Tuesday, October 14, 2008

Order prozac online approved pharmacy

Technorati : buy prozac, order prozac, prozac, prozac cost

Del.icio.us : buy prozac, order prozac, prozac, prozac cost

Zooomr : buy prozac, order prozac, prozac, prozac cost

Flickr : buy prozac, order prozac, prozac, prozac cost

Prozac online pharmacy

Technorati : antidepressant, online, pharmacy, prozac

Del.icio.us : antidepressant, online, pharmacy, prozac

Zooomr : antidepressant, online, pharmacy, prozac

Flickr : antidepressant, online, pharmacy, prozac

Monday, October 13, 2008

The Viagra Files: The Web as Anticipatory Medium

Exposing Viagra For What It ‘Is’

;

We shall not rehearse claims about the Internet and the Web as an overall renegade space. (Those Internet days are numbered.) Rather, we shall attempt to look into the interaction between subspaces, between spaces of the palpably non-author- itative, and the palpably authoritative. We do so with a knowledge search exercise— in the style of the old travellers now with collaborative filtering collection and evaluation techniques—and enquire into which subspaces come to play the part of the overall authoritative sources, according to the findings and keepings of a group of ‘surfer-experts’. The ‘search for information and knowledge’ exercises described here, and the ideas for the knowledge instrumentation below, were conducted with 10 advanced students at the University of Vienna in October 2000, and again with 25 advanced students at the University of Amsterdam in April 2001. The focus groups of students were invited to ‘travel’, ‘surf’ and ‘forage’ for information and knowledge on the Internet, i.e. find and determine what is known about a given subject that would provide answers to particular questions. Upon conclusion of the exercise, the groups were then invited to explain their ‘search for information and knowledge’ strategies, i.e. how they came to know about the subject, in this case a new drug— Viagra. Thus, initially, we are interested in the groups’ knowledge acquisition technique, for, beyond that of mere travellers, we would like to ensure their expert status. The ‘advanced-ness’ of the students, noted above, derives from their self- descriptions as ‘webby’, meaning their experience-based capacity to forage and their alleged grasp of different foraging methods. We also briefly tested (or, in fact, hardened) this claim with a search engine tinkering sub-exercise, whereby the groups were invited to compare the same queries across three distinct engines, and devise a means (usually analogies) to describe the different engine logics to a layperson. (So we attempted to create a lay–expert divide, and make them into experts, at least briefly.) This sub-exercise also provided the groups with a vocabulary to provide a rationale for their search strategy (and, as it turned out, their ‘favourite engine’), as we come to below. What were they after? The lead questions were: What is Viagra, and whom is it for? Viagra was chosen as a subject matter because it is, in some sense, a special Internet phenomenon—a (mail order) prescription drug that is available via the Internet (click and buy) without face-to-face consultation with a physician. The drug’s ‘net flavour’ has more features, too. Beyond the new online medical and e-commercial elements, it could be associated with two leading (underground) areas of the net: ‘pornography’ or sex (Viagra may be thought of as a ‘sex drug’) and ‘piracy’ (Viagra may be had through quasi-legal, unregulated channels).

Buy Viagra At Online Pharmacy

Buy Viagra Online With Overnight Delivery At Canadian drug shop Viagra is used to treat impotence in men. Viagra increases the body's ability to achieve and maintain an erection during sexual stimulation. Viagra does not protect you from getting sexually transmitted diseases, including HIV. Viagra comes as a tablet to take it orally. It should be taken as needed about 1 hour before sexual activity. However, Viagra can be taken anytime from 4 hours to 30 minutes before sexual activity. Viagra should not be taken more than once a day. Do not take more or less of it or take it more often than prescribed by your doctor Now you can buy Viagra with no prior prescription anytime day or night at Canadian drug shop.When you buy Viagra we will have a US physician review your online questionaire and then prescribe you Viagra for free. After that your order will be next day FedEx shipped by a US pharmacy in a discreet unmarked package. Buy Viagra from us at Canadian drug shop and you will see how easy it is to buy Viagra anytime you need it day or night.

Technorati Tags: viagra,drug,online

Sunday, October 12, 2008

Order viagra online, we accept: visa, mastercard, amex, e check

Sildenafil offers an opportunity to treat male erectile dysfunction with an effective, licensed oral
preparation.
• It is taken on a “when required” basis and only works in the presence of sexual stimulation.
• 70-80% of men in trials show a statistically significant improvement in erectile or sexual function
compared with about 25% of men who receive placebo. In the dose-escalation study in 329 men,
around 2 men would need to be treated with sildenafil for 12 weeks for one man to report improved
erections (NNT). There is no clear figure of how this relates to successful sexual intercourse, although
69% of all attempts were successful compared to 22% with placebo.
• Open label follow up studies indicate that most men who initially respond to the drug continue to take
it. A fully-published randomised controlled trial has also demonstrated the efficacy of sildenafil in men
with diabetes mellitus and erectile dysfunction.
• Sildenafil appears to be well tolerated. 2.5% of patients withdrew from studies because of adverse
effects, compared to 2.3% with placebo. The US Food and Drug Administration has reported 69
deaths in people taking sildenafil which led to an update of the US label. Forty-six deaths were known
to be due to cardiovascular events. Since sexual activity is itself a risk factor in cardiovascular death
the role of sildenafil is difficult to determine.
• As yet there are no direct comparisons of sildenafil with alternative treatments.
• The long-term safety profile of sildenafil is yet to be established.

