THE 2002 OFFICIAL PATIENT’S SOURCEBOOK
on
MPOTENCE J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS
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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright Ó2002 by ICON Group International, Inc. Copyright Ó2002 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1
Publisher, Health Care: Tiffany LaRochelle Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher’s note: The ideas, procedures, and suggestions contained in this book are not intended as a substitute for consultation with your physician. All matters regarding your health require medical supervision. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation, in close consultation with a qualified physician. The reader is advised to always check product information (package inserts) for changes and new information regarding dose and contraindications before taking any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960The 2002 Official Patient’s Sourcebook on Impotence: A Revised and Updated Directory for the Internet Age/James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary and index. ISBN: 0-597-83220-X 1. Impotence-Popular works. I. Title.
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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem or as a substitute for consultation with licensed medical professionals. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors or authors. ICON Group International, Inc., the editors, or the authors are not responsible for the content of any Web pages nor publications referenced in this publication.
Copyright Notice If a physician wishes to copy limited passages from this sourcebook for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications are copyrighted. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs or other materials, please contact us to request permission (e-mail:
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Dedication To the healthcare professionals dedicating their time and efforts to the study of impotence.
Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this sourcebook which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which directly or indirectly are dedicated to impotence. All of the Official Patient’s Sourcebooks draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this sourcebook. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany LaRochelle for her excellent editorial support.
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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for the Official Patient’s Sourcebook series published by ICON Health Publications.
Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for the Official Patient’s Sourcebook series published by ICON Health Publications.
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About ICON Health Publications In addition to impotence, Official Patient’s Sourcebooks are available for the following related topics: ·
The Official Patient's Sourcebook on Cystocele
·
The Official Patient's Sourcebook on Glomerular Disease
·
The Official Patient's Sourcebook on Goodpasture Syndrome
·
The Official Patient's Sourcebook on Hematuria
·
The Official Patient's Sourcebook on Hemochromatosis
·
The Official Patient's Sourcebook on Immune Thrombocytopenic Purpura
·
The Official Patient's Sourcebook on Interstitial Cystitis
·
The Official Patient's Sourcebook on Kidney Failure
·
The Official Patient's Sourcebook on Kidney Stones
·
The Official Patient's Sourcebook on Lupus Nephritis
·
The Official Patient's Sourcebook on Nephrotic Syndrome
·
The Official Patient's Sourcebook on Peyronie
·
The Official Patient's Sourcebook on Polycystic Kidney Disease
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The Official Patient's Sourcebook on Prostate Enlargement
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The Official Patient's Sourcebook on Prostatitis
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The Official Patient's Sourcebook on Proteinuria
·
The Official Patient's Sourcebook on Pyelonephritis
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The Official Patient's Sourcebook on Renal Osteodystrophy
·
The Official Patient's Sourcebook on Renal Tubular Acidosis
·
The Official Patient's Sourcebook on Simple Kidney Cysts
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The Official Patient's Sourcebook on Urinary Incontinence
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The Official Patient's Sourcebook on Urinary Incontinence for Women
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The Official Patient's Sourcebook on Urinary Incontinence with Children
·
The Official Patient's Sourcebook on Urinary Tract Infection in Children
·
The Official Patient's Sourcebook on Urinary Tract Infections in Adults
·
The Official Patient's Sourcebook on Vasectomy
·
The Official Patient's Sourcebook on Vesicoureteral Reflux
To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes & Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health
Contents vii
Table of Contents INTRODUCTION ................................................................................................................................. 1 Overview ....................................................................................................................................... 1 Organization ................................................................................................................................. 3 Scope.............................................................................................................................................. 3 Moving Forward............................................................................................................................ 4 PART I: THE ESSENTIALS ............................................................................................................. 7 CHAPTER 1. THE ESSENTIALS ON IMPOTENCE: GUIDELINES ........................................................... 9 Overview ....................................................................................................................................... 9 What Is Impotence? ..................................................................................................................... 11 How Does an Erection Occur?.................................................................................................... 11 What Causes Impotence?............................................................................................................. 12 How Is Impotence Diagnosed? .................................................................................................... 13 How Is Impotence Treated? ......................................................................................................... 15 What Will the Future Bring? ...................................................................................................... 19 Points to Remember..................................................................................................................... 19 For More Information.................................................................................................................. 19 More Guideline Sources .............................................................................................................. 20 Vocabulary Builder...................................................................................................................... 34 CHAPTER 2. SEEKING GUIDANCE ................................................................................................... 41 Overview ..................................................................................................................................... 41 Associations and Impotence......................................................................................................... 41 Finding More Associations ......................................................................................................... 43 Finding Doctors........................................................................................................................... 45 Finding a Urologist ..................................................................................................................... 46 Selecting Your Doctor ................................................................................................................. 47 Working with Your Doctor ......................................................................................................... 47 Broader Health-Related Resources .............................................................................................. 49 Vocabulary Builder...................................................................................................................... 49 PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL ........................... 51 CHAPTER 3. STUDIES ON IMPOTENCE............................................................................................. 53 Overview ..................................................................................................................................... 53 The Combined Health Information Database .............................................................................. 53 Federally-Funded Research on Impotence ................................................................................... 60 E-Journals: PubMed Central ....................................................................................................... 69 The National Library of Medicine: PubMed................................................................................ 70 Vocabulary Builder...................................................................................................................... 71 CHAPTER 4. PATENTS ON IMPOTENCE ........................................................................................... 79 Overview ..................................................................................................................................... 79 Patents on Impotence................................................................................................................... 80 Patent Applications on Impotence............................................................................................... 94 Keeping Current .......................................................................................................................... 95 Vocabulary Builder...................................................................................................................... 95 CHAPTER 5. BOOKS ON IMPOTENCE ............................................................................................... 99 Overview ..................................................................................................................................... 99 Book Summaries: Federal Agencies ............................................................................................. 99 Book Summaries: Online Booksellers ........................................................................................ 109 The National Library of Medicine Book Index........................................................................... 113 Chapters on Impotence .............................................................................................................. 116 Directories ................................................................................................................................. 128
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General Home References .......................................................................................................... 129 Vocabulary Builder.................................................................................................................... 129 CHAPTER 6. MULTIMEDIA ON IMPOTENCE .................................................................................. 135 Overview ................................................................................................................................... 135 Video Recordings....................................................................................................................... 135 Audio Recordings ...................................................................................................................... 140 Bibliography: Multimedia on Impotence ................................................................................... 142 Vocabulary Builder.................................................................................................................... 144 CHAPTER 7. PERIODICALS AND NEWS ON IMPOTENCE ............................................................... 147 Overview ................................................................................................................................... 147 News Services & Press Releases ................................................................................................ 147 Newsletters on Impotence.......................................................................................................... 155 Newsletter Articles .................................................................................................................... 156 Academic Periodicals covering Impotence................................................................................. 158 Vocabulary Builder.................................................................................................................... 161 CHAPTER 8. PHYSICIAN GUIDELINES AND DATABASES .............................................................. 163 Overview ................................................................................................................................... 163 NIH Guidelines ......................................................................................................................... 163 NIH Databases .......................................................................................................................... 164 Other Commercial Databases .................................................................................................... 171 The Genome Project and Impotence .......................................................................................... 171 Specialized References ............................................................................................................... 176 Vocabulary Builder.................................................................................................................... 177 CHAPTER 9. DISSERTATIONS ON IMPOTENCE .............................................................................. 179 Overview ................................................................................................................................... 179 Dissertations on Impotence ....................................................................................................... 179 Keeping Current ........................................................................................................................ 181 PART III. APPENDICES .............................................................................................................. 183 APPENDIX A. RESEARCHING YOUR MEDICATIONS ..................................................................... 185 Overview ................................................................................................................................... 185 Your Medications: The Basics ................................................................................................... 186 Learning More about Your Medications ................................................................................... 187 Commercial Databases............................................................................................................... 189 Contraindications and Interactions (Hidden Dangers)............................................................. 196 A Final Warning ....................................................................................................................... 197 General References..................................................................................................................... 198 Vocabulary Builder.................................................................................................................... 199 APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE ............................................................... 203 Overview ................................................................................................................................... 203 What Is CAM? .......................................................................................................................... 203 What Are the Domains of Alternative Medicine? ..................................................................... 204 Can Alternatives Affect My Treatment?................................................................................... 207 Finding CAM References on Impotence.................................................................................... 208 Additional Web Resources......................................................................................................... 216 General References..................................................................................................................... 232 APPENDIX C. RESEARCHING NUTRITION..................................................................................... 235 Overview ................................................................................................................................... 235 Food and Nutrition: General Principles .................................................................................... 236 Finding Studies on Impotence ................................................................................................... 240 Federal Resources on Nutrition................................................................................................. 244 Additional Web Resources......................................................................................................... 244 Vocabulary Builder.................................................................................................................... 247 APPENDIX D. FINDING MEDICAL LIBRARIES ............................................................................... 249
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Overview ................................................................................................................................... 249 Preparation ................................................................................................................................ 249 Finding a Local Medical Library ............................................................................................... 250 Medical Libraries Open to the Public ........................................................................................ 250 APPENDIX E. NIH CONSENSUS STATEMENT ON IMPOTENCE ..................................................... 257 Overview ................................................................................................................................... 257 Abstract ..................................................................................................................................... 258 What Is Impotence? ................................................................................................................... 258 Prevalence and Association with Age........................................................................................ 260 Clinical, Psychological, and Social Impact ................................................................................ 261 Physiology of Erection ............................................................................................................... 262 Erectile Dysfunction.................................................................................................................. 263 Evaluation and Diagnosis ......................................................................................................... 265 Treatment Considerations ......................................................................................................... 269 Improving Public and Professional Knowledge about Impotence ............................................. 274 Directions for Future Research.................................................................................................. 276 Conclusions ............................................................................................................................... 278 Vocabulary Builder.................................................................................................................... 279 ONLINE GLOSSARIES ............................................................................................................... 281 Online Dictionary Directories................................................................................................... 284 IMPOTENCE GLOSSARY........................................................................................................... 287 General Dictionaries and Glossaries ......................................................................................... 312 INDEX.............................................................................................................................................. 314
Introduction
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INTRODUCTION Overview Dr. C. Everett Koop, former U.S. Surgeon General, once said, “The best prescription is knowledge.”1 The Agency for Healthcare Research and Quality (AHRQ) of the National Institutes of Health (NIH) echoes this view and recommends that every patient incorporate education into the treatment process. According to the AHRQ: Finding out more about your condition is a good place to start. By contacting groups that support your condition, visiting your local library, and searching on the Internet, you can find good information to help guide your treatment decisions. Some information may be hard to find—especially if you don’t know where to look.2 As the AHRQ mentions, finding the right information is not an obvious task. Though many physicians and public officials had thought that the emergence of the Internet would do much to assist patients in obtaining reliable information, in March 2001 the National Institutes of Health issued the following warning: The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading.3
Quotation from http://www.drkoop.com. The Agency for Healthcare Research and Quality (AHRQ): http://www.ahcpr.gov/consumer/diaginfo.htm. 3 From the NIH, National Cancer Institute (NCI): http://cancertrials.nci.nih.gov/beyond/evaluating.html. 1 2
2
Impotence
Since the late 1990s, physicians have seen a general increase in patient Internet usage rates. Patients frequently enter their doctor’s offices with printed Web pages of home remedies in the guise of latest medical research. This scenario is so common that doctors often spend more time dispelling misleading information than guiding patients through sound therapies. The Official Patient’s Sourcebook on Impotence has been created for patients who have decided to make education and research an integral part of the treatment process. The pages that follow will tell you where and how to look for information covering virtually all topics related to impotence, from the essentials to the most advanced areas of research. The title of this book includes the word “official.” This reflects the fact that the sourcebook draws from public, academic, government, and peerreviewed research. Selected readings from various agencies are reproduced to give you some of the latest official information available to date on impotence. Given patients’ increasing sophistication in using the Internet, abundant references to reliable Internet-based resources are provided throughout this sourcebook. Where possible, guidance is provided on how to obtain free-ofcharge, primary research results as well as more detailed information via the Internet. E-book and electronic versions of this sourcebook are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). Hard copy users of this sourcebook can type cited Web addresses directly into their browsers to obtain access to the corresponding sites. Since we are working with ICON Health Publications, hard copy Sourcebooks are frequently updated and printed on demand to ensure that the information provided is current. In addition to extensive references accessible via the Internet, every chapter presents a “Vocabulary Builder.” Many health guides offer glossaries of technical or uncommon terms in an appendix. In editing this sourcebook, we have decided to place a smaller glossary within each chapter that covers terms used in that chapter. Given the technical nature of some chapters, you may need to revisit many sections. Building one’s vocabulary of medical terms in such a gradual manner has been shown to improve the learning process. We must emphasize that no sourcebook on impotence should affirm that a specific diagnostic procedure or treatment discussed in a research study, patent, or doctoral dissertation is “correct” or your best option. This sourcebook is no exception. Each patient is unique. Deciding on appropriate
Introduction
3
options is always up to the patient in consultation with their physician and healthcare providers.
Organization This sourcebook is organized into three parts. Part I explores basic techniques to researching impotence (e.g. finding guidelines on diagnosis, treatments, and prognosis), followed by a number of topics, including information on how to get in touch with organizations, associations, or other patient networks dedicated to impotence. It also gives you sources of information that can help you find a doctor in your local area specializing in treating impotence. Collectively, the material presented in Part I is a complete primer on basic research topics for patients with impotence. Part II moves on to advanced research dedicated to impotence. Part II is intended for those willing to invest many hours of hard work and study. It is here that we direct you to the latest scientific and applied research on impotence. When possible, contact names, links via the Internet, and summaries are provided. It is in Part II where the vocabulary process becomes important as authors publishing advanced research frequently use highly specialized language. In general, every attempt is made to recommend “free-to-use” options. Part III provides appendices of useful background reading for all patients with impotence or related disorders. The appendices are dedicated to more pragmatic issues faced by many patients with impotence. Accessing materials via medical libraries may be the only option for some readers, so a guide is provided for finding local medical libraries which are open to the public. Part III, therefore, focuses on advice that goes beyond the biological and scientific issues facing patients with impotence.
Scope While this sourcebook covers impotence, your doctor, research publications, and specialists may refer to your condition using a variety of terms. Therefore, you should understand that impotence is often considered a synonym or a condition closely related to the following: ·
Impotence
·
Male Erectile Disorder
·
Sexual Dysfunction (a Nonspecific Term)
4
Impotence
In addition to synonyms and related conditions, physicians may refer to impotence using certain coding systems. The International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) is the most commonly used system of classification for the world’s illnesses. Your physician may use this coding system as an administrative or tracking tool. The following classification is commonly used for impotence:4 ·
302 sexual disorders
·
302.7 psychosocial dysfunction
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302.70 psychosocial dysfunc nos
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302.71 inhibited sexual desire
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302.72 inhibited sex excitement
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302.79 psychosocial dysfunc nec
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302.8 psychosocial dis nec
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302.89 psychosexual dis nec
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302.9 psychosexual dis nos
·
607.84 impotence, organic origin
For the purposes of this sourcebook, we have attempted to be as inclusive as possible, looking for official information for all of the synonyms relevant to impotence. You may find it useful to refer to synonyms when accessing databases or interacting with healthcare professionals and medical librarians.
Moving Forward Since the 1980s, the world has seen a proliferation of healthcare guides covering most illnesses. Some are written by patients or their family members. These generally take a layperson’s approach to understanding and coping with an illness or disorder. They can be uplifting, encouraging, and highly supportive. Other guides are authored by physicians or other healthcare providers who have a more clinical outlook. Each of these two styles of guide has its purpose and can be quite useful. 4 This list is based on the official version of the World Health Organization’s 9th Revision, International Classification of Diseases (ICD-9). According to the National Technical Information Service, “ICD-9CM extensions, interpretations, modifications, addenda, or errata other than those approved by the U.S. Public Health Service and the Health Care Financing Administration are not to be considered official and should not be utilized. Continuous maintenance of the ICD-9-CM is the responsibility of the federal government.”
Introduction
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As editors, we have chosen a third route. We have chosen to expose you to as many sources of official and peer-reviewed information as practical, for the purpose of educating you about basic and advanced knowledge as recognized by medical science today. You can think of this sourcebook as your personal Internet age reference librarian. Why “Internet age”? All too often, patients diagnosed with impotence will log on to the Internet, type words into a search engine, and receive several Web site listings which are mostly irrelevant or redundant. These patients are left to wonder where the relevant information is, and how to obtain it. Since only the smallest fraction of information dealing with impotence is even indexed in search engines, a non-systematic approach often leads to frustration and disappointment. With this sourcebook, we hope to direct you to the information you need that you would not likely find using popular Web directories. Beyond Web listings, in many cases we will reproduce brief summaries or abstracts of available reference materials. These abstracts often contain distilled information on topics of discussion. While we focus on the more scientific aspects of impotence, there is, of course, the emotional side to consider. Later in the sourcebook, we provide a chapter dedicated to helping you find peer groups and associations that can provide additional support beyond research produced by medical science. We hope that the choices we have made give you the most options available in moving forward. In this way, we wish you the best in your efforts to incorporate this educational approach into your treatment plan. The Editors
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PART I: THE ESSENTIALS
ABOUT PART I Part I has been edited to give you access to what we feel are “the essentials” on impotence. The essentials of a disease typically include the definition or description of the disease, a discussion of who it affects, the signs or symptoms associated with the disease, tests or diagnostic procedures that might be specific to the disease, and treatments for the disease. Your doctor or healthcare provider may have already explained the essentials of impotence to you or even given you a pamphlet or brochure describing impotence. Now you are searching for more in-depth information. As editors, we have decided, nevertheless, to include a discussion on where to find essential information that can complement what your doctor has already told you. In this section we recommend a process, not a particular Web site or reference book. The process ensures that, as you search the Web, you gain background information in such a way as to maximize your understanding.
Guidelines
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CHAPTER 1. THE ESSENTIALS ON IMPOTENCE: GUIDELINES Overview Official agencies, as well as federally-funded institutions supported by national grants, frequently publish a variety of guidelines on impotence. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. The great advantage of guidelines over other sources is that they are often written with the patient in mind. Since new guidelines on impotence can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.
The National Institutes of Health (NIH)5 The National Institutes of Health (NIH) is the first place to search for relatively current patient guidelines and fact sheets on impotence. Originally founded in 1887, the NIH is one of the world’s foremost medical research centers and the federal focal point for medical research in the United States. At any given time, the NIH supports some 35,000 research grants at universities, medical schools, and other research and training institutions, both nationally and internationally. The rosters of those who have conducted research or who have received NIH support over the years include the world’s most illustrious scientists and physicians. Among them are 97 scientists who have won the Nobel Prize for achievement in medicine.
5
Adapted from the NIH: http://www.nih.gov/about/NIHoverview.html.
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There is no guarantee that any one Institute will have a guideline on a specific disease, though the National Institutes of Health collectively publish over 600 guidelines for both common and rare diseases. The best way to access NIH guidelines is via the Internet. Although the NIH is organized into many different Institutes and Offices, the following is a list of key Web sites where you are most likely to find NIH clinical guidelines and publications dealing with impotence and associated conditions: ·
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
·
National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines available at http://www.nlm.nih.gov/medlineplus/healthtopics.html
·
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm
Among these, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) is particularly noteworthy. The NIDDK’s mission is to conduct and support research on many of the most serious diseases affecting public health.6 The Institute supports much of the clinical research on the diseases of internal medicine and related subspecialty fields as well as many basic science disciplines. The NIDDK’s Division of Intramural Research encompasses the broad spectrum of metabolic diseases such as diabetes, inborn errors of metabolism, endocrine disorders, mineral metabolism, digestive diseases, nutrition, urology and renal disease, and hematology. Basic research studies include biochemistry, nutrition, pathology, histochemistry, chemistry, physical, chemical, and molecular biology, pharmacology, and toxicology. NIDDK extramural research is organized into divisions of program areas: ·
Division of Diabetes, Endocrinology, and Metabolic Diseases
·
Division of Digestive Diseases and Nutrition
·
Division of Kidney, Urologic, and Hematologic Diseases
The Division of Extramural Activities provides administrative support and overall coordination. A fifth division, the Division of Nutrition Research Coordination, coordinates government nutrition research efforts. The Institute supports basic and clinical research through investigator-initiated This paragraph has been adapted from the NIDDK: http://www.niddk.nih.gov/welcome/mission.htm. “Adapted” signifies that a passage is reproduced exactly or slightly edited for this book. 6
Guidelines 11
grants, program project and center grants, and career development and training awards. The Institute also supports research and development projects and large-scale clinical trials through contracts. The following patient guideline was recently published by the NIDDK on impotence.
What Is Impotence?7 Impotence is a consistent inability to sustain an erection sufficient for sexual intercourse. Medical professionals often use the term “erectile dysfunction” to describe this disorder and to differentiate it from other problems that interfere with sexual intercourse, such as lack of sexual desire and problems with ejaculation and orgasm. This fact sheet focuses on impotence defined as erectile dysfunction. Impotence can be a total inability to achieve erection, an inconsistent ability to do so, or a tendency to sustain only brief erections. These variations make defining impotence and estimating its incidence difficult. Experts believe impotence affects between 10 and 15 million American men. In 1985, the National Ambulatory Medical Care Survey counted 525,000 doctor-office visits for erectile dysfunction. Impotence usually has a physical cause, such as disease, injury, or drug sideeffects. Any disorder that impairs blood flow in the penis has the potential to cause impotence. Incidence rises with age: about 5 percent of men at the age of 40 and between 15 and 25 percent of men at the age of 65 experience impotence. Yet, it is not an inevitable part of aging. Impotence is treatable in all age groups, and awareness of this fact has been growing. More men have been seeking help and returning to near-normal sexual activity because of improved, successful treatments for impotence. Urologists, who specialize in problems of the urinary tract, have traditionally treated impotence--especially complications of impotence.
How Does an Erection Occur? The penis contains two chambers, called the corpora cavernosa, which run the length of the organ (see figure 1). A spongy tissue fills the chambers. The corpora cavernosa are surrounded by a membrane, called the tunica Adapted from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK): http://www.niddk.nih.gov/health/urolog/pubs/impotnce/impotnce.htm. 7
12 Impotence
albuginea. The spongy tissue contains smooth muscles, fibrous tissues, spaces, veins, and arteries. The urethra, which is the channel for urine and ejaculate, runs along the underside of the corpora cavernosa. Erection begins with sensory and mental stimulation. Impulses from the brain and local nerves cause the muscles of the corpora cavernosa to relax, allowing blood to flow in and fill the open spaces. The blood creates pressure in the corpora cavernosa, making the penis expand. The tunica albuginea helps to trap the blood in the corpora cavernosa, thereby sustaining erection. Erection is reversed when muscles in the penis contract, stopping the inflow of blood and opening outflow channels.
What Causes Impotence? Since an erection requires a sequence of events, impotence can occur when any of the events is disrupted. The sequence includes nerve impulses in the brain, spinal column, and area of the penis, and response in muscles, fibrous tissues, veins, and arteries in and near the corpora cavernosa.
Guidelines 13
Damage to arteries, smooth muscles, and fibrous tissues, often as a result of disease, is the most common cause of impotence. Diseases--including diabetes, kidney disease, chronic alcoholism, multiple sclerosis, atherosclerosis, and vascular disease--account for about 70 percent of cases of impotence. Between 35 and 50 percent of men with diabetes experience impotence. Surgery (for example, prostate surgery) can injure nerves and arteries near the penis, causing impotence. Injury to the penis, spinal cord, prostate, bladder, and pelvis can lead to impotence by harming nerves, smooth muscles, arteries, and fibrous tissues of the corpora cavernosa. Also, many common medicines produce impotence as a side effect. These include high blood pressure drugs, antihistamines, antidepressants, tranquilizers, appetite suppressants, and cimetidine (an ulcer drug). Experts believe that psychological factors cause 10 to 20 percent of cases of impotence. These factors include stress, anxiety, guilt, depression, low selfesteem, and fear of sexual failure. Such factors are broadly associated with more than 80 percent of cases of impotence, usually as secondary reactions to underlying physical causes. Other possible causes of impotence are smoking, which affects blood flow in veins and arteries, and hormonal abnormalities, such as insufficient testosterone.
How Is Impotence Diagnosed? Patient History Medical and sexual histories help define the degree and nature of impotence. A medical history can disclose diseases that lead to impotence. A simple recounting of sexual activity might distinguish between problems with erection, ejaculation, orgasm, or sexual desire. A history of using certain prescription drugs or illegal drugs can suggest a chemical cause. Drug effects account for 25 percent of cases of impotence. Cutting back on or substituting certain medications often can alleviate the problem.
14 Impotence
Physical Examination A physical examination can give clues for systemic problems. For example, if the penis does not respond as expected to certain touching, a problem in the nervous system may be a cause. Abnormal secondary sex characteristics, such as hair pattern, can point to hormonal problems, which would mean the endocrine system is involved. A circulatory problem might be indicated by, for example, an aneurysm in the abdomen. And unusual characteristics of the penis itself could suggest the root of the impotence--for example, bending of the penis during erection could be the result of Peyronie’s disease.
Laboratory Tests Several laboratory tests can help diagnose impotence. Tests for systemic diseases include blood counts, urinalysis, lipid profile, and measurements of creatinine and liver enzymes. For cases of low sexual desire, measurement of testosterone in the blood can yield information about problems with the endocrine system. Other Tests Monitoring erections that occur during sleep (nocturnal penile tumescence) can help rule out certain psychological causes of impotence. Healthy men have involuntary erections during sleep. If nocturnal erections do not occur, then the cause of impotence is likely to be physical rather than psychological. Tests of nocturnal erections are not completely reliable, however. Scientists have not standardized such tests and have not determined when they should be applied for best results.
Psychosocial Examination A psychosocial examination, using an interview and questionnaire, reveals psychological factors. The man’s sexual partner also may be interviewed to determine expectations and perceptions encountered during sexual intercourse.
Guidelines 15
How Is Impotence Treated? Most physicians suggest that treatments for impotence proceed along a path moving from least invasive to most invasive. This means cutting back on any harmful drugs is considered first. Psychotherapy and behavior modifications are considered next, followed by vacuum devices, oral drugs, locally injected drugs, and surgically implanted devices (and, in rare cases, surgery involving veins or arteries).
Psychotherapy Experts often treat psychologically based impotence using techniques that decrease anxiety associated with intercourse. The patient’s partner can help apply the techniques, which include gradual development of intimacy and stimulation. Such techniques also can help relieve anxiety when physical impotence is being treated. Drug Therapy Drugs for treating impotence can be taken orally, injected directly into the penis, or inserted into the urethra at the tip of the penis. In March 1998, the Food and Drug Administration approved sildenafil citrate (marketed as Viagra), the first oral pill to treat impotence. Taken 1 hour before sexual activity, sildenafil works by enhancing the effects of nitric oxide, a chemical that relaxes smooth muscles in the penis during sexual stimulation, allowing increased blood flow. While sildenafil improves the response to sexual stimulation, it does not trigger an automatic erection as injection drugs do. The recommended dose is 50 mg, and the physician may adjust this dose to 100 mg or 25 mg, depending on the needs of the patient. The drug should not be used more than once a day. Oral testosterone can reduce impotence in some men with low levels of natural testosterone. Patients also have claimed effectiveness of other oral drugs--including yohimbine hydrochloride, dopamine and serotonin agonists, and trazodone--but no scientific studies have proved the effectiveness of these drugs in relieving impotence. Some observed improvements following their use may be examples of the placebo effect, that is, a change that results simply from the patient’s believing that an improvement will occur.
16 Impotence
Many men gain potency by injecting drugs into the penis, causing it to become engorged with blood. Drugs such as papaverine hydrochloride, phentolamine, and alprostadil (marked as Caverject) widen blood vessels. These drugs may create unwanted side effects, however, including persistent erection (known as priapism) and scarring. Nitroglycerin, a muscle relaxant, sometimes can enhance erection when rubbed on the surface of the penis. A system for inserting a pellet of alprostadil into the urethra is marketed as MUSE. The system uses a pre-filled applicator to deliver the pellet about an inch deep into the urethra at the tip of the penis. An erection will begin within 8 to 10 minutes and may last 30 to 60 minutes. The most common side effects of the preparation are aching in the penis, testicles, and area between the penis and rectum; warmth or burning sensation in the urethra; redness of the penis due to increased blood flow; and minor urethral bleeding or spotting. Research on drugs for treating impotence is expanding rapidly. Patients should ask their doctors about the latest advances. Vacuum Devices Mechanical vacuum devices cause erection by creating a partial vacuum around the penis, which draws blood into the penis, engorging it and expanding it. The devices have three components: a plastic cylinder, in which the penis is placed; a pump, which draws air out of the cylinder; and an elastic band, which is placed around the base of the penis, to maintain the erection after the cylinder is removed and during intercourse by preventing blood from flowing back into the body (see figure 2). One variation of the vacuum device involves a semirigid rubber sheath that is placed on the penis and remains there after attaining erection and during intercourse.
Guidelines 17
Surgery Surgery usually has one of three goals: ·
To implant a device that can cause the penis to become erect,
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To reconstruct arteries to increase flow of blood to the penis,
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To block off veins that allow blood to leak from the penile tissues.
Implanted devices, known as prostheses, can restore erection in many men with impotence. Possible problems with implants include mechanical breakdown and infection. Mechanical problems have diminished in recent years because of technological advances. Malleable implants usually consist of paired rods, which are inserted surgically into the corpora cavernosa, the twin chambers running the length of the penis. The user manually adjusts the position of the penis and, therefore, the rods. Adjustment does not affect the width or length of the penis.
18 Impotence
Inflatable implants consist of paired cylinders, which are surgically inserted inside the penis and can be expanded using pressurized fluid (see figure 3). Tubes connect the cylinders to a fluid reservoir and pump, which also are surgically implanted. The patient inflates the cylinders by pressing on the small pump, located under the skin in the scrotum. Inflatable implants can expand the length and width of the penis somewhat. They also leave the penis in a more natural state when not inflated.
Surgery to repair arteries can reduce impotence caused by obstructions that block the flow of blood to the penis. The best candidates for such surgery are young men with discrete blockage of an artery because of an injury to the crotch area or fracture of the pelvis. The procedure is less successful in older men with widespread blockage. Surgery to veins that allow blood to leave the penis usually involves an opposite procedure--intentional blockage. Blocking off veins (ligation) can reduce the leakage of blood that diminishes rigidity of the penis during erection. However, experts have raised questions about this procedure’s long-term effectiveness.
Guidelines 19
What Will the Future Bring? Advances in suppositories, injectable medications, implants, and vacuum devices have expanded the options for men seeking treatment for impotence. These advances also have helped increase the number of men seeking treatment. An oral form of the drug phentolamine may soon join sildenafil in the armamentarium of noninvasive treatments for impotence. Other treatments in the experimental stages include reconstruction surgery for damaged veins and arteries in the penis. Whether or not this method proves to be safe and effective, ongoing improvements in traditional methods should continue to create more successful and widespread treatment of impotence.
Points to Remember ·
Impotence is a consistent inability to sustain an erection sufficient for sexual intercourse.
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Impotence affects 10 to 15 million American men.
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Impotence usually has a physical cause.
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Impotence is treatable in all age groups.
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Treatments include psychotherapy, drug therapy, vacuum devices, and surgery.
For More Information For more information, contact: Impotence Information Center P.O. Box 9 Minneapolis, MN 55440 1-800-843-4315 Sexual Function Health Council American Foundation for Urologic Disease 300 West Pratt Street Suite 401 Baltimore, MD 21201 1-800-242-2383
20 Impotence
The Geddings Osbon, Sr. Foundation P.O. Drawer 1593 Augusta, GA 30903-1593 1-800-433-4215 National Kidney and Urologic Diseases Information Clearinghouse 3 Information Way Bethesda, MD 20892-3580 E-mail: National Kidney and Urologic Diseases Information Clearinghouse The National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The NIDDK is part of the National Institutes of Health under the U.S. Public Health Service. Established in 1987, the clearinghouse provides information about diseases of the kidneys and urologic system to people with kidney and urologic disorders and to their families, health care professionals, and the public. NKUDIC answers inquiries; develops, reviews, and distributes publications; and works closely with professional and patient organizations and Government agencies to coordinate resources about kidney and urologic diseases. Publications produced by the clearinghouse are carefully reviewed for scientific accuracy, content, and readability.
More Guideline Sources The guideline above on impotence is only one example of the kind of material that you can find online and free of charge. The remainder of this chapter will direct you to other sources which either publish or can help you find additional guidelines on topics related to impotence. Many of the guidelines listed below address topics that may be of particular relevance to your specific situation or of special interest to only some patients with impotence. Due to space limitations these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly.
Topic Pages: MEDLINEplus For patients wishing to go beyond guidelines published by specific Institutes of the NIH, the National Library of Medicine has created a vast and patient-
Guidelines 21
oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages.” You can think of a health topic page as a guide to patient guides. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following as being relevant to impotence: ·
Guides On impotence Impotence http://www.nlm.nih.gov/medlineplus/impotence.html
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Other Guides Male Genital Disorders http://www.nlm.nih.gov/medlineplus/malegenitaldisorders.html
Within the health topic page dedicated to impotence, the following was recently recommended to patients: ·
General/Overviews Endocrinology and Impotence (Erectile Dysfunction) Source: Endocrine Society http://www.endosociety.org/pubrelations/patientInfo/impotence.htm Erectile Dysfunction Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=DS00162
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Diagnosis/Symptoms Testosterone Test Source: American Association for Clinical Chemistry http://labtestsonline.org/understanding/analytes/testosterone/glan ce.html
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Treatment Erectile Dysfunction - Viagra Source: Patient Education Institute http://www.nlm.nih.gov/medlineplus/tutorials/erectiledysfunction viagraloader.html
22 Impotence
Testosterone Replacement Therapy - Many Effective Treatments Available Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=MC00004 Viagra Online: Is It Safe? Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?objectid=6BAEB2AA-EF224F04-B949E11FD66D6F8A&locID= Viagra: Proper Use Can Restore Erections Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=MC00011 ·
Coping Where to Seek Professional Help: Sexuality and Cancer Source: American Cancer Society http://www.cancer.org/eprise/main/docroot/MIT/content/MIT_7 _2X_Where_To_Seek_Professional_Help_Women
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Specific Conditions/Aspects Erectile Dysfunction and Diabetes: Many Possible Solutions Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=DA00045 Male Sexual Problems Source: American Association for Marriage and Family Therapy http://www.aamft.org/families/Consumer_Updates/MaleSexualPr oblems.htm Patient's Guide to Low Testosterone Source: Endocrine Society, Hormone Foundation http://www.medem.com/medlb/article_detaillb.cfm?article_ID=ZZ ZO7PDVDLC&sub_cat=57 Truth about Impotence Treatment Claims Source: Federal Trade Commission http://www.ftc.gov/bcp/conline/pubs/alerts/impoalrt.htm
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·
From the National Institutes of Health Impotence Source: National Institute of Diabetes and Digestive and Kidney Diseases http://www.niddk.nih.gov/health/urolog/pubs/impotnce/impotnc e.htm
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Latest News Company Touts New Erectile Drug Source: 05/27/2002, Associated Press http://www.nlm.nih.gov/medlineplus/news/fullstory_7788.html Gene Therapy May Offer Long-term Impotence Remedy Source: 05/29/2002, Reuters Health http://www.nlm.nih.gov/medlineplus/news/fullstory_7819.html Viagra Alternative Shows Promise Source: 05/28/2002, Reuters Health http://www.nlm.nih.gov/medlineplus/news/fullstory_7796.html
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Organizations American Foundation for Urologic Disease http://www.afud.org/ Directory of Kidney and Other Urologic Diseases Organizations Source: National Institute of Diabetes and Digestive and Kidney Diseases http://www.niddk.nih.gov/health/kidney/pubs/kuorg/kuorg.htm National Institute of Diabetes and Digestive and Kidney Diseases http://www.niddk.nih.gov/
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Pictures/Diagrams Overview of the Male Anatomy Source: University of Utah, Health Sciences Center http://www.uuhsc.utah.edu/healthinfo/adult/Men/maleanat.htm
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Research Regular Cycling Can Improve Sexual Function in Men With Heart Failure Source: American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=11999
24 Impotence
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Statistics JAMA Patient Page: Sexual Dysfunction -- Silence About Sexual Problems Can Hurt Relationships Source: American Medical Association http://www.medem.com/MedLB/article_detaillb.cfm?article_ID=Z ZZSAC20NAC&sub_cat=2 Kidney and Urologic Disease Statistics for the United States Source: National Kidney and Urologic Diseases Information Clearinghouse http://www.niddk.nih.gov/health/kidney/pubs/kustats/kustats.ht m
If you do not find topics of interest when browsing health topic pages, then you can choose to use the advanced search utility of MEDLINEplus at http://www.nlm.nih.gov/medlineplus/advancedsearch.html. This utility is similar to the NIH Search Utility, with the exception that it only includes material linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search.
