Mental Impotence No More

Cure Erectile Dysfunction

This is how This Erectile Dysfunction Cure Works: A man's penis gets hard because blood is pumped into it, like balloon. There are numerous basic reasons why your sexual organ doesn't get hard enough any more. The causes are considered emotional and physical. To simplefy things, you can say it's either because it's not enough blood flows into the penis (pumping in) or an excessive amount blood leaks out of the penis (leaking). I don't need to get into any technical details. The main thing is that if your cause is physical, then you definitely must exercise all the muscles around the genital area and balance the energy flow down there. (which includes soft muscles inside the penis itself that prevent blod from leaking out). If the problem is emotional (usually connected to anxiety or stress), then you need to learn relaxation techniques as well as some basic emotional techniques which will bring you back to your old self. You'll be amazed what these techniques can do to your day to day life too. The majority of men benefit most from practising both the physical and em Read more here...

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Erect At Will Cures ED

Japanese people have everything their own way, you know this. But no matter how weird their ways are, the world knows that they work. The same is true for the product Erect At Will. It is derived from the ancient Japanese culture and is brought to you exclusively by the author of it. Appropriately named, the product Erect At Will is a PDF on the number 1 technique that has even 82 years old elderberries get boners like teenagers. That technique had a say in the history of Japan and it still has a lot of share in the bedtime stories of its present. Calling it a technique is conservative because it is, in fact, a formula made out of simple ingredients you can buy today from your local store. The ingredients used, thus, are entirely natural and they can be found conveniently, as said. Erect At Will has this formula enhanced and evolved to an erectile dysfunction buster shake that can be prepared easily and consumed easily. That's not all. You also get two bonuses: Become Her Sex Addiction, Premature Ejaculation Conqueror. Both of these bonuses focus on their topic. Read more here...

Erect At Will Cures ED Summary

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Author: Ronald Richards
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Erectile Dysfunction In Diabetes

In recent years, there has been a seismic change in the recognition and management of diabetic patients with erectile dysfunction (ED). Fundamental to this is the recognition that ED represents a vascular complication of the disease. Cardiovascular disease increases the risk of ED, but ED itself is probably a risk factor for cardiovascular disease. The estimated prevalence of ED in diabetic populations is of the order of 38-55 making it one of the most common complications of diabetes in men. ED in diabetes is most likely to be as a result of a defect in nitric oxide-mediated smooth-muscle relaxation as a consequence of autonomic nerve damage and endothelial dysfunction. Large vessel disease and hypertension may also contribute. If a diabetic male with ED wishes treatment for the condition, he should be offered an oral agent as firstline therapy assuming there is no contraindication. It is fruitless to try and determine whether the ED has a psychogenic component or not....

Erectile dysfunction ED

The first step is to define the patient's problem. ED is the inability to develop and maintain a penile erection sufficient for sexual performance. Although some men with diabetes do have permanent ED associated with diabetic tissue damage, many have reversible ED. Reversible factors, or those suggesting another condition requiring investigation and treatment should be sought, but a final decision that the ED is due to diabetes does not mean that the patient and his partner cannot be helped. Causes of erectile dysfunction in diabetic men Treatment of erectile dysfunction Sildenafil (Viagra) is licensed for use in diabetic men with ED and may be effective in over 50 per cent of cases depending on the severity of any vascular or neurological tissue damage. Do not prescribe sildenafil for men in whom sexual activity could be harmful (e.g. patients with unstable angina). Avoid sildenafil in patients with renal failure (creatinine clearance below 30 ml min), hepatic failure, blood pressure...

What other sexual disturbances apart from erectile dysfunction can occur

Apart from erectile dysfunction, one out of three men with DM can manifest ejaculation disturbances. The most frequent disturbance is retrograde ejaculation, during which some sperm, instead of exiting through the urethra, regresses into the urinary bladder. This condition is due to A 55 year old man has suffered from Type 2 DM for 5 years, and is treated with oral antidiabetic medicines. He does not regularly monitor his blood sugar levels (he is rather negligent). He has smoked since the age of 37 years (1 -2 packs day), and has high blood pressure and cholesterol levels. He was recently prescribed an ACE inhibitor with diuretic combination and a statin for this reason. Recently, he also complained of pains in his calves when walking. He visited his family doctor, who detected decreased peripheral pulses in the lower extremities bilaterally. When asked by the doctor, the patient admitted to recent, significant problems with achieving and maintaining an erection, which he attributes...