Sildenafil is rapidly absorbed after oral administration
reaching maximum plasma concentration within 30-120
minutes of dosing in fasted subjects. It has a bioavailability
of about 40% and fatty food has been shown to reduce the
rate of absorption and the peak concentrations achieved,
without affecting the extent of absorption. It is therefore
advised that sildenafil is taken 30-60 minutes before planned
sexual activity. One small study, which is only available as
an abstract, has shown that sildenafil still has an effect on
erectile function for 4-5 hours after dosing [4].
Sildenafil is mainly eliminated by hepatic metabolism
(principally cytochrome P450 3A4) and converted to the
active N-desmethyl metabolite, which accounts for about
20% of its overall pharmacological effect. Both sildenafil
and the metabolite have terminal half-lives of about 4 hours
and are excreted predominately in the faeces. No significant
accumulation is expected to occur on single daily dosing.
Studies have shown that renal insufficiency (creatinine
clearance (CLcr) <30ml/min), hepatic insufficiency and age
(over 65 years) are all associated with increased plasma
concentrations when compared with matched controls.
Sildenafil and its major metabolite are highly bound to plasma
proteins

MALE SEXUAL DYSFUNCTION. Popular drug: Cialis and viagra

Sexual Dysfunction describes any of a group of sexual disorders characterized by inhibition either of sexual
desire or the physiological changes that usually characterize sexual response. Sexual dysfunction disorders
are generally classified into four categories: sexual desire disorders, sexual arousal disorders, orgasm disor-
ders, and sexual pain disorders.
Male sexual dysfunction may reflect problems with the following factors: Libido, ejaculation, erectile func-
tion or a combination of these factors. Erectile Dysfunction (ED), also known as impotence, is the inability
to achieve and maintain penile erection and thus engage in sexual intercourse. This is a common, treatable
condition affecting an estimated 18 million men in the United States alone. Yet, data suggest that less than
10% of affected men actually receive treatment. Male sexual dysfunction may be a result of one or more of
the following conditions: medication side effects, endocrine disorders, peripheral vascular disease, neuro-
logical dysfunction, penile diseases, psychological disorders, and lifestyle factors. Once male sexual dys-
function is diagnosed, each of these potential causes must be carefully addressed prior to initiating
treatment.

Services eligible for coverage for men with sexual dysfunction due to organic

causes include:

a. Treatment of the underlying organic/medical condition causing sexual dysfunction.
b. Oral prescription medications for erectile dysfunction such as Viagra®, Levitra® and Cialis®.
Most BCBSNC benefit plans have a limit of 4 tablets per 30 days. These medications have been
shown to potentiate hypotensive effects of nitrates and are contraindicated in patients taking any
form of nitrates or have known allergy to nitrates. Caution should also be taken in patients taking
alpha-blockers as the combination may produce hypotension. Safety and efficacy of use with other
treatments for erectile dysfunction have not been studied and are not recommended. Viagra®,
Levitra® and Cialis® are not indicated for use by newborns, children or women.
c. Penile injection therapy which involves the self-injection of medications into the base of the penis.
Papavarine, phenotolamine, and/or prostaglandin E
1
(alprostadil) (Caverject®, Edex®) are com-
monly used. This type of therapy is most useful when used for organic impotence due to neuro-
genic causes and lesser for vascular problems. Most BCBSNC benefit plans have a limit of 4 units
per 30 days.
d. MUSE (Medicated Urethral System for Erection). This consists of a urethral suppository (alpros-
tadil) in a very small, smooth plastic applicator. Once the applicator is in place, a button is pushed
down which pushes the suppository out into the urethra where it is absorbed. Most BCBSNC ben-
efit plans have a limit of 4 units per 30 days.
e. A vacuum erection system which is an external device used to provide erection in men and may be
used in some cases as an alternative to the implanted device.
f.
Surgical implantation of a Penile Prosthesis. Implantation of a penile prosthesis may be considered
medically necessary for men who meet all of the following criteria:
i.
Results from Nocturnal Penile Tumescence (NPT) and/or rigidity testing (e.g., Rigi-scan) indi-
cate that the erectile dysfunction is organic and not psychogenic in nature; and
ii. Patient has attempted the above less invasive therapies (a, b, c, d, and/or e) with failure to have
an adequate erection.
g. Surgical revascularization. Penile revascularization may be considered medically necessary only in
men less than 50 years old who meet all of the following criteria:
i.
The erectile dysfunction is the direct result of an arterial injury caused by blunt trauma to the
pelvis and/or perineum; and
ii. A focal blockage of arterial inflow is demonstrated by duplex Doppler ultrasonography or arte-
riography; and
iii. Diagnostic work-up reveals normal corporeal venous function; and
iv. Member is not diabetic and has no evidence of systemic vascular occlusive disease; and
v. Member is not actively smoking.

When Treatment of Male Sexual Dysfunction is not covered

•
When the above medical criteria and guidelines are not met.
•
Viagra®, Levitra® and Cialis® are not indicated for newborns, children, or women.

Policy: Sexual Dysfunction Treatment, Male

•
Treatment of sexual dysfunction not related to organic disease is excluded under most plans.
•
Sural nerve graft in association with radical prostatectomy is considered investigational.
•
Oral yohimbine therapy.
•
Arterial reconstructive procedures, dorsal vein arterialization procedures, or penile venous occlusive
surgery (e.g., venous ligation, dorsal vein ligation) in men with erectile dysfunction secondary to arte-
riosclerotic occlusive disease are considered investigational.
•
Topical cream or gel containing vasodilators are considered investigational.
•
Extracorporeal shock wave therapy (ESWT) for Peyronie’s Disease is considered investigational.

Policy: Sexual Dysfunction Treatment, Male

Iatrogenic
any adverse condition in a patient occurring as a result of treatment by a physician or surgeon, espe-
cially to infections acquired by the patient during the course of treatment.
Neurogenic
arising from or caused by the nervous system.
Neurological
pertains to the nervous system.
Organic
refers to a physiological cause; pertaining to or arising from an organ or the organs.
Potentiate
increasing of potency; particularly, the synergistic action of two drugs, being greater than the sum of the
effects of each used alone.
Prostatectomy
surgical removal of the prostate gland.
Vascular
pertains to blood vessels in the body.

