; http://www.amazon.com/exec/obidos/ASIN/0683121170/icongroupin terna
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Lifelong Sexual Vigor: How to Avoid and Overcome Impotence by Marvin B. Brooks (1981); ISBN: 0385177127; http://www.amazon.com/exec/obidos/ASIN/0385177127/icongroupin terna
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Making Love Again : Renewing Intimacy and Helping Your Man Overcome Impotence by Terry Dr. Mason, Valerie Greene Norman (1988); ISBN: 0809246236; http://www.amazon.com/exec/obidos/ASIN/0809246236/icongroupin terna
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Male Impotence: A Cure: Penile Prothesis by Raymond J. Arensberg (1985); ISBN: 0933297009; http://www.amazon.com/exec/obidos/ASIN/0933297009/icongroupin terna
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Male Sexual Dysfunction by Robert Krane (1983); ISBN: 0316503312; http://www.amazon.com/exec/obidos/ASIN/0316503312/icongroupin terna
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Male Sexual Health : A Couple's Guide by Richard F. Spark (1991); ISBN: 0890433194; http://www.amazon.com/exec/obidos/ASIN/0890433194/icongroupin terna
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Male Sexuality and the Challenge of Healing Impotence by Richard Y. Handy (1988); ISBN: 0879754656; http://www.amazon.com/exec/obidos/ASIN/0879754656/icongroupin terna
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Management of Male Impotence by Alan H. Bennett (1983); ISBN: 0683005464; http://www.amazon.com/exec/obidos/ASIN/0683005464/icongroupin terna
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New Power to Love : Concentrated Virility Foods by William H. Lee (1987); ISBN: 0941683001; http://www.amazon.com/exec/obidos/ASIN/0941683001/icongroupin terna
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Overcoming Impotence : What Every Husband and Wife Should Know by Lee I. Jacobs (1978); ISBN: 0809274701; http://www.amazon.com/exec/obidos/ASIN/0809274701/icongroupin terna
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Self-Therapy for Sex Problems by Daniel Steele (1987); ISBN: 096182770X; http://www.amazon.com/exec/obidos/ASIN/096182770X/icongroupi nterna
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Sexual Anxiety: A Study of Male Impotence by Eric J Carlton (1980); ISBN: 0064909603; http://www.amazon.com/exec/obidos/ASIN/0064909603/icongroupin terna
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Sexual Impotence in the Male and Female (Sex, Marriage and Society Series) by William Hammond (1974); ISBN: 0405058020; http://www.amazon.com/exec/obidos/ASIN/0405058020/icongroupin terna
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State Failure: The Impotence of Politics in Industrial Society by Martin Janicke, Alan Braley (Translator) (1990); ISBN: 0271007141; http://www.amazon.com/exec/obidos/ASIN/0271007141/icongroupin terna
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The Lifelong Lover: How to Avoid and Overcome Impotence by Marvin B. Brooks, Sally West Brooks (1985); ISBN: 0385177135; http://www.amazon.com/exec/obidos/ASIN/0385177135/icongroupin terna
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The Potent Male : Facts Fiction Future by Irwin Goldstein, Larry Rothstein (1990); ISBN: 0399518479; http://www.amazon.com/exec/obidos/ASIN/0399518479/icongroupin terna
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The Prevention of the Obstruction of Vital Arteries : With Emphasis on the Role of Arterial Obstruction in Causing Heart Attacks, Strokes, Impotence, by William Dock (1983); ISBN: 0875272029;
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http://www.amazon.com/exec/obidos/ASIN/0875272029/icongroupin terna ·
The Rejuvenating Plants of Tropical Africa : Aphrodisiacs, Sterility, Impotence, Infertility by Albert A. Enti (Illustrator), Anthony K. Andoh (Editor) (1988); ISBN: 0916299074; http://www.amazon.com/exec/obidos/ASIN/0916299074/icongroupin terna
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Therapy in the Ghetto : Political Impotence and Personal Disintegration by Barbara Lerner (1972); ISBN: 0801813735; http://www.amazon.com/exec/obidos/ASIN/0801813735/icongroupin terna
The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “impotence” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:23 ·
Atlas of erectile dysfunction. Author: Roger S. Kirby; foreword by Tom F. Lue; Year: 1999; New York: Parthenon Publishing Group, c1999; ISBN: 1850700427 http://www.amazon.com/exec/obidos/ASIN/1850700427/icongroupin terna
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Contemporary diagnosis and management of male erectile dysfunction. Author: Tom F. Lue; Year: 1999; Newtown, Pa.: Handbooks in Health Care Co., c1999; ISBN: 1884065279
In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a “Books” button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.