Experimental Erectile Dysfunction

Experimental erectile dysfunction in experimental diabetes and aging has been studied in the rat (40-42). Rat studies typically consist a measurement of intracavernous pressure in response to electrical stimulation of the cavernous nerve in normal and diabetic rats (43). The pathophysiology of erectile dysfunction in DAN appears to mimic the human condition wherein it is vasculogenic resulting in engorgement of corpora cavernosa and is because of a deficiency of nitric oxide (40,44-46). In the penile corpora cavernosa, nitric oxide is produced mainly by the activation of the neuronal nitric oxide synthase (NOS) in the nerve terminals and, to a lesser extent, by endothelial NOS in the lacunar and vascular endothelium (40,46). Nitric oxide stimulates guanylate cyclase cGMP activation of phosphokinase G reduction of intracellular Ca2+ relaxation of the smooth muscle cells penile engorgement. Support for this concept in the rat derives from a number of observations. Nitric oxide...

Erectile Dysfunction in Diabetes and Its Treatment

The existence of sexual disorders in diabetes mellitus has long been recognized. In the pre-insulin era, impotence was considered one of the commonest symptoms of diabetes, being present in both severe and milder forms of the disease. However, only now are sexual function problems receiving their rightful attention, as the medical professional has moved from a mere 'survivalist' approach to diabetes and its more invalidating complications towards care for the diabetic individual in all his or her complexity. Erectile dysfunction is 3 times more common among diabetics than in the healthy control population. However, the complication is still considered occult since it is often unreported by patients. In the various studies published, the incidence of this dysfunction in diabetics varies from 28 to 59 . The predictive factors are age, duration of the disease, degree of metabolic com pensation, the presence of microvascular complications (especially retinopathy) and neuropathy, high...

Diabetes And Erectile Dysfunction

The ability to get an adequate erection depends upon adequate blood flow to the penis and intact nerve function. Men with diabetes whose nerves to the penis are damaged and or whose blood supply to the penis is reduced may not be able to get a strong erection. Before blaming nerve damage and blood supply problems for erectile dysfunction, however, it is important to exclude other causes such as low testosterone levels, medicines (for blood pressure and depression), alcohol, and cannabis (marijuana). Psychological issues such as depression, job stress, and other relationship problems may also contribute to erectile dysfunction. There are a number of treatment options for erectile dysfunction PDE5 enzyme inhibitors. Sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis) are the medicines prescribed for erectile dysfunction. These medicines block an enzyme (called cyclic GMP-specific phosphodiesterase type 5), prolonging the blood flow into the penis and so improving the...

Erectile Dysfunction

Neuroendocrine Control Penile Erection

Erectile dysfunction (ED), defined as the consistent or recurrent inability of a man to attain and or maintain a penile erection sufficient for sexual activity (15), is one of the most common sexual dysfunctions in men. ED is more common with advancing age, and since the aged population will increase, its prevalence will continue to rise (16). Diabetes mellitus is the most frequent organic cause for ED, the onset of which starts about 15 years earlier in the diabetic than in the nondiabetic population. In the Massachusetts Male Aging Study (MMAS), the age-adjusted prevalence of minimal, moderate, or complete ED was 17, 25, and 10 among 1238 men without diabetes and 8, 30, and 25 among 52 treated men with diabetes, respectively (17). Thus, although the number of diabetic subjects in the MMAS was low, this population based study showed an increased prevalence particularly of complete ED among men with diabetes. In the Cologne Male Survey (18) the prevalence of ED was threefold...

Diabetic autonomic neuropathy

The symptoms of autonomic dysfunction should be elicited carefully during the history and review of systems, particularly since many ofthese symptoms are potentially treatable. Major clinical manifestations of diabetic autonomic neuropathy include resting tachycardia, exercise intolerance, orthostatic hypotension, constipation, gastroparesis, erectile dysfunction, sudomo-tor dysfunction, impaired neurovascular function, brittle diabetes, and hypoglycemic autonomic failure.