Viagra 50 mg Bulgaria fedex
Sildenafil medicine United Arab Emirates how to use
Sildenafil 100 mg Germany paypal
Sildenafil 50 mg Brasilia fedex
Viagra medicine New Zealand Where can I buy?
Sildenafil to treat impotence in men Greece price
Viagra 25 mg UK cost
Sildenafil to treat impotence in men Lithuania Where can I buy?
Sildenafil 25 mg Germany e check
Sildenafil medicine Greece how to use
Sildenafil to treat impotence in men Netherlands how to use
Viagra 25 mg Norway no prescription
Viagra to treat impotence in men Cyprus where you can learn
Viagra 25 mg Brazil diners
Viagra to treat impotence in men Finland help find
Viagra 100 mg Great britain online
Sildenafil medicine Brasilia online
Sildenafil to treat impotence in men Spain diners
Sildenafil to treat impotence in men Israel where to order
Sildenafil 50 mg Ireland paypal
Sildenafil medicine Hong Kong e check
Viagra to treat impotence in men Croatia AMEX
Viagra 100 mg Cyprus Where can I buy?
Sildenafil 50 mg USA no prescription
Viagra to treat impotence in men Argentina online
Sildenafil 100 mg Malta mastercard
Viagra medicine Australia e check
Sildenafil 100 mg Norway cost
Viagra to treat impotence in men Spain where to order
Viagra 100 mg Hungary paypal
Viagra 25 mg Great britain price
Sildenafil 25 mg Hungary how to use
Viagra 50 mg UK order
Viagra 25 mg Lithuania as you can buy
Viagra 100 mg Switzerland online
Sildenafil 100 mg Finland e check
Viagra medicine United Arab Emirates where to order
Viagra medicine Norway no prescription
Sildenafil medicine USA e check
Sildenafil to treat impotence in men Brazil help find
Viagra 100 mg Israel diners
Sildenafil 25 mg Egypt price
Sildenafil 50 mg Greece where to order
Sildenafil 100 mg Slovenia online
Viagra 50 mg Denmark pharmacy
Sildenafil medicine Saudi Arabia order
Viagra 25 mg Mexico e check
Viagra 100 mg Spain e check
Viagra 50 mg Slovenia price
Sildenafil medicine Holland cost
Viagra 25 mg Latvia e check
Viagra 100 mg Ireland order
Sildenafil 100 mg Hungary AMEX
Sildenafil 50 mg the United states paypal
Viagra 50 mg Mexico no prescription
Sildenafil 50 mg Brazil help find
Sildenafil 25 mg Greece cost
Sildenafil 50 mg Israel Where can I buy?
Sildenafil 50 mg Hungary e check
Viagra 50 mg Korea AMEX
Sildenafil 50 mg Argentina where you can learn
Sildenafil 100 mg South Africa mastercard
Sildenafil to treat impotence in men United Arab Emirates price
Sildenafil 25 mg Finland as you can buy
Viagra medicine Mexico online
Viagra 25 mg Latvia paypal
Viagra 25 mg Korea AMEX
Viagra to treat impotence in men Brasilia e check
Viagra 100 mg Great britain where you can learn
Viagra 100 mg Hong Kong price
Viagra medicine Slovakia where you can learn
Sildenafil 50 mg Croatia Where can I buy?
Viagra medicine Nederland diners
Viagra 50 mg Greece where to order
Viagra to treat impotence in men United Arab Emirates pharmacy
Sildenafil 100 mg Netherlands diners
Sildenafil 50 mg Saudi Arabia order
Sildenafil 25 mg France as you can buy
Viagra 50 mg Hungary order
Sildenafil to treat impotence in men Germany no prescription
Viagra to treat impotence in men Belgium no prescription
Sildenafil 25 mg Cyprus mastercard
Viagra 25 mg Saudi Arabia mastercard
Viagra to treat impotence in men Singapore AMEX
Sildenafil 100 mg Estonia how to use
Viagra to treat impotence in men Mexico paypal
Sildenafil 100 mg Latvia how to use
Viagra to treat impotence in men Malta where you can learn
Viagra 100 mg UK e check

MALE SEXUAL FUNCTION

MALE SEXUAL FUNCTION

Stage One - Excitement
• Vasocongestion, or the accumulation of blood in the pelvic area during early sexual arousal contributes to
erection of the penis. The degree of erection during this phase depends on the intensity of sexual stimuli.
• Routing of blood to the penis requires a working nervous system and the body to be relaxed enough and free
from anxiety. Constriction of blood vessels, due to stress or anxiety, does not allow enough blood to enter
the penis to cause an erection.
• During an erection, the inner diameter of the urethra doubles and the scrotum pulls toward the body.
Muscular tension increases in the body. Heart rate and blood pressure both increase.
• It is normal for men to experience periods when the erection is lost during sex play, but then regained.
• Distraction can lead to loss of excitement and erection.
• Emotional or mental well-being can affect desire, excitement/arousal and therefore, erectile functioning. For
example, depression is associated with increased sexual problems.
Stage Two - Plateau Phase
• The penis increases in size slightly during second stage of sexual response, particularly toward the glans or
“head.”
• It is less likely for a man to lose his erection if distracted during plateau phase than during excitement.
• The testes increase in size by 50 percent or more and become elevated toward the body.
• Muscular tension heightens considerably and involuntary body movements increase as orgasm approaches.
Heart rate increases to between 100-175 beats per minute.
• Usually during the plateau phase, a man will notice a small amount of clear fluid at the opening of the urethra
that is released from the Cowper’s gland. This is known as “pre-cum” and serves to change the Ph balance
of the urethra so that sperm may survive. This pre-ejaculatory fluid may be released during the excitement
phase, may vary with each man and each sexual act. The pre-ejaculatory fluid may contain Sexually
Transmissible Infections (STI’s) or, sometimes, sperm that has remained in the urethra from previous
ejaculations.
Stage Three - Orgasm
• Actual climax and ejaculation are preceded by a distinct inner sensation that orgasm is imminent. This is
called ejaculatory inevitability. Almost immediately after that feeling is reached, the male senses that
ejaculation cannot be stopped.
• The most noticeable change in the penis during orgasm is the ejaculation of semen. The muscles at the
base of the penis and around the anus contract rhythmically, with intervals of about 0.8 second between the
first three or four contractions.
• Physiologically, the sensations of orgasm and the response of ejaculation are two separate functions. As
such, a man can experience orgasm without ejaculation, or vice versa. However, these two functions most
often occur at about the same time.
• Males often have strong involuntary muscle contractions through the body during orgasm and can exhibit
involuntary pelvic thrusting. The hands and feet show spastic contractions and the entire body may arch
backward or contract in a clutching manner.
Stage Four - Resolution
• Immediately following ejaculation, the male body begins to return to its unexcited state. About 50% of the
penile erection is lost right away, and the remainder of the erection is lost over a longer period of time.
• Muscular tension usually is fully dissipated within five minutes after orgasm, and the male feels relaxed and
drowsy.
• Resolution is a gradual process that may take as long as two hours.