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Diagnosing impotence. Author: edited by Diego Pozza, Giovanni M. Colpi; 1st International Meeting of Andrology, Rome, June 10, 1989; Year: 1990; Milano: Masson, 1990; ISBN: 882141938X
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Diagnosis and management of male sexual dysfunction. Author: [edited by] John J. Mulcahy; Year: 1997; New York: Igaku-Shoin, c1997; ISBN: 089640322X
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Efficacy of prostatectomy in treatment of benign prostatic hyperplasia. Author: L. R. Levy, J. I. Williams; Year: 1993; Ontario: Institute for Clinical Evaluative Sciences in Ontario, 1993
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Erectile dysfunction: a clinical guide. Author: by Roger Kirby, Culley Carson and Irwin Goldstein; with contributions from Ahmet Fawzy, Kevin McVary; Year: 1999; Oxford: Isis Medical Media; Herndon, VA: Distributed in the USA by Books International, 1999; ISBN: 190186524X
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Erectile dysfunction: integrating couple therapy, sex therapy, and medical treatment. Author: Gerald R. Weeks, Nancy Gambescia; Year: 2000; New York: W.W. Norton, 2000; ISBN: 0393703304 http://www.amazon.com/exec/obidos/ASIN/0393703304/icongroupin terna
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Erectile dysfunction: issues in current pharmacotherapy. Author: edited by Alvaro Morales; Year: 1998; London: Martin Dunitz; Malden, MA: Distributed in the US by Blackwell Science, 1998; ISBN: 1853175773 http://www.amazon.com/exec/obidos/ASIN/1853175773/icongroupin terna
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Implanted and injected materials in urology. Author: edited by Jean Marie Buzelin; Year: 1995; Oxford: Isis Medical Media, 1995; ISBN: 1899066152 http://www.amazon.com/exec/obidos/ASIN/1899066152/icongroupin terna
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Impotence: diagnosis and management of erectile dysfunction. Author: [edited by] Alan H. Bennett; Year: 1994; Philadelphia: W.B. Saunders Co., c1994; ISBN: 072163768X
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Impotence: January 1986 through September 1992: 956 citations. Author: prepared by Marian E. Beratan, Leroy M. Nyberg; Year: 1992; Bethesda, Md.: U.S. Dept. of Health and Human Services, Public Health Service, National Institutes of Health, National Library of Medicine, Reference Section; Washington, D.C.: Sold by the Supt. of Docs., U.S. G.P.O., 1992
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Impotence and infertility. Author: volume editors, Tom F. Lue, Marc Goldstein; with 26 contributors; Year: 1999; Philadelphia: Current Medicine, c1999; ISBN: 1573401196
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http://www.amazon.com/exec/obidos/ASIN/1573401196/icongroupin terna ·
Male sexual function: a guide to clinical management. Author: edited by John J. Mulcahy; Year: 2001; Totowa, N.J.: Humana Press, c2001; ISBN: 089603917X (alk. paper) http://www.amazon.com/exec/obidos/ASIN/089603917X/icongroupi nterna
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Management of ED: focus on sildenafil: a diabetologist's. Author: endocrinologist's approach / editor, C.E. Morgensen; Year: 1998; Montreal; Chicago: PharmaLibri, 1998; ISBN: 0919839541 (pbk.) http://www.amazon.com/exec/obidos/ASIN/0919839541/icongroupin terna
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Management of ED: focus on sildenafil: a neurologist's approach. Author: editor, Clare J. Fowler; Year: 1999; Montreal; Chicago: PharmaLibri, c1999; ISBN: 0919839525 (pbk.)