Examining Erection Problems

If carefully questioned, up to 50 percent of all males with diabetes admit to having difficulty with sexual function. This difficulty usually takes the form of erectile dysfunction (ED), the inability to have or sustain an erection sufficient for intercourse. It develops 10 to 15 years earlier in men with diabetes than in men without diabetes. After the age of 70 more than 95 percent of men with diabetes have erectile dysfunction. Many factors besides diabetes can cause the same problem, and you should rule them out before blaming diabetes. After you eliminate the following possibilities for erectile dysfunction, you can feel confident that diabetes is the source of the problem i Psychogenic impotence, an inability to have an erection for psychological rather than physical reasons. This would be managed by a therapist, especially a sex therapist rather than drugs. In order to understand how diabetes affects an erection, you need to first understand how an erection is normally produced.

Human Studies of Endothelium Dependent Vasodilation

Human studies evaluating the effects of DM on endothelium-dependent vasodilation have yielded some conflicting results, although they generally corroborate those found in animal studies. Saenz de Tejada et al. (60) studied penile tissue excised from men with erectile dysfunction and found that endothelium-dependent relaxation is reduced in the corpus cavernosa of impotent men with diabetes relative to those who are nondiabetic.

What are the chronic complications of DM in the elderly

Erectile dysfunction is more frequent in elderly diabetics (around 5595 percent of elderly diabetic men are affected compared with around 50 percent of elderly non-diabetics). Its causes comprise vasculopathy, neuropathy of autonomic nervous system, hormonal disturbances, endothelial dysfunction, psychological factors and various medications. Evaluation and treatment of this problem should not be neglected in elderly people, since it can have tremendously beneficial effects in the psychological well-being of the patients (see Chapter 19 'Sexual function in diabetes').

Duration of Diabetes Diabetes Related Complications and Diabetes Control

Peripheral and autonomic neuropathies have been frequently associated with and are considered an important cause of erectile dysfunction in diabetic men. With the specific aim to assess whether peripheral neuropathy may be causally associated with the development of sexual disorders among diabetic women, Erol et al. (44) experimentally evaluated the genital and extragenital somatic sensory system using biothesiometry. In this case-control survey of 30 premenopausal diabetic women and 20 healthy sexually active women, women with diabetes showed a mean FSFI total score significantly lower than that of controls (23.6 vs. 38.3 p < 0.0005). Moreover, for each genital and extragenital site, the mean biothesiometric values were significantly higher in diabetics, with the sensation at the vaginal introitus, the labium minora, and the clitoris the most deteriorated in diabetic women. A correlation was not found in women with diabetes, because the difference between women with or without SD...

Pathophysiology Of Ed In Diabetes

The flaccid penis is restrained by the tonic contraction of the vascular smooth muscle in the cavernosal ar-terioles and sinusoids under the influence of nora-drenergic sympathetic neurons, allowing only a small amount of blood (1-4mL 100g tissue) to enter the penis. Penile erection is produced by the relaxation of these vessels combined with restriction of venous return, both of which result in engorgement of the sinusoids. It requires intact arterial blood flow via the iliac, femoral, pudendal, cavernosal and helicene arteries. The cavernosal smooth muscle surrounds a complex vascular network consisting of endothelial cell lined sinuses, or lacunae, and the helicene arteries. The corpora are enclosed by a dense non-distensible fibrous sheath, the tunica albuginea, and communicate with each other via a medial septum. Subtunical vessels pierce this sheath, coalescing to form the emissary veins, which provide the venous drainage of the corpora into the dorsal vein (Figure 7.2).

Metformin and Repaglinide

A4 enzyme system, drugs that are metabolized through this system (Rifampin, barbiturates, carbamazepine, certain statin drugs, amiodarone, benzodiazepines, sildenafil (Viagra), theophylline, and certain selective serotonin reuptake inhibitors) may increase repaglinide metabolism (19). Although in vitro data indicate that repaglinide metabolism may be inhibited by antifungal agents (such as ketoconazole and miconazole) or antibacterial agents (such as clarithromycin), systematically acquired data is not available on increased or decreased plasma levels with other cytochrome P-450 3-A4 inhibitors or inducers.

