Recommendations

1. East a healthy, well-balanced diet. Include in the diet pumpkin seeds, bee pollen, or royal jelly. (Caution: Bee pollen may cause an allergic reaction in some individuals. Start with a small amount, and discontinue use if a rash, wheezing, discomfort or other symptom occurs.
2. Avoid alcohol, particularly before sexual encounters.
3. Do not consume animal fats, sugar, fried or junk foods.
4. Do not smoke. Avoid being around cigarette smoke.
5. Avoid stress.
6. Consult a urologist for testing to determine whether impotence is caused by an underlying illness that requires treatment.
7. Consider possible psychological factors that may be contributing to impotence, especially repressed anger or a fear of intimacy. Exploring psychological issues with a qualified therapist can help.
8. If you suspect impotence may be related to a drug you are taking, discuss this with your physician. There may be satisfactory, alternatives that will not cause this problem. Certain blood pressure medications and tranquilizers often cause erectile difficulties. The drugs cimetidine (Tagamet) and ranitidine (Zantac) which are used to treat ulcers and heartburn, also have significant side effects in some men. (Caution: Do not stop taking a prescription drug or change the dosage without consulting your physician.
9. Investigate the possibility of heavy metal intoxication. A hair analysis can reveal possible heavy metal poisoning. Keep in mind that sexual function changes with age. As you age, you may require more stimulation and a longer period of time to achieve an erection

Viagra: Time to Separate Reality from Hype

When Viagra-the first pill to conquer male impotence-was approved earlier this year, doctors couldn't keep up with their patients' demands for prescriptions. All the brou-ha-ha is easy to understand. If normal sexual function can be restored by simply swallowing a little pill, why bother with devices, injections or implants? Still, the wonder drug that can has its limits. And reports of deaths among men taking the sex pill is causing some alarm.

Viagra seemed to burst on the scene out of the blue, but it does have a track record. Sildenafil citrate, the active ingredient in Viagra, was originally developed to treat high blood pressure. It didn't work for that disorder, but in 1993, Pfizer Pharmaceuticals, the drug's manufacturer, started clinical trails of Viagra involving more than 3,000 men with varying degrees of impotence associated with diabetes, spinal cord injury, history of prostate surgery, and other illnesses. The results: 48 percent of men with severe impotence were almost always able to get aroused when using Viagra, and 70 percent of men with milder problems had success using the pill. Men with diabetes or radical prostate surgery had somewhat less improvement than did other groups.

One of the little love pill's major assets is that men who take it get turned on "naturally." That is, Viagra does not directly cause erections as do other impotence treatments. Rather it affects a man's response to sexual stimulation. Taken one hour before sexual activity, the drug acts by enhancing the effects of a chemical the body normally releases into the penis when sexually aroused. This increases blood flow into the penis, which results in an erection. (Viagra should not be taken more than once a day.)

On the down side, there have been reports of deaths and severe side-effects in some men taking Viagra. Men with a history of heart trouble, heart attacks, and low blood pressure should be examined carefully before getting a prescription for the drug, and heart patients taking nitroglycerin or other nitrate-based drugs must not take Viagra because the mix may cause a deadly dip in blood pressure. Other adverse effects of Viagra may include headache, flushing, indigestion, and temporary changes in vision -- including seeing a 'blue haze.' Opthalmologists are concerned that the long-term effects of Viagra on vision are not yet known. Men with sickle cell anemia, leukemia, or multiple myeloma should also avoid Viagra because it is feared that they may develop priapism -- a persistent, painful erection that can permanently damage the penis. Additionally, men are cautioned against using other treatments for impotence while taking Viagra as such combinations have not been tested yet.

Despite problems linked to the sex pill, enthusiasm for it among patients and doctors is still riding high. But men are cautioned to use common sense. They should not take it before having a thorough medical history, including a review of medications, and a physical examination. Viagra is a drug with potentially serious health consequences and is meant only for men diagnosed with impotence. It is not a novelty item for men who achieve normal erections and simply want to heighten their sexual prowess.

Information Regarding Impotency

American Foundation for Urologic Disease, Provides free information on impotence and how to assess treatment options. 800.242.2383

Impotence Information Center Provides free literature on impotence. 800.843.4315

National Kidney & Urologic Disease Clearinghouse Offers free literature on a number of

urological problems, including impotence. 800.669.1603

Impotence Institute of America, Offers literature on impotence and doctor referrals for a $3.00 shipping charge. 800.669.1603

What Lifestyle Changes May Help Prevent or Treat Impotence?

Maintaining General Health
Because many cases of impotence are due to reduced blood flow from blocked arteries, it is important to maintain the same lifestyle habits as those who face an increased risk for heart disease. Such good habits include a diet rich in fresh fruits and vegetables, whole grains, and fiber and low in saturated fats and sodium. Men who drink alcohol should do so in moderation. A regular exercise program is extremely important. Quitting smoking is essential.

Frequent Erections
Staying sexually active can help prevent impotence. Frequent erections stimulate blood flow to the penis. It may be helpful to note that erections are firmest during deep sleep right before waking up. Autumn is the time of the year when male hormone levels are highest and sexual activity is most frequent.