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Management of ED: focus on sildenafil: a urologist's approach. Author: editor, J.C. Gingell; Year: 1998; Montreal; Chicago: PharmaLibri, 1998; ISBN: 0919839509 (pbk.) http://www.amazon.com/exec/obidos/ASIN/0919839509/icongroupin terna
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Management of impotence and infertility. Author: edited by E. Douglas Whitehead, Harris M. Nagler; with 41 additional contributors; Year: 1994; Philadelphia: Lippincott, c1994; ISBN: 0197511531 (alk. paper)
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New injection treatment for impotence: medical and psychological aspects. Author: Gorm Wagner, Helen Singer Kaplan; Year: 1993; New York: Brunner/Mazel, c1993; ISBN: 087630689X
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Pelvic floor dysfunction: investigations & conservative treatment. Author: editors, R.A. Appell, A.P. Bourcier, F. La Torre; Year: 1999; Rome: Casa Editrice Scientifica Internazionale, c1999; ISBN: 8886062435
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Practical remarks on the treatment of spermatorrhoea and some forms of impotence: reprinted and enlarged from the original papers in the "Lancet". Author: by John L. Milton; Year: 1855; London: S. Highley, 1855
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Report on the treatment of organic erectile dysfunction. Author: the American Urological Association, Erectile Dysfunction Clinical Guidelines Panel; Year: 1996; Baltimore, Md.: The Association, c1996; ISBN: 096497021X http://www.amazon.com/exec/obidos/ASIN/096497021X/icongroupi nterna
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Reproductive issues and the aging male. Author: Florence P. Haseltine, C. Alvin Paulsen, Christina Wang, editors; Year: 1993; Washington, DC:
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American Association for the Advancement of Science, c1993; ISBN: 087168523X (alk. paper) http://www.amazon.com/exec/obidos/ASIN/087168523X/icongroupi nterna ·
Role of alprostadil in the diagnosis and treatment of erectile dysfunction: proceedings of a symposium, August 3-4, 1993, Brook Lodge, Kalamazoo, Michigan. Author: editors, Irwin Goldstein, Tom F. Lue; Year: 1993; Princeton: Excerpta Medica, c1993; ISBN: 0444019022 http://www.amazon.com/exec/obidos/ASIN/0444019022/icongroupin terna
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Sexual impotence: the contribution of Paolo Zacchia, 1584-1659. Author: Joseph Bajada; Year: 1988; Roma: Editrice Pontificia Università Gregoriana, 1988; ISBN: 8876525963
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Textbook of erectile dysfunction. Author: edited by Culley C. Carson, III, Roger S. Kirby, and Irwin Goldstein; Year: 1999; Oxford: Isis Medical Media; Herndon, VA, USA: Distributed in USA by Books International, 1999; ISBN: 1899066969
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Traumatic and reconstructive urology. Author: [edited by] Jack W. McAninch; associate editors, Peter R. Carroll, Gerald H. Jordan; Year: 1996; Philadelphia: Saunders, c1996; ISBN: 0721638864 http://www.amazon.com/exec/obidos/ASIN/0721638864/icongroupin terna
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Treatment options for male erectile dysfunction: a systematic review of published studies of effectiveness. Author: Timothy J. Wilt ... [et. al], coordinating editor; contributors, Karen Flynn ... [et. al.]; Year: 1999; Boston, MA: MDRC, HSR&D, [1999]
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Vascular andrology: erectile dysfunction, priapism, and varicocele. Author: Andrea Ledda (ed.); Year: 1996; Berlin; New York: Springer, c1996; ISBN: 3540594728 (softcover: alk. paper)
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World book of impotence. Author: edited by Tom F. Lue; Year: 1992; London: Smith-Gordon, 1992; ISBN: 1854630768
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Youth, love, and ecology: proceedings of the XI World Congress of Sexology, Rio de Janeiro (Brazil), June 1-5, 1993. Author: editors, Isaac Charam and Gerson Lopes; Year: 1994; Bologna: Monduzzi editore, International Proceedings Division, c1994; ISBN: 8832306018
Chapters on Impotence Frequently, impotence will be discussed within a book, perhaps within a specific chapter. In order to find chapters that are specifically dealing with
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impotence, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and impotence using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” By making these selections and typing in “impotence” (or synonyms) into the “For these words:” box, you will only receive results on chapters in books. The following is a typical result when searching for book chapters on impotence: ·
Organ Involvement: Sexual Function and Pregnancy Source: in Clements, P.J.; Furst, D.E., Eds. Systemic Sclerosis. Baltimore, MD: Williams and Wilkins. 1996. p. 483-499. Contact: Available from Williams and Wilkins, Special Sales Department. (800) 358-3583. Summary: This chapter for health professionals explores the effect of systemic sclerosis (SSc) on sexual function in males and females. Non pregnancy issues involving patients with SSc are addressed, including gynecologic concerns, breast complications, sex hormone-related issues, and impotence. A model for addressing the sexual concerns of both male and female patients with SSc are described. The issues of contraception and fertility are addressed. The effects of SSc on pregnancy and the effects of pregnancy on SSc are discussed. Organ system problems associated with pregnancy in patients with SSc are examined, focusing on musculoskeletal, gastrointestinal, and cardiovascular problems; thyroid disorders; pulmonary disease; peripheral gangrene; renal disease; and CREST syndrome. The effects of various medications on a pregnant woman and her baby are presented. In addition, postpartum considerations are addressed, including the use of medications while breast feeding. 135 references and 4 tables.