The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on impotence and related conditions. One of the advantages of CHID over other sources is that it offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: ·
[Geddings Osbon, Sr. Foundation Information Packet] Source: Augusta, GA: Geddings Osbon Sr. Foundation. 1995. [70 p.]. Contact: Available from Geddings Osbon Sr. Foundation. P.O. Box 1593, Augusta, GA 30903. (800) 433-4215. Price: Single copy free. Summary: This information packet from the Geddings D. Osbon, Sr. Foundation contains information about impotence. Included are two
Guidelines 25
booklets on male impotence, one a treatment guide written for men, the other a woman's perspective on the problem of male impotence. Also included are fact sheets on the Foundation and its work; diabetes and erectile dysfunction; heart disease and erectile dysfunction; impotence statistics and facts; and the 1992 NIH Consensus Development Conference on impotence. A recommended patient management algorithm for erectile dysfunction is also included. The materials are presented in a printed folder. ·
Diabetes [Equals] Impotence? Source: Minnetonka, MN: American Medical Systems. 1998. [4 p.]. Contact: Available from American Medical Systems. 10700 Bren Road West, Minnetonka, MN 55343. (800) 843-4315 or (800) 328-3881. Fax (612) 930-6157. Website: www.VisitAMS.com. Price: Single copy free. Order number 21600014D. Summary: This article uses a question and answer format to explain how diabetes is related to erectile dysfunction (ED) and what treatment options are available. ED, a condition in which a man is not able to have an erection that is firm enough or that lasts long enough to have successful sexual intercourse, is one of the most common problems men with diabetes may experience. Although the cause of the high prevalence of ED among men with diabetes is unknown, it is possible that the nerves or blood vessels that control the flow of blood to the penis may become permanently damaged as a result of diabetes. Treatment options include keeping diabetes in tight control; receiving counseling from a qualified psychologist, psychiatrist, or sex therapist; taking oral medications; using intra-urethral suppositories, injection therapy, or vacuum erection devices; and undergoing vascular surgery.
·
Diabetes and Male Impotence: Information and Treatment Guide Source: Augusta, GA: Geddings Osbon Sr. Foundation. 1995. 2 p. Contact: Available from Geddings Osbon Sr. Foundation. P.O. Box 1593, Augusta, GA 30903. (800) 433-4215. Price: Single copy free. Summary: This brochure provides an overview of diabetes and male erectile dysfunction (impotence). The brochure defines impotence and encourages readers who are experiencing impotence to seek health care advice. The brochure addresses common myths and provides facts in the areas of impotence and aging, the diagnosis of impotence, and impotence as a key indicator of total health. The brochure then focuses on treatment, emphasizing the importance of choosing a treatment that is right for both the patient and his partner. The brochure concludes with a brief
26 Impotence
description of presently available treatments for impotence, including counseling or sex therapy, topical vasodilators, oral medications, hormone replacement therapy, external vacuum therapy, penile injection therapy, penile prostheses, and penile reconstruction and venous ligation procedures. ·
Your Question and Answer Guide for Impotence Treatment Source: Augusta, GA: Osbon Medical Systems. 1995. 8 p. Contact: Available from Osbon Medical Systems. 1253 Broad Street, Augusta, GA 30903. (800) 438-8592 or (706) 821-6879. Price: Single copy free; bulk orders available to health professionals. Summary: This booklet provides basic information about impotence, or male erectile dysfunction. Topics include a definition of impotence; causes; treatment options and health care providers who treat impotence; and choosing the treatment option that is best for each individual. Treatment options include sex counseling or sex therapy, yohimbine, hormone replacement therapy, external vacuum therapy, penile injection therapy, and penile implant surgery. The booklet emphasizes the use of external vacuum therapy, including detailed illustrations of how the system works. The final page of the booklet provides a quick reference guide to the medical and surgical treatment alternatives for impotence and the advantages and disadvantages of each. 8 figures.
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Impotence: You Can Do Something About It! Source: Santa Barbara, CA: Mentor Urology. 1994. 11 p. Contact: Available from Mentor Urology. 5425 Hollister Avenue, Santa Barbara, CA 93111. (800) 235-5731 or (805) 681-6000. Fax (805) 967-7108. Price: Single copy free. Summary: This brochure is designed to help readers better understand erectile dysfunction (impotence) and its causes and to become more comfortable with the subject. The brochure stresses that a consultation with a urologist who is experienced in evaluating and treating impotence is the best source of information. Written in a question and answer format, the booklet discusses the physiology of erection, some of the potential causes of impotence, psychological versus physical impotence, diagnostic tests used to confirm physical impotence, and treatment options including counseling, drug therapy, vacuum erection devices, penile injection therapy, vascular reconstructive surgery, venous ligation, and penile implants. The brochure concludes with a brief discussion of insurance considerations. 4 references.
Guidelines 27
·
Male Impotence: A Treatment Guide Source: Augusta, GA: Geddings Osbon Sr. Foundation. 1993. 23 p. Contact: Available from Geddings Osbon Sr. Foundation. P.O. Box 1593, Augusta, GA 30903. (800) 433-4215. Price: Single copy free; bulk orders for physicians available at $1.00 per booklet. Summary: This booklet is a general guide for men who are impotent. It is designed to help men understand erectile dysfunction (impotence), what causes it, and what treatments are available. The booklet is written to help patients be more comfortable discussing impotence with their physicians and, along with their partners, in choosing a treatment best suited for their own needs. Topics include the evaluation of erectile dysfunction; causes of erectile dysfunction; working with health care providers; impotence treatments, including counseling, topical vasodilators, oral medications, hormone replacement therapy, external vacuum therapy, penile injection therapy, penile prosthesis, and penile reconstruction and venous ligation; and cost and insurance issues. 6 figures.
·
Male Impotence: A Woman's Perspective Source: Augusta, GA: Geddings Osbon Sr. Foundation. 1993. 25 p. Contact: Available from Geddings Osbon Sr. Foundation. P.O. Box 1593, Augusta, GA 30903. (800) 433-4215. Price: Single copy free; bulk orders for physicians available at $1.00 per booklet. Summary: This booklet, written from the woman's perspective, is a general guide for those in a relationship with a partner who suffers from erectile dysfunction (impotence). The booklet discusses impotence, what causes it, what treatments are available, and its psychological impact on the couple. The booklet is written to encourage discussion of impotence with a physician and to help men, along with their partners, choose the best treatment for their needs. Topics include the effects of impotence on a relationship; how erectile dysfunction is diagnosed; causes of erectile dysfunction; working with health care providers; impotence treatments, including counseling, oral medications, hormone replacement therapy, external vacuum therapy, penile injections, penile implants, and vascular reconstructive surgery; premature ejaculation; and the importance of effective communication between partners. 8 figures.
·
Patient's Guide for the Treatment of Impotence Source: Augusta, GA: Geddings Osbon Sr. Foundation. 1993. 33 p.
28 Impotence
Contact: Available from Geddings Osbon Sr. Foundation. P.O. Box 1593, Augusta, GA 30903. (800) 433-4215. Price: Single copy free; bulk orders for physicians available at $1.00 per booklet. Summary: This booklet is a general guide to the treatment options available for men who are impotent. It is designed to help men understand erectile dysfunction (impotence) and its treatments. The booklet is written to help patients be more comfortable discussing impotence with their physicians and, along with their partners, choose the best treatment for their own needs. Topics include the evaluation of erectile dysfunction; causes of erectile dysfunction; working with health care providers; impotence treatments, including sex counseling and therapy, Yohimbine tablets, hormone replacement therapy, external vacuum therapy, penile injection therapy, penile prosthesis, and vascular surgery; choosing a treatment; and cost and insurance issues. One chart summarizes the advantages and disadvantages of each of the treatment choices. 11 figures. 1 table. ·
Impotence: A Guide for Men With Diabetes Source: Minnetonka, MN: American Medical Systems, Inc. 1993. 4 p. Contact: Available from Impotence Information Center, American Medical Systems, Inc. P.O. Box 9, Minneapolis, MN 55440. (800) 843-4315. Price: Single copy free. Order number 21600022. Summary: This brochure, written for men with diabetes, outlines the condition of impotence (erectile dysfunction), why it occurs, and the treatment options available. The brochure notes that the overall incidence of impotence in men with diabetes is two to five times higher than it is in the general male population. However, this does not mean that impotence is inevitable or permanent in these men. Written in a question and answer format, the brochure defines impotence, covers the physical and psychological factors that can contribute to impotence, considers the impact of diabetes on erectile function, notes the diagnostic tests used to confirm a diagnosis of impotence, and outlines treatment options. The brochure stresses that problems with physical impotence may be minimized by keeping diabetes in tight control. This means keeping blood sugar levels within normal ranges as much as possible. Treatment options covered include counseling, medication, vacuum devices, injection therapy, vascular surgery, and penile prostheses. The brochure encourages readers to work closely with their health care providers to diagnose and treat any impotence problems.
Guidelines 29
·
Impotence: Causes and Treatments Source: Minneapolis, MN: American Medical Systems. 1991. 8 p. Contact: Available from American Medical Systems. Pfizer Hospital Products Group. 1101 Bren Road East, Minnetonka, MN 55343. (800) 3283881. Price: Free. Publication No. 10313. Order Number 21000435. Summary: This pamphlet explains penile/erectile physiology, the psychological and physical causes of impotence, and the diagnosis and treatment of impotence. Treatments discussed include the use of penile implants, especially the American Medical System (AMS) malleable semirigid rod prosthesis and the AMS inflatable penile prosthesis.
·
Diabetes and Impotence Source: Lenexa, KS: Diagnostic Center for Men, Integrated Medical Resources, Inc. 199x. 2 p. Contact: Available from Diagnostic Center for Men, Integrated Medical Resources, Inc. 8326 Melrose Drive, Lenexa, KS 66214. (800) 331-4636 or (913) 894-0591. Price: Single copy free. Summary: This brochure provides general information about erectile dysfunction (impotence) in men with diabetes. The brochure is designed to help readers feel more comfortable with the subject and to better understand the causes and treatments of this common health problem. Written in a question and answer format, the brochure defines impotence and discusses how diabetes may cause impotence. Also reviewed are diagnostic tests used to confirm impotence, and treatment options, including counseling, drug therapy, external vacuum devices, and surgery. The brochure concludes with a brief discussion of costs and insurance coverage.
·
Understanding Erectile Dysfunction (Impotence): A Common and Treatable Problem. [Como Entender Mejor Los Trastornos de la Ereccion: Un Problema Comun Que Puede Tratarse] Source: San Bruno, CA: StayWell Company. 1999. 15 p. Contact: Available from StayWell Company. Order Department, 1100 Grundy Lane, San Bruno, CA 94066-9821. (800) 333-3032. Fax (650) 2444512. E-mail:
[email protected]. Website: www.staywell.com. Price: $1.35 plus shipping and handling. Summary: This patient education brochure offers a guide to erectile dysfunction (ED, or impotence). The brochure emphasizes that ED is a common problem and that most men can be helped with medical treatment or counseling. Diagnosis begins with a thorough history,
30 Impotence
physical exam, and lab tests. The psychological causes of ED include depression, stress, performance anxiety, and misinformation about sexuality. The physical causes of ED include drug effects (very common), blood flow abnormalities (including those caused by systemic diseases such as diabetes mellitus or hardening of the arteries), nerve impulse abnormalities, and hormonal abnormalities. The brochure reviews the anatomy and physiology of erection, with labeled illustrations showing the flaccid (soft) penis, the tumescent (swollen) penis, and the erect (rigid) penis, and describes the normal changes that occur as the man ages. The brochure outlines the types of questions that will be asked during the patient history taking, including in the areas of medical history, sexual history, and psychological history. The physical examination will include laboratory tests, penile blood flow studies, sleep monitoring, rectal examination, and tests for genetic abnormalities (such as Peyronie's disease). The brochure then describes the nonsurgical treatments available, including medications, vacuum erection therapy, transurethral therapy, and penile self injection; and surgical options (penile implants), including malleable implants, self contained inflatable implants, and fully inflatable implants. The brochure concludes with general suggestions for improved sex and intimacy, in the areas of sharing and relaxing, relapse exercises, tips for better physical intimacy, and the importance of good general health. The brochure is illustrated with full color line drawings. The brochure is available in English or Spanish. 32 figures.
The National Guideline Clearinghouse™ The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search their site located at http://www.guideline.gov by using the keyword “impotence” or synonyms. The following was recently posted: ·
AACE clinical practice guidelines for the evaluation and treatment of hypogonadism in adult male patients. Source: American Association of Clinical Endocrinologists/American College of Endocrinology.; 1996; 28 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 0454&sSearch_string=impotence
Guidelines 31
·
ACR Appropriateness Criteria™ for thrombolysis for lower extremity arterial and graft occlusions. Source: American College of Radiology.; 1996 (revised 1999); 14 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1725&sSearch_string=impotence
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Benign prostatic hyperplasia. Source: Finnish Medical Society Duodecim.; 2001 April 30; Various pagings http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 2081&sSearch_string=impotence
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Diagnosis and management of hypertension in the primary care setting. Source: Department of Defense/Veterans Health Administration.; 1999 May; Various pagings http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1805&sSearch_string=impotence
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Drug treatment for hyperlipidaemias. Source: Finnish Medical Society Duodecim.; 2001 April 4; Various pagings http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1837&sSearch_string=impotence
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Herniated disc. In: North American Spine Society phase III clinical guidelines for multidisciplinary spine care specialists. Source: North American Spine Society.; 2000; 104 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 2029&sSearch_string=impotence
32 Impotence
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Massachusetts guidelines for adult diabetes care. Source: Massachusetts Department of Public Health, Bureau of Family and Community Health, Diabetes Control Program.; 1999 June; Various pagings http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1389&sSearch_string=impotence
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Pharmacologic treatment of acute major depression and dysthymia. Source: American College of Physicians-American Society of Internal Medicine.; 2000; 5 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1773&sSearch_string=impotence
Healthfinder™ Healthfinder™ is an additional source sponsored by the U.S. Department of Health and Human Services which offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: ·
Confronting Erectile Dysfunction as a Team Summary: This fact sheet seeks to answer some of your questions about erectile dysfunction (ED), also known as impotence. Source: American Foundation for Urologic Disease http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=3949
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FAQ - About Viagra Summary: In response to numerous inquiries, the FDA answers your questions online concerning Viagra, the first oral pill approved to treat impotence. Source: Center for Drug Evaluation and Research, U.S. Food and Drug Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=2266
Guidelines 33
·
Impotence Summary: Impotence is a consistent inability to sustain an erection sufficient for sexual intercourse. This fact sheet focuses on impotence defined as erectile dysfunction. Source: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=827
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Impotence Resource Web Site Summary: This web site is designed to provide both consumers and medical professionals with reliable information about impotence. Source: American Foundation for Urologic Disease http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=3948
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International Journal of Impotence Research Summary: This publication is designed to assist Urologists, impotence specialists, vascular surgeons, sex therapists and psychiatrists in keeping abreast of new developments in the treatment of impotence. Source: Commercial Entity--Follow the Resource URL for More Information http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=1949
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The Truth About Impotence Treatment Claims Alert Summary: Tips for evaluating claims concerning healthcare or medical products that promises a miracle cure for impotence. Source: Federal Trade Commission http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=4506
The NIH Search Utility After browsing the references listed at the beginning of this chapter, you may want to explore the NIH Search Utility. This allows you to search for
34 Impotence
documents on over 100 selected Web sites that comprise the NIH-WEBSPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to impotence. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html.
Additional Web Sources A number of Web sites that often link to government sites are available to the public. These can also point you in the direction of essential information. The following is a representative sample: ·
AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats
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drkoop.comÒ: http://www.drkoop.com/conditions/ency/index.html
·
Family Village: http://www.familyvillage.wisc.edu/specific.htm
·
Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/
·
Med Help International: http://www.medhelp.org/HealthTopics/A.html
·
Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/
·
Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/
·
WebMDÒHealth: http://my.webmd.com/health_topics
Vocabulary Builder The material in this chapter may have contained a number of unfamiliar words. The following Vocabulary Builder introduces you to terms used in this chapter that have not been covered in the previous chapter: Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally
Guidelines 35
stimulated by naturally occurring substances. [EU] Alprostadil: A potent vasodilator agent that increases peripheral blood flow. It inhibits platelet aggregation and has many other biological effects such as bronchodilation, mediation of inflammation, etc. [NIH] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Aneurysm: A sac formed by the dilatation of the wall of an artery, a vein, or the heart. The chief signs of arterial aneurysm are the formation of a pulsating tumour, and often a bruit (aneurysmal bruit) heard over the swelling. Sometimes there are symptoms from pressure on contiguous parts. [EU]
Antidepressant: An agent that stimulates the mood of a depressed patient, including tricyclic antidepressants and monoamine oxidase inhibitors. [EU] Antihistamine: A drug that counteracts the action of histamine. The antihistamines are of two types. The conventional ones, as those used in allergies, block the H1 histamine receptors, whereas the others block the H2 receptors. Called also antihistaminic. [EU] Anxiety: The unpleasant emotional state consisting of psychophysiological responses to anticipation of unreal or imagined danger, ostensibly resulting from unrecognized intrapsychic conflict. Physiological concomitants include increased heart rate, altered respiration rate, sweating, trembling, weakness, and fatigue; psychological concomitants include feelings of impending danger, powerlessness, apprehension, and tension. [EU] Atrophy: A wasting away; a diminution in the size of a cell, tissue, organ, or part. [EU] Biopsy: The removal and examination, usually microscopic, of tissue from the living body, performed to establish precise diagnosis. [EU] Cimetidine: A histamine congener, it competitively inhibits histamine binding to H2 receptors. Cimetidine has a range of pharmacological actions. It inhibits gastric acid secretion, as well as pepsin and gastrin output. It also blocks the activity of cytochrome P-450. [NIH] Cirrhosis: Liver disease characterized pathologically by loss of the normal microscopic lobular architecture, with fibrosis and nodular regeneration. The term is sometimes used to refer to chronic interstitial inflammation of any organ. [EU] Distention: The state of being distended or enlarged; the act of distending. [EU]
Ejaculation: A sudden act of expulsion, as of the semen. [EU] Elastic: Susceptible of resisting and recovering from stretching, compression or distortion applied by a force. [EU]
36 Impotence
Endocrinology: A subspecialty of internal medicine concerned with the metabolism, physiology, and disorders of the endocrine system. [NIH] Enzyme: A protein molecule that catalyses chemical reactions of other substances without itself being destroyed or altered upon completion of the reactions. Enzymes are classified according to the recommendations of the Nomenclature Committee of the International Union of Biochemistry. Each enzyme is assigned a recommended name and an Enzyme Commission (EC) number. They are divided into six main groups; oxidoreductases, transferases, hydrolases, lyases, isomerases, and ligases. [EU] Erection: The condition of being made rigid and elevated; as erectile tissue when filled with blood. [EU] Extraction: The process or act of pulling or drawing out. [EU] Extremity: A limb; an arm or leg (membrum); sometimes applied specifically to a hand or foot. [EU] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH] Ferritin: An iron-containing protein complex that is formed by a combination of ferric iron with the protein apoferritin. [NIH] Fibrosis: The formation of fibrous tissue; fibroid or fibrous degeneration [EU] Flaccid: Weak, lax and soft. [EU] Hematology: A subspecialty of internal medicine concerned with morphology, physiology, and pathology of the blood and blood-forming tissues. [NIH] Hyperlipidaemia: A general term for elevated concentrations of any or all of the lipids in the plasma, including hyperlipoproteinaemia, hypercholesterolaemia, etc. [EU] Hyperplasia: The abnormal multiplication or increase in the number of normal cells in normal arrangement in a tissue. [EU] Hypertension: Persistently high arterial blood pressure. Various criteria for its threshold have been suggested, ranging from 140 mm. Hg systolic and 90 mm. Hg diastolic to as high as 200 mm. Hg systolic and 110 mm. Hg diastolic. Hypertension may have no known cause (essential or idiopathic h.) or be associated with other primary diseases (secondary h.). [EU] Hypogonadism: A condition resulting from or characterized by abnormally decreased functional activity of the gonads, with retardation of growth and sexual development. [EU] Impotence: The inability to perform sexual intercourse. [NIH] Invasive: 1. having the quality of invasiveness. 2. involving puncture or
Guidelines 37
incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU] Jaundice: A clinical manifestation of hyperbilirubinemia, consisting of deposition of bile pigments in the skin, resulting in a yellowish staining of the skin and mucous membranes. [NIH] Ligation: Application of a ligature to tie a vessel or strangulate a part. [NIH] Lipid: Any of a heterogeneous group of flats and fatlike substances characterized by being water-insoluble and being extractable by nonpolar (or fat) solvents such as alcohol, ether, chloroform, benzene, etc. All contain as a major constituent aliphatic hydrocarbons. The lipids, which are easily stored in the body, serve as a source of fuel, are an important constituent of cell structure, and serve other biological functions. Lipids may be considered to include fatty acids, neutral fats, waxes, and steroids. Compound lipids comprise the glycolipids, lipoproteins, and phospholipids. [EU] Membrane: A thin layer of tissue which covers a surface, lines a cavity or divides a space or organ. [EU] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Nitroglycerin: A highly volatile organic nitrate that acts as a dilator of arterial and venous smooth muscle and is used in the treatment of angina. It provides relief through improvement of the balance between myocardial oxygen supply and demand. Although total coronary blood flow is not increased, there is redistribution of blood flow in the heart when partial occlusion of coronary circulation is effected. [NIH] Oral: Pertaining to the mouth, taken through or applied in the mouth, as an oral medication or an oral thermometer. [EU] Orgasm: The apex and culmination of sexual excitement. [EU] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the islets of langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Papaverine: An alkaloid found in opium but not closely related to the other opium alkaloids in its structure or pharmacological actions. It is a directacting smooth muscle relaxant used in the treatment of impotence and as a vasodilator, especially for cerebral vasodilation. The mechanism of its pharmacological actions is not clear, but it apparently can inhibit phosphodiesterases and it may have direct actions on calcium channels. [NIH]
38 Impotence
Penis: The male organ of copulation and of urinary excretion, comprising a root, body, and extremity, or glans penis. The root is attached to the descending portions of the pubic bone by the crura, the latter being the extremities of the corpora cavernosa, and beneath them the corpus spongiosum, through which the urethra passes. The glans is covered with mucous membrane and ensheathed by the prepuce, or foreskin. The penis is homologous with the clitoris in the female. [EU] Phentolamine: A nonselective alpha-adrenergic antagonist. It is used in the treatment of hypertension and hypertensive emergencies, pheochromocytoma, vasospasm of Raynaud's disease and frostbite, clonidine withdrawal syndrome, impotence, and peripheral vascular disease. [NIH]
Porphyria: A pathological state in man and some lower animals that is often due to genetic factors, is characterized by abnormalities of porphyrin metabolism, and results in the excretion of large quantities of porphyrins in the urine and in extreme sensitivity to light. [EU] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Priapism: Persistent abnormal erection of the penis, usually without sexual desire, and accompanied by pain and tenderness. It is seen in diseases and injuries of the spinal cord, and may be caused by vesical calculus and certain injuries to the penis. [EU] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Prosthesis: An artificial substitute for a missing body part, such as an arm or leg, eye or tooth, used for functional or cosmetic reasons, or both. [EU] Psychotherapy: A generic term for the treatment of mental illness or emotional disturbances primarily by verbal or nonverbal communication. [NIH]
Radiology: A specialty concerned with the use of x-ray and other forms of radiant energy in the diagnosis and treatment of disease. [NIH] Rectal: Pertaining to the rectum (= distal portion of the large intestine). [EU] Relaxant: 1. lessening or reducing tension. 2. an agent that lessens tension. [EU]
Rigidity: Stiffness or inflexibility, chiefly that which is abnormal or morbid; rigor. [EU] Sclerosis: A induration, or hardening; especially hardening of a part from inflammation and in diseases of the interstitial substance. The term is used
Guidelines 39
chiefly for such a hardening of the nervous system due to hyperplasia of the connective tissue or to designate hardening of the blood vessels. [EU] Siderosis: The deposition of iron in a tissue. In the eye, the iron may be deposited in the stroma adjacent to the Descemet's membrane. [NIH] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Spotting: A slight discharge of blood via the vagina, especially as a sideeffect of oral contraceptives. [EU] Topical: Pertaining to a particular surface area, as a topical anti-infective applied to a certain area of the skin and affecting only the area to which it is applied. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Transurethral: Performed through the urethra. [EU] Ulcer: A local defect, or excavation, of the surface of an organ or tissue; which is produced by the sloughing of inflammatory necrotic tissue. [EU] Urinalysis: Examination of urine by chemical, physical, or microscopic means. Routine urinalysis usually includes performing chemical screening tests, determining specific gravity, observing any unusual color or odor, screening for bacteriuria, and examining the sediment microscopically. [NIH] Urinary: Pertaining to the urine; containing or secreting urine. [EU] Urology: A surgical specialty concerned with the study, diagnosis, and treatment of diseases of the urinary tract in both sexes and the genital tract in the male. It includes the specialty of andrology which addresses both male genital diseases and male infertility. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Withdrawal: 1. a pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) a substancespecific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU] Yohimbine: A plant alkaloid with alpha-2-adrenergic blocking activity. Yohimbine has been used as a mydriatic and in the treatment of impotence. It is also alleged to be an aphrodisiac. [NIH]
Seeking Guidance 41
CHAPTER 2. SEEKING GUIDANCE Overview Some patients are comforted by the knowledge that a number of organizations dedicate their resources to helping people with impotence. These associations can become invaluable sources of information and advice. Many associations offer aftercare support, financial assistance, and other important services. Furthermore, healthcare research has shown that support groups often help people to better cope with their conditions.8 In addition to support groups, your physician can be a valuable source of guidance and support. Therefore, finding a physician that can work with your unique situation is a very important aspect of your care. In this chapter, we direct you to resources that can help you find patient organizations and medical specialists. We begin by describing how to find associations and peer groups that can help you better understand and cope with impotence. The chapter ends with a discussion on how to find a doctor that is right for you.
Associations and Impotence As mentioned by the Agency for Healthcare Research and Quality, sometimes the emotional side of an illness can be as taxing as the physical side.9 You may have fears or feel overwhelmed by your situation. Everyone has different ways of dealing with disease or physical injury. Your attitude, your expectations, and how well you cope with your condition can all Churches, synagogues, and other houses of worship might also have groups that can offer you the social support you need. 9 This section has been adapted from http://www.ahcpr.gov/consumer/diaginf5.htm. 8
42 Impotence
influence your well-being. This is true for both minor conditions and serious illnesses. For example, a study on female breast cancer survivors revealed that women who participated in support groups lived longer and experienced better quality of life when compared with women who did not participate. In the support group, women learned coping skills and had the opportunity to share their feelings with other women in the same situation. In addition to associations or groups that your doctor might recommend, we suggest that you consider the following list (if there is a fee for an association, you may want to check with your insurance provider to find out if the cost will be covered): ·
American Foundation for Urologic Disease Address: American Foundation for Urologic Disease 1128 North Charles Street, Baltimore, MD 21201 Telephone: (410) 468-1800 Toll-free: (800) 242-2383 Fax: (410) 468-1808 Email:
[email protected] Web Site: http://www.afud.or Background: The American Foundation for Urologic Disease (AFUD) is a national not-for-profit health organization dedicated to the prevention and cure of urologic diseases through the expansion of medical research and the education of health care professionals and the public. Such urologic diseases include bladder cancer, urinary incontinence, urinary tract disorders, interstitial cystitis, kidney stones, benign prostatic hyperplasia, prostate cancer, prostatitis, and sexual dysfunction. Established in 1987, the Foundation sponsors a Research Scholars Program to encourage physicians to conduct research into urologic diseases, provides appropriate referrals, engages in patient advocacy, and offers networking services. AFUD also offers a variety of educational materials including brochures, pamphlets, and a quarterly magazine entitled 'Family Urology.' In addition, the Foundation has a web site on the Internet at http://www.afud.org. Relevant area(s) of interest: Impotence, Interstitial Cystitis, Kidney Stones, Prostatitis
·
LEMS Update Address: LEMS Update 2016 Willamette View Court, West Linn, OR 97068 Telephone: (503) 657-4592 Email:
[email protected] Seeking Guidance 43
Web Site: http://www.europa.com/~clark Background: 'LEMS Update' is a newsletter dedicated to disseminating information and promoting awareness of Lambert-Eaton Myasthenic Syndrome (LEMS). LEMS, or Eaton-Lambert Syndrome, a rare neuromuscular disorder, is suspected to be an autoimmune disease. Major symptoms include muscle weakness and fatigue especially of the pelvic and thigh muscles. Other symptoms may include dryness of the mouth, impotence, pain in the thighs, and a pricking, tingling, or creeping sensation on the skin (paresthesias) around the affected areas. 'LEMS Update' endeavors to provide current information on treatments and studies and to answer questions about this disorder. 'LEMS Update' also maintains a site on the World Wide Web at http://www.europa.com/~clarkc.
Finding More Associations There are a number of directories that list additional medical associations that you may find useful. While not all of these directories will provide different information than what is listed above, by consulting all of them, you will have nearly exhausted all sources for patient associations. The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about impotence. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797.
DIRLINE A comprehensive source of information on associations is the DIRLINE database maintained by the National Library of Medicine. The database comprises some 10,000 records of organizations, research centers, and government institutes and associations which primarily focus on health and biomedicine. DIRLINE is available via the Internet at the following Web site: http://dirline.nlm.nih.gov/. Simply type in “impotence” (or a synonym) or the name of a topic, and the site will list information contained in the database on all relevant organizations.
44 Impotence
The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “impotence”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” By making these selections and typing in “impotence” (or synonyms) into the “For these words:” box, you will only receive results on organizations dealing with impotence. You should check back periodically with this database since it is updated every 3 months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by specific diseases. You can access this database at the following Web site: http://www.rarediseases.org/cgi-bin/nord/searchpage. Select the option called “Organizational Database (ODB)” and type “impotence” (or a synonym) in the search box.
Online Support Groups In addition to support groups, commercial Internet service providers offer forums and chat rooms for people with different illnesses and conditions. WebMDÒ, for example, offers such a service at their Web site: http://boards.webmd.com/roundtable. These online self-help communities can help you connect with a network of people whose concerns are similar to yours. Online support groups are places where people can talk informally. If you read about a novel approach, consult with your doctor or other healthcare providers, as the treatments or discoveries you hear about may not be scientifically proven to be safe and effective. The following Internet sites may be of particular interest: ·
About Impotence and Erectile Dysfunction http://www.aboutimpotencetherapies.com
Seeking Guidance 45
·
Impotence Support Group http://cpmcnet.columbia.edu/dept/urology/ events/impsupport.html
·
MD Advice http://www.mdadvice.com/topics/impotence
Finding Doctors One of the most important aspects of your treatment will be the relationship between you and your doctor or specialist. All patients with impotence must go through the process of selecting a physician. While this process will vary from person to person, the Agency for Healthcare Research and Quality makes a number of suggestions, including the following:10 ·
If you are in a managed care plan, check the plan’s list of doctors first.
·
Ask doctors or other health professionals who work with doctors, such as hospital nurses, for referrals.
·
Call a hospital’s doctor referral service, but keep in mind that these services usually refer you to doctors on staff at that particular hospital. The services do not have information on the quality of care that these doctors provide.
·
Some local medical societies offer lists of member doctors. Again, these lists do not have information on the quality of care that these doctors provide.
Additional steps you can take to locate doctors include the following: ·
Check with the associations listed earlier in this chapter.
·
Information on doctors in some states is available on the Internet at http://www.docboard.org. This Web site is run by “Administrators in Medicine,” a group of state medical board directors.
·
The American Board of Medical Specialties can tell you if your doctor is board certified. “Certified” means that the doctor has completed a training program in a specialty and has passed an exam, or “board,” to assess his or her knowledge, skills, and experience to provide quality patient care in that specialty. Primary care doctors may also be certified as specialists. The AMBS Web site is located at
10
This section is adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm.
46 Impotence
http://www.abms.org/newsearch.asp.11 You can also contact the ABMS by phone at 1-866-ASK-ABMS. ·
You can call the American Medical Association (AMA) at 800-665-2882 for information on training, specialties, and board certification for many licensed doctors in the United States. This information also can be found in “Physician Select” at the AMA’s Web site: http://www.amaassn.org/aps/amahg.htm.
Finding a Urologist The American Urological Association (AUA) provides the public with a freeto-use “Find A Urologist” service to help patients find member urologists in their area. The database can be searched by physician name, city, U.S. State, or country and is available via the AUA’s Web site located at http://www.auanet.org/patient_info/find_urologist/index.cfm. According to the AUA: “The American Urological Association is the professional association for urologists. As the premier professional association for the advancement of urologic patient care, the AUA is pleased to provide Find A Urologist, an on-line referral service for patients to use when looking for a urologist. All of our active members are certified by the American Board of Urology, which is an important distinction of the urologist’s commitment to continuing education and superior patient care.”12 If the previous sources did not meet your needs, you may want to log on to the Web site of the National Organization for Rare Disorders (NORD) at http://www.rarediseases.org/. NORD maintains a database of doctors with expertise in various rare diseases. The Metabolic Information Network (MIN), 800-945-2188, also maintains a database of physicians with expertise in various metabolic diseases.
11 While board certification is a good measure of a doctor’s knowledge, it is possible to receive quality care from doctors who are not board certified. 12 Quotation taken from the AACE’s Web site: http://www.aace.com/memsearch.php.
Seeking Guidance 47
Selecting Your Doctor13 When you have compiled a list of prospective doctors, call each of their offices. First, ask if the doctor accepts your health insurance plan and if he or she is taking new patients. If the doctor is not covered by your plan, ask yourself if you are prepared to pay the extra costs. The next step is to schedule a visit with your chosen physician. During the first visit you will have the opportunity to evaluate your doctor and to find out if you feel comfortable with him or her. Ask yourself, did the doctor: ·
Give me a chance to ask questions about impotence?
·
Really listen to my questions?
·
Answer in terms I understood?
·
Show respect for me?
·
Ask me questions?
·
Make me feel comfortable?
·
Address the health problem(s) I came with?
·
Ask me my preferences about different kinds of treatments for impotence?
·
Spend enough time with me?
Trust your instincts when deciding if the doctor is right for you. But remember, it might take time for the relationship to develop. It takes more than one visit for you and your doctor to get to know each other.
Working with Your Doctor14 Research has shown that patients who have good relationships with their doctors tend to be more satisfied with their care and have better results. Here are some tips to help you and your doctor become partners: ·
You know important things about your symptoms and your health history. Tell your doctor what you think he or she needs to know.
·
It is important to tell your doctor personal information, even if it makes you feel embarrassed or uncomfortable.
13 This
section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm. 14 This section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm.
48 Impotence
·
Bring a “health history” list with you (and keep it up to date).
·
Always bring any medications you are currently taking with you to the appointment, or you can bring a list of your medications including dosage and frequency information. Talk about any allergies or reactions you have had to your medications.
·
Tell your doctor about any natural or alternative medicines you are taking.
·
Bring other medical information, such as x-ray films, test results, and medical records.
·
Ask questions. If you don’t, your doctor will assume that you understood everything that was said.
·
Write down your questions before your visit. List the most important ones first to make sure that they are addressed.
·
Consider bringing a friend with you to the appointment to help you ask questions. This person can also help you understand and/or remember the answers.
·
Ask your doctor to draw pictures if you think that this would help you understand.
·
Take notes. Some doctors do not mind if you bring a tape recorder to help you remember things, but always ask first.
·
Let your doctor know if you need more time. If there is not time that day, perhaps you can speak to a nurse or physician assistant on staff or schedule a telephone appointment.
·
Take information home. Ask for written instructions. Your doctor may also have brochures and audio and videotapes that can help you.
·
After leaving the doctor’s office, take responsibility for your care. If you have questions, call. If your symptoms get worse or if you have problems with your medication, call. If you had tests and do not hear from your doctor, call for your test results. If your doctor recommended that you have certain tests, schedule an appointment to get them done. If your doctor said you should see an additional specialist, make an appointment.
By following these steps, you will enhance the relationship you will have with your physician.
Seeking Guidance 49
Broader Health-Related Resources In addition to the references above, the NIH has set up guidance Web sites that can help patients find healthcare professionals. These include:15 ·
Caregivers: http://www.nlm.nih.gov/medlineplus/caregivers.html
·
Choosing a Doctor or Healthcare Service: http://www.nlm.nih.gov/medlineplus/choosingadoctororhealthcareserv ice.html
·
Hospitals and Health Facilities: http://www.nlm.nih.gov/medlineplus/healthfacilities.html
Vocabulary Builder The following vocabulary builder provides definitions of words used in this chapter that have not been defined in previous chapters: Cystitis: Inflammation of the urinary bladder. [EU] Incontinence: Inability to control excretory functions, as defecation (faecal i.) or urination (urinary i.). [EU] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Neuromuscular: Pertaining to muscles and nerves. [EU] Prostatitis: Inflammation of the prostate. [EU]
You can access this information at: http://www.nlm.nih.gov/medlineplus/healthsystem.html.
15
51
PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL
ABOUT PART II In Part II, we introduce you to additional resources and advanced research on impotence. All too often, patients who conduct their own research are overwhelmed by the difficulty in finding and organizing information. The purpose of the following chapters is to provide you an organized and structured format to help you find additional information resources on impotence. In Part II, as in Part I, our objective is not to interpret the latest advances on impotence or render an opinion. Rather, our goal is to give you access to original research and to increase your awareness of sources you may not have already considered. In this way, you will come across the advanced materials often referred to in pamphlets, books, or other general works. Once again, some of this material is technical in nature, so consultation with a professional familiar with impotence is suggested.
Studies 53
CHAPTER 3. STUDIES ON IMPOTENCE Overview Every year, academic studies are published on impotence or related conditions. Broadly speaking, there are two types of studies. The first are peer reviewed. Generally, the content of these studies has been reviewed by scientists or physicians. Peer-reviewed studies are typically published in scientific journals and are usually available at medical libraries. The second type of studies is non-peer reviewed. These works include summary articles that do not use or report scientific results. These often appear in the popular press, newsletters, or similar periodicals. In this chapter, we will show you how to locate peer-reviewed references and studies on impotence. We will begin by discussing research that has been summarized and is free to view by the public via the Internet. We then show you how to generate a bibliography on impotence and teach you how to keep current on new studies as they are published or undertaken by the scientific community.