Refractory Period

• During resolution, most males experience a period of time in which they cannot be re-stimulated to
ejaculation.
• On average, men in their late thirties cannot be re-stimulated for 30 minutes or more.
• Very few men beyond their teenage years are capable of more than one orgasm during sexual encounters.
• Most men feel sexually satiated with one orgasm

Saturday, October 11, 2008

Lifestyle management in ED with concomitant risk factors

Lifestyle management in ED with concomitant risk factors

The basic work-up must identify reversible risk factors for ED. Lifestyle changes and risk factor modification
must precede or accompany ED treatment. These guidelines include lifestyle modification (e.g. weight loss,
exercise) for ED, but also address psychosocial issues, adverse side-effects of prescription or non-prescription
drugs and the presence of hypogonadism as a modifiable aetiology or comorbidity of ED.
The potential benefits of lifestyle changes may be of special relevance in individuals with ED and
specific comorbid cardiovascular or metabolic diseases, such as diabetes or hypertension (9,29,30). For these
men, the positive consequences of aggressive lifestyle changes may be of special benefit not only for
improving erectile function, but also for improving overall cardiovascular and metabolic health. Recent studies
support the potential value of lifestyle intervention, for both ED and overall health benefits (10).
Clearly, further studies are needed to expand and clarify the role of lifestyle changes in the manage-
ment of ED and related cardiovascular disease (CVD). Lifestyle changes may be recommended independently
or in combination with PDE5 therapy. Some studies have suggested that the therapeutic effects of PDE5
inhibitors may be enhanced if other co-morbidities or risk factors are aggressively managed (31). Although
suggestive, these results have yet to be confirmed in well-controlled, long-term studies. Given the success of
pharmacological therapy for ED, clinicians in the future will need to provide specific evidence for the potential
benefits of lifestyle change. Hopefully, further evidence for these benefits will become available in the future.

Specialized diagnostic tests ED

Nocturnal penile tumescence and rigidity (NPTR)

The nocturnal penile tumescence and rigidity (NPTR) assessment should take place for at least two nights.
The presence of an erectile event of at least 60% rigidity recorded on the tip of the penis, which lasts for
10 minutes or more, should be considered as indicative of a functional erectile mechanism (24).

Intracavernous injection test

The intracavernous injection test offers limited information regarding vascular status. A positive test is defined
as a rigid erectile response (unable to bend the penis) that appears within 10 minutes after the intracavernous
injection and lasts for 30 minutes (25). Such a response may indicate a functional but not necessarily normal
erection, since an erection may coexist with arterial insufficiency or veno-occlusive dysfunction (26). Its clinical
implication is that the patients will respond to the intracavernous injection programme. In all other cases, the
test is inconclusive, and a duplex ultrasound of the penile arteries should be requested.

Duplex ultrasound of penile arteries

A peak systolic blood flow higher than 30 cm/sec and a resistance index higher than 0.8 are generally conside-
red to be normal (25). There is no need to continue vascular investigation when the duplex examination is normal.

Arteriography and dynamic infusion cavernosometry or cavernosography (DICC)

When it is abnormal, arteriography and dynamic infusion cavernosometry or cavernosography should be
performed only for patients who are considered potential candidates for vascular reconstructive surgery.

Psychiatric assessment

Patients with psychiatric disorders must be referred to a psychiatrist particularly interested in ED. For younger
patients (<40>

Penile abnormalities

Patients with ED due to penile abnormalities, such as hypospadias, congenital curvature, or Peyronie’s disease
with preserved rigidity, may require surgical correction with high success rates.

Pathophysiology of erectile dysfunction

Pathophysiology of erectile dysfunction

Vasculogenic
-
Cardiovascular disease
-
Hypertension
-
Diabetes mellitus
-
Hyperlipidaemia
-
Smoking
-
Major surgery or radiotherapy (pelvis or retroperitoneum)
•
Neurogenic
-
Central causes
-
Multiple sclerosis
-
Multiple atrophy
-
Parkinson’s disease
-
Tumours
-
Stroke
-
Disk disease
-
Spinal cord disorders
-
Peripheral causes
-
Diabetes mellitus
-
Alcoholism
-
Uraemia
-
Polyneuropathy
-
Surgery (pelvis or retroperitoneum)
•
Anatomical/structural
-
Peyronie’s disease
-
Penile fracture
-
Congenital curvature of the penis
-
Micropenis
-
Hypospadias, epispadias
•
Hormonal
-
Hypogonadism
-
Hyperprolactinemia
-
Hyper- and hypothyroidism
-
Cushing’s disease
•
Drug-induced
-
Antihypertensives (of all classes, most common by diuretics and beta-blockers)
-
Antidepressants
-
Antipsychotics
-
Antiandrogens
-
Antihistamines
-
Recreational drugs (heroin, cocaine, methadone)
•
Psychogenic
-
Generalized type (e.g. lack of arousability and disorders of sexual intimacy)
-
Situational type (e.g. partner-related, performance-related issues or due to distress)

Sexual history
The sexual history may include information about previous and current sexual relationships, current emotional
status, onset and duration of the erectile problem, as well as possible previous consultations and treatments.
Detailed descriptions of the quality of both erotic and morning erections, in terms of rigidity and duration, as
well as arousal, ejaculation and orgasmic problems, should be discussed. The use of validated questionnaires,
such as the International Index for Erectile Function (IIEF), may be helpful in order to assess all sexual function
domains (erectile function, orgasmic function, sexual desire, ejaculation, intercourse and overall satisfaction),
but also the impact of a specific treatment modality .