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Ileoanal Pouch Anastomosis Source: in Bayless, T.M. and Hanauer, S.B. Advanced Therapy of Inflammatory Bowel Disease. Hamilton, Ontario: B.C. Decker Inc. 2001. p. 197-202. Contact: Available from B.C. Decker Inc. 20 Hughson Street South, P.O. Box 620, L.C.D. 1 Hamilton, Ontario L8N 3K7. (905) 522-7017 or (800) 5687281. Fax (905) 522-7839. Email:
[email protected]. Website: www.bcdecker.com. Price: $129.00 plus shipping and handling. ISBN: 1550091220.
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Summary: This chapter on ileoanal pouch anastomosis is from the second edition of a book devoted to the details of medical, surgical, and supportive management of patients with Crohn's disease (CD) and ulcerative colitis (UC), together known as inflammatory bowel disease (IBD). The authors report that long term follow-up of pouch function and quality of life indicates a very high degree of acceptance and happiness level of the patients undergoing restorative proctocolectomy (RP). In ileoanal pouch anastomosis (IPAA), the entire diseased colon and rectum are removed, but the anal sphincters are preserved. A new rectum is formed from the terminal ileum (ileal pouch); attaching the pouch to the anal canal restores defecation to the standard transanal route with satisfactory fecal continence. Bowel movement frequency ranges from four to nine movements every 24 hours, averaging six times per day. This, however, is not a good indication of success as many patients will evacuate their pouches when it is convenient to do so, rather than defer defecation. Urgency, defined as inability to defer defecation for 15 minutes, is a major concern for many patients preoperatively. Invariably, this is negated by the pouch procedure; the exception is when patients develop pouchitis. Pad use, either due to need or for a sense of security, increases with age, episodes of pouchitis, and the patients with mucosal stripping of the anal canal as well as decreasing sphincter function. Operative mortality (deaths from the surgery) remains under 0.5 percent and reported impotence rates are less than 1 percent. Although dyspareunia (painful sexual intercourse) may occur post-pouch construction, overall, there is an improvement in female sexual function post-pouch compared to pre-pouch. Perhaps the most singled out problem of the pelvic pouch procedure is that of pouchitis; by eliminating one disease, the patient is set up for another. Yet this has to be viewed with the perspective that 90 percent of pouchitis cases are transient and easily treated, and that fewer than three-quarters of patients are subject to repeated episodes. Patients, in their quest for preservation of their anal function, understand and generally are satisfied with the trade-off of RP. 1 figure. 15 references. ·
Liver Disease Source: in King, J.E., ed. Mayo Clinic on Digestive Health. Rochester, MN: Mayo Clinic. 2000. p. 151-166. Contact: Available from Mayo Clinic Health Information. 5505 36th Street, SE, Grand Rapids, MI 49512. (800) 291-1128. Website: www.mayoclinic.com. Price: $14.95 plus shipping and handling. ISBN: 1893005046.