The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and impotence, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the
54 Impotence
format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type in “impotence” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is a sample of what you can expect from this type of search: ·
Impotence Treatment Update Source: Diabetes Self-Management. 17(4): 110-111. July-August 2000. Contact: Available from R.A. Rapaport Publishing, Inc. 150 West 22nd Street, New York, NY 10011. (800) 234-0923. Website: www.diabetes-selfmgmt.com. Summary: This article provides updated information on treatments for erectile dysfunction. Many different factors can disrupt the process of male sexual arousal, including psychological barriers, heart disease, excess alcohol consumption, and diabetes. The latter contributes to erectile dysfunction because men who have diabetes are more likely to develop atherosclerosis, which makes it harder for blood to flow into the penis, and to have nerve damage, which can prevent normal transmission of nerve signals from the brain to the penis. When the drug sildenafil, commonly known as Viagra, was introduced to the United States in 1998, it was an immediate hit because it was the first impotence treatment to come in pill form. Despite its popularity, sildenafil can have dangerous and even fatal side effects, mainly when it interacts with nitrate-containing heart drugs. A second oral impotence treatment, apomorphine, may soon receive Food and Drug Administration approval. This drug, marketed under the brand name Uprima, is placed under the tongue and allowed to dissolve. The drug works by stimulating a chemical in the brain called dopamine that helps initiate erections. However, this drug also has side effects, including nausea and vomiting, dizziness, and fainting.
·
Treating Impotence Source: Diabetes Self-Management. 15(5): 37, 41-43, 46-47. SeptemberOctober 1998. Contact: Available from R.A. Rapaport Publishing, Inc. 150 West 22nd Street, New York, NY 10011. (800) 234-0923. Summary: This review article examines the relationship between impotence and diabetes. It begins by explaining the physiological aspects
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of a normal erection and defining impotence. The article then discusses the ways impotence can result as a complication of diabetes. First, accelerated arteriosclerosis restricts blood flow to the penis, and, second, nerve damage prevents the normal transmission of nerve impulses to the blood vessels in the penis. Good blood sugar control may prevent or slow down the onset of complications related to diabetes, including erectile dysfunction. The article continues with information on the diagnosis and treatment of impotence as a complication of diabetes. An evaluation by a physician usually involves a review of a man's medical history, a physical examination, and laboratory tests. A nocturnal penile tumescence test may also be used to evaluate erectile dysfunction. A variety of options are available to treat impotence, including oral drugs such as Viagra, penile suppositories, penile injection therapy, external vacuum devices, penile implant surgery, vascular surgery, testosterone supplements, yohimbine extract, and counseling. In addition, several drugs are under investigation as treatments for impotence, including apomorphine, phentolamine, and prazosin. The article recommends that a man work with his partner in overcoming his impotence. 1 figure. ·
Impotence in Older Patients with Diabetes Source: Practical Diabetology. 10(4): 8-10, 12-13. July-August 1991. Summary: Diabetes, as a specific disease entity, is the most common organic cause of impotence, resulting in approximately two million cases in the United States. This article discusses impotence in older patients with diabetes. Topics include the health problems, sexual activity, and sexual changes in older men with diabetes; etiologies of impotence, including psychogenic, vasculogenic, neurogenic causes, diabetic cavernous muscle myopathy, and endocrine abnormalities; the evaluation of impotence; medical treatment; external vacuum erection assistance devices; intracavernous pharmacotherapy; surgical treatment, including vascular surgery, and implantation of penile prostheses; and sex therapy and psychotherapy. 1 figure. 10 references.
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Relationship of Psychiatric Illness to Impotence in Men With Diabetes Source: Diabetes Care. 13(8): 893-895. August 1990. Summary: This article reports on a review of clinical data from 37 adult males with diabetes mellitus who had undergone psychiatric diagnosis and peripheral nerve conduction studies to determine whether psychiatric illness was significantly related to complaints of sexual dysfunction. Main-effects testing revealed that impotence was associated with both neuropathy and psychiatric illness. These data allow for the hypothesis that psychiatric illness may be an important contributor to
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impotence in men with diabetes, as it is in men who do not have diabetes, even when neuropathic complications of the disease are present. 1 table. 11 references. (AA-M). ·
Long-Term Followup of Treatment for Peyronie's Disease: Modeling the Penis Over an Inflatable Penile Prosthesis Source: Journal of Urology. 165(6): 825-829. March 2001. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-3030 or (301) 714-2334. Fax (301) 824-7290. Summary: Peyronie's disease is a benign condition characterized by the formation of fibrotic plaques in the corpora cavernosa of the penis. Patients may present with painful erection, palpable penile plaque, or penile curvature. The authors of this article originally reported on the use of inflatable penile implants used to treat erectile dysfunction (ED, formerly called impotence) in patients with Peyronie's disease (Wilson et al, 1993). In this article, the authors present a historical prospective study of 104 patients in whom the modeling procedure was used to correct Peyronie's curvature after implantation with the Mentor Alpha 1 and AMS 700CX penile prostheses. The authors compared revision free survival experience of these implants with 905 similar implants in men with non Peyronie's disease. The reasons for revision were classified as mechanical failure, patient dissatisfaction, infection and medical causes, including reoperation for straightening. Maximum followup was more than 12 years (average followup was more than 5 years). No significant difference in device survival was observed in the two study cohorts in 5 years. Similarly, each prosthesis provided the same permanent straightening without the need for revision. In Peyronie's disease cases, mechanical survival of the Mentor Alpha 1 was superior to that of the AMS 700CX. There was no significant difference in mechanical reliability of the devices in non Peyronie's disease cases. 5 figures. 3 tables. 10 references.
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Quality of Life in Men with Urinary Incontinence After Prostate Cancer Surgery Source: Journal of WOCN. Journal of Wound, Ostomy and Continence Nurses. 27(3): 174-178. May 2000. Contact: Available from Journal of WOCN, Mosby-Year Book, Inc. 11830 Westline Industrial Drive, St. Louis, MO 63146. (800) 453-4351. Summary: Quality of life assessment is significant to health care providers because it helps them to understand the experience of well
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being as it relates to an illness and its severity. Attempting to deduce the influence of illness on quality of life is complex; however, this area of research has demonstrated that the measurement of quality of life is as important in providing comprehensive care as the treatment itself. This article considers quality of life in men with urinary incontinence (UI) after surgery for prostate cancer. Prostate cancer is the most prevalent cancer in American men and radical prostatectomy (removal of the prostate) is frequently considered the treatment of choice for localized prostate cancer. Despite its widespread use, considerable morbidity exists, including erectile dysfunction (ED, formerly called impotence) and UI. Although not all men who undergo radical prostatectomy will experience UI, those who do find that it influences their daily lives, affecting the clothes they wear, their activities, sleep patterns, social relationships, and self esteem. The severity of voiding symptoms seems to be a major factor in determining the effect of radical prostatectomy on quality of life (QOL). The response of health care professionals to men before and after prostatectomy also influences their QOL. Despite this link between information, appraisal, and coping, few studies have focused on the informational needs of patients with treatment related morbidities. The author concludes by discussing the implications of these findings on the care offered by WOC (wound, ostomy and continence) nurses. Nursing interventions likely to improve QOL in patients undergoing treatment for prostate cancer include providing accurate information about what to expect after surgery and about treatment for postoperative UI. 31 references. ·
Asthma and Impotence: The Story of an Unexpected Connection Source: JAAPA. Journal of the American Academy of Physician Assistants. 13(6): 59-60, 62, 68, 70. June 2000. Contact: Available from Medical Economics. 5 Paragon Drive, Montvale, NJ 07645. (800) 432-4570. Fax (201) 573-4956. Summary: In this case report, the author describes a man who was seeking relief of a debilitating respiratory illness (asthma) who also told his primary care clinician that he was deeply concerned about his erectile dysfunction (ED, formerly called impotence). The author explores the etiology (causes) of ED, including vascular, endocrinologic, neurologic, drug induced, psychological, or traumatic. The author notes that, in retrospect, it was clearly inappropriate to refer this patient to an internist. Instead, the primary care clinician should have taken a complete history and performed a physical examination. The workup for ED is fairly straightforward and can be started by a primary care provider. The workup should include history, physical examination, and laboratory
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tests, as well as investigation of the patient's relationship with his sexual partner. Many treatment options are available, including systemic drug therapy or adjustment of ongoing drug therapy, surgical intervention, and mechanical devices to simulate physiologic erections. In the patient described in the case report, it was concluded that primary hypogonadism was the patient's underlying condition. The methylprednisolone prescribed for his asthma probably activated the androgen receptors, and this improved his ED. 3 tables. 19 references. ·
[What is Impotence? Is Viagra a Viable Treatment for Dialysis Patients?] Source: Renalife. 14(4): 22-23. Winter 1999. Contact: Available from American Association of Kidney Patients (AAKP). 100 South Ashley Drive, Suite 280, Tampa, FL 33602. (800) 749AAKP or (813) 223-7099. E-mail:
[email protected]. Website: www.aakp.org. Summary: This entry on Viagra (sildenafil) is one from a regular column that provides readers with an opportunity to submit renal related health questions to health care professionals. This column answers a reader's question about Viagra and its use as a treatment option for erectile dysfunction in patients on dialysis. The author notes that a loss of interest in sexual activity is common in patients with progressive kidney failure. Coping with the stress of an abdominal or vascular access for dialysis, surviving the usual muscle loss, and accommodating to drugs given to control hypertension, phosphate overload, and other components of uremia poses adjustment stresses that place sex at a relatively low priority. The author notes that recent publicity over Viagra has opened doors for more frank discussion between health care providers and patients regarding erectile dysfunction. The author briefly reviews four steps in the evaluation and treatment of erectile dysfunction: identify and correct all correctable medical problems; review all prescribed medications to check for any impact on sexual function; inspect all aspects of life quality, particularly those contributing to exhaustion, conflict, and psychological factors; and a comprehensive urologic evaluation. The author concludes that sildenafil (Viagra) may be an appropriate drug therapy for men on dialysis, but only after going through the steps noted above. The author cautions that men who have angina under treatment with nitroglycerine or similar drugs may be at extra risk of sudden death from a heart attack when treated with Viagra. However, this risk has not been confirmed and should be now classified as a worry rather than a reality.
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Role of Viagra in the Treatment of Male Impotence in ESRD Source: ANNA Journal. American Nephrology Nurses Association Journal. 26(2): 242. April 1999. Contact: Available from American Nephrology Nurses' Association. Box 56, East Holly Avenue, Pitman, NJ 08071. (609) 256-2320. Summary: This brief article, from a regular column called Clinical Consult, reviews the role of Viagra (sildenafil) in the treatment of erectile dysfunction (impotence) in men with end-stage renal disease (ESRD). The article emphasizes a treatment process that begins with the least invasive treatment. After a thorough medical evaluation, treatment options should be counseling, if appropriate; external vacuum devices; oral medication (sildenafil, yohimbine, testosterone); urethral suppositories; penile injection; penile implant surgery; and vascular surgery. Sildenafil is indicated for erectile dysfunction only; it does not increase libido or enhance performance. In clinical trials with over 3,000 subjects with erectile dysfunction ranging from mild to severe, the success rate for sildenafil was 65 to 85 percent compared to 39 percent of placebo subjects. Main adverse reactions to Viagra are headache (16 percent), flushing (10 percent), and dyspepsia (7 percent). Less than 4 percent of subjects experienced nasal congestion, urinary tract infection, abnormal pain, blue green vision, diarrhea, and dizziness. Viagra is contraindicated in persons using any form of nitrates. The use of Viagra may be problematic for ESRD patients in several areas. Hemodialysis patients are prescribed an average of 8 medications, and at least 75 percent of hemodialysis patients and 81 percent of peritoneal dialysis patients use at least one antihypertensive medication. These statistics increase the probability of drug interactions. 3 references.
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Prevalence and Etiology of Impotence in 101 Male Hypertensive Outpatients Source: American Journal of Hypertension. 12(3): 271-275. March 1999. Contact: Available from Elsevier Science, Inc. 655 Avenue of the Americas, New York, NY 10010. (888) 4ES-INFO or (212) 633-3680. Email:
[email protected]. Summary: Erectile dysfunction (impotence) has a high prevalence among men with hypertension. Whether this relates mainly to specific drug side effects or to primary pathogenic disorders is unknown. This article reports on a study of 101 male patients from an outpatient hypertension clinic who answered detailed questionnaires about hypertension and sexual function. Patients with perceived impotence were offered a thorough penile evaluation and examination performed by specialists in
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the urology department. Twenty seven (27 percent) men had impotence. The main cause of impotence was an arterial dysfunction (89 percent). The prevalence of impotence was related to the degree of secondary organ manifestation, reflected by World Health Organization (WHO) classification I through III. Intermittent claudication and ischemic heart disease were the best determinants in these respect. Twelve patients with impotence (44 percent) ascribed onset of impotence to drug initiation. A variety of drugs were implicated in the occurrence of drug induced impotence. The authors summarize that their results indicate impotence in men with hypertension is caused mainly by penile arterial vascular changes, probably atherosclerosis. Drug induced impotence could well be the result of blood pressure reduction itself and not specific drug side effects. 5 tables. 9 references.
Federally-Funded Research on Impotence The U.S. Government supports a variety of research studies relating to impotence and associated conditions. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.16 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally-funded biomedical research projects conducted at universities, hospitals, and other institutions. Visit the CRISP Web site at http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket. You can perform targeted searches by various criteria including geography, date, as well as topics related to impotence and related conditions. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally-funded studies use animals or simulated models to explore impotence and related conditions. In some cases, therefore, it may be difficult to understand how some basic or fundamental research could eventually translate into medical practice. The following sample is typical of the type of information found when searching the CRISP database for impotence:
16 Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).
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Project Title: Prevention and Treatment of Impotence Principal Investigator & Institution: Lue, Tom F.; Professor of Urology; Urology; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 94143 Timing: Fiscal Year 2000; Project Start 1-AUG-1994; Project End 1-DEC2001 Summary: This is a competitive renewal application in which the authors have found that growth hormone significantly facilitated the regeneration of nitric oxide synthase containing nerves after cavernous nerve injury in a group of young rats. The authors propose to examine and compare the response to cavernous nerve injury in a group of both young and old rats and to study the effect of growth hormone and its mediator insulin-like growth factor system on the erectile mechanism. If proved beneficial in the proposed experiments, clinical application of growth hormone or IGF could become an important preventative and therapeutic manure for neurogenic impotence in humans. The specific aims are: 1: To test the hypothesis that injury to the cavernous nerve has different effects on the nonadrenergic noncholinergic vasodilator system in young and old rats. 2: To test the hypothesis that the cellular and molecular mechanisms of impotence associated with cavernous nerve injuries are due to altered gene and protein expression of NOS, TGF, NGF, IGF, FGF and adrenoreceptor in young and old rats. 3: To test the hypothesis that growth hormone facilitates regeneration of the cavernous nerve in both young and old rats. 4: To test hypothesis that the mechanism of facilitated NANC and parasympathetic nerve regeneration by growth hormone is due to production of IGF and IGFBBPs. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
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Project Title: Diabetes and Erectile Function Principal Investigator & Institution: Dahiya, Rajvir; Professor and Director; Northern California Institute Res & Educ for Research and Education San Francisco, Ca 94121 Timing: Fiscal Year 2000; Project Start 0-SEP-1998; Project End 1-AUG2003 Summary: (adapted from the application) The long term goal of this application is to investigate the cellular and molecular mechanisms of diabetic impotence. Based on prior publications and preliminary data, we hypothesize that diabetic impotence is associated with alterations in signaling pathways of noradrenergic non-cholinergic (NANC) neurotransmission adenosine 3', 5' cyclic monophosphate (cAMP), guanosine 3', 5' cyclic monophosphate (cGMP), nitric oxide synthase
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(NOS), adrenoreceptor alpha, and growth factors (TGFa, TGFb1, TGFb2, TGFb3, IGF, and NGF). We will induce diabetes in Fisher rats by streptozotocin (35 mg /kg) and pursue the following experiments to test our hypothesis: In Specific Aim 1, we will test the hypothesis that streptozotocin-induced diabetes will alter NANC vasodilator system in rats. Under this aim we will analyze intracavernous pressure (functional assessment) of penile erection in streptozotocin-induced diabetic (2, 4, 6, 8 weeks) rats. Immunohistochemical examination (NADPH diaphorase and NOS antibodies staining) of NOS-containing neurons and nerve fibers of the following sites: major pelvic ganglion and intra-penile nerves (dorsal, cavernous and spongiosal) and endothelium in early and late diabetic rats. In Specific Aim 2, we will test the hypothesis that the cellular and molecular mechanisms of impotence associated with streptozotocin-induced diabetes are due to altered gene and protein expression of NOS, transforming growth factor (TGF), nerve growth factor (NGF), insulin like growth factor (IGF), and adrenoreceptor in rats. Under this specific aim, we will analyze NOS activity by enzymatic assay, NOS gene expression by Norther blot, cAMP, cGMP by radioimmunoassay in diabetic rats. The protein and gene expression for adrenoreceptor, NOS, TGFa, TGFb, NGF, and IGF-I will be done by immunohistochemistry/ Western blotting and Norther blot / reverse transcription/polymerase chain reaction (RT-PCR), respectively. In Specific Aim 3, we will test the hypothesis that insulin treatment can alter diabetes induced cellular and molecular mechanisms of importance in rats. Under this we will first induced diabetes in rats (streptozotocin injection/35 mg/kg i.p., for 2, 4, 6, and 8 weeks, and then treat them with insulin 915 IU/Kg wt, subcutaneous injection). We will study: (1) functional assessment of penile erection, (2) immunohistochemical parameters (NADPH diaphorase and NOS antibodies staining) of NOS containing neurons and nerve fibers, and (3) protein and gene expression for adrenoreceptor, NOS, TGFa, TGFb, NGF, and IGF-I will be done by immunohistochemistry/ Western blotting and Norther blot / RT-PCR, respectively. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Hormones and Erectile Dysfunction in Aging Men Principal Investigator & Institution: Mckinlay, John B.; Senior Vice President and Director; New England Research Institutes, Inc. 9 Galen St Watertown, Ma 02472 Timing: Fiscal Year 2001; Project Start 9-MAY-1995; Project End 1-AUG2005
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Summary: (provided by applicant): The Massachusetts Male Aging Study (MMAS) is considered a landmark research effort in the fields of aging, urology, and endocrinology. It employs a random sample of communitydwelling men (not a convenience sample of patient volunteers). Its size permits estimation of even relatively rare phenomena (e.g., hypogonadism). It is longitudinal (intra-subject variation) not crosssectional (inter-subject variation) and has successfully followed a cohort from 987-89 (T1) through 1995-97 (T2). Worldwide, it remains the largest male endocrine database. It is the first and still the only major longitudinal study of ED. It is multidisciplinary. The MMAS team has been extraordinarily productive. Emphasis has been given to the practical clinical applications of scientific findings. The proposed project ("Epidemiology Of Hormones And Erectile Dysfunction In Aging Men") is designed to extend the highly productive MMAS by following a projected 800 already participating subjects through a third wave (T3). Building directly on earlier work we will: continue investigation of lifespan changes in 14 carefully selected hormones in the same subjects; precisely delineate any hypogonadal syndrome and its major correlates; continue pioneering work on erectile dysfunction (ED) and its various predictors; precisely measure the hypothesized relation between ED (sentinel event) and subsequent CVD; extend knowledge concerning EDrelated utilization behavior and quality of life in older men; and assess the validity of the single question measure of ED against a clinical urologic examination by a nationally-respected urologist blinded to subjects' self-reported ED status. Methods of data collection will be identical to those used previously for the MMAS. The proposed research will continue to provide the most comprehensive and reliable information available on ED, life-span hormonal changes and their physiological, psychosocial, anthropometric, and behavioral predictors in normally aging men. Prior to the MMAS there was: (a) no well-designed prospective study describing life span changes in endocrine functioning (hormones) in normally aging men; and (b) no definitive populationbased study of ED and its biobehavioral correlates. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Male Urogenital Function and Chronic Spinal Cord Injury Principal Investigator & Institution: Hubscher, Charles H.; Assistant Scientist; Physiological Sciences; University of Florida Gainesville, Fl 32611 Timing: Fiscal Year 2000; Project Start 8-SEP-2000; Project End 1-AUG2003
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Summary: The neural mechanisms involved in the control/coordination of urogenital functions is poorly understood, making restoration of function following traumatic spinal cord injury a difficult task. In humans, spinal cord injury occurs predominantly in young males, compromises sexual function, and leaves most patients infertile because of an inability to ejaculate. Moreover, bladder voiding dysfunction is common due to bladder-sphincter dyssynergia. Incoordination of perineal motoneuron circuits, resulting from spinal cord injury-induced changes in non-locomotor segmental reflex circuits involved in male reproductive function and micturition, likely contributes to these complications. Since normal ejaculation and micturition require both an intact segmental reflex arc and brainstem integration, we have, in recent years, developed and characterized an in vivo brainstem-spinal cord electrophysiological animal model to study the neurological causes of sexual dysfunction following severe midthoracic spinal cord injury. Our previous studies with this model have shown that chronic bilateral lesions of the dorsal 3/5 of T8 spinal cord is correlated with (i) impaired bladder/sexual reflexes, (ii) changes in lumbosacral neural circuits mediating perineal muscle function and (iii) loss of ascending and descending connections between the distal urogenital tract and the medullary reticular formation (ii/iii - as determined in terminal electrophysiological experiments). The overall aim of the proposed research is to use this spino-bulbo-spinal model to address important questions regarding the neural control/coordination of smooth and striated muscles subserving sexual and bladder functions in male rats following chronic spinal cord injury. A unique benefit of our model lies in our ability to focus on the integration of information from multiple pelvic viscera. The knowledge gained from these basic scientific experiments will more specifically ascertain the spinal cord regions and the specific neural circuitry which should be targeted for therapeutic interventions designed to improve the control/coordination of sexual, bladder and bowel functions following chronic spinal cord injury. Parallel electrophysiological, behavioral and neuroanatomical studies are proposed. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Mechanisms of Muscle Sensory Recovery Principal Investigator & Institution: Cope, Timothy C.; Professor; Emory University 1380 S Oxford Rd Atlanta, Ga 30322 Timing: Fiscal Year 2000; Project Start 1-JUL-2000; Project End 0-JUN2005
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Summary: (Applicant's abstract): Despite the capacity of peripheral nerves to regenerate after injury or disease, functional recovery of the sensory system is only partially realized. The broad objective of this proposal is to determine the cellular mechanisms that constrain recovery of the sensory restoration of normal movement, and its profound ineffectiveness, even long after a cut peripheral nerve has regenerated into its original muscle, results in persistent motor disability. The impotence of sensory feedback from muscle is likely to be explained by limitations in the recovery of sensory transduction in the muscle and possibly by a diminished strength of central synaptic transmission are accounted for, as commonly accepted, by the inability of the sensory nerves to reconnect with their cognate muscle receptors. The absence of direct evidence for and the presence of strong challenges to this premise lead us to hypothesize that simple failure of a muscle afferent to reconnect with the appropriate muscle receptor is neither necessary nor sufficient to explain sensory dysfunction. This central hypothesis will be tested through combined electrophysiological and immunohistological studies of sensory nerves supplying long-term reinnervated muscles in living adult rats and cats. Three specific aims are proposed to determine whether the reconnection with a muscle receptor fully explains: (1) the normal response properties of some muscle afferents, (2) the abnormal response properties of others, and (3) the central synaptic constraints on recovery of sensory function under conditions in which sensory neuropathies, e.g. Guillain-Baree syndrome, diabetic neuropathy, or chronic inflammatory demyelinating polyneuropathy. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Regulation of PDE 5 in Human Penile Smooth Muscle Cells Principal Investigator & Institution: Kim, Noel N.; Urology; Boston University 121 Bay State Rd Boston, Ma 02215 Timing: Fiscal Year 2000; Project Start 1-SEP-1999; Project End 1-JUL-2002 Summary: The nitric oxide/cGMP signalling pathway is a major regulator of penile vascular smooth muscle tone and plays a critical role in erection. Phosphodiesterases, enzymes which hydrolyze cyclic nucleotides, are an integral part of this signalling pathway. Phosphodiesterase type 5 (PDE 5) is one of the main phosphodiesterases expressed in penile corpus cavernosum smooth muscle. Sildenafil, a reversible PDE 5 selective inhibitor, has been successfully utilized in the clinical treatment of erectile dysfunction. The efficacy of this inhibitor in ameliorating erectile function in men with impotence, resulting from a broad range of etiologies, emphasizes the crucial aspect which PDE5
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plays in regulating penile smooth muscle tone. Yet the regulation of PDE 5 expression or activity is not well understood and the consequences of prolonged inhibition of this enzyme are unknown. Fundamental knowledge of the cellular and molecular mechanisms which regulate PDE 5 expression and/or activity is important to the understanding of erectile function. The novel perspective that intracellular cGMP levels are actively regulated by PDE 5 broadens our understanding of the cGMP signalling pathway and the integrated mechanisms which control penile trabecular smooth muscle tone. Thus, in this study we will investigate potential regulatory mechanisms which may alter the expression and/or activity of PDE 5 in human penile corpus cavernosum smooth muscle. We will utilize primary cultures of human penile trabecular smooth muscle cells to study and characterize mechanisms of PDE 5 regulation without disrupting the intracellular regulatory pathways which are under investigation. Using cyclic nucleotide radioimmunoassays, Northern and Western blot analyses, and enzyme activity assays, we will investigate: 1) the effects of nitric oxide and cGMP on PDE 5 expression and/or activity; 2) the effects of cAMP and agonists which stimulate adenylate cyclase on PDE 5 expression and/or activity; 3) the effects of cAMP and agonists which stimulate adenylate cyclase on PDE 5 expression and/or activity; 4) cross-talk regulation between cyclic nucleotides and their respective protein kinases, and estrogen and testosterone signalling pathways. This investigation of multiple signalling systems and their influence on PDE 5 will increase our current understanding of the extensive nature by which distinct signalling pathways can interact and provide integrated regulation of smooth muscle tone. This work will provide new and useful information on regulation of PDE5 which will improve treatment strategies for management o erectile dysfunction. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Sonic Hedgehog, a Morphogen in Penile Development Principal Investigator & Institution: Podlasek, Carol A.; Urology; Northwestern University 303 E Chicago Ave Chicago, Il 60611 Timing: Fiscal Year 2002; Project Start 6-MAR-2002; Project End 1-JAN2004 Summary: (provided by applicant): The proposed research will examine the role of Sonic hedgehog (Shh) in penile development and the dysregulation of this pathway in diabetes induced erectile dysfunction. Shh is a secreted glycopeptide that is critically relevant in mesenchymalepithelial interaction in developing tissues. We will show preliminary evidence that Shh signaling in the corpora is neurally regulated during
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penile development and in the adult, and propose to determine the impact of diabetic neuropathy on the expression and activity of Shh in corporal bodies. Diabetes mellitus is a common risk factor for erectile dysfunction, which is a devastating pathologic development that effects 10-30 million American men and costs in excess of $150 million for inpatient urologic care alone (1985 dollars). Although angiopathy and neuropathy are frequent complications in the natural history of DM, the precise cause of diabetic impotence remains unknown. We will examine the hypothesis that neural Shh signaling is elemental in establishing and maintaining normal penile morphology and that erectile dysfunction associated with diabetic neuropathy results from disruption of the homeostatic functions of the Shh pathway. The power of this proposal is its potential to provide novel and critically important insight into the mechanism of diabetes induced erectile function. This may provide the basis for new treatments to prevent or treat this complication and may provide collateral insights into other neurovascular complications of diabetes. The proposed experiments are ideally suited to satisfy the goals of this RFA since novel and innovative technology is utilized to advance our current understanding of one aspect of urogenital development, specifically how neural Shh signaling during postnatal morphogenesis of the penis establishes corporal cavernosal integrity required for erection. Re-establishment of this signaling pathway offers great promise for erectile dysfirnction treatment. Knowledge gained in these studies may be applied to investigate the role of neural input in establishing tissue identity and examining the function of neuropathy in disease. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Urological Research Training Grant Principal Investigator & Institution: Coffey, Donald S.; Professor; Urology; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2002; Project Start 1-MAY-1987; Project End 0-APR2007 Summary: (provided by applicant): Genitourinary diseases cover abnormal development and growth, benign tumors and malignant cancers, abnormalities in kidney function and stone formation, infections, micturition, impotence and reproductive failure, as well as the neurological and endocrine control of the sex systems. This represents colossal medical problems requiring expertise in many areas of research. There is a critical shortage of trained research scientists in the field of urology. This research training program trains highly qualified young physician scientists for academic careers in urological research and
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develops young basic scientists (Ph.D. or M.D./Ph.D.) to pursue careers in urological research. Trainees function side-by-side in modern urology research laboratories occupied by 5 full-time Ph.D. basic scientists plus 6 M.D./Ph.D. and 10 M.D. clinical research investigators. These laboratories carry out major funded research programs in the physiology of the smooth muscle of the genitourinary tract, biochemical and physiological studies on benign prostatic hyperplasia, endocrine studies on male secondary sex characteristics, cell biology and structure, mechanisms of action of steroid hormones, genetic studies, neurotransmitter and receptor studies of genitoruinary tissues, reproductive physiology; and basic and clinical studies on cancer. Each trainee participates in a research training program that is customized for his/her particular needs and interests and includes courses in molecular biology, biostatistics, endocrinology, pathology and physiology. The six research trainees are comprised of three types: 1.) Postresident physician scientists - completed residency training, spending an additional 1-2 years in research, 2.) M.D. Urological Research Fellows will spend 1 or more years in full time research, and 3.) Postdoctoral Research Fellows Ph.D. or M.D./Ph.D., in full time research, who have already completed graduate training in a basic science discipline, plus 4.) Predoctoral Trainees, Ph.D. graduate program students carrying out thesis research in the urology labs who are not funded by this grant but who form part of the research-training environment. Each of these four components of our urological training program enriches and contributes to the success of each part. A multidisciplinary environment of graduate students, postdoctorals, postresidency, M.D.'s all doing research within the same environment has proven to be synergistic. The ability to understand the biology of the disease and to work on human pathological material with the application of precise molecular and pathological techniques that are now forthcoming provides a rich environment for future research leaders to study the major medical problems within the field of urology. Past successes of these laboratories in bridging clinical and basic research has produced a large number of scientists and physician scientists who are dedicated to solving urological diseases. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
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E-Journals: PubMed Central17 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).18 Access to this growing archive of e-journals is free and unrestricted.19 To search, go to http://www.pubmedcentral.nih.gov/index.html#search, and type “impotence” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for impotence in the PubMed Central database: ·
Cardiovascular events in users of sildenafil: results from first phase of prescription event monitoring in England by Saad A W Shakir, Lynda V Wilton, Andrew Boshier, Deborah Layton, and Emma Heeley; 2001 March 17 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=26545
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Cost utility analysis of sildenafil compared with papaverinephentolamine injections by Elly A Stolk, Jan J V Busschbach, Max Caffa, Eric J H Meuleman, and Frans F H Rutten; 2000 April 29 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=27357
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Erectile dysfunction in cyclic GMP-dependent kinase I-deficient mice by Petter Hedlund, Attila Aszodi, Alexander Pfeifer, Per Alm, Franz Hofmann, Marianne Ahmad, Reinhard Fassler, and Karl-Erik Andersson; 2000 February 29 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=15804
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Gene transfer of endothelial nitric oxide synthase to the penis augments erectile responses in the aged rat by H. C. Champion, T. J. Bivalacqua, A. L. Hyman, L. J. Ignarro, W. J. G. Hellstrom, and P. J. Kadowitz; 1999 September 28 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=18088
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Lifestyle drugs: issues for debate by Joel Lexchin; 2001 May 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=81072&ren dertype=external
Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html. 18 With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 19 The value of PubMed Central, in addition to its role as an archive, lies the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print. 17
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Sexual dysfunction in men after treatment for lower urinary tract symptoms: evidence from randomised controlled trial by Sara T Brookes, Jenny L Donovan, Tim J Peters, Paul Abrams, and David E Neal; 2002 May 4 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=104331
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Sildenafil: from the bench to the bedside by Evangelos Michelakis, Wayne Tymchak, and Stephen Archer; 2000 October 31 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=80254&ren dertype=external
The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine. The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to the public.20 If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with impotence, simply go to the PubMed Web site at www.ncbi.nlm.nih.gov/pubmed. Type “impotence” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for “impotence” (hyperlinks lead to article summaries): ·
100 cases of impotence treated by acupuncture and moxibustion. Author(s): Wu JZ, Zhang Q, Wu WC, Guo ZH, Yin FX, Yan CH, Zhou RL, Zhu LX. Source: J Tradit Chin Med. 1989 September; 9(3): 184-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2615452&dopt=Abstract
PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.