Genitourinary Autonomic Neuropathy

Involvement of the genitourinary system in DAN may result in syndromes including cystopathy, retrograde ejaculation, erectile impotence and vaginal atrophy, and dys-pareunia (105). It has been reported that 50 of diabetic men and 30 of diabetic women have some degree of sexual dysfunction (106,107). Retrograde ejaculation reflects loss of coordinated internal sphincter closure with external vesicle sphincter relaxation during ejaculation and may become apparent as cloudy urine postcoitally, reflecting the presence of sperm. Diagnosis of retrograde ejaculation entails documentation of a low sperm count in the ejaculate. Impotence is commonly reported in DAN patients and usually occurs in the presence of other systemic manifestations of either somatic or autonomic neuropathy, but an attempt should be made to exclude other causes, including psychogenic, endocrine, vascular, iatrogenic (secondary to drugs, including antihypertensives, anti-cholinergics, antidepressants, and narcotics)....

Other Things You Can Do Quit Smoking

The role of smoking in causing lung disease is well known. But smoking is even more risky for people with diabetes. Over time, smoking damages your heart and circulatory system by narrowing your blood vessels. When blood flow to cells is restricted, the cells in your body can die. This damage can lead to heart disease, impotence, and amputation. Coupled with the already high risk for people with diabetes, the effect can be devastating. If you smoke now, talk to the members of your health care team about strategies that can help you quit.

Why Diabetes and Metabolic Syndrome Matter

The ultimate impact on health of type 2 diabetes and metabolic syndrome is through cardiovascular disease. The cluster of features associated with type 2 diabetes or the metabolic syndrome is a highly potent recipe for heart disease and stroke. People with type 2 diabetes or the metabolic syndrome have at least a two-to fivefold increased risk of cardiovascular disease. The relative risks are even higher in women with diabetes compared with their counterparts who are nondiabetic. In addition, in the United States, type 2 diabetes is the major cause of blindness, kidney failure, amputations, and neurological complications, such as impotence. Type 2 diabetes decreases life span by an average of seven to twelve years.

Screening for Complications at Diagnosis

Diarrhoea or constipation, and impotence should alert you to the possibility autonomic neuropathy (see Chapter 7). Symptoms of claudication should be inquired about. Physical examination requires measurement of lying and standing blood pressure and assessment of peripheral blood vessels. Visual acuity (VA) can be checked using a 3 m Snellen chart. Patients whose VA is worse than 6 6 in either eye should be examined using the pinhole test which will partially correct a refractive error. Alternatively, they may use their distance glasses if worn. In patients with poor VA which remains unaltered or worsens in the pinhole test, the retina should be closely inspected for lesions, particularly those of maculopathy.

If You Need Insulin Youre Doomed

Some people believe that insulin, itself, causes complications like impotence or other damage. There is no evidence for this. A recent study that was publicized but not yet published suggested that using insulin to lower the blood glucose so the hemoglobin A1c was less than 6 percent caused more deaths than lowering it to a more modest level like 7 percent.

Medications Monotherapy

Neurological manifestations include peripheral nervous system abnormalities of impotence, autonomic dysfunction, peripheral neuropathy, and postural hypotension central nervous system disturbances include behavioral changes, memory loss, hallucinations, nightmares, depressions, and insomnia.

Recent Developments

2 Soon after sildenafil became available, there were reports of transient changes in colour vision.1 Blue vision affects approximately 3 of men using sildenafil and does not seem to be a clinically significant problem. There have been no reports of blue vision with vardenafil and tadalafil. More recently, there have been reports of non-arteritic optic ischaemic neuropathy (NAOIN) associated with sildenafil.2 NAOIN has been associated with permanent unilateral or bilateral reduction in visual acuity. Though the mechanism of action is uncertain, it is known that sildenafil cross-reacts with retinal PDE-6. All reported cases were in patients with an adverse cardiovascular risk profile and it may be prudent to avoid sildenafil use in such patients. However, the risk of permanent visual loss is minimal and rare side effects of the newer PDE-5 inhibitors may not yet have come to light. There have been a number of reports of sudden death in men using sildenafil despite the precautions...