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Summary: This chapter on liver disease is from a comprehensive guidebook from the Mayo Clinic that focuses on a variety of digestive symptoms, including heartburn, abdominal pain, constipation, and diarrhea, and the common conditions that are often responsible for these symptoms. Written in nontechnical language, the book includes practical information on how the digestive system works, factors that can interfere with its normal functioning, and how to prevent digestive problems. The first section of the chapter focuses on hepatitis, including the key signs and symptoms of hepatitis, notably fatigue, loss of appetite, nausea, unexplained weight loss, and yellowing of skin and eyes (jaundice). The authors describe the different types of hepatitis (alcohol or drug induced, hepatitis A, hepatitis B, hepatitis C, hepatitis D and E, autoimmune hepatitis, and nonalcoholic steatohepatitis); review the blood tests (liver function tests) that may be used to help diagnose or monitor hepatitis; and discuss treatment options, including corticosteroids, interferon, lamivudine, and liver transplantation. A final section reviews healthy lifestyle approaches for living with hepatitis, and strategies for preventing the disease. The next section of the chapter addresses hemochromatosis (a genetic abnormality that causes the intestines to absorb too much iron), noting that the symptoms can include fatigue, joint pain, impotence (erectile dysfunction) or loss of sex drive, increased skin pigmentation (bronzing), and increased thirst and urination. This section also reviews diagnosis, determining whether screening is necessary for family members of patients with hemochromatosis, and the use of diet therapy (reduced iron intake) to help treat the disease. One sidebar mentions Wilson's disease and alpha 1 antitrypsin deficiency as other inherited liver disease. The last section of the chapter addresses cirrhosis, a condition in which scar tissue forms in the liver and keeps it from functioning normally. 1 figure. ·
Sex and Diabetes Source: in American Diabetes Association. Diabetes A to Z: What You Need to Know About Diabetes, Simply Put. 4th ed. Alexandria, VA: American Diabetes Association. 2000. p. 148-151. Contact: Available from American Diabetes Association (ADA). Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 442-9742. Website: www.diabetes.org. Price: $12.95 for members; $14.95 for nonmembers; plus shipping and handling. ISBN: 1580400353. Summary: This chapter provides people who have diabetes with information on sexual problems caused by diabetes. Physical causes of sexual problems include being too tired to have sex, having a urinary
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tract infection, lacking bladder control, and having damaged limbs or joints. In women, nerve damage to the sex organs can cause a loss of sensation and vaginal dryness. Women who have diabetes tend to get more vaginal infections than women who do not have diabetes, and the pain or discomfort from vaginal infections or vaginal dryness can make women more likely to have vaginismus. Men who have diabetes may be affected by impotence as a result of damage to the nerves in the penis, damage to blood vessels in the penis, or poor blood glucose control. Sexual problems may also have psychological causes. ·
Medications Used To Treat Complications of Diabetes Source: in Carlisle, B.A.; Kroon, L.A.; Koda-Kimble, M.A. 101 Medication Tips for People with Diabetes. Alexandria, VA: American Diabetes Association. 1999. p. 66-75. Contact: Available from American Diabetes Association (ADA). Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 442-9742. Website: www.diabetes.org. Price: $14.95 plus shipping and handling. ISBN: 1580400329. Order number 483301. Summary: This chapter answers questions about the meditations used to treat diabetes complications, including nonprescription analgesics, tricyclic antidepressants, capsaicin cream, angiotensin converting enzyme (ACE) inhibitors, laxatives, and calcium channel blockers. Nonprescription analgesics, antidepressants, and narcotic analgesics can be used to treat the pain associated with diabetic neuropathy. Capsaicin cream, a chemical found in hot chili peppers, can be applied to the feet to relieve pain. ACE inhibitors can be used to treat microalbuminuria, an early sign of kidney damage. The symptoms of gastroparesis, a condition that affects the nerves of the stomach, can be treated with metoclopramide, cisapride, and erythromycin. These medications increase the stomach's ability to contract and aid in digestion. Constipation can be treated by increasing the amount of fluid and fiber in a person's diet. Laxatives may also be useful in treating constipation. Men who have diabetes and experience impotence can use the medications alprostadil and sildenafil to maintain an erection. People who have diabetes and high blood pressure can be treated with ACE inhibitors, diuretics, and calcium channel blockers. Angiotensin receptor II antagonists and calcium channel blockers can be used to treat kidney disease. People who have diabetes should take any medications their doctor prescribes for other conditions, such as high blood pressure, heart disease, high cholesterol or triglycerides, obesity, and insulin resistance.