Physical examination
A focused physical examination must be performed on every patient, with particular emphasis on the
genitourinary, endocrine, vascular and neurological systems (16). The physical examination may reveal
unsuspected findings, such as Peyronie’s disease, prostatic enlargement or cancer, as well as the signs and
symptoms indicative of hypogonadism (small testes, alterations in secondary sexual characteristics, diminished
sexual desire, and changes in mood) (17). A rectal examination should be performed in every patient older than
50 years. Blood pressure and heart rate should be measured if they have not been assessed in the previous
3-6 months. Particular attention must be given to patients with cardiovascular disease.
Laboratory testing
Laboratory testing must be tailored to the patient complaints and risk factors. All patients must undergo a
fasting glucose and lipid profile if not assessed in the previous 12 months. Hormonal tests must include a

Managing ED: implications for the every-day clinical practice

Managing ED: implications for the every-day clinical practice

The advances in basic and clinical research in ED made during the last 15 years has led to the development of
several new treatment options for ED, including new pharmacological agents for intracavernous, intraurethral,
and, more recently, oral use (11-13). Reconstructive vascular surgery is associated with poor outcomes in long-
term follow-up (14,15). As a result, treatment strategies have been significantly modified.
The current availability of effective and safe oral drugs for ED, together with the tremendous media
interest in this condition, has resulted in an increasing number of men seeking help for ED. Many physicians
without background knowledge and clinical experience of the diagnosis and treatment of ED are involved in
decision-making concerning the evaluation and treatment of these men. Therefore, some men with ED may
undergo little or no evaluation before treatment is initiated, or men without ED may seek treatment in order to
enhance their sexual performance. In such circumstances, the underlying disease causing the symptom (ED)
may remain untreated. Such observations have made the development of guidelines for the diagnosis and
treatment of ED, a necessity.

Epidemiology and risk factors. Male erectile dysfunction

Male erectile dysfunction has been defined as the persistent inability to attain and maintain an erection

sufficient to permit satisfactory sexual performance. Although erectile dysfunctionis a benign disorder, it is related to physical
and psychosocial health, and has a significant impact on the quality of life of both sufferers and their partners
and families.
Recent epidemiological data have shown a high prevalence and incidence of erectile dysfunctionworldwide. The first
large-scale, community-based study, Massachusetts Male Aging Study (MMAS), reported a combined
prevalence of 52% erectile dysfunction in non-institutionalized 40 to 70-year-old men in the Boston area (2). In this study, the
individual prevalences were 17.2, 25.2 and 9.6 for minimal, moderate and complete erectile dysfunction, respectively. In the
Cologne study (men 30-80 year-old), the prevalence of ED was 19.2%, with a steep age-related increase
(2.3-53.4%) (3), while the prevalence of sexual dysfunctions (not specific ED) in the National Health and Social
Life Survey was 31% (4). Analysis of the longitudinal results from the MMAS study estimated that the incidence
of ED was 26 new cases per 1000 men annually (5), while the incidence rates (new cases per 1000 men annually)
of ED in a Brazilian (6) and in a Dutch (7) study were estimated at 65.6 (mean follow-up 2 years) and 19.2 (mean
follow-up 4.2 years), respectively. Differences in these studies can be explained by the methodology design of
the different surveys, the age and the socio-economic status of the populations studied.
Erection is a neurovascular phenomenon under hormonal control. It includes arterial dilatation,
trabecular smooth muscle relaxation and activation of the corporeal veno-occlusive mechanism (8). Several risk
factors have been identified based on the knowledge of physiology or erection. Actually, it became clear that
ED shares common risk factors with cardiovascular disease as the lack of exercise, obesity, smoking,
hypercholesterolaemia and the metabolic syndrome. Several life-style risk factors can be modified. In the
MMAS, men who initiated physical activity in midlife had a 70% reduced risk for ED relative to those who
remained sedentary, while in its longitudinal results, regular exercising showed a significantly lower incidence of
ED over an 8-year follow up period (9). A multicentre, randomized, open-label study compared 2 years of
intensive exercise and weight loss with an educational control in obese men with moderate ED (10).
Significant improvements in body mass index (BMI) and physical activity scores, as well as in erectile function
were observed in the lifestyle intervention group, while those changes were highly correlated with both weight
loss and activity levels. However, it should be emphasized that controlled prospective studies are necessary to
determine the effects of exercise or other lifestyle changes in prevention or treatment of ED.

Friday, October 10, 2008

When You Should See Your Doctor About Erectile Dysfunction

Erectile Dysfunction may occur within a man's life for a variety of reasons. Some of these
reasons are related to non-medical causes and do not warrant a visit to your physician or
health care professional. Some issues such as fatigue or excessive drinking may cause
temporary Erectile Dysfunction (ED) that will clear up as soon as the man is rested or becomes
sober. However, some situations may arise that signal that the Erectile Dysfunction a man may
be experiencing may be caused by more serious factors. Knowing when you should see a
doctor could help relieve the anxiety commonly associated with ED.
One way to determine whether or not you are experiencing significant Erectile Dysfunction is
to assess how much Dysfunction you are experiencing. A brief stint here and there is not cause
for alarm, but if you are experiencing ED more than 25% of the time, you should schedule an
appointment with your doctor. Some men feel uncomfortable discussing the condition with their
doctor. If this is the case then ask your physician for a recommendation to an urologist. An
urologist specializes in treating ED and will have access to tests and treatments that your
doctor may not have.
If you have a predetermined health condition and begin to experience Erectile Dysfunction, it
is imperative that you see your doctor or urologist right away. Some conditions may increase
your chances of developing ED and your doctor or urologist will be able to offer various
treatments and remedies. Diabetes, high blood pressure, hardening of the arteries, and
heart disease can increase your risk of developing Erectile Dysfunction. Your urologist can
prescribe medications or other erectile dysfunction treatment that will help improve your sexual
health.
Sometimes Erectile Dysfunction is the cause of emotional issues, such as anxiety, fear, and
depression. Often these emotional issues will subside naturally. However, if the emotional
issues seem to increase or if they begin to affect your daily life, then you should contact your
doctor right away. There are a number of medications that may be prescribed to help treat
depression and anxiety disorders and seeking the advice of your health care professional is
instrumental restoring your emotional health. Your doctor may also recommend that you see a
psychiatrist or psychologist as well and you should not find this discouraging. Treating depression and other anxiety disorders are not just beneficial to your sexual health, but
untreated depression and anxiety disorders can lead to life threatening issues.
If you are suffering with depression or other anxiety issues that lasts for longer than 2 weeks,
schedule an appointment with your health care professional immediately.
Only a qualified health care professional can assess the exact cause of your Erectile
Dysfunction. Though there are many benign causes, the fact that ED can signify a serious
underlying health condition makes it a necessity to seek treatment. Also, if you are taking
medications for another condition, it is possible that the medication that you are currently being
prescribed is contributing to the Erectile Dysfunction. Only a qualified health care worker can
make the adjustments necessary to either change your dosage or prescribe a different
medication entirely. Though you may feel uncomfortable discussing your sexual health with
your doctor, you will feel better once you have determined the cause of the problem and have
appropriated methods to resolve Erectile Dysfunction.