20
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·
Marital crisis intervention: hypnosis in impotence-frigidity cases. Author(s): Levit HI. Source: Am J Clin Hypn. 1971 July; 14(1): 56-60. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=5163567&dopt=Abstract
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Validation of a psychophysiological waking erectile assessment (WEA) for the diagnosis of male erectile disorder. Author(s): Janssen E, Everaerd W, Van Lunsen RH, Oerlemans S. Source: Urology. 1994 May; 43(5): 686-95; Discussion 695-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8165769&dopt=Abstract
Vocabulary Builder Adenosine: A nucleoside that is composed of adenine and d-ribose. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA. Adenosine itself is a neurotransmitter. [NIH] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Anthropology: The science devoted to the comparative study of man. [NIH] Antihypertensive: An agent that reduces high blood pressure. [EU] Antioxidant: One of many widely used synthetic or natural substances added to a product to prevent or delay its deterioration by action of oxygen in the air. Rubber, paints, vegetable oils, and prepared foods commonly contain antioxidants. [EU] Apomorphine: A derivative of morphine that is a dopamine D2 agonist. It is a powerful emetic and has been used for that effect in acute poisoning. It has also been used in the diagnosis and treatment of parkinsonism, but its adverse effects limit its use. [NIH] Arginine: An essential amino acid that is physiologically active in the Lform. [NIH] Arthralgia: Pain in a joint. [EU] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Bethanidine: A guanidinium antihypertensive agent that acts by blocking adrenergic transmission. The precise mode of action is not clear. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or
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involving chemical reactions in living organisms. [EU] Calmodulin: A heat-stable, low-molecular-weight activator protein found mainly in the brain and heart. The binding of calcium ions to this protein allows this protein to bind to cyclic nucleotide phosphodiesterases and to adenyl cyclase with subsequent activation. Thereby this protein modulates cyclic AMP and cyclic GMP levels. [NIH] Cardiomegaly: Cardiac hypertrophy. [EU] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Conduction: The transfer of sound waves, heat, nervous impulses, or electricity. [EU] Congestion: Excessive or abnormal accumulation of blood in a part. [EU] Contractility: stimulus. [EU]
Capacity for becoming short in response to a suitable
Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Debrisoquin: An adrenergic neuron-blocking drug similar in effects to guanethidine. It is also noteworthy in being a substrate for a polymorphic cytochrome P-450 enzyme. Persons with certain isoforms of this enzyme are unable to properly metabolize this and many other clinically important drugs. They are commonly referred to as having a debrisoquin 4hydroxylase polymorphism. [NIH] Desensitization: The prevention or reduction of immediate hypersensitivity reactions by administration of graded doses of allergen; called also hyposensitization and immunotherapy. [EU] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Dizziness: An imprecise term which may refer to a sense of spatial disorientation, motion of the environment, or lightheadedness. [NIH] Dorsal: 1. pertaining to the back or to any dorsum. 2. denoting a position more toward the back surface than some other object of reference; same as posterior in human anatomy; superior in the anatomy of quadrupeds. [EU] Dyspepsia: Impairment of the power of function of digestion; usually applied to epigastric discomfort following meals. [EU]
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Electrophoresis: An electrochemical process in which macromolecules or colloidal particles with a net electric charge migrate in a solution under the influence of an electric current. [NIH] Electrophysiological: Pertaining to electrophysiology, that is a branch of physiology that is concerned with the electric phenomena associated with living bodies and involved in their functional activity. [EU] Endoscopy: Visual inspection of any cavity of the body by means of an endoscope. [EU] Endothelium: The layer of epithelial cells that lines the cavities of the heart and of the blood and lymph vessels, and the serous cavities of the body, originating from the mesoderm. [EU] Enterotoxins: Substances that are toxic to the intestinal tract causing vomiting, diarrhea, etc.; most common enterotoxins are produced by bacteria. [NIH] Fatal: Causing death, deadly; mortal; lethal. [EU] Filtration: The passage of a liquid through a filter, accomplished by gravity, pressure, or vacuum (suction). [EU] Flushing: A transient reddening of the face that may be due to fever, certain drugs, exertion, stress, or a disease process. [NIH] Frigidity: Coldness; especially, lack of sexual response in the female. [EU] Ganglion: 1. a knot, or knotlike mass. 2. a general term for a group of nerve cell bodies located outside the central nervous system; occasionally applied to certain nuclear groups within the brain or spinal cord, e.g. basal ganglia. 3. a benign cystic tumour occurring on a aponeurosis or tendon, as in the wrist or dorsum of the foot; it consists of a thin fibrous capsule enclosing a clear mucinous fluid. [EU] Gastritis: Inflammation of the stomach. [EU] Gastroduodenal: Pertaining to or communicating with the stomach and duodenum, as a gastroduodenal fistula. [EU] Genitourinary: Pertaining to the genital and urinary organs; urogenital; urinosexual. [EU] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Guanabenz: An alpha-2 selective adrenergic agonist used as an antihypertensive agent. [NIH] Helicobacter: A genus of gram-negative, spiral-shaped bacteria that is pathogenic and has been isolated from the intestinal tract of mammals, including humans. [NIH] Hepatomegaly: Enlargement of the liver. [EU]
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Homeostasis: A tendency to stability in the normal body states (internal environment) of the organism. It is achieved by a system of control mechanisms activated by negative feedback; e.g. a high level of carbon dioxide in extracellular fluid triggers increased pulmonary ventilation, which in turn causes a decrease in carbon dioxide concentration. [EU] Hormones: Chemical substances having a specific regulatory effect on the activity of a certain organ or organs. The term was originally applied to substances secreted by various endocrine glands and transported in the bloodstream to the target organs. It is sometimes extended to include those substances that are not produced by the endocrine glands but that have similar effects. [NIH] Immunohistochemistry: Histochemical localization of immunoreactive substances using labeled antibodies as reagents. [NIH] Implantation: The insertion or grafting into the body of biological, living, inert, or radioactive material. [EU] Infarction: 1. the formation of an infarct. 2. an infarct. [EU] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Innervation: 1. the distribution or supply of nerves to a part. 2. the supply of nervous energy or of nerve stimulus sent to a part. [EU] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulindependent diabetes mellitus. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Lesion: Any pathological or traumatic discontinuity of tissue or loss of function of a part. [EU] Libido: Sexual desire. [EU] Locomotor: Of or pertaining to locomotion; pertaining to or affecting the locomotive apparatus of the body. [EU] Malaise: A vague feeling of bodily discomfort. [EU] Malignant: Tending to become progressively worse and to result in death. Having the properties of anaplasia, invasion, and metastasis; said of tumours. [EU] Mediator: An object or substance by which something is mediated, such as
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(1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Medullary: Pertaining to the marrow or to any medulla; resembling marrow. [EU] Microsomal: Of or pertaining to microsomes : vesicular fragments of endoplasmic reticulum formed after disruption and centrifugation of cells. [EU]
Morphogenesis: The development of the form of an organ, part of the body, or organism. [NIH] Mutagenesis: Process of generating genetic mutations. It may occur spontaneously or be induced by mutagens. [NIH] Myopathy: Any disease of a muscle. [EU] Nausea: An unpleasant sensation, vaguely referred to the epigastrium and abdomen, and often culminating in vomiting. [EU] Nephrology: A subspecialty of internal medicine concerned with the anatomy, physiology, and pathology of the kidney. [NIH] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neuropathy: A general term denoting functional disturbances and/or pathological changes in the peripheral nervous system. The etiology may be known e.g. arsenical n., diabetic n., ischemic n., traumatic n.) or unknown. Encephalopathy and myelopathy are corresponding terms relating to involvement of the brain and spinal cord, respectively. The term is also used to designate noninflammatory lesions in the peripheral nervous system, in contrast to inflammatory lesions (neuritis). [EU] Neurotransmitter: Any of a group of substances that are released on excitation from the axon terminal of a presynaptic neuron of the central or peripheral nervous system and travel across the synaptic cleft to either excite or inhibit the target cell. Among the many substances that have the properties of a neurotransmitter are acetylcholine, norepinephrine, epinephrine, dopamine, glycine, y-aminobutyrate, glutamic acid, substance P, enkephalins, endorphins, and serotonin. [EU] Nitrates: Inorganic or organic salts and esters of nitric acid. These compounds contain the NO3- radical. [NIH] Osteoarthritis: Noninflammatory degenerative joint disease occurring chiefly in older persons, characterized by degeneration of the articular
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cartilage, hypertrophy of bone at the margins, and changes in the synovial membrane. It is accompanied by pain and stiffness, particularly after prolonged activity. [EU] Outpatients: Persons who receive ambulatory care at an outpatient department or clinic without room and board being provided. [NIH] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of YEASTS. [NIH] Pigmentation: 1. the deposition of colouring matter; the coloration or discoloration of a part by pigment. 2. coloration, especially abnormally increased coloration, by melanin. [EU] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Prazosin: A selective adrenergic alpha-1 antagonist used in the treatment of heart failure, hypertension, pheochromocytoma, Raynaud's syndrome, prostatic hypertrophy, and urinary retention. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychosomatic: Pertaining to the mind-body relationship; having bodily symptoms of psychic, emotional, or mental origin; called also psychophysiologic. [EU] Receptor: 1. a molecular structure within a cell or on the surface characterized by (1) selective binding of a specific substance and (2) a specific physiologic effect that accompanies the binding, e.g., cell-surface receptors for peptide hormones, neurotransmitters, antigens, complement fragments, and immunoglobulins and cytoplasmic receptors for steroid hormones. 2. a sensory nerve terminal that responds to stimuli of various kinds. [EU] Reflex: 1; reflected. 2. a reflected action or movement; the sum total of any particular involuntary activity. [EU] Regeneration: The natural renewal of a structure, as of a lost tissue or part. [EU]
Reoperation: A repeat operation for the same condition in the same patient. It includes reoperation for reexamination, reoperation for disease
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progression or recurrence, or reoperation following operative failure. [NIH] Resorption: The loss of substance through physiologic or pathologic means, such as loss of dentin and cementum of a tooth, or of the alveolar process of the mandible or maxilla. [EU] Serine: A non-essential amino acid occurring in natural form as the Lisomer. It is synthesized from glycine or threonine. It is involved in the biosynthesis of purines, pyrimidines, and other amino acids. [NIH] Serum: The clear portion of any body fluid; the clear fluid moistening serous membranes. 2. blood serum; the clear liquid that separates from blood on clotting. 3. immune serum; blood serum from an immunized animal used for passive immunization; an antiserum; antitoxin, or antivenin. [EU] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Sphincter: A ringlike band of muscle fibres that constricts a passage or closes a natural orifice; called also musculus sphincter. [EU] Symptomatic: 1. pertaining to or of the nature of a symptom. 2. indicative (of a particular disease or disorder). 3. exhibiting the symptoms of a particular disease but having a different cause. 4. directed at the allying of symptoms, as symptomatic treatment. [EU] Synaptic: Pertaining to or affecting a synapse (= site of functional apposition between neurons, at which an impulse is transmitted from one neuron to another by electrical or chemical means); pertaining to synapsis (= pairing off in point-for-point association of homologous chromosomes from the male and female pronuclei during the early prophase of meiosis). [EU] Synergistic: Acting together; enhancing the effect of another force or agent. [EU]
Threonine: An essential amino acid occurring naturally in the L-form, which is the active form. It is found in eggs, milk, gelatin, and other proteins. [NIH]
Tyrosine: A non-essential amino acid. In animals it is synthesized from phenylalanine. It is also the precursor of epinephrine, thyroid hormones, and melanin. [NIH]
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CHAPTER 4. PATENTS ON IMPOTENCE Overview You can learn about innovations relating to impotence by reading recent patents and patent applications. Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.21 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available to patients with impotence within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available to patients with impotence. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information.
21Adapted
from The U. S. Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.
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Patents on Impotence By performing a patent search focusing on impotence, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an example of the type of information that you can expect to obtain from a patent search on impotence: ·
Male impotence diagnostic ultrasound system Inventor(s): Hovland; Claire T. (Minnetonka, MN), Abrams; Jerome H. (St. Paul, MN), Wons; Edward J. (Minnetonka, MN) Assignee(s): UroMetrics Inc. (St. Paul, MN) Patent Number: 6,251,076 Date filed: August 1, 1997 Abstract: An apparatus for diagnosing male impotence by measuring blood velocity in a cavernosal artery of a male penis includes at least one transducer for transmitting/receiving energy and reading corresponding Doppler effect to detect blood velocity in the cavernosal artery, a transducer housing for supporting the transducer in a substantially fixed orientation with respect to the penis as the transducer measures blood velocity in the cavernosal artery, and a fixing device, mechanically coupled to the transducer housing, to substantially mechanically fix the transducer housing in place with respect to the penis and hold the at least one transducer in a substantially constant angular orientation with respect to the cavernosal artery during an impotence diagnostic procedure. Corresponding methods are also disclosed. Excerpt(s): Male impotence is defined as the chronic inability to attain and/or maintain an erection of sufficient rigidity for sexual intercourse. This problem affects approximately 10 million American men, with increasing incidence in those of advanced age. Impotence is a source of great anxiety for many and is the subject of many thousands of visits to physicians and other medical professionals every year. ... During a normal erection, neurochemical stimulation causes penile arterial inflow to increase in the paired cavernosal arteries. The result is increased blood flow into the corpora cavernosa. The subtunical venus plexus is compressed against the tunica albuginea, and venous outflow is reduced
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to trap blood in the corpora cavernosa. This combination of increased inflow and decreased outflow results in vascular congestion of the penis, tumescence, and rigidity sufficient for sexual intercourse. It is believed that abnormal reduction of blood flow to the cavernosal arteries and/or excess venal outflow, i.e. corporal venous leakage, are the primary physical causes of impotence. These abnormal blood flow characteristics to and from the cavernosal arteries can be caused by a number of factors, for example atherosclerotic vascular disease, traumatic arterial occlusive disease, or defective venoocclusive mechanisms. ... Quam, J.P., et al., "Duplex and Color Doppler Sonographic Evaluation of Venogenic Impotence," AJR, 1989; 159:1141-7. Web site: http://www.delphion.com/details?pn=US06251076__ ·
Powered external vacuum appliance for the treatment of impotence Inventor(s): Gamper; Steven C. (Atlanta, GA), Rowley; David S. (Smyrna, GA), Flynn; Stephen J. (Peachtree City, GA), Moore; Devin L. (Decatur, GA), McMillan; John A. (Atlanta, GA), Mitchell; John M. (Martinez, GA), Carroll; Maureen (Atlanta, GA) Assignee(s): Timm Medical Technologies, Inc. (Eden Prairie, MN) Patent Number: 6,248,059 Date filed: May 3, 1996 Abstract: Pump assisted vacuum therapy impotence treatment apparatus may be provided in either electric or manually operated embodiments. The axis of a pump housing affixed to a vacuum chamber via an elastomeric coupler is at an angle to the vacuum chamber axis, and turned towards a user's torso to be drawn into the user's body for better vacuum sealing. The pump cylinder of a manual embodiment has an enlarged annular rest area for receiving a resilient skirt around the piston head during nonuse of the pump. This prevents compression set of the resilient skirt, for more reliable subsequent use of the pump. The vacuum chamber is tapered and transitions from a relatively smaller round end for receipt of a male sex organ to a relatively larger oval shaped end for bayonet mounting on the resilient coupler. A pair of sizing inserts adjusts the vacuum chamber end which receives the male sex organ. The smaller of the two inserts recesses into the larger insert, which improves the vacuum seal formed with the larger insert. The inserts help reduce scrotal tissue intake. Excerpt(s): The present invention relates in general to improved impotence treatment appliances and, in particular to pump assisted vacuum therapy impotence treatment technology improved for
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reliability, performance, and user controlled convenience. ... The medical condition of male impotence (i.e., the inability to achieve adequate penile erection for sexual intercourse) has been the subject of significant medical and scientific attention. Various therapies, both surgical and nonsurgical, have been previously made available for treating male impotence. One nonsurgical therapy generally involves the therapeutic use of a vacuum chamber for producing penile engorgement by drawing blood into the erectile bodies of the user's male sex organ, i.e., penis, by using a vacuum. The user's penis is placed within a vacuum chamber or cylinder. With a relative vacuum seal established between the user's body and such vacuum chamber, negative pressure or vacuum is produced within the chamber, leading to vacuum induced engorgement. An elastic cincture band or similar device is then used to secure the engorged condition of the male sex organ. ... Because vacuum therapy impotence treatment requires some physical manipulations, the user's dexterity and strength are inherently involved in the process. With some patients, particularly if advanced age, disease, or other degenerative physical condition is involved, the physical aspects of the therapy may be more significant than with other more generally fit or capable patients. Because of the sensitive nature of the therapy involved, the reliability of any system or technology and its ease of use can be other significant factors in the overall success of the therapy for a given patient. Web site: http://www.delphion.com/details?pn=US06248059__ ·
Use of cGMP-phosphodiesterase compositions to treat impotence
inhibitors
in
methods
and
Inventor(s): Daugan; Alain Claude-Marie (Les Ulis, FR) Assignee(s): ICOS Corporation (Bothell, WA) Patent Number: 6,140,329 Date filed: March 10, 1998 Abstract: The use of (6R,12aR)-2,3,6,7,12,12a-hexahydro-2-methyl-6-(3,4methylenedioxyphenyl)-p yrazino[2',1':6,1]pyrido[3,4-b]indole-1,4-dione, (3S 6R,12aR)-2,3,6,7,12,12a-hexahydro-2,3-dimethyl-6-(3,4methylenedioxyhenyl) -pyrazino[2',1':6,1]pyrido[3,4-b]indole-1,4-dione, and physiologically acceptable salts and solvates thereof, in methods and compositions for the treatment of impotence. Excerpt(s): This invention relates to the use of tetracyclic derivatives which are potent and selective inhibitors of cyclic guanosine 3',5'monophosphate specific phosphodiesterase (cGMP specific PDE) in the treatment of impotence. ... Impotence can be defined as a lack of power,
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in the male, to copulate and may involve an inability to achieve penile erection or ejaculation, or both. More specifically, erectile impotence or dysfunction may be defined as an inability to obtain or sustain an erection adequate for intercourse. Its prevalence is claimed to be between 2 and 7% of the human male population, increasing with age, up to 50 years, and between 18 and 75% between 55 and 80 years of age. Web site: http://www.delphion.com/details?pn=US06140329__ ·
Composition for treating impotence in men containing dried roe and yohimbine Inventor(s): Omar; Lotfi Ismail (P.O. Box F396, Kew Gardens, NY 11415) Assignee(s): none reported Patent Number: 6,086,884 Date filed: February 7, 1998 Abstract: A composition for treating impotence in human males contains a synergistic mixture of dried sturgeon roe and yohimbine hydrochloride wherein the weight percent ratio of said dried sturgeon roe:yohimbine hydrochloride is from about 25:1 to 1000:1, with an optimum ratio of about 132:1. The roe can be dried via either lyophilization or air drying under ambient temperature and pressure with reduced environmental humidity. A method of treating impotence in human males includes administration of such compositions containing the synergistic mixture of roe and yohimbine. Also, a method of treating impotence in human males by administration of dried roe in doses of from 300 to 900 mg. The roe is prepared either via lyophilization or air drying under ambient temperature and pressure with reduced environmental humidity. Excerpt(s): The instant invention relates generally to a composition for treating impotence in men that relieves erectile dysfunction and enhances sexual desire, and specifically to a composition for treating impotence by using fish roe either alone or in combination with yohimbine. The invention relates also to methods of preparing fish roe for use as a pharmaceutical product to treat impotence and for incorporation into the compositions of the present invention. ... Therapies for treating impotence are known in the art. These include the compositions and treatment methods described below. ... Testosterone and its derivatives are obtained only by prescription. They are administered orally or via injection, buccal tablets or other pharmaceutical dosage forms. The main use is for hypogonadism, male climactric and impotence. Testosterone also has other applications in medicine. As with other hormonal treatments, during administration of exogenous testosterone,
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endogenous testosterone release is inhibited through the negative feedback mechanism of pituitary lutenizing hormone (LH, or lutropin). Web site: http://www.delphion.com/details?pn=US06086884__ ·
Compositions for topical treatment of erectile impotence Inventor(s): Curri; Sergio (Milan, IT) Assignee(s): Inpharma S.A. (Lugano, CH) Patent Number: 6,013,277 Date filed: March 8, 1996 Abstract: Description of pharmaceutical or cosmetic compositions aimed at improving the local microcirculation of the penis for chronic topical treatment of vascular impotence due to vascular causes, with main impairment of the arterial-arteriolar afferents of the cavernous bodies. The new pharmacological properties of the complex between PGE1 and/or Troxerutine with Phosphatidylcholine are administered locally on the skin of the penis; the activity is obtained using the T.E.B. system according to Curri. Excerpt(s): This invention refers in general to pharmaceutical or cosmetic compositions aimed at improving local microcirculation of the penis in conditions such as erectile impotence of vascular origin in which the cause of the dysfunction is attributable to a deficiency in blood flow to the cavernous bodies. ... It is known that during the last few years the pathogenetic question as to the real cause of erectile impotence has continued to place ever increasing emphasis on the vascular origin of the problem rather than on the psychological causes. This is due to the continuous improvement of the instrumental techniques available for diagnosis. In a consistent number of cases of impotence it is, therefore, now possible to identify the organic (and not simply functional) origin of the affliction. ... This obviously means that medical treatment of impotence reverts less to psychotherapy, favouring drugs or methods that enable adequate treatment of local vascular deficiencies. Web site: http://www.delphion.com/details?pn=US06013277__
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·
Method for counteracting vasospasms, ischemia, renal failure, and treating male impotence using calcitonin gene related peptide Inventor(s): Wimalawansa; Sunil J. (907 Laurel Field, Friendswood, TX 77546) Assignee(s): none reported Patent Number: 5,958,877 Date filed: May 18, 1995 Abstract: The present invention provides a method for counteracting vasospasms and treating male impotence using calcitonin gene-related peptide (CGRP). CGRP is a naturally occurring substance in the human body. As such, CGRP does not have the same toxicity and allergy problems as the foreign substances that currently are used for similar purposes. When locally applied or infused, the effects of CGRP are limited to a local vascular area. Virtually no systemic effects are induced, making CGRP extremely safe and effective. Excerpt(s): The present invention relates to the local administration of calcitonin gene-related peptide (CGRP) to treat male impotence, and to prevent vasospasms induced by vasoconstrictor peptides, particularly during angioplasty or to prevent reocclusion of blood vessels during and/or after either angioplasty, stent insertion, or the implantation of a vascular graft. ... The present invention provides a method for counteracting vasospasms and treating male impotence using calcitonin gene-related peptide (CGRP). CGRP is a naturally occurring vasodilator substance in the human body. As such, CGRP does not have the same toxicity and allergy problems as the foreign substances that currently are used for similar purposes. When locally applied or infused, the effects of CGRP are limited to a local vascular area. Virtually no systemic effects are induced, making CGRP extremely safe and effective. ... Where CGRP is used to treat impotence, topical application directly on the penis in the form of a cream is preferred. Any pharmaceutically acceptable preparation may be used, in particular a preferred cream being Aquaphore, which is commercially available from Beiersdorf Inc., Norwalk, Conn. The concentration of CGRP in the cream should range from about 1-3 nmol, and in one preferred embodiment be about 2.5 nmol/ml. In a preferred embodiment, the CGRP is conjugated to linolenic acid--a naturally occurring polyunsaturated fatty acid--as an ester. (Acetoxymethyl acetate or acetoxymethyl esters can also be used for this purpose instead of linolenic acid.) This CGRP ester (conjugate) may be prepared using an automated peptide synthesizer and known methods. Alternately, the CGRP ester may be prepared by reacting the
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CGRP and linolenic acid using carbodiimide, glutaraldehyde, or a similar compounds, as a coupling agent. Web site: http://www.delphion.com/details?pn=US05958877__ ·
External device for eluding masculine impotence Inventor(s): Vergara; Roberto Jose Romero (Turina 10-1o., 47006 Valladolid, ES) Assignee(s): none reported Patent Number: 5,928,134 Date filed: January 30, 1997 Abstract: An external device for eluding masculine impotence, comprising: (A) SUPPORT, with a rigid core and a softer lining, it lies along the penis, to which it communicates its rigidity, since both are enveloped in a preservative. To avoid tautness, rubbing and pinching, the inner side of the preservative is previously wetted with an aqueous type lubricant. (B) FASTENER, made of rigid material, is attached to said support by means of two hinges, thus maintaining the support in its proper place despite the effort exerted during its use. (C) TIE, made of soft, flexible material, maintains the fastener well tightened to the body by pulling from it from the front and rear. It is useful for coitus performance when the erection is nonexistent or insufficient in intensity or duration. Excerpt(s): Masculine impotence is the male's inability to achieve and maintain an erection to a sufficient degree for full coitus performance. ... The rigidity in a normal erection is caused by the swelling of the cavernous bodies: two erectile tubes contained in the penis which are attached to the pubic bone by the penis' suspensory ligament. In order to maintain an erection, a 40 to 60 milliliter/minute blood flow is necessary. The length of an erect penis normally varies from 8 to 16 centimeters; its circumference perimeter, from 8 to 11 centimeters. However, impotence is a matter of rigidity, not size: the penetrating force in the vagina under normal circumstances is approximately 5 newtons (i.e. half a kilo), an exercise which is possible only if the penis acquires a sufficient rigidity; simply increasing the size is not enough. ... The majority of men are said to suffer an erectile disfunction at some time in their lives. However, a severe condition arises on reaching a 20% failure index. The causes of impotence can be: a) Of a psychic or mental source, such as life traumas, sense of guilt, apprehension of failure, etc., and generally any emotionally stressing condition, including a subconscious one. b) Of a physical or organic source, such as certain ailments, medicines,
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alcoholism, drug addiction, neurological, hormonal and vascular problems (blood irrigation), and sequelae from traumatisms, malformations, etc., namely deriving from anatomic and metabolic alterations. Causes of a psychic and organic nature can be simultaneously present in one same individual. Web site: http://www.delphion.com/details?pn=US05928134__ ·
Transurethral administration of vasoactive agents to treat peripheral vascular disease, related vascular diseases, and vascular impotence associated therewith Inventor(s): Place; Virgil A. (Kawaihae, HI), Hanamoto; Mark S. (Belmont, CA), Doherty, Jr.; Paul C. (Cupertino, CA), Spivack; Alfred P. (Menlo Park, CA), Gesundheit; Neil (Los Altos, CA), Bennett; Sean R. (Denver, CO) Assignee(s): VIVUS, Inc. (Mountain View, CA) Patent Number: 5,919,474 Date filed: October 28, 1997 Abstract: A method for treating peripheral vascular disease (PVD), related vascular diseases, and vascular impotence associated with such diseases, is provided. The method involves transurethral administration of a pharmaceutical formulation containing a selected vasoactive agent within the context of an effective dosing regimen. Preferred vasoactive agents are vasodilating agents selected from the group consisting of naturally occurring prostaglandins, synthetic prostaglandin derivatives, and combinations thereof. The pharmaceutical formulations used in conjunction with the novel method may also contain enzyme inhibitors, transurethral permeation enhancers, carriers, preservatives, surfactants, and the like. Kits and pharmaceutical formulations are provided as well. Excerpt(s): In addition, atherosclerotic PVD, involving the distal aortoiliac arteries and trauma to those vessels, are thus a common cause of vascular impotence. Individuals suffering from such vascular impotence generally have diminished or substantially absent femoral pulses, and generally present with Leriche's syndrome, although claudication may be absent in some cases. Furthermore, atherosclerotic macro- and microvascular disease are major factors contributing to erectile dysfunction in from 30 to 50 per cent of diabetic men who develop impotence. ... The present invention is directed to a novel method of treating the aforementioned vascular diseases as well as a novel method for treating vascular impotence as may be associated with such diseases. The treatment involves transurethral administration of a
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vasoactive agent, particularly a vasodilating agent, as will be described in detail herein. ... Transurethral administration of pharmacologically active agents has been described. For example, U.S. Pat. No. 4,478,822 to Haslam et al. relates to a controlled release, thermosetting gel formulation for delivering drugs into a body cavity such as the urethra. Also, U.S. Pat. No. 4,610,868 to Fountain et al. describes a biodegradable lipid matrix composition for administering a drug, wherein the composition is stated to be deliverable through the urethra. Basile et al. (1994), "Medical Treatment of Neurogenic Impotence," Sexual Disabilities 12(1):81-94 describes the intraurethral administration of drugs. PCT Publication No. WO91/16021, U.S. Pat. No. 4,801,587 to Voss et al., and U.S. Pat. No. 5,242,391 to Place et al. relate to the treatment of erectile dysfunction by administration of vasoactive agents into the male urethra. While these references mention urethral drug delivery, the potential importance of administering specific drugs in this manner to induce a desired local or systemic effect has only recently been recognized. Further, applicant is unaware of any art disclosing the effectiveness of transurethral administration of vasoactive agents in the treatment of PVD or PVD-associated vascular impotence. Web site: http://www.delphion.com/details?pn=US05919474__ ·
Device for percutaneous administration of medicaments for treating male impotence Inventor(s): Millot; Philippe (Dijon, FR), Lamoise; Michel (Bessey-lesCiteaux, FR) Assignee(s): Laboratoires D'Hygiene et de Dietetique (L.H.D.) (Paris, FR) Patent Number: 5,899,875 Date filed: May 12, 1997 Abstract: A device for the percutaneous administration of a medicament for treating male impotence comprises two reservoirs (1,2) hydratable with a medicament solution and intended to be applied to the skin of the penis. The reservoirs are mounted on substantially cylindrical braceletshaped means (8) with an elastically expansible diameter to support and press the reservoirs (1,2) against said skin during the treatment. The device includes a sensor which is fixed on the bracelet and is sensitive to the expansion of the bracelet in order to deliver a signal to the user. Excerpt(s): The present invention relates to a device for percutaneous administration of a medicament for treating male impotence and, more particularly, to such a device comprising at least one reservoir which can be moisturized with a solution of the medicament and is designed to bear
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on the skin of the penis. ... Organic male impotence, that is to say erectile dysfunction, is in most cases of iatrogenic, hormonal, vascular or psychologic origin. Attempts have hitherto been made to treat this condition in some cases by injecting papaverine into the cavernous bodies of the penis. This technique presents various disadvantages. The administration of papaverine by injection is on the one hand painful and on the other hand dangerous. This is because it can result, in the long term, in irreversible lesions, such as the appearance of fibrous plates or nodules in the cavernous bodies. It sometimes also causes excessively prolonged erections, which have to be treated with other injections in order to reduce them. It has also been proposed to treat erectile dysfunction by purely mechanical means consisting of a pneumatic vacuum device which is fitted around the penis in order to provoke its erection. A ring then blocks any escape of blood from the cavernous bodies. ... The present invention therefore has the aim of making available a device for treating male impotence which does not have any of these disadvantages and which thus ensures that this condition is treated in a manner which is painless, straightforward and without danger. Web site: http://www.delphion.com/details?pn=US05899875__ ·
Use of odorants to treat male impotence, and article of manufacture therefor Inventor(s): Hirsch; Alan R. (180 E. Pearson #4702, Chicago, IL 60611) Assignee(s): none reported Patent Number: 5,885,614 Date filed: February 23, 1996 Abstract: A method is provided for inducing or enhancing penile erection through the delivery of odorants for inhalation. The administration of odorants provides an increase in blood flow to the penis, and a therapeutic aid to stimulate sexual activity and alleviate male vasculogenic impotence. Excerpt(s): Male erectile dysfunction, or impotence, is the inability to achieve or sustain an erection of sufficient rigidity to have sexual intercourse. The causes of impotence are psychological and/or organic (i.e., endocrinologic, neurogenic and vasculogenic). Ten to fifteen percent of male impotence is organic in nature. Organic causes can be from local lesions of the genitalia, endocrine diseases, organic lesions of the nervous system, and/or vasculogenic impotence from reduced blood flow is the most common organic cause usually seen in diabetes. Impotence may be
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a side effect of a therapeutic drug or associated with a disease such as multiple sclerosis, diabetes and sickle cell anemia, and can be exacerbated by smoking, inadequate diet among other factors. Emotional disturbances, including stress, fatigue or distraction, can also cause impotence. ... Alteration of blood flow to and from the penis is considered to be the most frequent organic cause of impotence. Vasculogenic impotence results from either arterial occlusion, i.e., the obstruction of adequate blood flow to the penile arteries, or excess venal outflow (cavernovenous leaking). ... Treatment of impotence can include counseling directed toward dealing with the male's insecurities and feelings to reduce fears of sexual performance. Treatments for male impotence include surgery, penile prostheses implants including flexible rods and inflatable balloons, drugs such as vasodilators given to induce an erection as an ointment for topical application or a solution for transurethral injection, and external aids such as penile splints to support the penis or constricting rings to alter the blood flow through the penis. A drawback of those systems is their invasiveness, unwanted side effects, cost, inconvenience, and complexity. Web site: http://www.delphion.com/details?pn=US05885614__ ·
Use of 5HT.sub.3 antagonist to treat impotence Inventor(s): Nomura; Kazuhiko (Tsukuba, JP), Yamaguchi; Isamu (Kawanishi, JP) Assignee(s): Fujisawa Pharmaceutical Co., Ltd. (Osaka, JP) Patent Number: 5,750,537 Date filed: March 17, 1997 Abstract: An impotence remedy containing a 5HT.sub.3 antagonist as the active ingredient. Excerpt(s): The present invention relates to a therapeutic agent for impotence which comprises a 5HT.sub.3 antagonist as the active ingredient, and is useful in the medical field. ... Recently, the need for a therapeutic agent for impotence has been growing clinically. Although there is a therapeutic method for impotence in which vasoactive drugs such as papaverine or PGE1 are injected directly in corpus cavernosum, this method is not desirable because of some undesirable side effects or the methodology. Consequently, the development of an effective oral therapeutic agent for impotence has been needed. Up to the present, however, the effects of conventional oral drugs which were considered to be beneficial for impotence has been proved to be unsatisfactory, because of their poor efficacy, their safety, or undesirable side effects. ... The object
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of the present invention is to provide a novel and effective medicine for the treatment of impotence. Web site: http://www.delphion.com/details?pn=US05750537__ ·
Medication for impotence containing lyophilized roe and a powdered extract of Ginkgo biloba Inventor(s): Omar; Lotfy Ismail (P.O. Box F396, Kew Gardens, NY 11415) Assignee(s): none reported Patent Number: 5,730,987 Date filed: June 10, 1996 Abstract: A composition for treating impotence in human males is disclosed, which includes a mixture of lyophilized roe and a dry powdered extract from leaves of Ginkgo biloba. The lyophilized roe is obtained from a species of Sturgeon. The dry powdered extract is standardized to include flavonoid glycosides and terpenes. The mixture preferably provides lyophilized roe to lyophilized Ginkgo biloba in the ratio of approximately 12.33:1. The composition is preferably encapsulated and orally given to patients. A process for producing the composition is also provided. Excerpt(s): The instant invention relates generally to a medication for impotence that relieves erectile dysfunction and enhances a man's sexual desire. ... Caverject is a brand name marketed and available only by prescription. It is the synthetic version of alprostadil (prostaglandin E) which the body uses to help produce an erection. The medication is to be injected directly into the penis shortly before intercourse. It relaxes smooth muscle tissue in the penis which in turn enhances blood flow to the penis and causes erection. Caverject is often effective for men whose impotence is due to diabetic complications, anxiety or radical prostatectomy. One of the major drawbacks of caverject is that the subject, after injection, may have long lasting painful erection (priapism), which may last more than 6 hours and cause serious and permanent damage to the delicate spongy structure of the penis which may never again function properly. ... It is, therefore, an object of the present invention to provide a medication for impotence which will achieve positive effects on the libido and the penile erection, both of which are necessary to result in successful copulation. Web site: http://www.delphion.com/details?pn=US05730987__
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·
Treatment of male impotence with s-nitrosylated compounds Inventor(s): Stamler; Jonathan (Boston, MA), Loscalzo; Joseph (Dedham, MA), Slivka; Adam (Randolph, MA), Simon; Daniel (Waban, MA), Brown; Robert (Natick, MA), Drazen; Jeffrey (Winchester, MA) Assignee(s): Brigham & Women's Hospital (Boston, MA) Patent Number: 5,648,393 Date filed: August 29, 1994 Abstract: Methods of relaxing corpus cavernosum smooth muscle, treating disease states responsive to prevention or relaxation of undesirable contractions of corpus cavernosum smooth muscle and of treating male impotence by administering an S-nitrosothiol such as a low molecular weight S-nitrosothiol, S-nitroso-ACE-inhibitor or S-nitrosoprotein. Excerpt(s): This invention relates to the use of low molecular weight Snitrosothiols, such as S-nitroso-N-acetylcysteine, S-nitroso-glutathione, Snitroso-homocysteine, S-nitroso-cysteine, S-nitroso-penicillamine and Snitroso-captopril, to relax non-vascular smooth muscle. Types of smooth muscle include airway, gastrointestinal, bladder uterine, and corpus cavernosum. The invention also relates to the use of S-nitrosothiols for the treatment or prevention of disorders which involve non-vascular smooth muscle, such as respiratory disorders, gastrointestinal disorders, urological dysfunction, impotence, uterine dysfunction or premature labor. The invention also relates to the use of S-nitrosothiols or ameliorate smooth muscle contraction or spasm and thus, facilitate diagnostic or therapeutic procedures, such as bronchoscopy, endoscopy, laparoscopy, and cystoscopy. S-nitrosothiols may also be used to increase hemoglobinoxygen binding, and thus enhance oxygen transport to bodily tissues. ... In summary, the relaxation kinetics of non-vascular smooth muscle are very important in numerous physiological system. Moreover, a variety of significant clinical disorders occur, which involve contraction, spasm, or failure to achieve the necessary relaxation of smooth muscle. Examples of such disorders include airway obstruction (i.e., asthma, bronchitis and emphysema), bladder dysfunction, gastrointestinal muscle spasm (i.e., irritable bowel syndrome, achalasia, dumping disorders), and impotence. Thus, a clinical need exists for pharmacological agents which can treat or prevent such disorders by inducing relaxation of the affected smooth muscle. ... The invention is also directed to the use of S-nitrosothiols for the treatment or prevention of disorders associated with relaxation of smooth muscle, such as airway obstruction, gastrointestinal spasm, bladder dysfunction and impotence. The invention is also directed to the use of S-nitrosothiols to alleviate smooth muscle contraction and spasm,
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and thus facilitate procedures involving diagnostic instrumentation such as endoscopy and bronchoscopy. Web site: http://www.delphion.com/details?pn=US05648393__ ·
Methods for treating erectile impotence Inventor(s): Kral; John G. (23 Prospect Ave., Larchmont, NY 10538) Assignee(s): none reported Patent Number: 5,583,144 Date filed: February 24, 1995 Abstract: The present invention relates to methods of relieving erectile impotence in a human male. The method comprises administering to the male an erectile impotence relieving amount of piperoxan and the compositions include an erectile impotence relieving amount of piperoxan or the pharmaceutically acceptable acid addition salts thereof optionally in combination with a pharmaceutically acceptable carrier. Excerpt(s): The present invention relates to compositions and methods for treating male erectile impotence and more particularly to pharmaceutical compositions comprising erection enhancing compounds and methods of their use for the treatment of human erectile impotence. ... Impotence is the inability to obtain and sustain an erection sufficient for intercourse. Erection is achieved as a result of arterial inflow into the corpus cavernosum of the penis, which produces engorgement of the corpus cavernosum, and subsequent penile erection. According to a 1993 National Institutes of Health Consensus Panel, it is estimated that as many as 30 million American men experience some degree of erectile dysfunction, the prevalence of which increases with age (NIH Consensus Statement, Vol 10(4): 1-31, (1992)). Fifteen to twenty-five percent of all men 65 years and older suffer from some sort of erectile dysfunction, but the disease is also experienced by as many as five percent of men age 40 years. Half of diabetic men exhibit erectile dysfunction. An increased prevalence of the disease is also associated with hypogonadism, hypertension, high blood cholesterol, drugs, neurogenic disorders, Peyronie's disease, priapism, depression, and renal failure (NIH Consensus Statement, Vol 10(4):1-31, (1992)). ... The causes of impotence are usually divided into two subcategories a) organic and b) psychological. The organic aspects of impotence are caused by underlying vascular disease such as that associated with hypertension, diabetes mellitus, and prescription medications. Conservative estimates indicate that half of all cases of impotence are of vascular origin. Because the physiologic process of erection is initiated by an increase in blood
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flow through the penile arteries and shunting of blood into the vascular spaces of the corpus cavernosum, erectile dysfunction can result from vasculogenic disorders. Since erection necessarily involves vasodilation of the arteries of the penis, the pathophysiologic basis of impotence can be contributed to the inability of the arteries of the penis to vasodilate, thereby inhibiting the flow of blood into the erectile tissue. Web site: http://www.delphion.com/details?pn=US05583144__
Patent Applications on Impotence As of December 2000, U.S. patent applications are open to public viewing.22 Applications are patent requests which have yet to be granted (the process to achieve a patent can take several years). The following patent applications have been filed since December 2000 relating to impotence: ·
Method of treating for impotence and apparatus particularly useful in such method Inventor(s): Sheinman, Shuki ; (Raanana, IL), Sidi, Abraham Ami ; (Ramat Gan, IL), Yacobi, Yacov ; (Kiryat Ono, IL) Correspondence: Birch Stewart Kolasch & Birch; PO Box 747; Falls Church; VA; 22040-0747; US Patent Application Number: 20010007080 Date filed: February 22, 2001 Abstract: A method and apparatus for treating a male for impotence, i.e., for enabling, or improving the ability of, the male to achieve or maintain a penile erection of adequate rigidity for sexual intercourse, by applying monochromatic light radiation, preferably low-power laser radiation of a wavelength of 440 nm, to the penis of the male, sufficient to induce relaxation of the walls of the blood vessels supplying blood to the corpora cavernosa of the penis. Excerpt(s): The invention relates to a method of treating a male for impotence, namely a male's inability to achieve or maintain a penile erection of adequate rigidity for sexual intercourse. The invention also relates to apparatus for irradiating an object with monochromatic light, preferably a laser beam, which apparatus is particularly useful in such method. ... erectile tissue disfunction impotence, secondary to fibrosis, trauma, diabetes, tumor infiltration and others. ... An object of the present invention is to provide a novel method of treating a male for impotence,
22
This has been a common practice outside the United States prior to December 2000.