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Diabetes and Sex Source: in American Diabetes Association. American Diabetes Association Complete Guide to Diabetes: The Ultimate Home Diabetes Reference. 2nd ed. Alexandria, VA: American Diabetes Association. 1999. p. 321-360. Contact: Available from American Diabetes Association (ADA). Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 442-9742. Website: www.diabetes.org. Price: $23.95 plus shipping and handling. ISBN: 1580400388. Summary: This chapter discusses the impact of diabetes on sexual health and pregnancy. Diabetes can affect a person's sexual performance, his or her choice of birth control, and his or her response to the aging of the reproductive system. Women need to deal with the effects of sex hormones on blood glucose levels throughout the menstrual cycle and as they go through menopause. For women whose blood glucose levels are affected by their menstrual cycle, steps for staying in control include controlling the symptoms of premenstrual syndrome and making changes in diet and physical activity in the days prior to the onset of menstruation. Menopause can also upset a diabetes management plan. Hormone replacement therapy may be an answer for some women. Practicing birth control and safe sex are especially important for people with diabetes. Birth control options for women include birth control pills, the intrauterine device, the diaphragm, the sponge and cervical cap, the female condom, and sterilization. Although men have more limited birth control options than women, the condom is the most popular. Sterilization is also an option for men. Sexual problems for women who have diabetes include poor vaginal lubrication and pain during intercourse or diminished sexual desire and problems achieving orgasm. For men, the major concern is impotence. Women also face challenges as they prepare for pregnancy and carrying a baby. Issues that women need to consider before they become pregnant include the genetic risk of passing diabetes to a child, the woman's health status and level of glucose control, and financial considerations. Once a woman becomes pregnant, she and her health care team need to choose blood glucose goals and she needs to consider her food and exercise habits, times for blood glucose testing, and obstetrical care. Other pregnancy related issues include delivery complications, postpartum care, and breastfeeding.
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Psychosocial Aspects of Diabetes in Adult Populations Source: in Harris, M.I., et al., eds., for the National Diabetes Data Group (NDDG). Diabetes in America. 2nd ed. Bethesda, MD: National Institute
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of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. 1995. p. 507-517. Contact: Available from National Diabetes Information Clearinghouse (NDIC). 1 Information Way, Bethesda, MD 20892-3560. (800) 860-8747 or (301) 654-3327. E-mail:
[email protected]. Price: $20.00. Also available at http://www.niddk.nih.gov/. Summary: This chapter on the psychosocial aspects of diabetes in the adult population is from a compilation and assessment of data on diabetes and its complications in the United States. It is a prevalent clinical belief that depression in diabetes is secondary to psychosocial hardship brought on by increasing severity of the diabetes. However, studies that examined this relationship did not find statistically significant associations between depression and severity of diabetes. The authors postulate that the presence of diabetes complications alone may not result in depression unless severe functional limitations such as blindness, impotence, and cognitive impairment are present. The nature of depression in diabetes is complex, and adverse life events, severity of the medical illness, genetic and personality factors, and psychiatric history are all likely contributors to its occurrence. The prevalence of psychiatric disorders other than depression in diabetes has not been extensively studied. There is evidence that anxiety disorders are significantly more common in this group, particularly generalized anxiety disorder and simple phobia. The prevalence of anorexia nervosa and bulimia nervosa in diabetes is unknown, but interest in these disorders remains high because of their potential for adverse effects on glycemic control. The relationship between stress and glucose regulation in diabetes has been the subject of considerable study, but findings have been inconsistent. Stress has been reported to increase, decrease, or have no significant effect on diabetes glycemic control. The threshold for the reporting of diabetes symptoms may be lowered by psychological factors, particularly depression and anxiety, and both psychological and physiological factors may contribute to diabetes symptoms. Also, the efficacy of psychotropic medication for psychiatric disorders in patients with diabetes is largely unknown. However, these pharmaceuticals may have side effects that limit their use in persons with diabetes. Thus, psychotherapy may have a prominent place in diabetes treatment options. 9 tables. 71 references. ·
Diabetes Source: in Daugirdas, J.T. and Ing, T.S., eds. Handbook of Dialysis. 2nd ed. Boston, MA: Little, Brown and Company. 1994. p. 422-432.