Kegel Exercises
The Kegel exercise is a simple exercise commonly used by people who have urinary incontinence and by pregnant women. It may also be helpful for men whose erectile dysfunction is caused by impaired blood circulation. The basic technique consists of tightening and releasing the pelvic muscle that controls urination. Since the muscle is internal and is sometimes difficult to isolate, doctors often recommend practicing while urinating on the toilet. The patient tries to contract the muscle until the flow of urine is slowed or stopped and then releases it. People should perform 5 to 15 contractions, attempting to hold each contraction for 10 seconds, three to five times daily.

Changing or Reducing Medications Causing Impotence
If medications are causing the problem, the patient and the physician should discuss alternatives or reduced dosages. In treating high blood pressure, for instance, ACE inhibitors are less likely to cause sexual dysfunction than many other medications.

Psychotherapy and Behavioral Therapy
Some form of psychological, behavioral, sexual, or combination therapy is often recommended for individuals suffering from impotence, regardless of cause. In such cases, it is beneficial to have the partner involved in this process whether sexual therapy is part of the treatment or not. The value of sex therapy itself is questionable. In one study 12 out of 20 of men whose dysfunction had a psychological basis and who were advised to enter a sex clinic resisted sex therapy out of embarrassment or because they felt it wouldn't help. Of the eight who entered therapy only one actually achieved satisfactory sex. Some kind of interpersonal, supportive, or behavioral therapy, however, can be of help to a patient during all phases of the decision-making process with regard to possible methods of treatment. Therapy may also ease the adjustment period after the initiation or completion of treatment.

In a totally unrelated development (unrelated to aging, that is), National Institute of Aging supported scientists from the University of South Carolina have found yet another compelling reason to avoid cholesterol. Men with lower blood cholesterol or higher amounts of the beneficial high-density lipoprotein (HDL) cholesterol may be less likely to develop erectile dysfunction or impotence.

According to the researchers, atherosclerosis (hardening of the arteries), which may impede blood flow to and from the penis, is one primary cause of impotence. While a positive link between blood cholesterol and atherosclerosis, the association between cholesterol and impotence has only been suggested until now. The South Carolina scientists conducted a study of more than 3,200 generally healthy men between the ages of 25 and 83. Data indicated that the men with total cholesterol over 240 milligrams per deciliter (mg/dl) of blood had nearly double the risk of penile dysfunction as men with readings of 180 mg/dl. A similar pattern held true in patients with significant amounts of HDL cholesterol. Those with HDL readings of 60 mg/dl or greater were one-third less likely to develop dysfunction than were men with less than 30 mg/dl HDL.

General Precautions with Viagra

What is Viagra used for?
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.

Who should not take Viagra?
Men who are currently using medicines that contain nitrates, such as nitroglycerin should not use Viagra because taken together they can lower the blood pressure too much. Viagra should not be used by women or children.

General Precautions with Viagra:
You should have a complete medical history and exam to determine the cause of your impotence before taking Viagra.

Men who have medical conditions that may cause a sustained erection such as sickle cell anemia, leukemia or multiple myeloma or who have an abnormally shaped penis may not be able to take Viagra.

There are several medications that are known to interact with Viagra, so be sure to tell your doctor about all medications you are taking including those you can get without a prescription.

Viagra has not been studied with other treatments for impotence, so use in combination with other treatments is not recommended.

How should I take Viagra? Your healthcare provider may prescribe Viagra as one tablet once a day, about 1 hour before sexual activity. However, Viagra may be taken anywhere from 30 minutes to 4 hours before sexual activity.

What are some possible side effects of Viagra? (This list is NOT a complete list of side effects reported with Viagra. Your healthcare provider can discuss with you a more complete list of side effects.)

Viagra is generally well tolerated. If any side effects are experienced, they are usually mild and temporary. The following is a listing of the most common side effects:

• Headache
• Flushing
• Upset stomach
• Stuffy nose
• Urinary tract infection
• Visual changes such as mild and temporary changes in blue/green colors or increased sensitivity to light.
• Diarrhea
  

For more detailed information on Viagra, ask your healthcare provider.

Other upcoming drugs

Dr. Robert Kramer of Boston University, and former president of the International Society of Impotence Research. He was chairman of a committee of leading scientists and researchers who reviewed the field of pharmacological therapy in a report to the meeting.

He mentioned two upcoming new oral medications:

Apomorphine - This compound acts on receptors in the brain. An FDA application has been made to market an oral version of this well-known compound. This follows completion of a number of clinical studies involving a total of about 1,000 patients which show a 50% success rate in improving erection. The tablet is placed under the tongue. It is expected to be available in the US by the end of 2000.

IC351- This is a compound similar to Viagra, but with a slightly different mechanism. It may not have the "blue haze" effect on the eyes that sometimes occurs with sildenafil. It is presently undergoing clinical trials.

Other upcoming drugs include:

Melanotan II- The mechanism is similar to apomorphine. This compound has shown good results in animal studies, and has been tested in small numbers of patients. It is still in the research phase.

Trazodone- This is also a well- known compound. "However, scientific data are lacking, and it seems to have little effect", notes, Dr Kramer.

Phentolamine- This medication is used in some combination therapies. However, clinical studies in Germany found no significant difference from placebo. In a US trial, it was found to have a modest effect on mild to moderate impotence.

Yohimbine- Dr. Kramer said his committee did not consider the available data sufficient to evaluate this drug.