Genital Sexual Arousal Disorders Among Women with Diabetes

The development of phosphodiesterase-type-5 (PDE5) inhibitors, such as sildenafil, tadalafil and vardenafil, has revolutionized the treatment of SD in men. Preclinical studies with clitoral tissue baths suggested a rationale for using these agents to treat women's SD (115, 116). However, clinical investigations regarding vasocongestive therapies for women's sexual complaints have yielded inconsistent results (116). Caruso et al. presented the largest peer-reviewed series regarding the use of sildenafil in both diabetic (117, 118) and nondiabetic (119, 120) women complaining of genital sexual arousal disorder. They assessed whether sildenafil was effective in modifying clitoral blood flow in a group of 30 premenopausal women with DM1 as compared with 39 healthy premenopausal women. A direct comparison showed that the DM1 patients had significantly lower scores for the arousal, orgasm and frequency of sexual activity domains of the Personal Experience Questionnaire. Moreover, diabetic...

Transurethral Alprostadil

Alprostadil was first licensed for the treatment of ED by intracavernous injection. Alprostadil, the synthetic preparation of the naturally occurring prostaglandin E1 acts by initiating the erection. In contrast to sildenafil it initiates the relaxation of cavernous smooth muscle to bring about erection. This drug has been incorporated into a pellet that can be given by intraurethral application Medical Urethral System for Erection (MUSE) . Patients need to be instructed in the use of MUSE which is introduced into the urethra with a disposable applicator. The patient first passes urine to act as a lubricant to facilitate the passage of the applicator and the absorption of the drug. Absorption of the drug is also facilitated by the patient rolling his penis between the palms of his hands. Some patients find that a constrictive ring around the base of the penis enhances the efficacy. The erection takes about 10 minutes to develop and the dose range varies between 125 and 1000 g although...

Intrinsic Neural Control

Abnormalities of nNOS have been observed in animal models of diabetes. Stomachs of spontaneously diabetic rats and rats with streptozotocin-induced diabetes exhibit decreased NO-mediated relaxation of gastric muscle strips and decreased expression of nNOS. Watkins et al. (33) have subsequently demonstrated that nNOS protein and mRNA are depleted in the pyloric myenteric neurons of diabetic mice. Insulin treatment restores pyloric nNOS protein and reverses the delay in gastric emptying observed in such mice. Sildenafil, a cGMP phosphodiesterase inhibitor augments NO signaling and also reverses delayed gastric

How does diabetes affect sexual function

A man's ability to have a normal erection depends upon a good supply of blood via the arteries to the penis, and on an intact nerve supply to constrict the veins leading from it. Blood enters the penis through the arteries, but cannot leave because the veins are constricted, thus producing an erection. Diabetes can affect both the blood supply and the nervous control needed to maintain an erection. It is important to remember, however, that sexual dysfunction can have psychological as well as physical causes, whether you have diabetes or not, so it is very important to discuss any sexual problems openly and frankly with your diabetes care team. There are treatments available for all forms of sexual dysfunction in men.

Discussing ED with your doctor

Although sexual intercourse tends to be an embarrassing topic for many men and women, if you have diabetes and have a problem in this key area of life, you need to discuss it with your doctor. Some doctors find this topic just as embarrassing as some patients. Any doctor who treats patients with diabetes should bring the topic up in the first meeting and annually thereafter. If he or she does not, it is up to you to broach the subject. If you read the explanation of the normal development of an erection and your experience differs from that, discuss it with your physician. There are so many ways to treat it, and the lack of an erection can have such a profound effect upon your self-esteem and your relationship with another person that it is sad to discover how often a new patient has been suffering in silence for years.

Symmetrical Neuropathies

On clinical examination there is little evidence of objective signs of nerve damage, apart from a reduction in pinprick and temperature sensation, which are reduced in a stocking and glove distribution. There is relative sparing of vibration and position sense (because of relative sparing of the large diameter Ap fibers). Muscle strength is usually normal and reflexes are also usually normal. However, autonomic function tests are frequently abnormal and affected male patients usually have erectile dysfunction. Electrophysiological tests support small-fiber dysfunction. Sural sensory conduction velocity may be normal, although the amplitude may be reduced. Motor nerves appear to be less affected. Controversy still exists regarding whether small-fiber neuropathy is a distinct entity or an earlier manifestation of chronic sensory motor neuropathy (28,29). Said et al. (28) studied a small series of subjects with this syndrome and showed that small-fiber degeneration predominated...