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i.e., for enabling, or improving the ability of, the male to achieve penile erection of adequate rigidity for sexual intercourse, which method has advantages in one or more of the above respects. Another object of the invention is to provide apparatus for irradiating an object with light radiation, preferably laser radiation, which apparatus is particularly useful in the above method but could conceivably be used in other applications. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
Keeping Current In order to stay informed about patents and patent applications dealing with impotence, you can access the U.S. Patent Office archive via the Internet at no cost to you. This archive is available at the following Web address: http://www.uspto.gov/main/patents.htm. Under “Services,” click on “Search Patents.” You will see two broad options: (1) Patent Grants, and (2) Patent Applications. To see a list of granted patents, perform the following steps: Under “Patent Grants,” click “Quick Search.” Then, type “impotence” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on impotence. You can also use this procedure to view pending patent applications concerning impotence. Simply go back to the following Web address: http://www.uspto.gov/main/patents.htm. Under “Services,” click on “Search Patents.” Select “Quick Search” under “Patent Applications.” Then proceed with the steps listed above.
Vocabulary Builder Acetylcysteine: The N-acetyl derivative of cysteine. It is used as a mucolytic agent to reduce the viscosity of mucous secretions. It has also been shown to have antiviral effects in patients with HIV due to inhibition of viral stimulation by reactive oxygen intermediates. [NIH] Angioplasty: Endovascular reconstruction of an artery, which may include the removal of atheromatous plaque and/or the endothelial lining as well as simple dilatation. These are procedures performed by catheterization. When reconstruction of an artery is performed surgically, it is called endarterectomy. [NIH] Aqueous: Watery; prepared with water. [EU] Arteriolar: Pertaining to or resembling arterioles. [EU]
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Bronchitis: Inflammation of one or more bronchi. [EU] Bronchoscopy: Endoscopic examination, therapy or surgery of the bronchi. [NIH]
Buccal: Pertaining to or directed toward the cheek. In dental anatomy, used to refer to the buccal surface of a tooth. [EU] Calcitonin: A peptide hormone that lowers calcium concentration in the blood. In humans, it is released by thyroid cells and acts to decrease the formation and absorptive activity of osteoclasts. Its role in regulating plasma calcium is much greater in children and in certain diseases than in normal adults. [NIH] Captopril: A potent and specific inhibitor of peptidyl-dipeptidase A. It blocks the conversion of angiotensin I to angiotensin II, a vasoconstrictor and important regulator of arterial blood pressure. Captopril acts to suppress the renin-angiotensin system and inhibits pressure responses to exogenous angiotensin. [NIH] Coitus: Sexual connection per vaginam between male and female. [EU] Conjugated: Acting or operating as if joined; simultaneous. [EU] Copulation: Sexual contact of a male with a receptive female usually followed by emission of sperm. Limited to non-human species. For humans use coitus. [NIH] Cystoscopy: Direct visual examination of the urinary tract with a cystoscope. [EU] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Emphysema: A pathological accumulation of air in tissues or organs; applied especially to such a condition of the lungs. [EU] Endogenous: Developing or originating within the organisms or arising from causes within the organism. [EU] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Femoral: Pertaining to the femur, or to the thigh. [EU] Glycoside: Any compound that contains a carbohydrate molecule (sugar), particularly any such natural product in plants, convertible, by hydrolytic cleavage, into sugar and a nonsugar component (aglycone), and named specifically for the sugar contained, as glucoside (glucose), pentoside (pentose), fructoside (fructose) etc. [EU] Iatrogenic: Resulting from the activity of physicians. Originally applied to disorders induced in the patient by autosuggestion based on the physician's
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examination, manner, or discussion, the term is now applied to any adverse condition in a patient occurring as the result of treatment by a physician or surgeon, especially to infections acquired by the patient during the course of treatment. [EU] Infiltration: The diffusion or accumulation in a tissue or cells of substances not normal to it or in amounts of the normal. Also, the material so accumulated. [EU] Inhalation: The drawing of air or other substances into the lungs. [EU] Irrigation: Washing by a stream of water or other fluid. [EU] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Kinetic: Pertaining to or producing motion. [EU] Laparoscopy: Examination, therapy or surgery of the abdomen's interior by means of a laparoscope. [NIH] LH: A small glycoprotein hormone secreted by the anterior pituitary. LH plays an important role in controlling ovulation and in controlling secretion of hormones by the ovaries and testes. [NIH] Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU] Malformation: A morphologic defect resulting from an intrinsically abnormal developmental process. [EU] Medicament: A medicinal substance or agent. [EU] Microcirculation: The flow of blood in the entire system of finer vessels (100 microns or less in diameter) of the body (the microvasculature). [EU] Penicillamine: 3-Mercapto-D-valine. The most characteristic degradation product of the penicillin antibiotics. It is used as an antirheumatic and as a chelating agent in Wilson's disease. [NIH] Percutaneous: Performed through the skin, as injection of radiopacque material in radiological examination, or the removal of tissue for biopsy accomplished by a needle. [EU] Piperoxan: A benzodioxane alpha-adrenergic blocking agent with considerable stimulatory action. It has been used to diagnose pheochromocytoma and as an antihypertensive agent. [NIH] Plexus: A network or tangle; a general term for a network of lymphatic vessels, nerves, or veins. [EU] Prostaglandins: A group of compounds derived from unsaturated 20carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway. They are extremely potent mediators of a diverse group of physiological processes. [NIH]
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Psychic: Pertaining to the psyche or to the mind; mental. [EU] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Vasoactive: Exerting an effect upon the calibre of blood vessels. [EU] Venus: The second planet in order from the sun. It has no known natural satellites. It is one of the four inner or terrestrial planets of the solar system. [NIH]
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CHAPTER 5. BOOKS ON IMPOTENCE Overview This chapter provides bibliographic book references relating to impotence. You have many options to locate books on impotence. The simplest method is to go to your local bookseller and inquire about titles that they have in stock or can special order for you. Some patients, however, feel uncomfortable approaching their local booksellers and prefer online sources (e.g. www.amazon.com and www.bn.com). In addition to online booksellers, excellent sources for book titles on impotence include the Combined Health Information Database and the National Library of Medicine. Once you have found a title that interests you, visit your local public or medical library to see if it is available for loan.
Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go to http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “impotence” (or synonyms) into the “For these words:” box. You will only receive results on books. You should check back periodically with this database which is updated every 3 months. The following is a typical result when searching for books on impotence: ·
Live Now, Age Later: Proven Ways to Slow Down the Clock Source: New York, NY: Warner Books. 1999. 398 p.
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Contact: Available from Warner Books. 1271 Avenue of the Americas, New York, NY 10020. (800) 759-0190. E-mail:
[email protected]. Website: www.twbookmark.com. Price: $7.99 plus shipping and handling. Summary: This book offers practical strategies and healthy living advice for people who want to slow down their own aging process. The book is written in casual language with an emphasis on explaining medical and health issues for the general public. Twenty chapters cover Alzheimer's disease, cancer, constipation, depression, hearing loss, heart attacks, erectile dysfunction (impotence), insomnia, libido, menopause, osteoarthritis, osteoporosis, prostate enlargement, aging skin, stroke, diminished taste and smell, tinnitus, tooth loss, and loss of vision (macular degeneration, cataracts, glaucoma). Each chapter reviews the topic in question, risk factors, the type of symptoms that can be expected, diagnostic tests that are used to confirm the problem, treatment options, and prognosis. A final section offers general health guidelines that focus on the importance of positive thinking and healthy lifestyle choices. A subject index concludes the book. ·
Mayo Clinic on Managing Diabetes Source: Rochester, MN: Mayo Clinic. 2001. 194 p. Contact: Available from Mayo Clinic Health Information. 200 First Street, S.W., Fifth Floor Centerplace Building, Rochester, MN 55905. (800) 4309699. Website: www.mayoclinic.com. Price: $14.95 plus shipping and handling. ISBN: 1893005062. Summary: This book provides practical and easy to understand information on controlling diabetes and preventing complications of the disease. Part one provides facts about diabetes. Topics include types of diabetes, the signs and symptoms of diabetes, the risk factors for diabetes, and the criteria and tests for diagnosing diabetes. In addition, the issue of diabetic complications is addressed, focusing on hypoglycemia, diabetic hyperosmolar syndrome, diabetic ketoacidosis, neuropathy, nephropathy, retinopathy, heart and blood vessel disease, and increased risk of infection. Part two deals with the components involved in controlling the disease. Chapters discuss monitoring blood glucose, eating a healthy diet, getting daily exercise, and maintaining a healthy weight. Part three examines medical therapies for managing diabetes. Chapters provide information on the use of insulin to manage type 1 and type 2 diabetes; the use of sulfonylureas, meglinitides, biguanides, alpha glucosidase inhibitors, thiazolidinediones, and drug combinations to manage type 2 diabetes; and pancreas and islet cell transplantation as possible cures for diabetes. Part four addresses issues
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related to living well with diabetes. One chapter focuses on important tests every person who has diabetes should be getting, including the glycosylated hemoglobin test, lipid tests, the serum creatinine test, and the urine microalbumin test. Another chapter discusses self care issues, including having annual physical examinations, visiting a dentist regularly, caring for feet, avoiding smoking, monitoring blood pressure, and managing stress. A third chapter explores sexual health issues for both men and women. Topics include the affect of the menstrual cycle and menopause on blood glucose, hormone replacement therapy, pregnancy, and impotence. Each chapter concludes with a question and answer section. The book also includes a list of additional resources. 17 figures. 1 table. ·
Uncomplicated Guide to Diabetes Complications Source: Alexandria, VA: American Diabetes Association. 1998. 256 p. Contact: Available from American Diabetes Association, Inc. Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 442-9742. Website: www.diabetes.org. Price: $18.95 plus shipping and handling. ISBN: 0945448872. Order number 481401. Summary: This book uses a question and answer format to provide information on the symptoms, prevention, treatment, and self-care of diabetes complications. The information presented in the book is intended to help people who have diabetes cope with the uncertainty and fear of developing complications. Chapters cover all major complications: diabetic ketoacidosis, hyperglycemic hyperosmolar nonketotic coma, lactic acidosis, hypoglycemia, foot problems, eye disease and blindness, kidney and heart disease, hypertension and stroke, neuropathy and vascular disease, gastrointestinal problems, skin and dental problems, psychosocial complications, and impotence and other sexual disorders. Chapters also address special concerns such as hypoglycemia and obesity. Many chapters include a case study or studies to illustrate the complications of diabetes. The book concludes with a glossary and an index. 2 appendices. 33 figures. 32 tables.
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Foods That Harm, Foods That Heal: An A-Z Guide to Safe and Healthy Eating Source: Pleasantville, NY: Reader's Digest. 1997. 400 p. Contact: Available from Customer Service, Reader's Digest. Pleasantville, NY 10570. (800) 846-2100. Price: $30.00. ISBN: 0895779129. Summary: This nutrition reference book features more than 400 photographs and illustrations with more than 400 A to Z entries on a vast
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range of foods and health concerns, including caffeine, cancer, diabetes, fast food, garlic, heart disease, influenza, osteoporosis, pregnancy, sexually transmitted diseases, and vegetarianism. The book is designed to help families understand the close links between foods and wellness. Each food entry provides at-a-glance information of its nutrients (or lack of) and its benefits and drawbacks. Each ailment is accompanied by a list of foods and beverages that are considered safe, and what foods or beverages should be cut down or avoided altogether. Case studies help to illustrate various topics. There are special features on eating during different life stages, from infancy to old age, as well as such issues as genetically altered foods, irradiation, pesticides, and pollution. Other topics include how to cook foods to achieve maximum nutritional benefits; which dietary supplements really work; tips on exercise, food storage, and reading food labels; an instructive analysis of the most popular diet regimes; and controversial foods and additives such as eggs, nitrites, bran, cheese, milk, fat, wine, and alcohol. A glossary defines unfamiliar or technical terms; there is also a listing of organizations that can provide further information and resources. Topics specifically related to diabetes include atherosclerosis, basic food groups, blood pressure, carbohydrates, childhood and adolescent nutrition, cholesterol, convenience and fast foods, cravings, diabetes, dieting and weight control, exercise and diet to boost energy and lift mood, eye disorders, fats, fiber, heart disease, hypoglycemia, immune system, impotence, indigestion and heartburn, infertility, juicing, kidney diseases, malnutrition and dietary deficiencies, medicine-food interactions, menopause, minerals, neuralgia, obesity, organic foods, osteoporosis, pregnancy, preparation and storage of food, protein, restaurants and eating out, salt and sodium, sleep and diet, smoking and diet, sports nutrition, stress, stroke, sugar and other sweeteners, supplements, traveler's health, vegetarian diets, and vitamins. ·
Diabetic Man: A Guide to Health and Success in All Areas of Your Life, With Advice, Empathy, and Support for Those Who Have a Diabetic Man in Their Lives Source: Los Angeles, CA: Lowell House, and Chicago, IL: Contemporary Books. 1996. 348 p. Contact: Available from Contemporary Books. 2 Prudential Plaza, Suite 1200, Chicago, IL 60601. (800) 621-1918. Price: $15 (as of 1996). ISBN: 1565654390. Summary: This book, revised in 1996, is primarily addressed to men who have diabetes, but also offers several sections which address the concerns of the wives, partners, and families of men who have diabetes. Topics
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discussed in the book include the physical, psychological, emotional, and social effects and challenges of having diabetes; diet and nutrition; alcohol; sports and exercise; work, employment discrimination, military service, insurance, and government protection; sex and impotence; and travel. The book includes extensive lists of suggested reading and listening materials, several appendices, and a subject index. ·
Getting Help: A Patient's Guide for Men With Impotence Source: Lenexa, KS: Integrated Medical Resources, Inc. 1995. 48 p. Contact: Available from Integrated Medical Resources, Inc. 8326 Melrose Drive, Lenexa, KS 66214. (913) 894-0591. Price: $6.95. Summary: This handbook provides basic information about the diagnosis and treatment of male erectile dysfunction, or impotence. After introductory chapters defining impotence and discussing its causes, the author considers diagnostic issues, including the patient history and physical, specialized blood tests, erection monitoring during sleep, inoffice impotence testing, and other specialized tests. The next chapter outlines treatment options, including sexual counseling, oral medications, testosterone hormone replacement, penile injections, vacuum constriction devices, penile implant surgery, and corrective surgeries. Also included is a chapter on penile curvature and Peyronie's disease. The handbook concludes with two brief sections to help readers determine if they really have a problem and to encourage them to consult a health care provider. A brief index concludes the book. Simple line drawings illustrate many of the concepts.
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Living With Diabetic Complications: A Survival Guide for Patients by a Patient Source: Portland, OR: Outreach Enterprises. 1993. 294 p. Contact: Available from Outreach Enterprises. 2309 Southwest First Avenue, Suite 1842, Portland, OR 97201. (503) 224-9857. Price: $15.95 plus shipping and handling. ISBN: 1560435283. Summary: This book addresses the chronic complications of diabetes. The author discusses current treatments and offers practical living strategies and helpful advice on coping with the emotional and social impact of the complications of diabetes. The manual includes information on recent discoveries and medical advances in the treatment of vision impairment, kidney disease, neuropathy, impotence, heart disease, foot problems, and other chronic complications. The author also gives guidelines for cultivating faith and an optimistic attitude, retaining healthy relationships with family and friends, finding the right doctor, dealing
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with employment and insurance barriers, and enjoying many travel and recreational options. The book concludes with a detailed listing of organizations, publications, products and services and a bibliography of helpful books and articles. 80 references. (AA-M). ·
Diabetic Neuropathy Source: Somerset, NJ: John Wiley and Sons. 1990. 634 p. Contact: Available from John Wiley and Sons, Inc. 1 Wiley Drive, Somerset, NJ 08875. (201) 469-4400. Price: $135. ISBN: 0471924865. Summary: If one considers the unpleasant, painful sensory and muscle wasting syndromes, problems of the neuropathic foot, and the significant contribution to the development of impotence, then diabetic neuropathy must be regarded as the single most common clinical problem associated with complications of diabetes. This symposium report covers all aspects of current research on diabetic neuropathies. Seventy-one chapters are divided into eight sections: an introduction; morphology of human and animal nerve; aldose reductase; vascular factors in diabetic neuropathy; measurement, quantitation, and clinical assessment; autonomic neuropathy; other potential treatments of diabetic neuropathy; and the diabetic foot. Each chapter includes numerous tables, figures, and references for additional research. A detailed subject index is appended.
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Shy Bladder Syndrome: Your Step-by-Step Guide to Overcoming Paruresis Source: Oakland, CA: New Harbinger Publications, Inc. 2001. 147 p. Contact: Available from New Harbinger Publications, Inc. 5674 Shattuck Avenue, Oakland, CA 94609. (800) 748-6273 or (510) 652-2002. Fax (510) 652-5472. Website: www.newharbinger.com. Price: $13.95 plus shipping and handling. ISBN: 1572242272. Summary: This book provides a comprehensive overview of paruresis (shy bladder) and explains what it is, how the condition is diagnosed, and how it can be treated. The author notes that other than erectile dysfunction (impotence) and incontinence (involuntary loss of urine), shy bladder syndrome is perhaps the most embarrassing bodily dysfunction to discuss. The book includes eight chapters that cover a description of the condition and its symptoms; the physiology of the brain, bladder, and urination; determining the causes of bashful bladder syndrome; self treatment for paruresis; adjunct therapies, support groups and workshops; the medical community and paruresis; how family members, intimate partners, and friends can support the patient's recovery; and evolving legal ramifications, including those related to mandatory drug
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testing and the Americans with Disabilities Act (ADA). The book includes many personal stories from people who have shy bladder; these stories are taken from anonymous postings on the International Paruresis Association's (IPA) talk board or from personal communications with the authors. The authors recommend that readers use a journal when reading the book, to help identify and keep track of those issues that are important. Three appendices offer a literature review, a historical overview of the evolution of the bathroom, and resources for additional help. The book concludes with a list of references. 2 figures. 93 references. ·
20 Common Problems in Urology Source: New York, NY: McGraw-Hill, Inc. 2001. 335 p. Contact: Available from McGraw-Hill, Inc. 1221 Avenue of the Americas, New York, NY 10020. (612) 832-7869. Website: www.bookstore.mcgrawhill.com. Price: $45.00;plus shipping and handling. ISBN: 0070634130. Summary: This text on common problems in urology is designed for the primary care provider. The text covers both pediatric and adult conditions and features quick reference algorithms, charts and tables that organize presenting signs and symptoms, diagnostic tests, and treatments. Twenty chapters cover fetal and postnatal hydronephrosis (fluid accumulation in the kidneys), urinary tract infections (UTIs) in children, cryptorchidism (undescended testicles), circumcision, nocturnal enuresis (bedwetting), UTIs in adults, urethritis, urinary incontinence, interstitial cystitis, geriatric urology, hematuria (blood in the urine), prostate cancer screening, benign prostatic hyperplasia (BPH), scrotal mass and pain, genital skin rash, urinary calculi (stones), erectile dysfunction (impotence), male infertility, vasectomy, male menopause, and imaging studies (diagnostic tests). Most chapters define the condition and then discuss the differential diagnosis, the physical examination, recommended diagnostic tests, special considerations, treatment options, and patient care strategies. The text also offers practice advice on when to refer to a specialist and what to expect post-referral. The text concludes with a subject index and is illustrated with black and white photographs and diagrams.
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AAKP Patient Plan. Phase Three: Stabilization Source: Tampa, FL: American Association of Kidney Patients. 2000. 43 p. Contact: Available from American Association of Kidney Patients (AAKP). 100 South Ashley Drive, Suite 280, Tampa, FL 33602. (800) 749AAKP or (813) 223-7099. E-mail:
[email protected]. Website:
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www.aakp.org. Price: Single copy free. Also available for free at http://www.aakp.org/ppbk3.pdf. Summary: This booklet is the third in a four phase series of instructional materials for kidney patients. Published by the American Association of Kidney Patients (AAKP), the booklets are designed to address questions and concerns at various phases of the disease process. The four phases covered are diagnosis and treatment options, access and initiation, stabilization, and ongoing treatment. During each of these phases, the patient can keep control of his or her life by staying active and learning as much as possible about kidney disease and treatment. This third booklet introduces the reader to the idea of stabilization and the importance of continuing to learn about kidney disease. During this phase, the patient has settled into the routine of treatments and medications. The booklet covers optimal dialysis (dialysis adequacy); optimal transplant; family, friends, and social life; work, employment and volunteering; and legal responsibilities. Specific topics include hemodialysis adequacy, peritoneal dialysis adequacy, the importance of nutrition, anemia and how to treat it, the use of erythropoietin (EPO), the role of exercise, the symptoms of transplant rejection, the physical changes that may accompany transplant, how to handle stress, erectile dysfunction (impotence) and its treatment, how to talk about end stage renal disease (ESRD) in a new relationship, strategies to help the ongoing adjustment to ESRD, the Americans With Disabilities Act (ADA), the ESRD Networks and how they can help, and how to report a grievance to the Network. The booklet concludes with a glossary of terms and an appendix that lists information resources, ESRD networks, questions to ask the health care team, and forms to record important medical information. The booklet encourages readers to educate themselves and become active members of their own health care team. There are quotes and suggestions from other kidney patients sprinkled throughout the text. When readers are finished with the book, there is a postage paid card to send in to receive the fourth booklet. The booklet is illustrated with black and white photographs and tables. 3 figures. 8 tables. ·
Beyond Viagra: Plain Talk About Treating Male and Female Sexual Dysfunction Source: Montgomery, AL: Starrhill Press. 1999. 196 p. Contact: Available from Black Belt Press. P.O. Box 551, Montgomery, AL 36101. (800) 959-3245 or (334) 265-6753. Fax (334) 265-8880. Price: $13.95 plus shipping and handling. ISBN: 1573590142. Summary: This book discusses the drug sildenafil (Viagra) in the context of a larger discussion about sexuality and sexual dysfunction. Twenty-
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four chapters cover normal male sexual function, an overview of male sexual dysfunction, the causes of male erectile dysfunction, evaluating the male with erectile dysfunction, treatment strategies for metabolic disorders (including diabetes and prolactinoma), hormone replacement therapy, penile injections with vasoactive drugs, urethral suppository with vasoactive drugs, vacuum erection devices, vascular surgery for impotence, an overview of penile implants, treatment of Peyronie's disease, treatment of psychological impotence, the role of impotence support groups, herbal medicine for males, Viagra for male erectile dysfunction, Viagra in combination with injections or vacuum erection devices, Viagra in combination with penile implants, future treatments for erectile dysfunction, normal female sexual function, the causes and treatment of female sexual dysfunction, Viagra and apomorphine for females, herbal medicine for females, and healthy relationships and sexual function. The chapters are written in nontechnical language but include enough medical information to be of use to medical professionals wishing to learn more about sexual dysfunction. The book concludes with a list of resources and a subject index. 10 figures. 5 tables. 237 references. ·
Manual of Urology: Diagnosis and Therapy. 2nd ed Source: Hagerstown, MD: Lippincott Williams and Wilkins. 1999. 362 p. Contact: Available from Lippincott Williams and Wilkins. P.O. Box 1600, Hagerstown, MD 21741. (800) 638-3030 or (301) 714-2300. Fax (301) 8247390. Website: www.lww.com. Price: $37.95 plus shipping and handling. ISBN: 078171785X. Summary: This manual is designed to be used by the house officer and medical student responsible for urology patients. The related endoscopic, medical, and diagnostic procedures are well described. Twenty two chapters cover imaging of the genitourinary tract, radionuclide imaging, endoscopic instruments and surgery, nontraumatic genitourinary emergencies, fluid and electrolyte disorders, lower urinary tract symptoms, hematuria (blood in the urine) and other urine abnormalities, evaluation of renal mass lesions, surgical disorders of the adrenal gland, urinary calculi (stones) and endourology, the management of urinary incontinence, male erectile dysfunction (impotence), male reproductive dysfunction, neoplasms (cancerous and benign) of the genitourinary tract, the medical management of genitourinary malignancy (cancer), radiation therapy of genitourinary malignancy, genitourinary infection, management of genitourinary trauma, pediatric urology, neurourology and urodynamic testing, and renal (kidney) transplantation. Each chapter presents information in outline form, with numerous tables and
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diagrams, as necessary. Each chapter concludes with a list of suggested reading. The handbook concludes with two appendices, presenting the American Urological Association Symptom Score (for benign prostatic hyperplasia) and the staging of genitourinary tumors, as well as a subject index. ·
Medical Advisor Home Edition: The Complete Guide to Alternative and Conventional Treatments Source: Alexandria, VA: Time-Life Books. 1997. 960 p. Contact: Available from Time-Life Books. 400 Keystone Industrial Park, Dunsmore, PA 18512. Price: $20.00. ISBN: 0783552505. Summary: This book offers information about 300 health problems, ranging from relatively benign conditions to the most serious diseases. The book provides symptom charts that name several related problems and help readers decide which ailment entry to look up. Ailment entries provide a more complete list of symptoms, plus guidelines to discern whether the condition is potentially serious or requires a doctor's attention. Each entry describes the ailment and how it affects the body. Next, the entry outlines the underlying causes of the ailment and tests and procedures a doctor may use to confirm the diagnosis. The treatment segment presents conventional and alternative recommendations for curing the problem or alleviating the symptoms. Most ailment entries conclude with advice on preventive measures that can be used to maintain health. Alternative treatments described include bodywork, acupuncture and acupressure, herbal therapies, homeopathy, lifestyle changes, and nutrition and diet. The book begins with a section on emergency medicine. Also included is a visual diagnostic guide, an atlas to the body, a medicine chest section (describing herbs, homeopathic remedies, and over the counter drugs), a glossary, a subject index, a bibliography, and a list of health associations and organizations. Topics related to kidney and urologic diseases include AIDS, anemia, bedwetting, bladder cancer, bladder infections, diabetes, drug abuse, fluid retention, groin strain, impotence, incontinence, infertility, kidney cancer, kidney disease, kidney infections, kidney stones, penile pain, prostate cancer, prostate problems, sexual dysfunction, sexually transmitted diseases, testicle problems, testicular cancer, and urinary problems. The book is illustrated with line drawings and full color photographs.
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Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes & Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in PrintÒ). The following have been recently listed with online booksellers as relating to impotence (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): ·
Biopotency : A Guide in Sexual Success by Ricard Berger, Deborah Berger (1987); ISBN: 0878576568; http://www.amazon.com/exec/obidos/ASIN/0878576568/icongroupin terna
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Common Problems in Infertility and Impotence by Jacob Rajfer (1990); ISBN: 0815169914; http://www.amazon.com/exec/obidos/ASIN/0815169914/icongroupin terna
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Contemporary Management of Impotence and Infertility by Emil A. Tanagho, et al (1988); ISBN: 0683081012; http://www.amazon.com/exec/obidos/ASIN/0683081012/icongroupin terna
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Counterfeit Sex (1982); ISBN: 0808900552; http://www.amazon.com/exec/obidos/ASIN/0808900552/icongroupin terna
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Counterfeit Sex: Homosexuality Impotence Frigidity by Edmund Bergler (1982); ISBN: 0808900579; http://www.amazon.com/exec/obidos/ASIN/0808900579/icongroupin terna
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Damning the Innocent: A History of the Persecution of the Impotent in Pre-Revolutionary France by Pierre Darmon (1986); ISBN: 067080911X; http://www.amazon.com/exec/obidos/ASIN/067080911X/icongroupi nterna
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Diabetes and Impotence : A Concern for Couples by Priscilla Hollander (1985); ISBN: 0937721093; http://www.amazon.com/exec/obidos/ASIN/0937721093/icongroupin terna
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Diagnosis and Treatment of Erectile Disturbances: A Guide for Clinicians by R. Taylor Segraves, Harry W. Schoenberg (Editor) (1985); ISBN: 0306418711;
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http://www.amazon.com/exec/obidos/ASIN/0306418711/icongroupin terna ·
Disorders of Male Sexual Function by Drogo K. Montague (1988); ISBN: 0815159390; http://www.amazon.com/exec/obidos/ASIN/0815159390/icongroupin terna
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How to Eat Away Your Impotence by Marsh Morrison (1978); ISBN: 013405654X; http://www.amazon.com/exec/obidos/ASIN/013405654X/icongroupi nterna
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How to Win over Impotence-Frigidity by Salem Kirban (1981); ISBN: 0686803337; http://www.amazon.com/exec/obidos/ASIN/0686803337/icongroupin terna
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Impotence (1989); ISBN: 0933803079; http://www.amazon.com/exec/obidos/ASIN/0933803079/icongroupin terna
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Impotence and the Fountain of Youth by Robert W. Wilson (1989); ISBN: 0898657466; http://www.amazon.com/exec/obidos/ASIN/0898657466/icongroupin terna
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Impotence in the Male by Stekel (1971); ISBN: 0871400502; http://www.amazon.com/exec/obidos/ASIN/0871400502/icongroupin terna
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Impotence Is Always Having to Say You're Sorry by Jack S. Margolis (1975); ISBN: 0843103647; http://www.amazon.com/exec/obidos/ASIN/0843103647/icongroupin terna
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Impotence: How to Overcome It by Richard B. Manning (1989); ISBN: 0933803125; http://www.amazon.com/exec/obidos/ASIN/0933803125/icongroupin terna
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Impotence: Physiological, Psychological, and Surgical Diagnosis and Treatment by Gorm. Wagner (1982); ISBN: 0306407191; http://www.amazon.com/exec/obidos/ASIN/0306407191/icongroupin terna
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Impotence: Understanding the Problem and Its Treatment by Thomas J. Rohner (1986); ISBN: 0877624518;
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http://www.amazon.com/exec/obidos/ASIN/0877624518/icongroupin terna ·
It's Not All in Your Head : A Couple's Guide to Overcoming Impotence by Eileen MacKenzie, et al (1988); ISBN: 0525246495; http://www.amazon.com/exec/obidos/ASIN/0525246495/icongroupin terna
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It's Up to You : Overcoming Erection Problems by Williams Warwick (1989); ISBN: 072251915X; http://www.amazon.com/exec/obidos/ASIN/072251915X/icongroupi nterna
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It's Up to You: Self-Help for Men With Erection Problems by Warwick Williams (1986); ISBN: 0683121170; http://www.amazon.com/exec/obidos/ASIN/0683121170/icongroupin terna
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Lifelong Sexual Vigor: How to Avoid and Overcome Impotence by Marvin B. Brooks (1981); ISBN: 0385177127; http://www.amazon.com/exec/obidos/ASIN/0385177127/icongroupin terna
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Making Love Again : Renewing Intimacy and Helping Your Man Overcome Impotence by Terry Dr. Mason, Valerie Greene Norman (1988); ISBN: 0809246236; http://www.amazon.com/exec/obidos/ASIN/0809246236/icongroupin terna
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Male Impotence: A Cure: Penile Prothesis by Raymond J. Arensberg (1985); ISBN: 0933297009; http://www.amazon.com/exec/obidos/ASIN/0933297009/icongroupin terna
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Male Sexual Dysfunction by Robert Krane (1983); ISBN: 0316503312; http://www.amazon.com/exec/obidos/ASIN/0316503312/icongroupin terna
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Male Sexual Health : A Couple's Guide by Richard F. Spark (1991); ISBN: 0890433194; http://www.amazon.com/exec/obidos/ASIN/0890433194/icongroupin terna
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Male Sexuality and the Challenge of Healing Impotence by Richard Y. Handy (1988); ISBN: 0879754656; http://www.amazon.com/exec/obidos/ASIN/0879754656/icongroupin terna
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Management of Male Impotence by Alan H. Bennett (1983); ISBN: 0683005464; http://www.amazon.com/exec/obidos/ASIN/0683005464/icongroupin terna
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New Power to Love : Concentrated Virility Foods by William H. Lee (1987); ISBN: 0941683001; http://www.amazon.com/exec/obidos/ASIN/0941683001/icongroupin terna
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Overcoming Impotence : What Every Husband and Wife Should Know by Lee I. Jacobs (1978); ISBN: 0809274701; http://www.amazon.com/exec/obidos/ASIN/0809274701/icongroupin terna
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Self-Therapy for Sex Problems by Daniel Steele (1987); ISBN: 096182770X; http://www.amazon.com/exec/obidos/ASIN/096182770X/icongroupi nterna
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Sexual Anxiety: A Study of Male Impotence by Eric J Carlton (1980); ISBN: 0064909603; http://www.amazon.com/exec/obidos/ASIN/0064909603/icongroupin terna
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Sexual Impotence in the Male and Female (Sex, Marriage and Society Series) by William Hammond (1974); ISBN: 0405058020; http://www.amazon.com/exec/obidos/ASIN/0405058020/icongroupin terna
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State Failure: The Impotence of Politics in Industrial Society by Martin Janicke, Alan Braley (Translator) (1990); ISBN: 0271007141; http://www.amazon.com/exec/obidos/ASIN/0271007141/icongroupin terna
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The Lifelong Lover: How to Avoid and Overcome Impotence by Marvin B. Brooks, Sally West Brooks (1985); ISBN: 0385177135; http://www.amazon.com/exec/obidos/ASIN/0385177135/icongroupin terna
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The Potent Male : Facts Fiction Future by Irwin Goldstein, Larry Rothstein (1990); ISBN: 0399518479; http://www.amazon.com/exec/obidos/ASIN/0399518479/icongroupin terna
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The Prevention of the Obstruction of Vital Arteries : With Emphasis on the Role of Arterial Obstruction in Causing Heart Attacks, Strokes, Impotence, by William Dock (1983); ISBN: 0875272029;
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http://www.amazon.com/exec/obidos/ASIN/0875272029/icongroupin terna ·
The Rejuvenating Plants of Tropical Africa : Aphrodisiacs, Sterility, Impotence, Infertility by Albert A. Enti (Illustrator), Anthony K. Andoh (Editor) (1988); ISBN: 0916299074; http://www.amazon.com/exec/obidos/ASIN/0916299074/icongroupin terna
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Therapy in the Ghetto : Political Impotence and Personal Disintegration by Barbara Lerner (1972); ISBN: 0801813735; http://www.amazon.com/exec/obidos/ASIN/0801813735/icongroupin terna
The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “impotence” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:23 ·
Atlas of erectile dysfunction. Author: Roger S. Kirby; foreword by Tom F. Lue; Year: 1999; New York: Parthenon Publishing Group, c1999; ISBN: 1850700427 http://www.amazon.com/exec/obidos/ASIN/1850700427/icongroupin terna
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Contemporary diagnosis and management of male erectile dysfunction. Author: Tom F. Lue; Year: 1999; Newtown, Pa.: Handbooks in Health Care Co., c1999; ISBN: 1884065279
In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a “Books” button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.
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Diagnosing impotence. Author: edited by Diego Pozza, Giovanni M. Colpi; 1st International Meeting of Andrology, Rome, June 10, 1989; Year: 1990; Milano: Masson, 1990; ISBN: 882141938X
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Diagnosis and management of male sexual dysfunction. Author: [edited by] John J. Mulcahy; Year: 1997; New York: Igaku-Shoin, c1997; ISBN: 089640322X
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Efficacy of prostatectomy in treatment of benign prostatic hyperplasia. Author: L. R. Levy, J. I. Williams; Year: 1993; Ontario: Institute for Clinical Evaluative Sciences in Ontario, 1993
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Erectile dysfunction: a clinical guide. Author: by Roger Kirby, Culley Carson and Irwin Goldstein; with contributions from Ahmet Fawzy, Kevin McVary; Year: 1999; Oxford: Isis Medical Media; Herndon, VA: Distributed in the USA by Books International, 1999; ISBN: 190186524X
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Erectile dysfunction: integrating couple therapy, sex therapy, and medical treatment. Author: Gerald R. Weeks, Nancy Gambescia; Year: 2000; New York: W.W. Norton, 2000; ISBN: 0393703304 http://www.amazon.com/exec/obidos/ASIN/0393703304/icongroupin terna
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Erectile dysfunction: issues in current pharmacotherapy. Author: edited by Alvaro Morales; Year: 1998; London: Martin Dunitz; Malden, MA: Distributed in the US by Blackwell Science, 1998; ISBN: 1853175773 http://www.amazon.com/exec/obidos/ASIN/1853175773/icongroupin terna
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Implanted and injected materials in urology. Author: edited by Jean Marie Buzelin; Year: 1995; Oxford: Isis Medical Media, 1995; ISBN: 1899066152 http://www.amazon.com/exec/obidos/ASIN/1899066152/icongroupin terna
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Impotence: diagnosis and management of erectile dysfunction. Author: [edited by] Alan H. Bennett; Year: 1994; Philadelphia: W.B. Saunders Co., c1994; ISBN: 072163768X
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Impotence: January 1986 through September 1992: 956 citations. Author: prepared by Marian E. Beratan, Leroy M. Nyberg; Year: 1992; Bethesda, Md.: U.S. Dept. of Health and Human Services, Public Health Service, National Institutes of Health, National Library of Medicine, Reference Section; Washington, D.C.: Sold by the Supt. of Docs., U.S. G.P.O., 1992
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Impotence and infertility. Author: volume editors, Tom F. Lue, Marc Goldstein; with 26 contributors; Year: 1999; Philadelphia: Current Medicine, c1999; ISBN: 1573401196
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http://www.amazon.com/exec/obidos/ASIN/1573401196/icongroupin terna ·
Male sexual function: a guide to clinical management. Author: edited by John J. Mulcahy; Year: 2001; Totowa, N.J.: Humana Press, c2001; ISBN: 089603917X (alk. paper) http://www.amazon.com/exec/obidos/ASIN/089603917X/icongroupi nterna
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Management of ED: focus on sildenafil: a diabetologist's. Author: endocrinologist's approach / editor, C.E. Morgensen; Year: 1998; Montreal; Chicago: PharmaLibri, 1998; ISBN: 0919839541 (pbk.) http://www.amazon.com/exec/obidos/ASIN/0919839541/icongroupin terna
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Management of ED: focus on sildenafil: a neurologist's approach. Author: editor, Clare J. Fowler; Year: 1999; Montreal; Chicago: PharmaLibri, c1999; ISBN: 0919839525 (pbk.)
