Case Study

1. A study done at the Boston University School of Medicine linked overall health to impotence. Researchers studied the medical histories of 1300 men aged 40 to 70. They found some impotence in a total of 52%. Men who were being treated for heart disease, high blood pressure, or diabetes were one and a half to four times more likely than the overall group to be completely impotent later in life. The situation was even worse for men who had heart disease or hypertension and who smoked.
2. Alcohol intake decreases the body’s ability to produce testosterone. Research at Chicago Medical School revealed that drinking alcohol may cause the mormonal equivalent of menopause in men. Alcohol not only affects sexual function, but also helps set the stage for a heart attack and other dangerous conditions.
3. Arteriosclerosis, which restricts blood supply to the penis and to the nerves that govern sexual arousal, may result in a "failure to perform." If impotence is related to clogged blood vessels, a diet low in fats can actually help reverse the problem.
4. A study done at Boston University showed that men who smoked one pack of cigarettes a day for five years were 15 percent more likely to develop clogging in the arteries that serve the penis, a situation that can cause impotence. In addition, heavy smoking decreases sexual capability by damaging the tiny blood vessels in the penis. The use of marijuana and cocaine also can result in impotence.
5. Duplex untrasonography, a noninvasive method of measuring penile blood flow, is a reliable method of determining whether arterial occlusion plays a role in impotence. If you doctor believes atherosclerosis to be the underlying problem, he or she may advise vascular surgey to improve blood flow to the penis.
6. According to figures from impotence organizations, only about 5 percent of the estimated 30 million men affected are aware of therapy options.
7. Urologists differ in the types of treatment they recommend for impotence, but many opt first for nonsurgical treatment.
8. Injections of the drugs papaverine (Pavabid) and phentolamine (Regitine) or prostaglandin E1 (PGE1) into the base of the penis before intercourse have been shown to be roughly 80% effective in producing "satisfactory erection" in impotent men who have tried it. The drug alprostadil also is available in an injection kit (Caverject). These drugs work by relaxing smooth muscle, causing the blood vessels in the penis to dilate, promoting an erection that can last an hour or more. An estimated 300,000 men in the U.S. use this technique each year. Possible side effects include priaprism (prolonged, painful erections). Also, although the injections are done with a tiny needle, and are supposed to be painless when done properly (proper technique is crucial), this prospect is unappealing to many men. A less invasive technique, which involves instilling alprostadil into the urethra with a tiny plunger, is under development and is expected to become available in the near future.
9. Yohimbine (sold under the brand names Dayto, Yocon, and Yohimex) is a prescription drug that has been approved by the FDA for treatment of impotence. Its effectiveness is questionable, however. Many experts consider it to be, in essence, a placebo. Yohimbine has an effect on the body similar to that of adrenaline; it speeds up the heartbeat and elevates blood pressure. Beware of yohimbine if you have high blood pressure.
   
10. Three drugs may offer hope. Viagra has achieved very good results in men with psychogenic impotence and also in men with organic impotence. The intensity of the erection is enhanced as well as overall performance and there may be major side effects, and a risk of death for some patients. A doctor will be able to determine if Viagra is right for you. (For books on the subject, check "Books" "Issues" "Health-General".) Vasomax has been used for years as an injectable medication and is now being tested in pill form. It is another medication which works to dilate penile blood flow in men with mild vascular problems. Apo-Morphine is being evaluated for treatment of only psychogenic impotence.
    Medical Urethral System for Erection (MUSE) is a cream which is absorbed through the urethra and dilates the cavernosal spongy tissue of the erectile chambers. It has about a 66% success rate and anxiously awaits approval to replace injectable forms of therapy.
11. Injection Therapies - Papaverine was the first effective medical treatment for ED. To date, there are two currently approved by the FDA. Caverject and Edex which are effective in about 85% of patients. Occasionally, Papaverine by itself or with Regitine and Prostaglandin E will be used, which is much better than any on eof them used alone. Some men will have erections lasting a few minutes to 45 minutes. Dosage determines this. Used immediately after radical prostatectomy or radiation therapy may prevent atrophy of the smooth muscle necessary for erection which is associated with non-use of the penis.
12. If impotence is linked to high levels of the hormone prolactin, bromocriptine (Parlodel) may be prescribed to correct the problem.
    
13. A number of vacuum devised are used to promote erection. With these devices, a cylinder is placed over the penis and a hand pump is used to create a vacuum in the cylinder. This in turn causes blood to flow into the penis, creating an erection. The user then puts a constriction band around the base of the penis, causing the erection to last up to thirty minutes. These devices are available by prescription only. Some 100,000 men in the U.S. choose this treatment each year. While this eliminates the need for medication, it does require some preparation time which decreases spontaneity. However, they work for many men and are covered by Medicare and many insurance companies. Problems abound with this technique, however.
14. Since the early 1970s, more than 250,000 American men have turned to inflatable penile implants to mechanically create erections. Penile implants are surgically installed devices that are made of silicone or polyurethane. One type is made of two semi-rigid but bendable rods; another type consists of a pump, a fluid-filled reservoir, and two cylinders into which the fluid is pumped to create an erection. Penile implants are now coming under FDA scrutiny. Since 1984, the FDA’s Center for Devices and Radiological Health has logged more than 6,500 reports of problems with inflatable devices - a large number for a medical device, according to the FDA. With the development of more effective agents, implants are now considered to be a last resort, to be tried only when all other methods have failed. Penile Prosthesis, rigid, semi-rigid or inflatable implants, can very a scary thing for many men. Getting your questions answered is most important because it is a serious decision. They are only necessary in about 10% of patients. For men who have become impotent following radical surgery, radiation or cryosurgery, or have arthritis and decreased manual dexterity, this procedure may be the last hope. The success rate is very high and they remain effective at a 90-95% rate 5 years after implantation.
15. Dr. Robert Frankt of Budapest University in Hungary found a great increase in sexual vitality and energy in men using a combination of two herbs, green oats (Avena sativa) and stinging nettle. "Feeling one’s oats" is an expression that originated centuries ago, and probably with good reason: a study by the Institute for Advanced Study of Human Sexuality found that men who suffered from reduced sexual desire and diminished performance were helped by green oats. Nettle if full of vital minerals and is good also for hypoglycemia, allergies, depressions, prostate and urinary tract disorders, and a host of other problems.