Erectile Dysfunction Treatment

Erectile Dysfunction Treatment

There are many types of treatments for erectile dysfunction, everything from medications,

simple mechanical devices to psychological counseling & therapy. The only way to manage
and solve erectile dysfunction problems is to get to the root of the cause. By understanding the
cause factors and severity of the condition could help in determining the best treatment or
combination of treatments.
Here is a rundown of some treatment to erectile dysfunction.
Medical Treatment
Erectile dysfunction (ED) is now easily treated with oral medication such as Sildenafil
Citrate or its popular name - Viagra. Viagra is an example of the category of drugs called
PDE5 inhibitors, and it treats ED by relaxing the smooth muscles of the penis during arousal,
leading to a successful and sustained erection. Viagra can produce this effect for 4 hours from
the time of ingestion. This small blue pill has a proven safety record and has been beneficial
for men with ED who have had wide ranging health issues.
The huge success of Viagra led to further research and soon other drugs like Cialis, which is
Viagra's greatest competitor, were introduced. Cialis is one of the most successful anti-ED drugs that can help men with erectile dysfunction (ED) get and keep an erection satisfactory
for sexual activity. Cialis should be taken an hour before sexual intercourse, it sometimes
starts working within 16 minutes and its effects lasts for 24 to 36 hours, several times longer
than other anti-ED drugs such as, Viagra. Because of its extended period of effectiveness, you
do not have the pressure to perform within a few hours. You and your partner can relax and
choose the suitable moment that is right for both of you.
However, Viagra and Cialis is only beneficial to some men.
Although these medications can help many people, not all men can or should take them to
treat erectile dysfunction. If you are under other medications, these drugs are not at all
advisable. This is because these drugs, on combining with the medications that are taken
everyday may cause blood pressure problems and heart attacks. Don't take Viagra or Cialis
with nitrate medications, such as the heart drugs nitroglycerin (Nitro-Bid, others), isosorbide
mononitrate (Imdur) and isosorbide dinitrate (Isordil). The combination of these medications,
which work to widen (dilate) blood vessels, can cause side effects such as dizziness, low
blood pressure and heart problems.
Though, there is another alternative like Zenerx can undo the side-effects. Zenerx works to
increase blood flow to the penis (similar to Viagra and Cialis), but it provides you with even
more. The herbal ingredients in Zenerx’s unique formulation is 100% natural which is what
sets it apart from products like Viagra, Cialis, Levitra and others. Zenerx is 100% herbal and
chemical free which means, all the benefits of better health is the key areas that most improve
and impact sexual ability and performance - only without any unpleasant side effects. Zenerx
has more advantages on treating erectile dysfunction than other well known brand in the
market. You can find more information on Zenerx at Zenerx.com
Others such as vacuum devices, injections, penile implants and blood vessel repair are
also options to treat Erectile Dysfunction (ED). Remember, all medical conditions can be
treated.
Therapy & Counseling
In cases where the sexual function has been inhibited by psychological reasons, therapy and
counseling can help address the feelings of anxiety and guilt. An open dialogue with your
doctor can help you overcome such anxieties and over time, release you from such inhibitions.
Some people think that it might be embarrassing to talk about sexual health to doctor. Just
remember that erectile dysfunction is a common problem, and your doctor won’t be surprised
when you mention the topic. Discussing it with your doctor before a problem occurs can help
you prevent or delay erectile dysfunction. Being open with your doctor can also help determine
the best treatment for you.
Communication
Men who suffer from poor sexual health such as erectile dysfunction may find themselves
distancing from their partners; physically and emotionally. This can give the mistaken
impression that they've lost interest or no longer find their partner attractive. If you find yourself
relating to such a scenario, learn to communicate with your partner. As in all relationships,
communication is the key, so address the issue with your partner. It takes two for a healthy
sexual relation and that means being open and frank about your needs and concerns.
Communication is an important part of sexuality and close relationships. It involves talking
clearly, listening carefully and fully understanding each other. Bridge the gap between you and
your partner and you will discover that not only will she be the support that you need; you will most likely be more open to explore new ways to enjoy an even more healthy and stimulating
sex life.
Lifestyle Modifications
Lifestyle modifications such as reducing the intake of alcohol, avoid smoking tobacco,
ensuring a proper diet, control your blood sugar, managing work stress and spending
quality time with your family will likely to decrease chances of erectile dysfunction. Learn to
prevent erectile dysfunction before it happen to you.
Re-Examine Your Attitude
As you grow older, two of the things that brought you the greatest joy - your children and your
career are no longer prevalent in your every day life. This means that your personal
relationship takes an increased importance. This is the time for you to re-examine your
attitude towards sex. Sensual closeness and sexual intimacy is a way to affirm the love of
life. It is an expression of the satisfaction gained from the present. It expresses the closeness
of your relationship and is an important measure of the quality of life. Ageing just signals a
change in sexual life - not the end of it.