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Management of ED: focus on sildenafil: a urologist's approach. Author: editor, J.C. Gingell; Year: 1998; Montreal; Chicago: PharmaLibri, 1998; ISBN: 0919839509 (pbk.) http://www.amazon.com/exec/obidos/ASIN/0919839509/icongroupin terna
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Management of impotence and infertility. Author: edited by E. Douglas Whitehead, Harris M. Nagler; with 41 additional contributors; Year: 1994; Philadelphia: Lippincott, c1994; ISBN: 0197511531 (alk. paper)
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New injection treatment for impotence: medical and psychological aspects. Author: Gorm Wagner, Helen Singer Kaplan; Year: 1993; New York: Brunner/Mazel, c1993; ISBN: 087630689X
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Pelvic floor dysfunction: investigations & conservative treatment. Author: editors, R.A. Appell, A.P. Bourcier, F. La Torre; Year: 1999; Rome: Casa Editrice Scientifica Internazionale, c1999; ISBN: 8886062435
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Practical remarks on the treatment of spermatorrhoea and some forms of impotence: reprinted and enlarged from the original papers in the "Lancet". Author: by John L. Milton; Year: 1855; London: S. Highley, 1855
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Report on the treatment of organic erectile dysfunction. Author: the American Urological Association, Erectile Dysfunction Clinical Guidelines Panel; Year: 1996; Baltimore, Md.: The Association, c1996; ISBN: 096497021X http://www.amazon.com/exec/obidos/ASIN/096497021X/icongroupi nterna
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Reproductive issues and the aging male. Author: Florence P. Haseltine, C. Alvin Paulsen, Christina Wang, editors; Year: 1993; Washington, DC:
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American Association for the Advancement of Science, c1993; ISBN: 087168523X (alk. paper) http://www.amazon.com/exec/obidos/ASIN/087168523X/icongroupi nterna ·
Role of alprostadil in the diagnosis and treatment of erectile dysfunction: proceedings of a symposium, August 3-4, 1993, Brook Lodge, Kalamazoo, Michigan. Author: editors, Irwin Goldstein, Tom F. Lue; Year: 1993; Princeton: Excerpta Medica, c1993; ISBN: 0444019022 http://www.amazon.com/exec/obidos/ASIN/0444019022/icongroupin terna
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Sexual impotence: the contribution of Paolo Zacchia, 1584-1659. Author: Joseph Bajada; Year: 1988; Roma: Editrice Pontificia Università Gregoriana, 1988; ISBN: 8876525963
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Textbook of erectile dysfunction. Author: edited by Culley C. Carson, III, Roger S. Kirby, and Irwin Goldstein; Year: 1999; Oxford: Isis Medical Media; Herndon, VA, USA: Distributed in USA by Books International, 1999; ISBN: 1899066969
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Traumatic and reconstructive urology. Author: [edited by] Jack W. McAninch; associate editors, Peter R. Carroll, Gerald H. Jordan; Year: 1996; Philadelphia: Saunders, c1996; ISBN: 0721638864 http://www.amazon.com/exec/obidos/ASIN/0721638864/icongroupin terna
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Treatment options for male erectile dysfunction: a systematic review of published studies of effectiveness. Author: Timothy J. Wilt ... [et. al], coordinating editor; contributors, Karen Flynn ... [et. al.]; Year: 1999; Boston, MA: MDRC, HSR&D, [1999]
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Vascular andrology: erectile dysfunction, priapism, and varicocele. Author: Andrea Ledda (ed.); Year: 1996; Berlin; New York: Springer, c1996; ISBN: 3540594728 (softcover: alk. paper)
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World book of impotence. Author: edited by Tom F. Lue; Year: 1992; London: Smith-Gordon, 1992; ISBN: 1854630768
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Youth, love, and ecology: proceedings of the XI World Congress of Sexology, Rio de Janeiro (Brazil), June 1-5, 1993. Author: editors, Isaac Charam and Gerson Lopes; Year: 1994; Bologna: Monduzzi editore, International Proceedings Division, c1994; ISBN: 8832306018
Chapters on Impotence Frequently, impotence will be discussed within a book, perhaps within a specific chapter. In order to find chapters that are specifically dealing with
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impotence, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and impotence using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” By making these selections and typing in “impotence” (or synonyms) into the “For these words:” box, you will only receive results on chapters in books. The following is a typical result when searching for book chapters on impotence: ·
Organ Involvement: Sexual Function and Pregnancy Source: in Clements, P.J.; Furst, D.E., Eds. Systemic Sclerosis. Baltimore, MD: Williams and Wilkins. 1996. p. 483-499. Contact: Available from Williams and Wilkins, Special Sales Department. (800) 358-3583. Summary: This chapter for health professionals explores the effect of systemic sclerosis (SSc) on sexual function in males and females. Non pregnancy issues involving patients with SSc are addressed, including gynecologic concerns, breast complications, sex hormone-related issues, and impotence. A model for addressing the sexual concerns of both male and female patients with SSc are described. The issues of contraception and fertility are addressed. The effects of SSc on pregnancy and the effects of pregnancy on SSc are discussed. Organ system problems associated with pregnancy in patients with SSc are examined, focusing on musculoskeletal, gastrointestinal, and cardiovascular problems; thyroid disorders; pulmonary disease; peripheral gangrene; renal disease; and CREST syndrome. The effects of various medications on a pregnant woman and her baby are presented. In addition, postpartum considerations are addressed, including the use of medications while breast feeding. 135 references and 4 tables.
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Ileoanal Pouch Anastomosis Source: in Bayless, T.M. and Hanauer, S.B. Advanced Therapy of Inflammatory Bowel Disease. Hamilton, Ontario: B.C. Decker Inc. 2001. p. 197-202. Contact: Available from B.C. Decker Inc. 20 Hughson Street South, P.O. Box 620, L.C.D. 1 Hamilton, Ontario L8N 3K7. (905) 522-7017 or (800) 5687281. Fax (905) 522-7839. Email:
[email protected]. Website: www.bcdecker.com. Price: $129.00 plus shipping and handling. ISBN: 1550091220.
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Summary: This chapter on ileoanal pouch anastomosis is from the second edition of a book devoted to the details of medical, surgical, and supportive management of patients with Crohn's disease (CD) and ulcerative colitis (UC), together known as inflammatory bowel disease (IBD). The authors report that long term follow-up of pouch function and quality of life indicates a very high degree of acceptance and happiness level of the patients undergoing restorative proctocolectomy (RP). In ileoanal pouch anastomosis (IPAA), the entire diseased colon and rectum are removed, but the anal sphincters are preserved. A new rectum is formed from the terminal ileum (ileal pouch); attaching the pouch to the anal canal restores defecation to the standard transanal route with satisfactory fecal continence. Bowel movement frequency ranges from four to nine movements every 24 hours, averaging six times per day. This, however, is not a good indication of success as many patients will evacuate their pouches when it is convenient to do so, rather than defer defecation. Urgency, defined as inability to defer defecation for 15 minutes, is a major concern for many patients preoperatively. Invariably, this is negated by the pouch procedure; the exception is when patients develop pouchitis. Pad use, either due to need or for a sense of security, increases with age, episodes of pouchitis, and the patients with mucosal stripping of the anal canal as well as decreasing sphincter function. Operative mortality (deaths from the surgery) remains under 0.5 percent and reported impotence rates are less than 1 percent. Although dyspareunia (painful sexual intercourse) may occur post-pouch construction, overall, there is an improvement in female sexual function post-pouch compared to pre-pouch. Perhaps the most singled out problem of the pelvic pouch procedure is that of pouchitis; by eliminating one disease, the patient is set up for another. Yet this has to be viewed with the perspective that 90 percent of pouchitis cases are transient and easily treated, and that fewer than three-quarters of patients are subject to repeated episodes. Patients, in their quest for preservation of their anal function, understand and generally are satisfied with the trade-off of RP. 1 figure. 15 references. ·
Liver Disease Source: in King, J.E., ed. Mayo Clinic on Digestive Health. Rochester, MN: Mayo Clinic. 2000. p. 151-166. Contact: Available from Mayo Clinic Health Information. 5505 36th Street, SE, Grand Rapids, MI 49512. (800) 291-1128. Website: www.mayoclinic.com. Price: $14.95 plus shipping and handling. ISBN: 1893005046.
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Summary: This chapter on liver disease is from a comprehensive guidebook from the Mayo Clinic that focuses on a variety of digestive symptoms, including heartburn, abdominal pain, constipation, and diarrhea, and the common conditions that are often responsible for these symptoms. Written in nontechnical language, the book includes practical information on how the digestive system works, factors that can interfere with its normal functioning, and how to prevent digestive problems. The first section of the chapter focuses on hepatitis, including the key signs and symptoms of hepatitis, notably fatigue, loss of appetite, nausea, unexplained weight loss, and yellowing of skin and eyes (jaundice). The authors describe the different types of hepatitis (alcohol or drug induced, hepatitis A, hepatitis B, hepatitis C, hepatitis D and E, autoimmune hepatitis, and nonalcoholic steatohepatitis); review the blood tests (liver function tests) that may be used to help diagnose or monitor hepatitis; and discuss treatment options, including corticosteroids, interferon, lamivudine, and liver transplantation. A final section reviews healthy lifestyle approaches for living with hepatitis, and strategies for preventing the disease. The next section of the chapter addresses hemochromatosis (a genetic abnormality that causes the intestines to absorb too much iron), noting that the symptoms can include fatigue, joint pain, impotence (erectile dysfunction) or loss of sex drive, increased skin pigmentation (bronzing), and increased thirst and urination. This section also reviews diagnosis, determining whether screening is necessary for family members of patients with hemochromatosis, and the use of diet therapy (reduced iron intake) to help treat the disease. One sidebar mentions Wilson's disease and alpha 1 antitrypsin deficiency as other inherited liver disease. The last section of the chapter addresses cirrhosis, a condition in which scar tissue forms in the liver and keeps it from functioning normally. 1 figure. ·
Sex and Diabetes Source: in American Diabetes Association. Diabetes A to Z: What You Need to Know About Diabetes, Simply Put. 4th ed. Alexandria, VA: American Diabetes Association. 2000. p. 148-151. Contact: Available from American Diabetes Association (ADA). Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 442-9742. Website: www.diabetes.org. Price: $12.95 for members; $14.95 for nonmembers; plus shipping and handling. ISBN: 1580400353. Summary: This chapter provides people who have diabetes with information on sexual problems caused by diabetes. Physical causes of sexual problems include being too tired to have sex, having a urinary
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tract infection, lacking bladder control, and having damaged limbs or joints. In women, nerve damage to the sex organs can cause a loss of sensation and vaginal dryness. Women who have diabetes tend to get more vaginal infections than women who do not have diabetes, and the pain or discomfort from vaginal infections or vaginal dryness can make women more likely to have vaginismus. Men who have diabetes may be affected by impotence as a result of damage to the nerves in the penis, damage to blood vessels in the penis, or poor blood glucose control. Sexual problems may also have psychological causes. ·
Medications Used To Treat Complications of Diabetes Source: in Carlisle, B.A.; Kroon, L.A.; Koda-Kimble, M.A. 101 Medication Tips for People with Diabetes. Alexandria, VA: American Diabetes Association. 1999. p. 66-75. Contact: Available from American Diabetes Association (ADA). Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 442-9742. Website: www.diabetes.org. Price: $14.95 plus shipping and handling. ISBN: 1580400329. Order number 483301. Summary: This chapter answers questions about the meditations used to treat diabetes complications, including nonprescription analgesics, tricyclic antidepressants, capsaicin cream, angiotensin converting enzyme (ACE) inhibitors, laxatives, and calcium channel blockers. Nonprescription analgesics, antidepressants, and narcotic analgesics can be used to treat the pain associated with diabetic neuropathy. Capsaicin cream, a chemical found in hot chili peppers, can be applied to the feet to relieve pain. ACE inhibitors can be used to treat microalbuminuria, an early sign of kidney damage. The symptoms of gastroparesis, a condition that affects the nerves of the stomach, can be treated with metoclopramide, cisapride, and erythromycin. These medications increase the stomach's ability to contract and aid in digestion. Constipation can be treated by increasing the amount of fluid and fiber in a person's diet. Laxatives may also be useful in treating constipation. Men who have diabetes and experience impotence can use the medications alprostadil and sildenafil to maintain an erection. People who have diabetes and high blood pressure can be treated with ACE inhibitors, diuretics, and calcium channel blockers. Angiotensin receptor II antagonists and calcium channel blockers can be used to treat kidney disease. People who have diabetes should take any medications their doctor prescribes for other conditions, such as high blood pressure, heart disease, high cholesterol or triglycerides, obesity, and insulin resistance.
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Diabetes and Sex Source: in American Diabetes Association. American Diabetes Association Complete Guide to Diabetes: The Ultimate Home Diabetes Reference. 2nd ed. Alexandria, VA: American Diabetes Association. 1999. p. 321-360. Contact: Available from American Diabetes Association (ADA). Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 442-9742. Website: www.diabetes.org. Price: $23.95 plus shipping and handling. ISBN: 1580400388. Summary: This chapter discusses the impact of diabetes on sexual health and pregnancy. Diabetes can affect a person's sexual performance, his or her choice of birth control, and his or her response to the aging of the reproductive system. Women need to deal with the effects of sex hormones on blood glucose levels throughout the menstrual cycle and as they go through menopause. For women whose blood glucose levels are affected by their menstrual cycle, steps for staying in control include controlling the symptoms of premenstrual syndrome and making changes in diet and physical activity in the days prior to the onset of menstruation. Menopause can also upset a diabetes management plan. Hormone replacement therapy may be an answer for some women. Practicing birth control and safe sex are especially important for people with diabetes. Birth control options for women include birth control pills, the intrauterine device, the diaphragm, the sponge and cervical cap, the female condom, and sterilization. Although men have more limited birth control options than women, the condom is the most popular. Sterilization is also an option for men. Sexual problems for women who have diabetes include poor vaginal lubrication and pain during intercourse or diminished sexual desire and problems achieving orgasm. For men, the major concern is impotence. Women also face challenges as they prepare for pregnancy and carrying a baby. Issues that women need to consider before they become pregnant include the genetic risk of passing diabetes to a child, the woman's health status and level of glucose control, and financial considerations. Once a woman becomes pregnant, she and her health care team need to choose blood glucose goals and she needs to consider her food and exercise habits, times for blood glucose testing, and obstetrical care. Other pregnancy related issues include delivery complications, postpartum care, and breastfeeding.
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Psychosocial Aspects of Diabetes in Adult Populations Source: in Harris, M.I., et al., eds., for the National Diabetes Data Group (NDDG). Diabetes in America. 2nd ed. Bethesda, MD: National Institute
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of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. 1995. p. 507-517. Contact: Available from National Diabetes Information Clearinghouse (NDIC). 1 Information Way, Bethesda, MD 20892-3560. (800) 860-8747 or (301) 654-3327. E-mail:
[email protected]. Price: $20.00. Also available at http://www.niddk.nih.gov/. Summary: This chapter on the psychosocial aspects of diabetes in the adult population is from a compilation and assessment of data on diabetes and its complications in the United States. It is a prevalent clinical belief that depression in diabetes is secondary to psychosocial hardship brought on by increasing severity of the diabetes. However, studies that examined this relationship did not find statistically significant associations between depression and severity of diabetes. The authors postulate that the presence of diabetes complications alone may not result in depression unless severe functional limitations such as blindness, impotence, and cognitive impairment are present. The nature of depression in diabetes is complex, and adverse life events, severity of the medical illness, genetic and personality factors, and psychiatric history are all likely contributors to its occurrence. The prevalence of psychiatric disorders other than depression in diabetes has not been extensively studied. There is evidence that anxiety disorders are significantly more common in this group, particularly generalized anxiety disorder and simple phobia. The prevalence of anorexia nervosa and bulimia nervosa in diabetes is unknown, but interest in these disorders remains high because of their potential for adverse effects on glycemic control. The relationship between stress and glucose regulation in diabetes has been the subject of considerable study, but findings have been inconsistent. Stress has been reported to increase, decrease, or have no significant effect on diabetes glycemic control. The threshold for the reporting of diabetes symptoms may be lowered by psychological factors, particularly depression and anxiety, and both psychological and physiological factors may contribute to diabetes symptoms. Also, the efficacy of psychotropic medication for psychiatric disorders in patients with diabetes is largely unknown. However, these pharmaceuticals may have side effects that limit their use in persons with diabetes. Thus, psychotherapy may have a prominent place in diabetes treatment options. 9 tables. 71 references. ·
Diabetes Source: in Daugirdas, J.T. and Ing, T.S., eds. Handbook of Dialysis. 2nd ed. Boston, MA: Little, Brown and Company. 1994. p. 422-432.
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Contact: Available from Lippincott-Raven Publishers. 12107 Insurance Way, Hagerstown, MD 21740-5184. (800) 777-2295. Fax (301) 824-7390. Email:
[email protected]. Website: http://www.lrpub.com. Price: $37.95. ISBN: 0316173835. Summary: This chapter, from a handbook of dialysis, outlines special problems in the dialysis patient with diabetes. The author notes that morbidity and mortality are substantially higher in patients with diabetes maintained on dialysis than in their nondiabetic counterparts, with cardiovascular disease and infection being the leading causes of death. Topics include when to initiate dialysis; hemodialysis versus peritoneal dialysis; the role of diet; control of blood glucose levels, including with insulin therapy, or oral hypoglycemic agents; hyperkalemia; hypertension and peripheral vascular disease; cerebrovascular disease; retinopathy; and impotence. One chart summarizes the advantages and disadvantages of hemodialysis, continuous ambulatory peritoneal dialysis (CAPD), and continuous cycler-assisted peritoneal dialysis (CCPD) for patients with diabetes. 22 references. 1 table. ·
Geriatric Urology Source: in Landau, L.; Kogan, B.A. 20 Common Problems in Urology. New York, NY: McGraw-Hill, Inc. 2001. p. 133-144. Contact: Available from McGraw-Hill, Inc. 1221 Avenue of the Americas, New York, NY 10020. (612) 832-7869. Website: www.bookstore.mcgrawhill.com. Price: $45.00;plus shipping and handling. ISBN: 0070634130. Summary: Geriatric urology is a specialized area of adult urology that concentrates on the evaluation and management of urologic (urinary tract) problems in older patients. In particular, it is focused on the care of frail, elderly individuals with multiple comorbidities (other diseases and problems that may have an impact on each other). This chapter on geriatric urology is from a text on common problems in urology (written for the primary care provider). Although elderly individuals are seen for a wide spectrum of urologic complaints, the two most common disorders seen in this age group are urinary incontinence (UI, the involuntary loss of urine) and urinary tract infections (UTIs). Other common disorders in this age group include urologic malignancies (particularly prostate and bladder cancer), stone disease, benign prostatic hyperplasia (BPH, overgrowth of the prostate), and erectile dysfunction (formerly called impotence). This chapter focuses on the evaluation and treatment of elderly patients who present with UI and UTIs, as these conditions are commonly seen in geriatric patients, and their management may differ from that of younger patients with similar clinical problems. Specific
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types of UI covered include transient, stress, urge, mixed, overflow, and functional incontinence. 2 tables. 23 references. ·
Impotence Source: in Landau, L.; Kogan, B.A. 20 Common Problems in Urology. New York, NY: McGraw-Hill, Inc. 2001. p. 257-272. Contact: Available from McGraw-Hill, Inc. 1221 Avenue of the Americas, New York, NY 10020. (612) 832-7869. Website: www.bookstore.mcgrawhill.com. Price: $45.00;plus shipping and handling. ISBN: 0070634130. Summary: Erectile dysfunction (ED, formerly called impotence) is defined as the inability to achieve or maintain an erection sufficient for satisfactory sexual performance. This chapter on ED is from a text on common problems in urology (written for the primary care provider). The author notes that advances in the understanding of the physiology of erection, marked media interest, and the development of more effective, less invasive therapies have resulted in an outpouring of patient interest in this problem. In this chapter, the author provides a framework for a systematic, goal directed approach to this common problem. Topics include the physiology of erection; principal diagnoses; the typical presentation of ED; key elements of the patient's history; the physical examination, including overall, genitourinary, neurologic, and vascular; ancillary diagnostic testing, including laboratory evaluation; treatment options, including identification of reversible causes, first line therapy (oral agents, vacuum constriction devices, sexual therapy, and hormone replacement), and second line therapy, including intracavernosal medication and intraurethral therapy. The author also covers third line therapy (surgical implantation of a penile prosthesis), indications for referral, and emerging concepts. A patient evaluation and care algorithm is provided. First line treatment is characterized as the least invasive with the lowest risk profile and the broadest utility to a majority of patients. Second and third line therapies have progressive increases in both invasiveness and treatment morbidity. Up to 25 percent of cases of ED have been attributed to prescription and nonprescription medications as well as illicit drug use. In addition to medications, high risk lifestyle factors such as lack of exercise, cigarette smoking, excessive alcohol consumption, or recreational drug use appear to play significant roles in the onset of ED. These reversible causes of ED should be considered or eliminated before undertaking any other treatment options. 3 figures. 10 tables. 20 references.
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Transurethral Resection of the Prostate for Benign Prostatic Hyperplasia Source: in Narayan, P. Benign Prostatic Hyperplasia. London, England: Churchill Livingstone. 2000. p. 355-367. Contact: Available from Harcourt Publishers. Foots Cray High Street, Sidcup, Kent DA14 5HP UK. 02083085700. Fax 02083085702. E-mail:
[email protected]. Website: www.harcourt-international.com. Price: $149.00 plus shipping and handling. ISBN: 0443056374. Summary: Transurethral resection of the prostate (TURP) is a procedure used to prevent unnecessary damage to the bladder and kidneys of men with benign prostatic hyperplasia (BPH). This chapter on TURP in the clinical management of BPH is from a textbook that compiles data and commentary from the world's leading experts in this field. The author considers the indications for TURP; the need for informed consent, particularly addressing the potential problems of retrograde ejaculation and erectile dysfunction (impotence); contraindications to transurethral resection; patient preparation, including position on the operating table; equipment, including irrigating fluid, diathermy, avoiding deep venous thrombosis, and anesthesia; the techniques used for TURP, including preliminary cystourethroscopy, internal urethrotomy, preliminary diathermy of the prostatic arteries, finding the landmarks, resecting the left lateral lobe, the capsule, hemostasis, the second lateral lobe, completing the procedure, and catheterization; complications that may be encountered during the procedure, including hemorrhage, perforation, and erection; postoperative complications, including reactionary hemorrhage, secondary hemorrhage, the transurethral resection syndrome, and incontinence; and dealing with the long term aftermath of cardiac disease. Each step of the surgical procedure is illustrated with line drawings. 24 figures. 41 references.
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Matter Over Mind: Treatment of Psychological Erectile Dysfunction Source: in Newman, A.J. Beyond Viagra: Plain Talk About Treating Male and Female Sexual Dysfunction. Montgomery, AL: Starrhill Press. 1999. p. 100-105. Contact: Available from Black Belt Press. P.O. Box 551, Montgomery, AL 36101. (800) 959-3245 or (334) 265-6753. Fax (334) 265-8880. Price: $13.95 plus shipping and handling. ISBN: 1573590142. Summary: This chapter on the treatment of psychological erectile dysfunction is from a book that discusses the drug sildenafil (Viagra) in the context of a larger discussion about sexuality and sexual dysfunction. The author stresses that purely psychogenic causes account for no more
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than 15 percent of the men with erectile dysfunction. However, it is rare indeed to see a man with a physical cause of erectile dysfunction who does not also complain of a marked psychological impact. Therefore, psychosexual therapy for impotence divides into two groups of patients: those whose underlying problem is primarily psychological and those whose underlying problem is primarily physical. Topics include psychotherapy for these two different groups and the use of sex therapy. Many patients with primarily psychological effects from a recent life event, such as the death of a family member or personal stresses at work or in their marriage, will see a return to normal erectile function once the relationship or work problems resolve, or an adequate amount of time has passed since the traumatic loss of a family member. The key to treating psychogenic erectile dysfunction is to involve the patient's partner in the treatment. The author notes that those people whose erectile dysfunction is primarily psychological in origin usually find minimally invasive treatments (vacuum erection devices, oral drugs like Viagra, or intracavernosal injections) effective. The chapter is written in nontechnical language but includes enough medical information to be of use to medical professionals wishing to learn more about sexuality and sexual dysfunction. ·
Potency Restored: Role of Impotence Support Groups Source: in Newman, A.J. Beyond Viagra: Plain Talk About Treating Male and Female Sexual Dysfunction. Montgomery, AL: Starrhill Press. 1999. p. 106-112. Contact: Available from Black Belt Press. P.O. Box 551, Montgomery, AL 36101. (800) 959-3245 or (334) 265-6753. Fax (334) 265-8880. Price: $13.95 plus shipping and handling. ISBN: 1573590142. Summary: This chapter on the role of impotence support groups is from a book that discusses the drug sildenafil (Viagra) in the context of a larger discussion about sexuality and sexual dysfunction. The role of any support group is to provide individuals or couples with encouragement, advice, educational information, and compassionate support; this is usually provided by individuals and couples who have had the same problem and have been able to overcome their individual medical, psychological, or relationship problem. People who have had their problem treated successfully can provide advice and encouragement, based on personal experience, to those who have yet to undergo treatment. Most support groups for erectile dysfunction comprise a urologist, a psychologist, and someone from the education department of a community hospital, which is where most of the support groups across the country hold their meetings. The first part of the meeting is usually a
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lecture or educational presentation; the second part is the informal meeting after the presentation. This is the time individuals have the opportunity to meet with others who have had their erectile dysfunction problem solved by penile implantation surgery or any of the nonsurgical treatments, including the recent use of Viagra. The author shares some memorable moments from groups in which he has been involved. The chapter is written in nontechnical language but includes enough medical information to be of use to medical professionals wishing to learn more about sexuality and sexual dysfunction. ·
Metabolic Disorders: Treatment Strategies for Diabetes, Prolactinoma Source: in Newman, A.J. Beyond Viagra: Plain Talk About Treating Male and Female Sexual Dysfunction. Montgomery, AL: Starrhill Press. 1999. p. 58-63. Contact: Available from Black Belt Press. P.O. Box 551, Montgomery, AL 36101. (800) 959-3245 or (334) 265-6753. Fax (334) 265-8880. Price: $13.95 plus shipping and handling. ISBN: 1573590142. Summary: Endocrine disorders can be grouped into three general categories: diabetes mellitus, elevated prolactin levels (hyperprolactinemia), and a third group including a number of chronic disorders, most of which suppress testosterone, thereby resulting in decreased libido with secondary erectile dysfunction. This chapter covers treatment strategies for diabetes and prolactinoma (a benign pituitary tumor that results in prolactinemia). It is from a book that discusses the drug sildenafil (Viagra) in the context of a larger discussion about sexuality and sexual dysfunction. Diabetes is the number one single cause of male erectile dysfunction, accounting for about 40 percent of all impotence cases. The author discusses erectile dysfunction in men with diabetes, noting the role of strict blood glucose (sugar) control in the prevention and control of this problem. Other endocrine, or hormonal, causes are far less common, accounting for only about 4 percent of all cases of male erectile dysfunction. However, when these other cases are properly recognized and properly treated, the result is often a marked improvement without any further treatment. Prolactinomas sometimes require surgery and radiation; however, medical therapy is highly effective using Bromocriptine. In addition, it is important to understand that a large number of chronic illnesses and medications can contribute to elevated blood prolactin levels. The chapter is written in nontechnical language but includes enough medical information to be of use to medical professionals wishing to learn more about sexuality and sexual dysfunction. 2 tables.
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When the Plumbing Fails: Overview of Male Sexual Dysfunction Source: in Newman, A.J. Beyond Viagra: Plain Talk About Treating Male and Female Sexual Dysfunction. Montgomery, AL: Starrhill Press. 1999. p. 21-25. Contact: Available from Black Belt Press. P.O. Box 551, Montgomery, AL 36101. (800) 959-3245 or (334) 265-6753. Fax (334) 265-8880. Price: $13.95 plus shipping and handling. ISBN: 1573590142. Summary: This chapter, from a book that discusses the drug sildenafil (Viagra) in the context of a larger discussion about sexuality and sexual dysfunction, offers an overview of male sexual dysfunction. The author defines and discusses a variety of sexual dysfunction problems, including premature ejaculation, inability to achieve orgasm, retrograde ejaculation, decreased libido, and erectile dysfunction (impotence). The author notes that in the United States, some 20 million men are estimated to have some degree of impotence problems. The advent of sildenafil (Viagra) has raised awareness of the problem and may result in many more men seeking treatment than in the past. The good news is that noninvasive oral medications (like Viagra) can help a large number of these men, and other treatments that have been developed over the past 30 years can help many others who do not respond to Viagra. The chapter is written in nontechnical language but includes enough medical information to be of use to medical professionals wishing to learn more about sexuality and sexual dysfunction.
Directories In addition to the references and resources discussed earlier in this chapter, a number of directories relating to impotence have been published that consolidate information across various sources. These too might be useful in gaining access to additional guidance on impotence. The Combined Health Information Database lists the following, which you may wish to consult in your local medical library:24
You will need to limit your search to “Directories” and impotence using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find directories, use the drop boxes at the bottom of the search page where “You may refine your search by”. For publication date, select “All Years”, select language and the format option “Directory”. By making these selections and typing in “impotence” (or synonyms) into the “For these words:” box, you will only receive results on directories dealing with impotence. You should check back periodically with this database as it is updated every three months.
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Complete Directory for People with Chronic Illness. 4th ed Source: Lakeville, CT: Grey House Publishing, Inc. 2000. 1009 p. Contact: Available from Grey House Publishing, Inc. Pocket Knife Square, Lakeville, CT 06039. (860) 435-0868. Fax (860) 435-0867. Price: $165.00. ISBN: 0939300931. Summary: This directory provides a comprehensive overview of the support services and information resources available for people with any of 80 specific chronic illnesses. It presents information on various organizations, educational materials, publications, and databases. A chapter is devoted to each chronic illness and includes a brief description of it. The sections related to kidney and urologic diseases include: AIDS, Alzheimer's disease, cancer, cerebral palsy, diabetes, hypertension, impotence, incontinence, infertility, kidney disease, multiple sclerosis, sexually transmitted diseases, spina bifida, stroke, and substance abuse. The description of each disease is followed by subchapters that identify national and State associations and agencies, libraries, research centers, reference books, children's books, magazines, newsletters, pamphlets, videotapes and films, support groups and hotlines, and websites. In addition, the directory includes a chapter on death and bereavement, as well as a chapter on Wish Foundations for terminally and chronically ill children.
General Home References In addition to references for impotence, you may want a general home medical guide that spans all aspects of home healthcare. The following list is a recent sample of such guides (sorted alphabetically by title; hyperlinks provide rankings, information, and reviews at Amazon.com): · Urodynamics Made Easy by Christopher R. Chapple, Scott A. MacDiarmid; Paperback -- 2nd edition (April 15, 2000), Churchill Livingstone; ISBN: 0443054630; http://www.amazon.com/exec/obidos/ASIN/0443054630/icongroupinterna
Vocabulary Builder Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Analgesics:
Compounds capable of relieving pain without the loss of
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consciousness or without producing anesthesia. [NIH] Anastomosis: An opening created by surgical, traumatic or pathological means between two normally separate spaces or organs. [EU] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH]
Anorexia: Lack or loss of the appetite for food. [EU] Bereavement: Refers to the whole process of grieving and mourning and is associated with a deep sense of loss and sadness. [NIH] Blindness: The inability to see or the loss or absence of perception of visual stimuli. This condition may be the result of eye diseases; optic nerve diseases; optic chiasm diseases; or brain diseases affecting the visual pathways or occipital lobe. [NIH] Bromocriptine: A semisynthetic ergot alkaloid that is a dopamine D2 agonist. It suppresses prolactin secretion and is used to treat amenorrhea, galactorrhea, and female infertility, and has been proposed for Parkinson disease. [NIH] Calculi: An abnormal concretion occurring mostly in the urinary and biliary tracts, usually composed of mineral salts. Also called stones. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, poly- and heterosaccharides. [EU] Cataract: An opacity, partial or complete, of one or both eyes, on or in the lens or capsule, especially an opacity impairing vision or causing blindness. The many kinds of cataract are classified by their morphology (size, shape, location) or etiology (cause and time of occurrence). [EU] Catheterization: The employment or passage of a catheter. [EU] Circumcision: Excision of the prepuce or part of it. [NIH] Colitis: Inflammation of the colon. [EU] Constipation: Infrequent or difficult evacuation of the faeces. [EU] Contraception: The prevention of conception or impregnation. [EU] Defecation: The normal process of elimination of fecal material from the rectum. [NIH] Diaphragm: The musculofibrous partition that separates the thoracic cavity from the abdominal cavity. Contraction of the diaphragm increases the
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volume of the thoracic cavity aiding inspiration. [NIH] Diathermy: Heating of the body tissues due to their resistance to the passage of high-frequency electromagnetic radiation, electric currents, or ultrasonic waves. In medical d. (thermopenetration) the tissues are warmed but not damaged; in surgical d. (electrocoagulation) tissue is destroyed. [EU] Dyspareunia: Difficult or painful coitus. [EU] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Enuresis: Involuntary discharge of urine after the age at which urinary control should have been achieved; often used alone with specific reference to involuntary discharge of urine occurring during sleep at night (bedwetting, nocturnal enuresis). [EU] Erythromycin: A bacteriostatic antibiotic substance produced by Streptomyces erythreus. Erythromycin A is considered its major active component. In sensitive organisms, it inhibits protein synthesis by binding to 50S ribosomal subunits. This binding process inhibits peptidyl transferase activity and interferes with translocation of amino acids during translation and assembly of proteins. [NIH] Erythropoietin: Glycoprotein hormone, secreted chiefly by the kidney in the adult and the liver in the fetus, that acts on erythroid stem cells of the bone marrow to stimulate proliferation and differentiation. [NIH] Gangrene: Death of tissue, usually in considerable mass and generally associated with loss of vascular (nutritive) supply and followed by bacterial invasion and putrefaction. [EU] Glucose: D-glucose, a monosaccharide (hexose), C6H12O6, also known as dextrose (q.v.), found in certain foodstuffs, especially fruits, and in the normal blood of all animals. It is the end product of carbohydrate metabolism and is the chief source of energy for living organisms, its utilization being controlled by insulin. Excess glucose is converted to glycogen and stored in the liver and muscles for use as needed and, beyond that, is converted to fat and stored as adipose tissue. Glucose appears in the urine in diabetes mellitus. [EU] Groin: The external junctural region between the lower part of the abdomen and the thigh. [NIH] Heartburn: Substernal pain or burning sensation, usually associated with regurgitation of gastric juice into the esophagus. [NIH] Hematuria: Presence of blood in the urine. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hemostasis: The process which spontaneously arrests the flow of blood
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from vessels carrying blood under pressure. It is accomplished by contraction of the vessels, adhesion and aggregation of formed blood elements, and the process of blood or plasma coagulation. [NIH] Hepatitis: Inflammation of the liver. [EU] Infertility: The diminished or absent ability to conceive or produce an offspring while sterility is the complete inability to conceive or produce an offspring. [NIH] Influenza: An acute viral infection involving the respiratory tract. It is marked by inflammation of the nasal mucosa, the pharynx, and conjunctiva, and by headache and severe, often generalized, myalgia. [NIH] Insomnia: Inability to sleep; abnormal wakefulness. [EU] Intestines: The section of the alimentary canal from the stomach to the anus. It includes the large intestine and small intestine. [NIH] Ketoacidosis: Acidosis accompanied by the accumulation of ketone bodies (ketosis) in the body tissues and fluids, as in diabetic acidosis. [EU] Lamivudine: A reverse transcriptase inhibitor and zalcitabine analog in which a sulfur atom replaces the 3' carbon of the pentose ring. It is used to treat HIV disease. [NIH] Lobe: A more or less well-defined portion of any organ, especially of the brain, lungs, and glands. Lobes are demarcated by fissures, sulci, connective tissue, and by their shape. [EU] Lubrication: The application of a substance to diminish friction between two surfaces. It may refer to oils, greases, and similar substances for the lubrication of medical equipment but it can be used for the application of substances to tissue to reduce friction, such as lotions for skin and vaginal lubricants. [NIH] Menopause: Cessation of menstruation in the human female, occurring usually around the age of 50. [EU] Menstruation: The cyclic, physiologic discharge through the vagina of blood and mucosal tissues from the nonpregnant uterus; it is under hormonal control and normally recurs, usually at approximately four-week intervals, in the absence of pregnancy during the reproductive period (puberty through menopause) of the female of the human and a few species of primates. It is the culmination of the menstrual cycle. [EU] Metoclopramide: A dopamine D2 antagonist that is used as an antiemetic. [NIH]
Narcotic: 1. pertaining to or producing narcosis. 2. an agent that produces insensibility or stupor, applied especially to the opioids, i.e. to any natural or synthetic drug that has morphine-like actions. [EU] Neoplasms: New abnormal growth of tissue. Malignant neoplasms show a
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greater degree of anaplasia and have the properties of invasion and metastasis, compared to benign neoplasms. [NIH] Nephropathy: Disease of the kidneys. [EU] Neuralgia: Paroxysmal pain which extends along the course of one or more nerves. Many varieties of neuralgia are distinguished according to the part affected or to the cause, as brachial, facial, occipital, supraorbital, etc., or anaemic, diabetic, gouty, malarial, syphilitic, etc. [EU] Osteoporosis: Reduction in the amount of bone mass, leading to fractures after minimal trauma. [EU] Perforation: 1. the act of boring or piercing through a part. 2. a hole made through a part or substance. [EU] Phobia: A persistent, irrational, intense fear of a specific object, activity, or situation (the phobic stimulus), fear that is recognized as being excessive or unreasonable by the individual himself. When a phobia is a significant source of distress or interferes with social functioning, it is considered a mental disorder; phobic disorder (or neurosis). In DSM III phobic disorders are subclassified as agoraphobia, social phobias, and simple phobias. Used as a word termination denoting irrational fear of or aversion to the subject indicated by the stem to which it is affixed. [EU] Prolactinoma: A pituitary adenoma which secretes prolactin, leading to hyperprolactinemia. Clinical manifestations include amenorrhea; galactorrhea; impotence; headache; visual disturbances; and cerebrospinal fluid rhinorrhea. [NIH] Psychotropic: Exerting an effect upon the mind; capable of modifying mental activity; usually applied to drugs that effect the mental state. [EU] Resection: Excision of a portion or all of an organ or other structure. [EU] Retinopathy: 1. retinitis (= inflammation of the retina). 2. retinosis (= degenerative, noninflammatory condition of the retina). [EU] Retrograde: 1. moving backward or against the usual direction of flow. 2. degenerating, deteriorating, or catabolic. [EU] Stabilization: The creation of a stable state. [EU] Sterility: 1. the inability to produce offspring, i.e., the inability to conceive (female s.) or to induce conception (male s.). 2. the state of being aseptic, or free from microorganisms. [EU] Sterilization: 1. the complete destruction or elimination of all living microorganisms, accomplished by physical methods (dry or moist heat), chemical agents (ethylene oxide, formaldehyde, alcohol), radiation (ultraviolet, cathode), or mechanical methods (filtration). 2. any procedure by which an individual is made incapable of reproduction, as by castration,
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vasectomy, or salpingectomy. [EU] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Suppository: A medicated mass adapted for introduction into the rectal, vaginal, or urethral orifice of the body, suppository bases are solid at room temperature but melt or dissolve at body temperature. Commonly used bases are cocoa butter, glycerinated gelatin, hydrogenated vegetable oils, polyethylene glycols of various molecular weights, and fatty acid esters of polyethylene glycol. [EU] Thrombosis: The formation, development, or presence of a thrombus. [EU] Tinnitus: A noise in the ears, as ringing, buzzing, roaring, clicking, etc. Such sounds may at times be heard by others than the patient. [EU] Transplantation: The grafting of tissues taken from the patient's own body or from another. [EU] Tricyclic: Containing three fused rings or closed chains in the molecular structure. [EU] Urethritis: Inflammation of the urethra. [EU]
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CHAPTER 6. MULTIMEDIA ON IMPOTENCE Overview Information on impotence can come in a variety of formats. Among multimedia sources, video productions, slides, audiotapes, and computer databases are often available. In this chapter, we show you how to keep current on multimedia sources of information on impotence. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine. If you see an interesting item, visit your local medical library to check on the availability of the title.