Physiology and Pathophysiology

Guanil Cyclase

Penile erection is a neurovascular event modulated by psychological factors and hormonal status depending on appropriate trabecular smooth muscle and arterial relaxation in the corpus cavernosum (Fig. 1). On sexual stimulation, nerve impulses cause the release of cholinergic and non-adrenergic non-cholinergic (NANC) neurotransmitters that mediate erectile function by relaxing the smooth muscle of the corpus cavernosum. A principal neural mediator of erection is NO which activates guanil cyclase to form intracellular cyclic guanosine monophosphate (GMP), a potent second messenger for smooth muscle relaxation. Cyclic GMP in turn activates a specific protein kinase, which phosphorylates certain proteins and ion channels, resulting in a drop of cytosolic calcium concentrations and relaxation of the smooth muscle. During the return to the flaccid state, cyclic GMP is hydrolyzed GMP by phosphodiesterase (PDE) type 5. In the corpus cavernosum four PDE isoforms have been In vivo studies of...

Disorders of automatic autonomic nerves

Sexual dysfunction, which occurs in as many as 60 percent of males and 30 percent of females with diabetes. Males can't sustain an erection, and females have trouble lubricating the vagina for intercourse. The drugs Viagra, Cialis, or Levitra are helpful for males with sexual dysfunction. For females, use of lubricating fluids may be helpful.

Symptomatic Treatment of Autonomic Neuropathy

Although T1DM has a high incidence rate of erectile dysfunction, it should not be taken as the causative factor without the exclusion of other possible agents. In this way, a therapy may be specifically targeted to the particular cause. The common alternative origin to erectile dysfunction is psychosomatic for which the patient should be directed to proper counseling (84). Low testosterone levels may also contribute to erectile dysfunction in which case testosterone supplementation is advised. Arteriosclerosis resulting in low genital blood flow should be directed to a vascular surgeon. The presentation of erectile dysfunction has comorbidity with other nonsymptomatic forms of DAN and atherosclerosis (85). Therefore, a thorough cardiac screening should be performed on all T1DM patients with erectile dysfunction. To treat erectile dysfunction, glycemic control should be instituted along with cessation of alcohol or tobacco. Prescription drugs which are known to cause erectile...

Repercussions of DM in sexual life

Erectile dysfunction is defined as the inability of a man to achieve and or maintain sufficient erection for sexual activity. This complication (less often called 'impotence' these days) often occurs in middle-aged men. In a large study performed in Massachusetts, 52 percent of healthy middle-aged men manifested some degree of erectile dysfunction. The same study showed that the frequency increases with age, while it is three times more frequent in diabetics compared to non-diabetics of a similar age. Table 19.1. Erectile dysfunction evaluation scale (International scale of erectile function, IIEF) 1. How often did you have an erection during any sexual activity 0-5 2. During sexual activity, how often did you have an erection In various studies, diabetic individuals manifest disturbances of erectile function at a rate from 33 to 75 percent. The problem of erectile dysfunction considerably influences the patient's quality of life because it decreases self-esteem while at the same time...

Epidemiology

Erectile dysfunction (ED), defined as the consistent or recurrent inability of a man to attain and or maintain a penile erection sufficient for sexual activity (100), is one of the most common sexual dysfunctions in men. ED is more common with advancing age, and since the aged population will increase, its prevalence will continue to rise (101). Diabetes mellitus is the most frequent organic cause for ED, the onset of which starts about 15 years earlier in the diabetic than in the non-diabetic population. In the Massachusetts Male Aging Study (MMAS), the age-adjusted prevalence of minimal, moderate, or complete ED was 17 , 25 , and 10 among 1238 non-diabetic men and 8 , 30 , and 25 among 52 treated diabetic men, respectively (102). Thus, although the number of diabetic subjects in the MMAS was low, this population-based study showed an increased prevalence particularly of complete ED among men with diabetes. In the Cologne Male Survey (103) the prevalence of ED was threefold...

Summary

For coronary heart disease, including insulin resistance, dyslipidemia and hypertension. Discussion of this topic should be attempted with every male patient. Treatment should be directed at the underlying cause. Hormonal abnormalities should be corrected, but that alone may not be the answer. Drugs should be changed to those with no (or a lower) potential for ED, and glycemic control should be optimized. For psycho-genic dysfunction the patient should be referred to a therapist with expertise in treating sexual dysfunction. Patients responsive to sildenafil (above 70 in non-organic cases, lower in elderly diabetics but still a good first-line choice) have this, and misaprostil urethral suppositories and intracavernous injections as therapeutic options. Those who are unresponsive usually have vascular disease and require prostheses or vascular surgery. No attempt should ever be made to treat ED without first consulting the significant other, and careful thought about the risk benefit...