PSYCHOLOGICAL FACTORS erectile dysfunction

PSYCHOLOGICAL FACTORS

Experts believe that 10% to 20% of cases of erectile dysfunction are caused by
psychological (emotional) factors. This doesn't necessarily mean that you are losing your mind,
but rather your emotional well-being is being affected by certain circumstances that are
plaguing your life which in turn affect your sexual health.
Here's a rundown of some of these psychological factors.
I ) Depression
In patients with depression, the causes of erectile dysfunction may by psychological, physical
or a combination of both. For many men, erectile dysfunction creates additional depression,
loss of self-esteem, poor self-image, anxiety and tension between themselves and their
partners. These emotional disturbances can create physical conditions that lead to increased
difficulty in getting an erection.
ii ) Lack of emotional well-being
Sex is not just a physical function - it is also an emotional experience. Just as how 'feeling
good' can stimulate sexual appetite, and negative feelings can have the exact opposite effect.
Feelings such as anxiety, fear, anger, sadness and resentment are just some of the
negative feelings that can overcome you in some stage in your life thus resulting in
psychological impotence. The very fear of impotence can be enough to cause the problem.
Once a problem occurs, fear of failure can add worry.iii ) Stress
Stress is any demand or pressure that induces physical or mental tension. Stress in itself is
not negative but too much stress is bad for us. Symptoms such as headaches, heartburn,
dizziness, muscle spasm, chest pains, cold sweats and loss of sex drive are some of the
most common symptoms faced by people who are stressed. Stress and sex don't mix as it can
adversely affect arousal and intimacy.
iv ) Poor sexual self-esteem
Good sexual self-esteem is about feeling confident about your own individual sexuality. It's
about identifying your own needs, wants and desires and communicating them to your partner.
It's also about having pleasurable sexual thoughts and fanning your flames of desire to feeling
confident about your body and making the most out of it.
v ) Inadequate sex education
There is a certain people are taught by their parents and other caregivers that sex is bad, and
sexual feelings are wrong. The cultural situation may also not allow for free talk on sexuality
thus inhibiting one's desire and freedom. Cultural and religious taboos relating to sex have also
been known to have an impact on sexual activity especially among older couples who have
passed their reproductive cycles.
LIFESTYLES FACTORS
It's bad for us but we do it anyway – smoking (tobacco) and excessive drinking (alcohol)
often cause erectile dysfunction and with decreased sexual drive. Smoking in addition to
causing cancer adversely affects circulation, and it also affects blood flow in veins and arteries.
Drinking can sedate your nervous system and interfere with your ability to get an erection.
Prolonged heavy drinking can damage the nerves and liver which further causes hormonal
abnormality.
Both of these can lead to erectile dysfunction.
In addition to numerous other health risks, the use of drugs such as marijuana and cocaine
has been reported to cause erectile dysfunction.

What is Erectile Dysfunction?

What is Erectile Dysfunction?

Experiencing erectile dysfunction is never easy. But in most cases, erectile dysfunction can
be treated, and it need to be treated on time. It is a problem that should be addressed and not
hidden. So men who are suffering from erectile dysfunction do not bear it in shame. It should
be understood that most men will experience this and that there are ways and methods to cure
and treat erectile dysfunction.
However, there are lot of imitation drugs out there that claim can heal erectile problems.
Beware of these claims and only get prescriptions from the expert or medical doctor. Generic
brand imitations of reputed pharmaceutical drugs can sometimes be more dangerous than
helpful in the long run as they may be manufactured in countries where high quality and safety
standards are not followed, or they may include controversial and at times harmful chemical
ingredients.

Cause of Erectile Dysfunction
“Not tonight dear, I have headache…”
You need not suffer in silence because there is a reason for erectile dysfunction. The
following paragraphs will give you an insight on the medical, emotional and lifestyle factors
that cause erectile dysfunction.

SYMPTOMS OF LOW TESTOSTERONE

How would you know if you weren’t
making enough testosterone? Some
symptoms are more or less common
depending on when the shortage
occurs. If the deficiency occurs during
puberty, a boy might not grow as tall
or as muscular as his friends, and he
might not grow pubic or body hair. In
a few, the breast tissue might begin to
develop, a condition called gyneco-
mastia. In adult men, the picture looks
a bit different because they previously
had normal levels that have declined
or are declining relative to what was
normal for them at a younger age. As
a result, they may experience none,
some or all of the following symptoms:
Lower libido (sex drive)
Erectile dysfunction (ED)
Poor concentration
Fatigue
Increased body fat
Muscle weakness
Osteoporosis (weakness of the
bones)
Loss of body hair (including soft-
ening or loss of the beard)
Depression
Hot flashes
Other mood problems.

Libido

Libido in men (and women) is driven by testosterone. Desire disorders
may present as hypoactive desire disorder (often lifelong), inhibited
desire (may be situational) and desire discrepancy (an increasingly
common disorder in couples)
Desire problems in younger men mostly have a psychological basis
(often around commitment issues). Older men experience a slow
decline in testosterone levels at about one per cent a year from
the age of 40. This may not only reduce libido but may also result
in a controversial condition called partial androgen defciency in the
ageing male (PADAM). As men age, higher levels of sex hormone
binding globulin reduce the amount of bioavailable testosterone.
The clinical symptoms of PADAM are said to be deceased libido,
ED, depression, fatigue, decreased muscle mass, decreased bone
density and increased visceral fat. Yet men who are depressed
may be accused of having PADAM due to the similarity of
presenting symptoms.
Testosterone is a requirement for nocturnal erections but appears
to play only a minor role in the quality of sexually induced erections.
Testosterone, through its receptor sites in cavernosal tissue, helps
improve the action of PDE5 inhibitors which otherwise have poor
results in hypogonadal men. Treatment with testosterone may
increase libido and provides an improved sense of wellbeing.
However, it may also aggravate prostate disorders, raise haematocrit
and aggravate symptoms of sleep apnoea.