Video Recordings Most diseases do not have a video dedicated to them. If they do, they are often rather technical in nature. An excellent source of multimedia information on impotence is the Combined Health Information Database. You will need to limit your search to “video recording” and “impotence” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” By making these selections and typing “impotence” (or synonyms) into the “For these words:” box, you will only receive results on video productions. The following is a typical result when searching for video recordings on impotence: ·
Preventing Long Term Complications of Diabetes Source: Timonium, MD: Milner-Fenwick. 2000. (videocassette).
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Contact: Available from Milner-Fenwick, Inc. 2125 Greenspring Drive, Timonium, MD 21093-3100. (800) 432-8433. Fax (410) 252-6316. Price: $125.00; bulk orders available; plus shipping and handling. Summary: The goal of this video program is to help patients with diabetes understand and prevent the long term complications of their disease. Viewers learn how high blood sugar (hyperglycemia) and the associated damage to blood vessels can possibly lead to heart attack, stroke, loss of vision (diabetic retinopathy), kidney disease (diabetic nephropathy), nerve damage (diabetic neuropathy), and amputation. Information is included about damage to both large and small blood vessels, updated terminology, HbA1c (glycosylated hemoglobin) testing (used to monitor blood glucose levels over time), heart disease risk factors, and erectile dysfunction (impotence). The video stresses that improving blood glucose (sugar) levels can help reduce the patient's risk of complications over time. The videotape was produced in cooperation with the American Association of Diabetes Educators (AADE), which defined the content of the video, selected the program consultants, and approved production at each stage of development. The program is closed-captioned. ·
Recognizing and Managing Erectile Dysfunction Source: Kansas City, MO: American Academy of Family Physicians. 2000. (videocassette). Contact: Available from American Academy of Family Physicians. 8880 Ward Parkway, Kansas City, MO 64114-2797. (800) 274-2237. Price: $17.95 for members; $25.00 for non-members, plus shipping and handling. Summary: Sexual dysfunction affects about 31 percent of men in the United States. The most common of these problems are erectile dysfunction (ED, formerly called impotence), premature ejaculation, inability to achieve orgasm or ejaculation, and decreased libido. This continuing education program focuses on ED, which is defined as the inability to achieve or maintain penile erection sufficient for sexual intercourse. The program includes a videotape program and study guide and covers the causes of ED, including vascular, neurologic, endocrine, anatomical, and medications and substance abuse; the evaluation of ED, including patient history, a focused physical examination, the indications for laboratory tests, and the role of referral; therapeutic options, including medical (drug) therapy, vacuum constriction devices, psychotherapy or sex therapy, intraurethral therapy, intracavernosal injection, and surgery; and patient education. The program stresses that any patient with a complaint of erectile problems should be thoroughly evaluated before treatment recommendations are made. The first step in treatment is
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addressing modifiable causes or exacerbating factors. If further treatment is necessary, a number of safe and effective options are available. Patients can be assured that ED is treatable. Men and their partners may also benefit from counseling to address related emotional and relationship issues. The program comes with a patient information fact sheet (which can be photocopied and distributed), and a form with which readers can qualify for continuing education credits. 11 tables. 13 references. ·
Impotence and Diabetes Source: Los Angeles, CA: National Health Video, Inc. 1999. (videocassette). Contact: Available from National Health Video, Inc. 12021 Wilshire Blvd., Suite 550, Los Angeles, CA 90025. (800) 543-6803. Fax (310) 477-8198. Email:
[email protected]. Price: $89.00 plus shipping and handling. Summary: This patient education videotape program reviews the problem of erectile dysfunction (impotence) and diabetes mellitus. The program defines erectile dysfunction (ED) as the consistent inability to get and maintain an erection. The program first explores the physiology of erections (how they happen), including the need for mental and physical stimulation, nerve impulses in the brain, and responses in muscles, fibrous tissues, and veins and arteries. The program offers a diagram and the use of a balloon to describe how an erection happens, the anatomy of the corpera cavernosa, and the role of nitrous oxide as a neurochemical transmitter. Age is noted as a factor in ED, and men with diabetes tend to develop ED 10 to 15 years earlier than men who do not have diabetes. The program notes that psychological factors (stress, depression, guilt, and performance anxiety) can cause 10 to 15 percent of ED; a series of self test questions are included for viewers to determine if psychological factors may play a role in their own ED. For men with diabetes, nerve damage (peripheral neuropathy) is the most likely culprit for causing ED; damage to the blood vessels (atherosclerosis) is another cause. Poor blood glucose control is the most important factor in both of these problems. The program includes a section noting the impact of drugs (including alcohol and nicotine) on ED. The program outlines the steps in diagnosing erectile problems, including first admitting that there is a problem, talking with a doctor, undergoing diagnostic tests, and participating in treatment. The final section reviews treatment options, reiterating the importance of good blood glucose control and describing the use of drug therapy (Viagra), vacuum erectile systems, self injection, and surgery (blood vessel repair and penile implants). The program includes drawings, graphics, and footage of patients and their physicians through the diagnosis and treatment processes.
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Current Approaches to Erectile Dysfunction Source: Madison, WI: University of Wisconsin Hospitals and Clinics, Department of Outreach Education. 1999. (videocassette). Contact: Available from University of Wisconsin Hospital and Clinics. Picture of Health, 702 North Blackhawk Avenue, Suite 215, Madison, WI 53705-3357. (800) 757-4354 or (608) 263-6510. Fax (608) 262-7172. Price: $19.95 plus shipping and handling; bulk copies available. Order number 060699A. Summary: Erectile dysfunction (impotence) is a common, treatable condition experienced by 10 to 20 million men in the United States. This videotape program, moderated by Carol Koby, discusses the current approaches to the diagnosis and treatment of erectile dysfunction (ED). The program features Dr. Wolfram Nolten, an endocrinologist, who first defines ED as the inability to achieve or maintain erection satisfactory for intercourse at least 50 percent of the time. Dr. Nolten stresses that effective treatments are available. Focusing primarily on Viagra (sildenafil), Dr. Nolten discusses the history of the drug's development, how Viagra works, cost considerations, side effects, patient selection issues, and the use of Viagra in women (an 'off label' use that is not recommended). Other topics covered include the role of depression and stress, hormones, systemic diseases (such as diabetes mellitus or cardiovascular diseases), and drug effects on the development of ED. Dr. Nolten then covers diagnostic issues, the appropriate use of primary care providers to treat most men with ED, other drugs used to treat ED (self injection and urethral administration of vasoactive drugs), penile implants, vacuum erection devices, and the implications of the presence of noctural erections. Dr. Nolten concludes by reminding viewers that 'erection is good for erection'; in other words, frequent erections oxygenate the penis and keep the physiology in good working condition. As the population ages, there is an accompanying change in awareness of sexuality and general health. The program concludes with a reference to a physician's guide to ED information and resources (www.pslgroup.com).
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What Every Man (and Woman) Should Know About Erectile Dysfunction Source: New York, NY: Pfizer, Inc. 1999. (videocassette). Contact: Available from Trigenesis Communications. 26 Main Street, Chatham, NJ 07928-2402. (800) 664-5484 or (877) 487-4436. Fax (973) 7018896. Price: Single copy free.
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Summary: For many men, the solution to erectile problems is a pill called Viagra (sildenafil). In this educational video, leading experts discuss the causes of erectile dysfunction (ED, also called impotence), dispel some common myths, and introduce how it is treated. The program interviews men who share their stories of how Viagra has helped them restore an important part of their lives. Viagra helps a man with erectile dysfunction get an erection only when he is sexually excited (taking the medication alone does not result in erection). The program reviews the most common side effects of Viagra, which include headache, facial flushing, and upset stomach. A small percentage of men (3 percent) reported mild and temporary visual effects. Viagra must not be taken by men who use drugs known as nitrates (most often used to control angina) in any form, at any time. The use of these drugs with Viagra can result in a sudden drop in blood pressure. In addition, viewers are advised to consult with their physicians about the cardiovascular stress of sexual activities. Accompanying the videotape program is a 24 page booklet that reviews the topics covered in the program and that summarizes the patient insert information that is packaged with the drug Viagra. Patients are encouraged to talk with their physicians and work cooperatively to address any issues of sexual dysfunction. ·
Straight Talk on Prostate Health Source: [Toronto, Ontario, Canada]: HB Pictures. 1994. (videocassette). Contact: Available from Medical Audio Visual Communications, Inc. Suite 240, 2315 Whirlpool Street, Niagara Falls, NY 14305. Or P.O. Box 84548, 2336 Bloor Street West, Toronto, ON M6S 1TO, Canada. (800) 7574868 or (905) 602-1160. Fax (905) 602-8720. Price: $99.00 (Canadian); contact producer for current price in American dollars. Order Number COR008. Summary: This videotape provides viewers with comprehensive information about prostate health. Topics include the prostate gland, its function, and prostatic problems; effective treatments for impotence and sexual dysfunction; treatment for benign prostatic enlargements (BPH) and prostatitis; prostate cancer and how it differs from other cancers; the pros and cons of the prostate specific antigen (PSA) blood test in detecting prostate cancer; the importance of the early detection of prostate cancer; and treatment options for localized and advanced prostate cancer. The program presents a Decision Analysis Model to help patients weigh benefits versus risks of treatment options. The program concludes with a question and answer session with Dr. Peter Scardino, a practicing urologist specializing in prostate cancer. (AA-M).
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Prostate: Why Does It Enlarge? What Should I Do About It? Source: Hanover, MD: American Prostate Society. 1994. (videocassette). Contact: Available from American Prostate Society. 1340-F Charwood Road, Hanover, MD 21076-3169. (410) 859-3735. E-mail:
[email protected]. Web site: http://www.ameripros.org. Price: Contact producer directly for current price. Summary: This patient education videotape provides viewers with an overview of benign prostatic hyperplasia (BPH) or enlargement. Narrated by Doug Roberts, the program first defines BPH, describes the role of the prostate gland, and describes how an enlarged prostate can affect urination. The program then covers the symptoms of BPH, which include a weak or interrupted urine stream, the sensation of incomplete bladder emptying, urine leakage, difficulty starting urination, frequent urination, especially at night, and an uncontrollable urge to urinate. The program then outlines three options for men with BPH: watchful waiting (close monitoring), medications, and surgery. The section on surgery focuses on transurethral resection of the prostate (TURP), showing how the procedure is done, and describing the possible side effects. These side effects include sexual dysfunction (retrograde ejaculation occurs in up to 50 percent of patients), sexual impotence (5 percent), and urinary incontinence (1 percent). The section on drug therapy describes Hytrin (terazosin hydrochloride), which works as a muscle relaxant on the 40 percent of the prostate that is made of smooth muscle, and Proscar, which shrinks the prostate. The side effects of both medications are discussed. The last section of the video describes the risk factors for BPH and the roles of the PSA (prostate specific antigen) test and the rectal examination in screening and diagnosis of prostate problems. The video concludes with a brief message from Claude Gerard, the founder of the American Prostate Society, who encourages viewers to consult a health care provider with any urinary problems and to take the time to have screening tests done for prostatic diseases. The program features graphics, real-time footage of a TURP procedure, interviews with patients, and footage of a variety of men in active physical settings, including sports and recreation activities.
Audio Recordings The Combined Health Information Database contains abstracts on audio productions. To search CHID, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find audio productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option
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“Sound Recordings.” By making these selections and typing “impotence” (or synonyms) into the “For these words:” box, you will only receive results on sound recordings (again, most diseases do not have results, so do not expect to find many). The following is a typical result when searching for sound recordings on impotence: ·
Diabetes and Impotence: A Concern for Couples Source: Minneapolis, MN: International Diabetes Center. 199x. (slides or audiocassette). Contact: Available from International Diabetes Center. 5000 West 39th Street, Minneapolis, MN 55416. (612) 927-3393. Fax (612) 927-1302. Price: $50 plus shipping for 50 slides; $10 plus shipping for audiocassette (as of 1995). Summary: This program presents a definition of impotence and its prevalence among males with diabetes. The necessary components of an erection are reviewed, and physiological barriers which may result from diabetes are related. Diagnosis and treatment, including surgical implants are considered, as well as the importance of maintaining careful control of diabetes. (UM-M).
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Practical Reviews in Urology Source: Birmingham, AL: Educational Reviews, Inc. 199x. (audiocassette subscription). Contact: Available from Educational Reviews, Inc. 6801 Cahaba Valley Road, Birmingham, AL 35242. (800) 633-4743 or (205) 991-5188. Fax (205) 995-1926. Price: $265.00 per year for AUA members; $295.00 for nonmembers; $185.00 for residents (as of 1996). Summary: This series of monthly audiocassettes summarizes the most important articles affecting urologists. Each audiocassette includes 18 reports extracted by a panel of authorities. Each month's updates also come with abstract cards, complete with citation and reprint information. Cards can be used as a preview or review of the month's updates. Colorcoded dividers and a subject index are also provided with the cards. Urologists can earn up to 36 continuing medical education (CME) credits using the tapes. Updates cover bladder function and neuropathic dysfunction, calculi, congenital anomalies, diagnostic studies, endocrine physiology and disorders, impotence, infertility, inflammations and infections, oncology, renal function and failure, renal vascular disease, sexual dysfunction, sexually transmitted disease, transplantation, trauma, and voiding dysfunction.
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Bibliography: Multimedia on Impotence The National Library of Medicine is a rich source of information on healthcare-related multimedia productions including slides, computer software, and databases. To access the multimedia database, go to the following Web site: http://locatorplus.gov/. Select “Search LOCATORplus.” Once in the search area, simply type in impotence (or synonyms). Then, in the option box provided below the search box, select “Audiovisuals and Computer Files.” From there, you can choose to sort results by publication date, author, or relevance. The following multimedia has been indexed on impotence. For more information, follow the hyperlink indicated: ·
Aspects of sexual interviewing: the impotent husband. Source: University of Pennsylvania School of Medicine Center for the Study of Sex Education in Medicine; produced by Ortho Pharmaceutical Corporation, Dept. of Educational Services through; Year: 1972; Format: Motion picture; [Raritan, N. J.]: The Corp., [c1972]
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Current concepts of erectile dysfunction : diagnosis & treatment. Source: sponsored by Mayo Clinic; CME Information Services, Inc., CMEVideo; Year: 1998; Format: Videorecording; Mt. Laurel, NJ: CMEVideo, 1998
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Diagnosing erectile problems : a film. Source: by Joseph LoPiccolo, Jerry M. Friedman, Stephen J. Weiler; Year: 1980; Format: Motion picture; New York,: Focus International, c1980
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Diagnostic methods in male impotence . Year: 1983; Format: Motion picture; [Copenhagen, Denmark]: Gorm Wagner, c1983
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Erectile dysfunction : oral therapy: current treatment and future therapies. Source: Marshfield Clinic, Saint Joseph's Hospital; a presentation of the Marshfield Video Network; Year: 1998; Format: Videorecording; Marshfield, WI: The Network, c1998
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Erectile dysfunction : recognition, diagnosis, and treatment. Source: Ridwan Shabsigh; Year: 1997; Format: Videorecording; Secaucus, N.J.: Network for Continuing Medical Education, 1997
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Erectile dysfunction in primary care : broaching the subject, treating the problem. Source: Andre T. Guay, Louis Kurtizky, Jacob Rajfer; guest commentary, Louis Ignarro; Year: 2000; Format: Videorecording; Secaucus, N.J.: Network for Continuing Medical Education, c2000
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Evaluation and treatment of impotence with the Jonas penile prosthesis. Source: from the Motion Picture Library of the American College of Surgeons; produced by Aegis Productions, Inc; Year: 1981; Format: Videorecording; [Chicago, Ill.]: The College, [1981]
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Heyer-Schulte-Small-Carrion penile implant for the management of impotence. Source: Michael P. Small; Year: 1981; Format: Motion picture; Los Angeles: Wexler Films, [1981]
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Implantation of a penile prosthesis. Source: [presented by] Informed Consent Incorporated; produced and distributed by Filmtec, Inc; Year: 1988; Format: Videorecording; [Reston, Va.]: Filmtec, c1988
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Implantation of an inflatable penile prosthesis in the treatment of erectile impotence. Source: author, F. Brantley Scott; co-author, Irving J. Fishman; produced by DG, Davis & Geck, Medical Device Division; Year: 1990; Format: Videorecording; [Wayne, N.J.]: American Cyanamid, c1990
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Impotence : treatment options. Source: Kaiser Permanente, Southern California Permanente Medical Group; Year: 1993; Format: Videorecording; [United States: s.n., 1993]
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Impotence & smoking. Source: NHV, National Health Video Inc; Year: 1999; Format: Videorecording; Los Angeles, CA: NHV, c1999
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Impotence. Source: a co-production of Audio Visual Communication Resources and Physician Education & Development; Year: 1997; Format: Videorecording; [Oakland, Calif.]: Kaiser Foundation Health Plan, c1997
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Impotence. Source: Faculty of Health Sciences, McMaster University ... [et al.]; Year: 1974; Format: Videorecording; Hamilton, Ont.: The University: [for sale by its Faculty of Health Sciences], 1974
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Impotency : prosthetic approach to impotency. Source: [presented by] Marshfield Medical Foundation in cooperation with Marshfield Clinic & St. Joseph's Hospital; Year: 1983; Format: Videorecording; Marshfield, WI: Marshfield Regional Video Network, 1983
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Male infertility. Source: presented by Department of Gynecology/Obstetrics, Emory University, School of Medicine; Year: 1982; Format: Videorecording; Atlanta, Ga.: Emory Medical Television Network, 1982
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Matter most delicate. Source: a Nomad Films International production; Year: 1986; Format: Videorecording; [Melbourne, Vic.]: NFI, c1986
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Medical and surgical treatment of impotence. Source: American College of Surgeons; Year: 1976; Format: Sound recording; Chicago: The College, p1976
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Medical management of impotence. Source: HSN, Health and Sciences Network; Year: 1991; Format: Videorecording; [Augusta, Ga.]: The Network, c1991
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Penile bypass for arteriogenic impotence. Source: author, Ralph G. DePalma; co-author, Michael Olding; produced by DG, Davis & Geck;
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Year: 1991; Format: Videorecording; [Wayne, N.J.]: American Cyanamid, c1991 ·
Perspectives on impotency. Source: [presented by] Audio-Video Digest Foundation, in collaboration with the University of California, San Francisco, School of Medicine; sponsored and produced by Extended Programs in Medical Education,School of M; Year: 1981; Format: Videorecording; [California]: Regents of the University of California, c1981
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Sex & alcohol. Source: NHV, National Health Video Inc; Year: 1999; Format: Videorecording; Los Angeles, CA: NHV, c1999
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Transscrotal approach for penile prosthesis insertion. Source: Kaiser Permanente, Southern California Permanente Medical Group; Wexler Films; Year: 1987; Format: Videorecording; Los Angeles: Wexler, [1987]
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Treating erectile problems : a film. Source: by Joseph LoPiccolo, Jerry M. Friedman; Year: 1980; Format: Motion picture; New York: Focus International, c1980
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Treatment of erectile impotence by an implantable hydraulic prosthesis. Source: F. Brantley Scott ... [et al.]; produced by Medical Illustration and Audiovisual Education, Baylor College of Medicine Texas Medical Center; Year: 1975; Format: Motion picture; Houston: The College: [for loan or sale by its Learning Resources Center], 1975
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Triple threat of genitourinary disease : implications for improving quality of life. Source: Geriatric Education Center; Year: 1992; Format: Videorecording; Richmond, Va.: Virginia Commonwealth University, c1992
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Urologic implications of spinal disease. Source: American Academy of Orthopaedic Surgeons [and] the Cleveland Clinic Foundation; Year: 1984; Format: Slide; [Chicago, Ill.]: The Academy, [1984]
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Viagra : a new sexual revolution? Source: a presentation of Films for the Humanities & Sciences; Nightline, ABCNEWS; Year: 1999; Format: Videorecording; Princeton, N.J.: Films for the Humanities and Sciences, c1999
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Workshop on correcting male impotence. Source: [presented by] Gerald F. Kein; Year: 1990; Format: Videorecording; DeLand, FL: Omni Hypnosis Training Center, c1990
Vocabulary Builder Antigen: Any substance which is capable, under appropriate conditions, of
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inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized Tlymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Facial: Of or pertaining to the face. [EU] Gynecology: A medical-surgical specialty concerned with the physiology and disorders primarily of the female genital tract, as well as female endocrinology and reproductive physiology. [NIH] Laparoscopes: Endoscopes for examining the interior of the abdomen. [NIH] Mobility: Capability of movement, of being moved, or of flowing freely. [EU] Neurophysiology: The scientific discipline concerned with the physiology of the nervous system. [NIH] Nicotine: Nicotine is highly toxic alkaloid. It is the prototypical agonist at nicotinic cholinergic receptors where it dramatically stimulates neurons and ultimately blocks synaptic transmission. Nicotine is also important medically because of its presence in tobacco smoke. [NIH] Obstetrics: A medical-surgical specialty concerned with management and care of women during pregnancy, parturition, and the puerperium. [NIH] Orthopaedic: Pertaining to the correction of deformities of the musculoskeletal system; pertaining to orthopaedics. [EU] Vasoconstriction: The diminution of the calibre of vessels, especially constriction of arterioles leading to decreased blood flow to a part. [EU]
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CHAPTER 7. PERIODICALS AND NEWS ON IMPOTENCE Overview Keeping up on the news relating to impotence can be challenging. Subscribing to targeted periodicals can be an effective way to stay abreast of recent developments on impotence. Periodicals include newsletters, magazines, and academic journals. In this chapter, we suggest a number of news sources and present various periodicals that cover impotence beyond and including those which are published by patient associations mentioned earlier. We will first focus on news services, and then on periodicals. News services, press releases, and newsletters generally use more accessible language, so if you do chose to subscribe to one of the more technical periodicals, make sure that it uses language you can easily follow.
News Services & Press Releases Well before articles show up in newsletters or the popular press, they may appear in the form of a press release or a public relations announcement. One of the simplest ways of tracking press releases on impotence is to search the news wires. News wires are used by professional journalists, and have existed since the invention of the telegraph. Today, there are several major “wires” that are used by companies, universities, and other organizations to announce new medical breakthroughs. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing.
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PR Newswire Perhaps the broadest of the wires is PR Newswire Association, Inc. To access this archive, simply go to http://www.prnewswire.com. Below the search box, select the option “The last 30 days.” In the search box, type “impotence” or synonyms. The search results are shown by order of relevance. When reading these press releases, do not forget that the sponsor of the release may be a company or organization that is trying to sell a particular product or therapy. Their views, therefore, may be biased. The following is typical of press releases that can be found on PR Newswire: ·
Seventy-Three Percent of Patients Taking Vardenafil Reported Improved Erections in Study of Diabetic Men With Erectile Dysfunction Summary: SAN FRANCISCO, June 15 /PRNewswire/ -- In a study specifically designed to assess an oral treatment for erectile dysfunction (ED) in men with diabetes, 73 percent of men taking the investigational drug vardenafil (20 mg) reported improved erections. In addition, in a further analysis of a previously-conducted pivotal, phase III trial, significant improvement was observed in erectile function in men whose diabetes was not well managed (as determined by hemoglobin A(1c) [HbA(1c)] levels). The data are being presented today at the American Diabetes Association 62nd Scientific Session. Men under treatment for diabetes are three times more likely to have erectile problems than men in the general population. Poorly-controlled diabetes increases the chance of vascular damage, which may lead to severe ED. Up to 5.6 million American men have both treated diabetes and ED. The onset of ED may occur 10 to 15 years earlier in men with diabetes than in the general population.(3) "These reported results are impressive because men with diabetes are among the most difficult to treat," said Irwin Goldstein, M.D., lead investigator of both reports and Professor of Urology, Director of the Institute for Sexual Medicine at Boston University, School of Medicine. "The patients in the trial with poorly controlled diabetes had the most severe ED of any patient group I've previously studied." "We're very encouraged by these data because they come on the heels of previous findings that demonstrated positive results with vardenafil in improving erectile function regardless of the cause, severity or presence
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of co-existing conditions," said Paul MacCarthy, M.D., Vice President, U.S. Erection Improvement Observed Regardless of Blood Glucose Control Because the frequency and severity of ED increase with the severity and duration of diabetes, Dr. Goldstein and his colleagues examined the effect of glycemic control (control of blood glucose levels) on the efficacy and safety of vardenafil in men with diabetes. After 12 weeks, those taking vardenafil (at the 10 or 20 mg dose) reported significant improvement in erectile function, partner penetration and maintenance of erection lasting long enough for successful intercourse, compared with study participants taking placebo. Efficacy responses were assessed by the erectile function domain score of the International Index of Erectile Function, diary assessments and the Global Assessment Question. In the trial -- a prospective, randomized, double-blind study in 542 men with diabetes and ED -- patients received vardenafil 10 or 20 mg or placebo as needed for 12 weeks. Glycemic control was measured by -and efficacy measures stratified according to -- HbA(1c) blood levels. The efficacy of vardenafil was not influenced by HbA1c levels. Men with diabetes and ED reported improvement in erectile function with vardenafil regardless of blood glucose control. Of the men who had the most poorly-controlled diabetes (defined by an HbA(1c)level greater than or equal to 8.0 percent), 72 percent of those taking vardenafil 20 mg reported improved erections compared with 15 percent of men taking placebo. Adverse events were transient and mostly mild to moderate in intensity. The most commonly reported adverse events were headache, flushing, rhinitis, dyspepsia and sinusitis. Long-Term Study Reports Significant Erectile Improvement To determine the long-term effectiveness of vardenafil in treating ED in men with diabetes, Dr. Goldstein and colleagues conducted a threemonth extension study that included 340 of 542 men enrolled in an earlier three-month, multicenter, randomized, double-blind study of men with diabetes and ED. After three months of double-blind therapy, the 340 patients (both those on placebo and those on vardenafil) were treated with vardenafil 10 or 20 mg for the next three months. After a total of six months, 73 percent of men taking vardenafil 20 mg and 61 percent taking vardenafil 10 mg reported improved erections. Also, patients previously receiving placebo reported marked improvement
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when crossed over to vardenafil therapy. The investigators concluded that men with diabetes who were suffering from ED responded to vardenafil for a prolonged six-month period, maintaining the improved erectile function that was observed at three months.
Reuters The Reuters’ Medical News database can be very useful in exploring news archives relating to impotence. While some of the listed articles are free to view, others can be purchased for a nominal fee. To access this archive, go to http://www.reutershealth.com/frame2/arch.html and search by “impotence” (or synonyms). The following was recently listed in this archive for impotence: ·
Impotence drug tadalafil demonstrates long-lasting effect Source: Reuters Medical News Date: May 31, 2002 http://www.reuters.gov/archive/2002/05/31/professional/links/20020 531clin013.html
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Gene therapy may offer long-term impotence remedy Source: Reuters Health eLine Date: May 29, 2002 http://www.reuters.gov/archive/2002/05/29/eline/links/20020529elin 018.html
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Impotence drug works if taken 36 hours before sex Source: Reuters Health eLine Date: May 28, 2002 http://www.reuters.gov/archive/2002/05/28/eline/links/20020528elin 020.html
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NexMed introduces Befar anti-impotence cream in Hong Kong Source: Reuters Industry Breifing Date: April 23, 2002 http://www.reuters.gov/archive/2002/04/23/business/links/20020423 drgd001.html
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Anti-impotence cream to take on Viagra Source: Reuters Health eLine Date: April 23, 2002 http://www.reuters.gov/archive/2002/04/23/eline/links/20020423elin 028.html
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Apomorphine for impotence well tolerated in patients taking nitrates Source: Reuters Medical News Date: February 26, 2002 http://www.reuters.gov/archive/2002/02/26/professional/links/20020 226clin019.html
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Impotence common among men with type 2 diabetes Source: Reuters Health eLine Date: January 28, 2002 http://www.reuters.gov/archive/2002/01/28/eline/links/20020128elin 015.html
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Lilly, ICOS remove impotence drug info from Web Source: Reuters Industry Breifing Date: January 15, 2002 http://www.reuters.gov/archive/2002/01/15/business/links/20020115 rglt008.html
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Bayer says vardenafil helps 85% of impotence sufferers in phase III Source: Reuters Industry Breifing Date: December 07, 2001 http://www.reuters.gov/archive/2001/12/07/business/links/20011207 drgd002.html
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Bayer says impotence drug helps 85% of men Source: Reuters Health eLine Date: December 07, 2001 http://www.reuters.gov/archive/2001/12/07/eline/links/20011207elin 027.html
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Viagra treats impotence in depressed men: study Source: Reuters Health eLine Date: October 25, 2001 http://www.reuters.gov/archive/2001/10/25/eline/links/20011025elin 010.html
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NexMed to begin two pivotal trials for male impotence cream Source: Reuters Industry Breifing Date: September 19, 2001 http://www.reuters.gov/archive/2001/09/19/business/links/20010919 rglt005.html
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Bayer says anti-impotence pills stolen Source: Reuters Health eLine Date: September 05, 2001 http://www.reuters.gov/archive/2001/09/05/eline/links/20010905elin 024.html
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Herbal anti-impotence Web sites stretch the truth Source: Reuters Health eLine Date: August 27, 2001 http://www.reuters.gov/archive/2001/08/27/eline/links/20010827elin 023.html
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Lilly ICOS files NDA for FDA approval of impotence drug Cialis Source: Reuters Industry Breifing Date: June 28, 2001 http://www.reuters.gov/archive/2001/06/28/business/links/20010628 rglt007.html
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Palatin Technologies reports positive phase I results for its impotence drug Source: Reuters Industry Breifing Date: May 31, 2001 http://www.reuters.gov/archive/2001/05/31/business/links/20010531 drgd005.html
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Takeda wins European approval for impotence drug Source: Reuters Industry Breifing Date: May 29, 2001 http://www.reuters.gov/archive/2001/05/29/business/links/20010529 rglt012.html
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NexMed affiliate files impotence drug for approval in Hong Kong Source: Reuters Industry Breifing Date: May 03, 2001 http://www.reuters.gov/archive/2001/05/03/business/links/20010503 rglt002.html
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Lilly says experimental impotence drug helps some for 24 hours Source: Reuters Industry Breifing Date: May 01, 2001 http://www.reuters.gov/archive/2001/05/01/business/links/20010501 drgd003.html
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Bayer in talks on impotence drug deal Source: Reuters Industry Breifing Date: April 16, 2001 http://www.reuters.gov/archive/2001/04/16/business/links/20010416 inds003.html
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New impotence drug promising: study Source: Reuters Health eLine Date: April 06, 2001 http://www.reuters.gov/archive/2001/04/06/eline/links/20010406elin 030.html
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Bayer impotence drug in phase II trial effective regardless of age, severity Source: Reuters Industry Breifing Date: April 06, 2001 http://www.reuters.gov/archive/2001/04/06/business/links/20010406 drgd005.html
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UK docs blast rationing of impotence treatments Source: Reuters Health eLine Date: February 07, 2001 http://www.reuters.gov/archive/2001/02/07/eline/links/20010207elin 025.html
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BMA criticises "cruel" rationing of impotence treatments Source: Reuters Industry Breifing Date: February 07, 2001 http://www.reuters.gov/archive/2001/02/07/business/links/20010207 prof002.html
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NexMed's topical impotence drug approved in China Source: Reuters Industry Breifing Date: February 02, 2001 http://www.reuters.gov/archive/2001/02/02/business/links/20010202 rglt002.html
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New impotence treatment may be on horizon Source: Reuters Health eLine Date: January 02, 2001 http://www.reuters.gov/archive/2001/01/02/eline/links/20010102elin 008.html
The NIH Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news
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items are indexed by MEDLINEplus within their search engine. The following was recently indexed as relating to impotence: ·
Gene Therapy May Offer Long-term Impotence Remedy http://www.nlm.nih.gov/medlineplus/news/fullstory_7819.html
Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com. You can scan the news by industry category or company name.
Internet Wire Internet Wire is more focused on technology than the other wires. To access this site, go to http://www.internetwire.com and use the “Search Archive” option. Type in “impotence” (or synonyms). As this service is oriented to technology, you may wish to search for press releases covering diagnostic procedures or tests that you may have read about.
Search Engines Free-to-view news can also be found in the news section of your favorite search engines (see the health news page at Yahoo: http://dir.yahoo.com/Health/News_and_Media/, or use this Web site’s general news search page http://news.yahoo.com/. Type in “impotence” (or synonyms). If you know the name of a company that is relevant to impotence, you can go to any stock trading Web site (such as www.etrade.com) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “impotence” (or synonyms).
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Newsletters on Impotence Given their focus on current and relevant developments, newsletters are often more useful to patients than academic articles. You can find newsletters using the Combined Health Information Database (CHID). You will need to use the “Detailed Search” option. To access CHID, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Your investigation must limit the search to “Newsletter” and “impotence.” Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter.” By making these selections and typing in “impotence” or synonyms into the “For these words:” box, you will only receive results on newsletters. The following list was generated using the options described above: ·
AAKP Patient Plan. Phase 2: Access and Initiation. [AAKP Patient Plan Newsletter] Source: AAKP Patient Plan Newsletter. 1(2): 1-11. 2000. Contact: Available from American Association of Kidney Patients (AAKP). 100 South Ashley Drive, Suite 280, Tampa, FL 33602. (800) 749AAKP or (813) 223-7099. E-mail:
[email protected]. Website: www.aakp.org. Summary: This newsletter is one component of a framework established to guide kidney patients through the treatment process for their illness. The four phases of the framework are diagnosis and treatment options, access and initiation, stabilization, and ongoing treatment. The program encourages patients to stay active and learn as much as they can about kidney disease and their treatment. The program stresses that the more patients know, the better they are able to make choices that are best for themselves and their families. The program was created by the American Association of Kidney Patients (AAKP), a national organization directed by kidney patients for kidney patients, with the mission of helping kidney patients and their families deal with the physical, emotional, and social impacts of kidney disease. This issue of the newsletter focuses on Phase Two, the access and initiation of therapy. The newsletter includes articles on one woman's experiences of coping with dialysis and kidney failure, erectile dysfunction (impotence) and dealing with sexual dysfunction, the role of the social worker, potassium control for hemodialysis patients, and how to discuss erectile dysfunction with the health care team. The newsletter also offers a list of resource organizations, their phone numbers and website addresses, as well as a brief glossary of terms. Blank space is available for patients to list
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questions they want to ask of their health care team. The newsletter includes a one page request form with which readers can ask for a free copy of the Patient Plan materials (an email option is also provided:
[email protected]). ·
Microwave Thermotherapy Reduces Symptoms Markedly Source: Urology Times. 22(2): 13-14. February 1994. Contact: Available from Advanstar Communications, Inc. Corporate and Editorial Offices, 7500 Old Oak Boulevard, Cleveland, OH 44130. (216) 243-8100. Summary: This article, from a professional newsletter, discusses the use of transurethral microwave thermotherapy (TUMT) for the treatment of bladder outflow obstruction in patients with benign prostatic hyperplasia (BPH). The author reports on the work of Dr. Ronald Sorensen and his colleagues and their experience of performing TUMT in more than 600 men. Topics include symptoms and how TUMT affects them; equipment used to perform the procedure; safety features; time and setting required for the procedure; follow-up results; side effects, including alteration in ejaculation function or impotence (no reported cases of impotence thus far with TUMT); and anticipated results from the use of TUMT.