And Epidemiology

The classic definitions of women's sexual disorders were based mainly on genitally focused events in a linear sequence model (desire, arousal and orgasm). More recently, SD has been considered a disturbance in SF involving one or multiple phases of the sexual response cycle or pain associated with sexual activity (7-9). A sexual disorder is SD that meets the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition criteria for sexual disorders however, a problem becomes a SD only if it causes distress, as opposed to a normal physiological response to difficult circumstances (7-9).

Diabetic Dermopathy

Necrobiosis Lipoidica

Figure 107 Clinical features of diabetic autonomic neuropathy. Many diabetic patients have evidence of autonomic dysfunction, but very few have autonomic symptoms. The most prominent symptom is postural hypotension. Erectile dysfunction, common in diabetic men, is not always due to autonomic neuropathy. Late manifestations other than postural hypotension include gustatory sweating, diabetic diarrhea, gastric atony and reduced awareness of hypoglycemia. Symptomatic autonomic neuropathy may be associated with a poor prognosis Figure 111 A vacuum system for management of diabetic impotence. Placing the cylinder over the penis and creating a vacuum with the pump produces an erection which can be maintained by placing constrictor rings over the base of the penis. Studies have shown that many patients prefer this non-invasive technique to other, more invasive, methods Figure 111 A vacuum system for management of diabetic impotence. Placing the cylinder over the penis and creating a vacuum...

Diabetic Neuropathy

Genitourinary abnormalities, including cystopathy, neurogenic bladder, defective vaginal lubrication, retrograde ejaculation, and erectile dysfunction. Often, erectile dysfunction may be the first manifestation of a developing autonomic neuropathy, followed by episodes of diminished ejaculation, loss of ejaculatory effort, or retrograde ejaculation. Poor glycemic control has shown to be the chief risk factor for autonomic neuropathy, although, in the Pittsburgh Epidemiology Study, increased low-density lipoproteins and hypertension were also contributing factors. Other data has implied associations between neuropathies and systolic and diastolic blood pressure or lipid disturbances (31). Metoclopramide (Reglan) is perhaps the best-studied drug and 10-40 mg is usually given in divided doses before meals and at bedtime. Although metoclopramide is generally well-tolerated, side effects can result in galactorrhea, irregular menses, or erectile dysfunction, and metoclopramide may...

Second Edition

Heart Disease Diagnosis and Therapy A Practical Approach, Second Edition, edited by M. Gabriel Khan, md, frcp, frcp(c), facc, 2005 Cardiovascular Genomics Gene Mining for Pharmacogenomics and Gene Therapy, edited by Mohan K. Raizada, phd, Julian F. R. Paton, phd, Michael J. Katovich, phd, and Sergey Kasparov, md, phd, 2005 Surgical Management of Congestive Heart Failure, edited by James C. Fang, md and Gregory S. Couper, md, 2005 Cardiopulmonary Resuscitation, edited by Joseph P. Ornato, md, fap, facc and Mary Ann Peberdy, md, facc, 2005 CT of the Heart Principles and Applications, edited by U. Joseph Schoepf, md, 2005 Heart Disease and Erectile Dysfunction, edited by

Dan Ziegler

Acute painful neuropathy has been described as a separate clinical entity (16). It is encountered infrequently in both type 1 and type 2 diabetic patients presenting with continuous burning pain particularly in the soles (like walking on burning sand) with nocturnal exacerbation. A characteristic feature is a cutaneous contact discomfort to clothes and sheet which can be objectified as hypersensitivity to tactile (allodynia) and painful stimuli (hyperalgesia). Motor function is preserved, and sensory loss may be only slight, being greater for thermal than for vibration sensation. The onset is associated with and preceded by precipitous and severe weight loss. Depression and impotence are constant features. The weight loss has been shown to respond to adequate glycemic control, and the severe manifestations subsided within 10 months in all cases. No recurrences were observed after follow-up periods of up to 6 years (16). The syndrome of acute painful neuropathy seems to be equivalent...

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