A note about ED post Radical Prostatectomy

Surgery for prostate cancer is a now a common procedure. If the neuro-vascular bundle on each side of the prostate cannot be saved, then ED will inevitably follow. Treatment with oral PDE5 inhibitors does not work without intact nerves due to the lack of neurotransmitters. Even with intact neurovascular bundles, the return of erectile function may take from six to 36 months to occur (if ever). The quality of erections also depends on the pre-surgery erectile function. Initial treatment is PGE1 injection therapy, however, some men respond early to oral medication. It is important to keep testing with oral medication from time to time because as soon as oral medication becomes efective, injections may stopped. There is some evidence of beneft being on continuous oral medication in the presence of neuropraxia due to the positive efect of PDE5 inhibitors on the endothelium within the cavernosal tissues.

What does SILDENAFIL(VIAGRA) TABLET contain?

What does SILDENAFIL TABLET contain?
The active ingredient is known as Sildenafil. Each tablet contains Sildenafil Citrate corresponding to
50 or 100 mg Sildenafil. SILDENAFIL TABLET also contains other inactive substances.
What does SILDENAFIL TABLET look like?
SILDENAFIL TABLETS are round, blue colored with two deep score lines for easy splitting on one
side and the words SILDENAFIL and 50mg (or 100mg) on the other.
What is SILDENAFIL TABLET?
SILDENAFIL TABLET is the first of a new group of medication which allows adequate sexual
stimulation, relaxes the blood vessels of the penis and helps erection.
SILDENAFIL TABLET does not increase sexual desire or fertility.
Who should not take SILDENAFIL TABLET?
Whosoever has an allergic reaction to Sildenafil, whosoever is receiving donor medicines of nitric
oxide or nitrates, which are used among other things, in certain cases of angina should not take
Sildenafil. The most commonly used nitrates are nitroglycerin pieces and monoitrate and dinitrate
substances of isosorbid. If you suffer from angina and are not sure whether your actual treatment
corresponds to some of the medicines mentioned above, consult your doctor before taking
SILDENAFIL TABLET.
What precautions should I take before having SILDENAFIL TABLET?
Inform your doctor if you have any penal illness, if you have had painful erections, if you have been
diagnosed with a rare hereditary ophthalmic illness known as retinosis pigmentosis, or peptic ulcer or
any problem of the blood coagulation. Also inform your doctor if you are taking any treatment for
erectile dysfunction.
What special advice should be given to aged patients?
The aged patients should start treatment with the minimal dose advised (25mg/day)
Can SILDENAFIL TABLET be administered to children?
SILDENAFIL TABLET should not be given to children. Keep the medication away from the reach of
children.
Is there any special advice for patients with kidney or liver disease?
Persons suffering from severe liver or kidney disease should take SILDENAFIL TABLET with
precaution, starting treatment with minimal recommended dose, i.e., 25mg

Does the ability to drive vehicles or operate machines reduce by taking SILDENAFIL
TABLET?
SILDENAFIL TABLET does not reduce the ability to drive vehicles or use machines.
Can SILDENAFIL TABLET be taken simultaneously with other medicines?
SILDENAFIL TABLET should not be given simultaneously with nitrates or nitric oxide donors nor
with mononitrate or dinitrate substances of Isosorbid. The combination of SILDENAFIL with other
medicines requires to be approved by the doctor treating you, especially Cimetidine, Erythromycin
and Ketoconazol.
How is SILDENAFIL TABLET taken?
The most convenient dose is decided by your doctor. For most men, the dose is 50 mg one hour
before sexual activity. SILDENAFIL TABLET should not be taken more than once a day. The effect
of SILDENAFIL TABLET is only obtained with a satisfactory sexual stimulation. SILDENAFIL
TABLET is not an aphrodisiac. The time necessary of SILDENAFIL TABLET to exercise its action
varies from half an hour to one hour and this period may be extended if SILDENAFIL TABLET is
taken with meals. Large quantities of alcohol are not recommended before taking SILDENAFIL
TABLET. Any change in the dose prescribed should be done by the doctor treating you.
Does SILDENAFIL TABLET produce side effects?
Just like the majority of medicines, it is possible that SILDENAFIL TABLET may have side effects,
which are usually light and temporary. The most common side effects are headache and facial
reddening. Other side effects reported but rarely seen are indigestion, dizziness, clogged nose and
effects on vision (including changes in the visual perception of colours, increase of brightness of
light and blurred vision).
How should SILDENAFIL TABLET be stored?
Keep the SILDENAFIL TABLETS in their original packing, at temperature which is below 30
degrees centigrade.
What is the shelf-life of TADALAFIL TABLET?
The shelf life of Tadalafil is 2 years

My doctor

Labels

Tuesday, October 14, 2008

Order prozac online approved pharmacy

Prozac online pharmacy

Monday, October 13, 2008

The Viagra Files: The Web as Anticipatory Medium

Exposing Viagra For What It ‘Is’

Buy Viagra At Online Pharmacy

Sunday, October 12, 2008

Order viagra online, we accept: visa, mastercard, amex, e check

MALE SEXUAL DYSFUNCTION. Popular drug: Cialis and viagra

MALE SEXUAL FUNCTION

Saturday, October 11, 2008

Lifestyle management in ED with concomitant risk factors

Specialized diagnostic tests ED

Pathophysiology of erectile dysfunction

Managing ED: implications for the every-day clinical practice

Epidemiology and risk factors. Male erectile dysfunction

Friday, October 10, 2008

When You Should See Your Doctor About Erectile Dysfunction

Erectile Dysfunction Treatment

PSYCHOLOGICAL FACTORS erectile dysfunction

What is Erectile Dysfunction?

SYMPTOMS OF LOW TESTOSTERONE

Libido

A note about ED post Radical Prostatectomy

What does SILDENAFIL(VIAGRA) TABLET contain?

Blog Archive

Labels

Subscribe To

Tuesday, October 14, 2008

Monday, October 13, 2008

Exposing Viagra For What It ‘Is’

Sunday, October 12, 2008

Saturday, October 11, 2008

Friday, October 10, 2008

Blog Archive