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Contact: Available from Lippincott-Raven Publishers. 12107 Insurance Way, Hagerstown, MD 21740-5184. (800) 777-2295. Fax (301) 824-7390. Email:
[email protected]. Website: http://www.lrpub.com. Price: $37.95. ISBN: 0316173835. Summary: This chapter, from a handbook of dialysis, outlines special problems in the dialysis patient with diabetes. The author notes that morbidity and mortality are substantially higher in patients with diabetes maintained on dialysis than in their nondiabetic counterparts, with cardiovascular disease and infection being the leading causes of death. Topics include when to initiate dialysis; hemodialysis versus peritoneal dialysis; the role of diet; control of blood glucose levels, including with insulin therapy, or oral hypoglycemic agents; hyperkalemia; hypertension and peripheral vascular disease; cerebrovascular disease; retinopathy; and impotence. One chart summarizes the advantages and disadvantages of hemodialysis, continuous ambulatory peritoneal dialysis (CAPD), and continuous cycler-assisted peritoneal dialysis (CCPD) for patients with diabetes. 22 references. 1 table. ·
Geriatric Urology Source: in Landau, L.; Kogan, B.A. 20 Common Problems in Urology. New York, NY: McGraw-Hill, Inc. 2001. p. 133-144. Contact: Available from McGraw-Hill, Inc. 1221 Avenue of the Americas, New York, NY 10020. (612) 832-7869. Website: www.bookstore.mcgrawhill.com. Price: $45.00;plus shipping and handling. ISBN: 0070634130. Summary: Geriatric urology is a specialized area of adult urology that concentrates on the evaluation and management of urologic (urinary tract) problems in older patients. In particular, it is focused on the care of frail, elderly individuals with multiple comorbidities (other diseases and problems that may have an impact on each other). This chapter on geriatric urology is from a text on common problems in urology (written for the primary care provider). Although elderly individuals are seen for a wide spectrum of urologic complaints, the two most common disorders seen in this age group are urinary incontinence (UI, the involuntary loss of urine) and urinary tract infections (UTIs). Other common disorders in this age group include urologic malignancies (particularly prostate and bladder cancer), stone disease, benign prostatic hyperplasia (BPH, overgrowth of the prostate), and erectile dysfunction (formerly called impotence). This chapter focuses on the evaluation and treatment of elderly patients who present with UI and UTIs, as these conditions are commonly seen in geriatric patients, and their management may differ from that of younger patients with similar clinical problems. Specific
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types of UI covered include transient, stress, urge, mixed, overflow, and functional incontinence. 2 tables. 23 references. ·
Impotence Source: in Landau, L.; Kogan, B.A. 20 Common Problems in Urology. New York, NY: McGraw-Hill, Inc. 2001. p. 257-272. Contact: Available from McGraw-Hill, Inc. 1221 Avenue of the Americas, New York, NY 10020. (612) 832-7869. Website: www.bookstore.mcgrawhill.com. Price: $45.00;plus shipping and handling. ISBN: 0070634130. Summary: Erectile dysfunction (ED, formerly called impotence) is defined as the inability to achieve or maintain an erection sufficient for satisfactory sexual performance. This chapter on ED is from a text on common problems in urology (written for the primary care provider). The author notes that advances in the understanding of the physiology of erection, marked media interest, and the development of more effective, less invasive therapies have resulted in an outpouring of patient interest in this problem. In this chapter, the author provides a framework for a systematic, goal directed approach to this common problem. Topics include the physiology of erection; principal diagnoses; the typical presentation of ED; key elements of the patient's history; the physical examination, including overall, genitourinary, neurologic, and vascular; ancillary diagnostic testing, including laboratory evaluation; treatment options, including identification of reversible causes, first line therapy (oral agents, vacuum constriction devices, sexual therapy, and hormone replacement), and second line therapy, including intracavernosal medication and intraurethral therapy. The author also covers third line therapy (surgical implantation of a penile prosthesis), indications for referral, and emerging concepts. A patient evaluation and care algorithm is provided. First line treatment is characterized as the least invasive with the lowest risk profile and the broadest utility to a majority of patients. Second and third line therapies have progressive increases in both invasiveness and treatment morbidity. Up