Newsletter Articles If you choose not to subscribe to a newsletter, you can nevertheless find references to newsletter articles. We recommend that you use the Combined Health Information Database, while limiting your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” By making these selections, and typing in “impotence” (or synonyms) into the “For these words:” box, you will only receive results on newsletter articles. You should check back periodically with this database as it is updated every 3 months. The following is a typical result when searching for newsletter articles on impotence: ·
Discussing Impotence with Your Healthcare Team Source: AAKP Patient Plan Newsletter. 1(2): 6, 7. 2000.
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Contact: Available from American Association of Kidney Patients (AAKP). 100 South Ashley Drive, Suite 280, Tampa, FL 33602. (800) 749AAKP or (813) 223-7099. E-mail:
[email protected]. Website: www.aakp.org. Summary: This article is from a newsletter that guides kidney patients through the treatment process for their illness. The newsletter is part of a program that encourages patients to stay active and learn as much as they can about kidney disease and their treatment. The program stresses that the more patients know, the better they are able to make choices that are best for themselves and their families. The program was created by the American Association of Kidney Patients (AAKP), a national organization directed by kidney patients for kidney patients, with the mission of helping kidney patients and their families deal with the physical, emotional, and social impacts of kidney disease. This article covers discussing erectile dysfunction (impotence) with the health care team. The author notes that in all chronic illnesses, a loss of interest in sexual activity is common. The author also stresses that to properly treat erectile dysfunction, it is important to discuss sexual dysfunction with the health care team, to help them determine proper treatment. The author reviews the steps in diagnosing and treating erectile dysfunction: identify and treat all correctable medical problems (such as diabetes, anemia, thyroid disorders), review all prescribed medications to check for impact on sexual function, review aspects of life quality and consider intervention by a social worker or counselor, and complete urologic evaluation. The article then discusses the medical treatments available for erectile dysfunction, including the use of sildenafil (Viagra). ·
Dealing With Male Impotence: Another Option Source: Voice of the Diabetic. 12(1): 6, 8. Winter 1997. Contact: Available from Voice of the Diabetic. 811 Cherry Street, Suite 309, Columbia, MO 65201-4892. (573) 875-8911. Fax (573) 875-8902. Web site: http://www.nfb.org/voice.htm. Summary: In this newsletter article, the author shares his experiences as a man with diabetes dealing with erectile dysfunction. The author, who has had diabetes for over 30 years and who has dealt with a number of complications, including diabetic nephropathy (and subsequent kidney transplant), diabetic neuropathy (and subsequent amputations), and impotence (erectile dysfunction), explains his explorations of the various treatments for impotence and his choice of self-injection. He explains in detail how to perform penile injections and the advantages offered by this type of therapy, including no need for expensive surgery, temporary effects, a minimum of discomfort, and a renewed sense of confidence. He
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also notes the disadvantages, including the need to use needles, the cost per treatment, and an erection that does not subside in a convenient and timely manner. The author shares his feelings and experiences openly, encouraging readers to contact him if they have any additional questions or concerns. ·
Impotence: Don't Let Embarrassment Stop You From Getting Help Source: Mayo Clinic Health Letter. 15(8): 4-5. August 1997. Contact: Available from Mayo Clinic Health Letter. Subscription Services, P.O. Box 53889, Boulder, CO 80322-3889. (800) 333-9037. Summary: This newsletter article encourages readers with concerns about erectile dysfunction (impotence) to consult their health care providers for information and treatment. The author stresses that, although impotence was once a taboo subject, attitudes are changing. More and more men are seeking help, and physicians now have a better understanding of the causes of impotence. A growing number of treatments are available, many them less invasive and less intimidating than previous options. The article outlines the causes of erectile dysfunction, including physical diseases and disorders, surgery or trauma, medications, substance abuse, and stress, anxiety, or depression. The author then details the treatment options currently in use, including treating the underlying disease or disorder, needle injection therapy, self-intraurethral therapy (MUSE, or medicated urethral system for erection), vacuum devices, vascular surgery, and penile implants. One sidebar briefly describes sildenafil, an experimental drug that can be taken orally to produce an erection. 1 figure. (AA-M).
Academic Periodicals covering Impotence Academic periodicals can be a highly technical yet valuable source of information on impotence. We have compiled the following list of periodicals known to publish articles relating to impotence and which are currently indexed within the National Library of Medicine’s PubMed database (follow hyperlinks to view more information, summaries, etc., for each). In addition to these sources, to keep current on articles written on impotence published by any of the periodicals listed below, you can simply follow the hyperlink indicated or go to the following Web site: www.ncbi.nlm.nih.gov/pubmed. Type the periodical’s name into the search box to find the latest studies published.
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If you want complete details about the historical contents of a periodical, you can also visit http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/ you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.” The following is a sample of periodicals which publish articles on impotence: ·
Aesthetic Plastic Surgery. (Aesthetic Plast Surg) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Ae sthetic+Plastic+Surgery&dispmax=20&dispstart=0
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Archives of Sexual Behavior. (Arch Sex Behav) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Ar chives+of+Sexual+Behavior&dispmax=20&dispstart=0
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Behaviour Research and Therapy. (Behav Res Ther) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Be haviour+Research+and+Therapy&dispmax=20&dispstart=0
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Biochemical and Biophysical Research Communications. (Biochem Biophys Res Commun) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Bi ochemical+and+Biophysical+Research+Communications&dispmax=20& dispstart=0
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Biological Psychiatry. (Biol Psychiatry) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Bi ological+Psychiatry&dispmax=20&dispstart=0
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European Urology. (Eur Urol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Eu ropean+Urology&dispmax=20&dispstart=0
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International Journal of Impotence Research : Official Journal of the International Society for Impotence Research. (Int J Impot Res) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Int ernational+Journal+of+Impotence+Research+:+Official+Journal+of+the+ International+Society+for+Impotence+Research&dispmax=20&dispstart =0
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Journal of the Royal Society of Medicine. (J R Soc Med) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Jo urnal+of+the+Royal+Society+of+Medicine&dispmax=20&dispstart=0
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Postgraduate Medicine. (Postgrad Med) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Po stgraduate+Medicine&dispmax=20&dispstart=0
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The American Journal of Emergency Medicine. (Am J Emerg Med) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Th e+American+Journal+of+Emergency+Medicine&dispmax=20&dispstart= 0
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The British Journal of Medical Psychology. (Br J Med Psychol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Th e+British+Journal+of+Medical+Psychology&dispmax=20&dispstart=0
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The British Journal of Psychiatry; the Journal of Mental Science. (Br J Psychiatry) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Th e+British+Journal+of+Psychiatry;+the+Journal+of+Mental+Science&disp max=20&dispstart=0
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The Journal of Nervous and Mental Disease. (J Nerv Ment Dis) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Th e+Journal+of+Nervous+and+Mental+Disease&dispmax=20&dispstart=0
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The Journal of Urology. (J Urol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Th e+Journal+of+Urology&dispmax=20&dispstart=0
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The Urologic Clinics of North America. (Urol Clin North Am) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Th e+Urologic+Clinics+of+North+America&dispmax=20&dispstart=0
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Urologic Nursing : Official Journal of the American Urological Association Allied. (Urol Nurs) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Ur ologic+Nursing+:+Official+Journal+of+the+American+Urological+Assoc iation+Allied&dispmax=20&dispstart=0
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Vocabulary Builder Argon: Argon. A noble gas with the atomic symbol Ar, atomic number 18, and atomic weight 39.948. It is used in fluorescent tubes and wherever an inert atmosphere is desired and nitrogen cannot be used. [NIH] Arrhythmia: Any variation from the normal rhythm of the heart beat, including sinus arrhythmia, premature beat, heart block, atrial fibrillation, atrial flutter, pulsus alternans, and paroxysmal tachycardia. [EU] Brachytherapy: A collective term for interstitial, intracavity, and surface radiotherapy. It uses small sealed or partly-sealed sources that may be placed on or near the body surface or within a natural body cavity or implanted directly into the tissues. [NIH] Cryosurgery: The use of freezing as a special surgical technique to destroy or excise tissue. [NIH] Epidural: Situated upon or outside the dura mater. [EU] Incision: 1. cleft, cut, gash. 2. an act or action of incising. [EU] Taboo: Any negative tradition or behavior that is generally regarded as harmful to social welfare and forbidden within a cultural or social group. [NIH]
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CHAPTER 8. PHYSICIAN GUIDELINES AND DATABASES Overview Doctors and medical researchers rely on a number of information sources to help patients with their conditions. Many will subscribe to journals or newsletters published by their professional associations or refer to specialized textbooks or clinical guides published for the medical profession. In this chapter, we focus on databases and Internet-based guidelines created or written for this professional audience.
NIH Guidelines For the more common diseases, The National Institutes of Health publish guidelines that are frequently consulted by physicians. Publications are typically written by one or more of the various NIH Institutes. For physician guidelines, commonly referred to as “clinical” or “professional” guidelines, you can visit the following Institutes: ·
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
·
National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/
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National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html
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National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm
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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.25 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:26 ·
Bioethics: Access to published literature on the ethical, legal and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html
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HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html
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NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html
·
Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/
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Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html
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Cancer Information: Access to caner-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html
Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 26 See http://www.nlm.nih.gov/databases/databases.html. 25
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·
Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/
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Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html
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Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html
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Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html
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MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html
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Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html
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Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html
While all of the above references may be of interest to physicians who study and treat impotence, the following are particularly noteworthy.
The Combined Health Information Database A comprehensive source of information on clinical guidelines written for professionals is the Combined Health Information Database. You will need to limit your search to “Brochure/Pamphlet,” “Fact Sheet,” or “Information Package” and impotence using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For the publication date, select “All Years,” select your preferred language, and the format option “Fact Sheet.” By making these selections and typing “impotence” (or synonyms) into the “For these words:” box above, you will only receive results on fact sheets dealing with impotence. The following is a sample result:
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·
Prostate Surgery [Equals] Impotence? Source: Minnetonka, MN: American Medical Systems. 1999. 2 p. Contact: Available from American Medical Systems. 10700 Bren Road West, Minnetonka, MN 55343. (800) 328-3881 or (952) 930-6157. Fax (952) 930-6157. Website: www.visitAMS.com. Price: Single copy free. Summary: Prostate surgery can be a life changing event, both physically and emotionally. This brochure reviews two possible physical results of prostate surgery: loss of bladder control and erectile dysfunction (ED, formerly called impotence). The brochure emphasizes that there are now treatments available for both conditions. Erectile dysfunction means that a man is not able to have an erection that is firm enough or that lasts long enough to have successful sexual intercourse. Most men occasionally have difficulty getting an erection; however, when the problem goes on too long, it may be a sign of other more serious conditions. Most cases of ED are caused by physical or organic reasons. Prostate surgery, generally performed to remove cancer from the prostate gland, may affect the nearby nerves and arteries that control erections and bladder function. Treatments for ED depend on the causes of the problem. If the ED is mild to moderate, treatment options include counseling, oral medications, intraurethral suppositories (drugs inserted into the urethra, or opening for urination), injection therapy (drugs are injected into the penis), or vacuum erection devices. More severe cases of ED may require surgery. Vascular surgery has been used to improve penile blood flow or repair leaking veins. More commonly, penile prostheses may be a longer term option, particularly for men who have tried less invasive methods and are not satisfied with the results. The author encourages readers to work closely with their health care providers for diagnosis and treatment. The brochure is illustrated with colorful graphics.
·
Impotence? A Guide to Understanding and Treating Erectile Dysfunction Source: Minnetonka, MN: American Medical Systems. 1998. 24 p. Contact: Available from American Medical Systems. 10700 Bren Road West, Minnetonka, MN 55343. (800) 328-3881 or (612) 933-4666. Fax (612) 930-6592. Website: www.VisitAMS.com. Price: Single copy free. Order number 21600026C. Summary: Erectile dysfunction (ED, or impotence) is the inability to maintain an erection that is firm enough or that lasts long enough to have successful sexual intercourse. It is a frustrating condition that may have either physical or psychological causes. This brochure offers a guide to understanding and treating ED. In more than half of all men with ED, the
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cause is physical; ED can be the result of diabetes, a hormone problem, blocked arteries, or other causes. And in many cases, physical causes can produce psychological side effects. Diagnosing the cause is the first step before determining an appropriate treatment. Psychological causes can include misinformation, performance anxiety, depression, or stress. Physical causes can include diabetes, vascular problems, pelvic surgery or trauma, neurological disorders, medications, alcoholism, or hormone problems. The brochure describes the physiology of the penis and how an erection occurs, including the stages of the flaccid state, the tumescent penis, and erection. The brochure describes what to expect at the urologist's examination, including the external physical (checking for the pulse to the penis), the rectal examination (to check for prostatitis), and checking for physical abnormalities such as Peyronie's disease (a curved and painful erection caused by scar tissue in the penis). Laboratory tests that may be called for include blood tests and urine analysis, penile blood flow studies, and sleep monitoring. The brochure briefly reviews treatment options, including counseling and sex therapy, oral medications, intraurethral suppositories, injection therapy, vacuum erection devices, venous and arterial surgery, and penile implants. Penile prostheses are described in some detail, including the advantages and disadvantages of the malleable prosthesis, the self contained inflatable prosthesis, the two piece inflatable prosthesis, and the three piece inflatable prosthesis. Diagrams are provided for each type of prosthesis. The brochure concludes with a self test: 23 questions that readers can ask themselves (and share with their urologists) to help ascertain the causes of ED. 26 figures. ·
Treating Impotence: A Sexual Problem in Men Source: New York, NY: National Kidney Foundation. 1997. 5 p. Contact: National Kidney Foundation. 30 East 33rd Street, New York, NY 10016. (800) 622-9010. Website: www.kidney.org. Price: Single copy free; bulk copies available. Summary: This brochure from the National Kidney Foundation provides an overview of the treatment options for men with impotence. Written in an easy-to-read, question and answer format, the brochure discusses the causes and diagnosis of impotence; treatment options including drugs, vacuum pumps, and surgery; the role of sex therapy; insurance coverage for impotence; and the importance of finding a health care provider with whom the patient feels comfortable.
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·
Tratamientos para la Inflamacion de la Prostata. [Treatment of Prostate Enlargement] Source: Rockville, MD: Agency for Health Care Policy and Research. 1994. 26 p. Contact: Available from AHCPR Publications Clearinghouse. P.O. Box 8547, Silver Spring, MD 20907. (800) 358-9295. Price: Single copy free. Publication number: 94-0585. Summary: This Spanish-language brochure provides patients with information about benign prostatic hyperplasia (BPH). Topics include a description of the anatomy and function of the prostate gland; symptoms of BPH; the causes of BPH symptoms; how BPH is diagnosed; how to know when to consult a health care provider; deciding when treatment is necessary; treatment options, including watchful waiting, drug therapy, balloon dilatation, and surgery; the success rate of each treatment option; and potential complications associated with each treatment option, including urinary incontinence and sexual impotence. One table summarizes the different treatment options and their benefits and disadvantages. The brochure concludes with resource organizations through which the reader can get more information.
·
Men's Sexual Health Seminar: Impotence Source: Augusta, GA: Geddings Osbon, Sr. Foundation. 199x. 2 p. Contact: Available from Geddings Osbon, Sr. Foundation. P.O. Box 1592, Augusta, GA 30903. (800) 433-4215. Price: Single copy free. Summary: This brochure describes the men's sexual health seminar on impotence, offered through the Geddings Osbon Sr. Foundation. After a description of impotence, its causes and current treatments, the brochure describes the seminar, including who should plan to attend. The brochure concludes with a brief summary of the Foundation and its philosophy and mission.
The NLM Gateway27 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing “one-stop searching” for
27
Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.
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many of NLM’s information resources or databases.28 One target audience for the Gateway is the Internet user who is new to NLM’s online resources and does not know what information is available or how best to search for it. This audience may include physicians and other healthcare providers, researchers, librarians, students, and, increasingly, patients, their families, and the public.29 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “impotence” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Items Found Journal Articles 8887 Books / Periodicals / Audio Visual 384 Consumer Health 80 Meeting Abstracts 35 Other Collections 1 Total 9387
HSTAT30 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.31 HSTAT’s audience includes healthcare providers, health service researchers, policy makers, insurance companies, consumers, and the information professionals who serve these groups. HSTAT provides access to a wide variety of publications, including clinical practice guidelines, quick-reference guides for clinicians, The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 29 Other users may find the Gateway useful for an overall search of NLM’s information resources. Some searchers may locate what they need immediately, while others will utilize the Gateway as an adjunct tool to other NLM search services such as PubMed® and MEDLINEplus®. The Gateway connects users with multiple NLM retrieval systems while also providing a search interface for its own collections. These collections include various types of information that do not logically belong in PubMed, LOCATORplus, or other established NLM retrieval systems (e.g., meeting announcements and pre-1966 journal citations). The Gateway will provide access to the information found in an increasing number of NLM retrieval systems in several phases. 30 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 31 The HSTAT URL is http://hstat.nlm.nih.gov/. 28
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consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.32 Simply search by “impotence” (or synonyms) at the following Web site: http://text.nlm.nih.gov. Coffee Break: Tutorials for Biologists33 Some patients may wish to have access to a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. To this end, we recommend “Coffee Break,” a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.34 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.35 This site has new articles every few weeks, so it can be considered an online magazine of sorts, and intended for general background information. You can access the Coffee Break Web site at http://www.ncbi.nlm.nih.gov/Coffeebreak/.
Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force’s Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations. 33 Adapted from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html. 34 The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 35 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process. 32
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Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are a few examples that may interest you: ·
CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.
·
Image Engine: Multimedia electronic medical record system that integrates a wide range of digitized clinical images with textual data stored in the University of Pittsburgh Medical Center’s MARS electronic medical record system; see the following Web site: http://www.cml.upmc.edu/cml/imageengine/imageEngine.html.
·
Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.
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MedWeaver: Prototype system that allows users to search differential diagnoses for any list of signs and symptoms, to search medical literature, and to explore relevant Web sites; see http://www.med.virginia.edu/~wmd4n/medweaver.html.
·
Metaphrase: Middleware component intended for use by both caregivers and medical records personnel. It converts the informal language generally used by caregivers into terms from formal, controlled vocabularies; see the following Web site: http://www.lexical.com/Metaphrase.html.
The Genome Project and Impotence With all the discussion in the press about the Human Genome Project, it is only natural that physicians, researchers, and patients want to know about how human genes relate to impotence. In the following section, we will discuss databases and references used by physicians and scientists who work in this area.
Online Mendelian Inheritance in Man (OMIM) The Online Mendelian Inheritance in Man (OMIM) database is a catalog of human genes and genetic disorders authored and edited by Dr. Victor A. McKusick and his colleagues at Johns Hopkins and elsewhere. OMIM was developed for the World Wide Web by the National Center for
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Biotechnology Information (NCBI).36 The database contains textual information, pictures, and reference information. It also contains copious links to NCBI’s Entrez database of MEDLINE articles and sequence information. Go to http://www.ncbi.nlm.nih.gov/Omim/searchomim.html to search the database. Type “impotence” (or synonyms) in the search box, and click “Submit Search.” If too many results appear, you can narrow the search by adding the word “clinical.” Each report will have additional links to related research and databases. By following these links, especially the link titled “Database Links,” you will be exposed to numerous specialized databases that are largely used by the scientific community. These databases are overly technical and seldom used by the general public, but offer an abundance of information. The following is an example of the results you can obtain from the OMIM for impotence: ·
17-@beta Hydroxysteroid Dehydrogenase Iii Deficiency Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?264300
·
Adrenoleukodystrophy Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?300100
·
Hemochromatosis Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?235200
·
Hemochromatosis, Autosomal Dominant Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?606069
·
Hexosaminidase B; Hexb Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?606873
·
Sandhoff Disease Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?268800
Adapted from http://www.ncbi.nlm.nih.gov/. Established in 1988 as a national resource for molecular biology information, NCBI creates public databases, conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information--all for the better understanding of molecular processes affecting human health and disease.
36
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·
Spinal and Bulbar Muscular Atrophy, X-linked 1 Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?313200
·
Transthyretin Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?176300 Genes and Disease (NCBI - Map)
The Genes and Disease database is produced by the National Center for Biotechnology Information of the National Library of Medicine at the National Institutes of Health. This Web site categorizes each disorder by the system of the body associated with it. Go to http://www.ncbi.nlm.nih.gov/disease/, and browse the system pages to have a full view of important conditions linked to human genes. Since this site is regularly updated, you may wish to re-visit it from time to time. The following systems and associated disorders are addressed: ·
Immune System: Fights invaders. Examples: Asthma, autoimmune polyglandular syndrome, Crohn’s disease, DiGeorge syndrome, familial Mediterranean fever, immunodeficiency with Hyper-IgM, severe combined immunodeficiency. Web site: http://www.ncbi.nlm.nih.gov/disease/Immune.html
·
Muscle and Bone: Movement and growth. Examples: Duchenne muscular dystrophy, Ellis-van Creveld syndrome, Marfan syndrome, myotonic dystrophy, spinal muscular atrophy. Web site: http://www.ncbi.nlm.nih.gov/disease/Muscle.html
·
Signals: Cellular messages. Examples: Ataxia telangiectasia, Baldness, Cockayne syndrome, Glaucoma, SRY: sex determination, Tuberous sclerosis, Waardenburg syndrome, Werner syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Signals.html
·
Transporters: Pumps and channels. Examples: Cystic Fibrosis, deafness, diastrophic dysplasia, Hemophilia A, long-QT syndrome, Menkes syndrome, Pendred syndrome, polycystic kidney disease, sickle cell anemia, Wilson’s disease, Zellweger syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Transporters.html
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Entrez Entrez is a search and retrieval system that integrates several linked databases at the National Center for Biotechnology Information (NCBI). These databases include nucleotide sequences, protein sequences, macromolecular structures, whole genomes, and MEDLINE through PubMed. Entrez provides access to the following databases: ·
PubMed: Biomedical literature (PubMed), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed
·
Nucleotide Sequence Database (Genbank): Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Nucleotide
·
Protein Sequence Database: Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Protein
·
Structure: Three-dimensional macromolecular structures, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Structure
·
Genome: Complete genome assemblies, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Genome
·
PopSet: Population study data sets, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Popset
·
OMIM: Online Mendelian Inheritance in Man, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=OMIM
·
Taxonomy: Organisms in GenBank, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Taxonomy
·
Books: Online books, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=books
·
ProbeSet: Gene Expression Omnibus (GEO), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo
·
3D Domains: Domains from Entrez Structure, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo
·
NCBI’s Protein Sequence Information Survey Results: Web site: http://www.ncbi.nlm.nih.gov/About/proteinsurvey/
To access the Entrez system at the National Center for Biotechnology Information, go to http://www.ncbi.nlm.nih.gov/entrez/, and then select the database that you would like to search. The databases available are listed in
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the drop box next to “Search.” In the box next to “for,” enter “impotence” (or synonyms) and click “Go.”
Jablonski’s Multiple Congenital Anomaly/Mental Retardation (MCA/MR) Syndromes Database37 This online resource can be quite useful. It has been developed to facilitate the identification and differentiation of syndromic entities. Special attention is given to the type of information that is usually limited or completely omitted in existing reference sources due to space limitations of the printed form. At http://www.nlm.nih.gov/mesh/jablonski/syndrome_toc/toc_a.html you can also search across syndromes using an alphabetical index. You can also search at http://www.nlm.nih.gov/mesh/jablonski/syndrome_db.html. The Genome Database38 Established at Johns Hopkins University in Baltimore, Maryland in 1990, the Genome Database (GDB) is the official central repository for genomic mapping data resulting from the Human Genome Initiative. In the spring of 1999, the Bioinformatics Supercomputing Centre (BiSC) at the Hospital for Sick Children in Toronto, Ontario assumed the management of GDB. The Human Genome Initiative is a worldwide research effort focusing on structural analysis of human DNA to determine the location and sequence of the estimated 100,000 human genes. In support of this project, GDB stores and curates data generated by researchers worldwide who are engaged in the mapping effort of the Human Genome Project (HGP). GDB’s mission is to provide scientists with an encyclopedia of the human genome which is continually revised and updated to reflect the current state of scientific knowledge. Although GDB has historically focused on gene mapping, its focus will broaden as the Genome Project moves from mapping to sequence, and finally, to functional analysis. To access the GDB, simply go to the following hyperlink: http://www.gdb.org/. Search “All Biological Data” by “Keyword.” Type “impotence” (or synonyms) into the search box, and review the results. If Adapted from the National Library of Medicine: http://www.nlm.nih.gov/mesh/jablonski/about_syndrome.html. 38 Adapted from the Genome Database: http://gdbwww.gdb.org/gdb/aboutGDB.html#mission. 37
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more than one word is used in the search box, then separate each one with the word “and” or “or” (using “or” might be useful when using synonyms). This database is extremely technical as it was created for specialists. The articles are the results which are the most accessible to non-professionals and often listed under the heading “Citations.” The contact names are also accessible to non-professionals.
Specialized References The following books are specialized references written for professionals interested in impotence (sorted alphabetically by title, hyperlinks provide rankings, information, and reviews at Amazon.com): · Adult and Pediatric Urology (3-Volume Set) (Includes a Card to Return to Receive the Free CD-ROM) by Jay Y. Gillenwater, M.D. (Editor), et al; Hardcover - 2828 pages, 4th edition (January 15, 2002), Lippincott, Williams & Wilkins Publishers; ISBN: 0781732204; http://www.amazon.com/exec/obidos/ASIN/0781732204/icongroupinterna · Campbell’s Urology (4-Volume Set) by Meredith F. Campbell (Editor), et al; Hardcover, 8th edition (May 15, 2002), W B Saunders Co; ISBN: 0721690580; http://www.amazon.com/exec/obidos/ASIN/0721690580/icongroupinterna · Clinical Manual of Urology by Philip M. Hanno, M.D. (Editor), et al; Paperback - 924 pages, 3rd edition (May 2, 2001), McGraw-Hill Professional Publishing; ISBN: 0071362010; http://www.amazon.com/exec/obidos/ASIN/0071362010/icongroupinterna · Comprehensive Urology by George Weiss O’Reilly; Hardcover - 724 pages, 1st edition (January 15, 2001), Elsevier Science, Health Science Division; ISBN: 0723429499; http://www.amazon.com/exec/obidos/ASIN/0723429499/icongroupinterna · Manual of Urology: Diagnosis & Therapy by Mike B. Siroky (Editor), et al; Spiral-bound - 362 pages, 2nd spiral edition (October 15, 1999), Lippincott, Williams & Wilkins Publishers; ISBN: 078171785X; http://www.amazon.com/exec/obidos/ASIN/078171785X/icongroupinterna · The Scientific Basis of Urology by A.R. Mundy (Editor), et al; 531 pages 1st edition (March 15, 1999), Isis Medical Media; ISBN: 1899066217; http://www.amazon.com/exec/obidos/ASIN/1899066217/icongroupinterna · Smith’s General Urology by Emil A. Tanagho (Editor), et al; Paperback 888 pages, 15th edition (January 21, 2000), McGraw-Hill Professional
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Publishing; ISBN: 0838586074; http://www.amazon.com/exec/obidos/ASIN/0838586074/icongroupinterna · Urology (House Officer Series) by Michael T. MacFarlane, M.D.; Paperback - 3rd edition (January 2001), Lippincott, Williams & Wilkins Publishers; ISBN: 0781731461; http://www.amazon.com/exec/obidos/ASIN/0781731461/icongroupinterna · Urology for Primary Care Physicians by Unyime O. Nseyo (Editor), et al; Hardcover - 399 pages, 1st edition (July 15, 1999), W B Saunders Co; ISBN: 0721671489; http://www.amazon.com/exec/obidos/ASIN/0721671489/icongroupinterna
Vocabulary Builder Bulbar: Pertaining to a bulb; pertaining to or involving the medulla oblongata, as bulbar paralysis. [EU] Dilatation: The condition, as of an orifice or tubular structure, of being dilated or stretched beyond the normal dimensions. [EU]
Dissertations 179
CHAPTER 9. DISSERTATIONS ON IMPOTENCE Overview University researchers are active in studying almost all known diseases. The result of research is often published in the form of Doctoral or Master’s dissertations. You should understand, therefore, that applied diagnostic procedures and/or therapies can take many years to develop after the thesis that proposed the new technique or approach was written. In this chapter, we will give you a bibliography on recent dissertations relating to impotence. You can read about these in more detail using the Internet or your local medical library. We will also provide you with information on how to use the Internet to stay current on dissertations.
Dissertations on Impotence ProQuest Digital Dissertations is the largest archive of academic dissertations available. From this archive, we have compiled the following list covering dissertations devoted to impotence. You will see that the information provided includes the dissertation’s title, its author, and the author’s institution. To read more about the following, simply use the Internet address indicated. The following covers recent dissertations dealing with impotence:
180 Impotence
·
Emotional and Functional Coping Outcomes of Men Receiving Pharmacologic Erection Therapy for Impotence by Wlasowicz, Grace Saidel; Phd from University of Rochester School of Nursing, 2001, 144 pages http://wwwlib.umi.com/dissertations/fullcit/3022782
·
Empowerment and Impotence: the Clash of Cultures and Media of Communication in Eighteenth Century Ireland by Fallon, Peter Kevin, Phd from New York University, 1996, 241 pages http://wwwlib.umi.com/dissertations/fullcit/9710917
·
Gertrud Kolmar's Prose: Stories about Inferiority, Violence, Social Impotence, Maternal Bonds and the Boundaries of Self. a Socialpsychological Study by Frantz, Barbara Charlotte, Phd from University of California, Santa Barbara, 1995, 245 pages http://wwwlib.umi.com/dissertations/fullcit/9605804
·
Impotence and Omnipotence: Homeric Evidence for the Existence of Generic Personality Types (greek Text) by Polsky, Jane Louisa, Phd from The Union Institute, 1992, 579 pages http://wwwlib.umi.com/dissertations/fullcit/9311965
·
Impoundment Policy and Congressional Oversight: Bureaucratic Perversity and Congressional Impotence by Moody, Robert James, Iii, Phd from The University of Texas at Austin, 1979, 335 pages http://wwwlib.umi.com/dissertations/fullcit/8100987
·
Moral Impotence As a Canonical Matrimonial Disability: Juristic Origin and Concept; Use and Developments in American Canonical Jurisprudence. by Hevia, Todd Orestes, Jcd from The Catholic University of America, 1976, 315 pages http://wwwlib.umi.com/dissertations/fullcit/7618134
·
Power, Influence and Impotence: the Church As a Socio-political Factor in the Dominican Republic. by Wipfler, William Louis, Phd from Union Theological Seminary, 1978, 490 pages http://wwwlib.umi.com/dissertations/fullcit/7817143
·
Representing Impotence: Systems of Belief in Ancient Popular Culture (belief Systems, Greek, Latin) by Mcmahon, John Michael, Phd from University of Pennsylvania, 1993, 269 pages http://wwwlib.umi.com/dissertations/fullcit/9321442
·
Something Like Love: Exhaustion and Impotence in the Works of John Barth and Sam Shepard by Elrod, Page Stranahan, Phd from The University of Toledo, 1998, 250 pages http://wwwlib.umi.com/dissertations/fullcit/9829254
Dissertations 181
·
The Raging Impotence: Humor in the Novels of Dostoevsky, Faulkner and Beckett. by Pisani, Assunta Sarnacchiaro, Phd from Brown University, 1976, 277 pages http://wwwlib.umi.com/dissertations/fullcit/7714176
Keeping Current As previously mentioned, an effective way to stay current on dissertations dedicated to impotence is to use the database called ProQuest Digital Dissertations via the Internet, located at the following Web address: http://wwwlib.umi.com/dissertations. The site allows you to freely access the last two years of citations and abstracts. Ask your medical librarian if the library has full and unlimited access to this database. From the library, you should be able to do more complete searches than with the limited 2-year access available to the general public.
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PART III. APPENDICES
ABOUT PART III Part III is a collection of appendices on general medical topics which may be of interest to patients with impotence and related conditions.
Researching Your Medications 185
APPENDIX A. RESEARCHING YOUR MEDICATIONS Overview There are a number of sources available on new or existing medications which could be prescribed to patients with impotence. While a number of hard copy or CD-Rom resources are available to patients and physicians for research purposes, a more flexible method is to use Internet-based databases. In this chapter, we will begin with a general overview of medications. We will then proceed to outline official recommendations on how you should view your medications. You may also want to research medications that you are currently taking for other conditions as they may interact with medications for impotence. Research can give you information on the side effects, interactions, and limitations of prescription drugs used in the treatment of impotence. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.
186 Impotence
Your Medications: The Basics39 The Agency for Health Care Research and Quality has published extremely useful guidelines on how you can best participate in the medication aspects of impotence. Taking medicines is not always as simple as swallowing a pill. It can involve many steps and decisions each day. The AHCRQ recommends that patients with impotence take part in treatment decisions. Do not be afraid to ask questions and talk about your concerns. By taking a moment to ask questions early, you may avoid problems later. Here are some points to cover each time a new medicine is prescribed: ·
Ask about all parts of your treatment, including diet changes, exercise, and medicines.
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Ask about the risks and benefits of each medicine or other treatment you might receive.
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Ask how often you or your doctor will check for side effects from a given medication.
Do not hesitate to ask what is important to you about your medicines. You may want a medicine with the fewest side effects, or the fewest doses to take each day. You may care most about cost, or how the medicine might affect how you live or work. Or, you may want the medicine your doctor believes will work the best. Telling your doctor will help him or her select the best treatment for you. Do not be afraid to “bother” your doctor with your concerns and questions about medications for impotence. You can also talk to a nurse or a pharmacist. They can help you better understand your treatment plan. Feel free to bring a friend or family member with you when you visit your doctor. Talking over your options with someone you trust can help you make better choices, especially if you are not feeling well. Specifically, ask your doctor the following: ·
The name of the medicine and what it is supposed to do.
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How and when to take the medicine, how much to take, and for how long.
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What food, drinks, other medicines, or activities you should avoid while taking the medicine.
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What side effects the medicine may have, and what to do if they occur.
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If you can get a refill, and how often.
39
This section is adapted from AHCRQ: http://www.ahcpr.gov/consumer/ncpiebro.htm.
Researching Your Medications 187
·
About any terms or directions you do not understand.
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What to do if you miss a dose.
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If there is written information you can take home (most pharmacies have information sheets on your prescription medicines; some even offer large-print or Spanish versions).
Do not forget to tell your doctor about all the medicines you are currently taking (not just those for impotence). This includes prescription medicines and the medicines that you buy over the counter. Then your doctor can avoid giving you a new medicine that may not work well with the medications you take now. When talking to your doctor, you may wish to prepare a list of medicines you currently take, the reason you take them, and how you take them. Be sure to include the following information for each: ·
Name of medicine
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Reason taken
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Dosage
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Time(s) of day
Also include any over-the-counter medicines, such as: ·
Laxatives
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Diet pills
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Vitamins
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Cold medicine
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Aspirin or other pain, headache, or fever medicine
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Cough medicine
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Allergy relief medicine
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Antacids
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Sleeping pills
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Others (include names)
Learning More about Your Medications Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications your doctor has recommended for impotence. One such source
188 Impotence
is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the “U.S. Pharmacopeia (USP).” Today, the USP is a non-profit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at www.usp.org. The USP currently provides standards for over 3,700 medications. The resulting USP DIÒ Advice for the PatientÒ can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database.40 While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopoeia. It is important to read the disclaimer by the United States Pharmacopoeia (http://www.nlm.nih.gov/medlineplus/drugdisclaimer.html) before using the information provided. Of course, we as editors cannot be certain as to what medications you are taking. Therefore, we have compiled a list of medications associated with the treatment of impotence. Once again, due to space limitations, we only list a sample of medications and provide hyperlinks to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.). The following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to impotence: Alprostadil ·
Local - U.S. Brands: Caverject; Edex; Muse http://www.nlm.nih.gov/medlineplus/druginfo/alprostadillocal 202023.html
Though cumbersome, the FDA database can be freely browsed at the following site: www.fda.gov/cder/da/da.htm.
40
Researching Your Medications 189
Phentolamine and Papaverine ·
Intracavernosal - U.S. Brands: Regitine http://www.nlm.nih.gov/medlineplus/druginfo/phentolaminean dpapaverineintra202459.html
Sildenafil ·
Systemic - U.S. Brands: Viagra http://www.nlm.nih.gov/medlineplus/druginfo/sildenafilsystem ic203533.html Vitamin E ·
Systemic - U.S. Brands: Amino-Opti-E; E-Complex-600; Liqui-E; Pheryl-E http://www.nlm.nih.gov/medlineplus/druginfo/vitaminesystemi c202598.html
Yohimbine ·
Systemic - U.S. Brands: Actibine; Aphrodyne; Baron-X; Prohim; Thybine; Yocon; Yohimar; Yohimex; Yoman; Yovital http://www.nlm.nih.gov/medlineplus/druginfo/yohimbinesyste mic202639.html
Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. You may be able to access these sources from your local medical library or your doctor’s office.
Reuters Health Drug Database The Reuters Health Drug Database can be searched by keyword at the hyperlink: http://www.reutershealth.com/frame2/drug.html. The following medications are listed in the Reuters’ database as associated with impotence (including those with contraindications):41 ·
Acebutolol HCl http://www.reutershealth.com/atoz/html/Acebutolol_HCl.htm
·
Alprostadil http://www.reutershealth.com/atoz/html/Alprostadil.htm
41
Adapted from A to Z Drug Facts by Facts and Comparisons.
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·
Amiloride HCl http://www.reutershealth.com/atoz/html/Amiloride_HCl.htm
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Amitriptyline HCl http://www.reutershealth.com/atoz/html/Amitriptyline_HCl.htm
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Amoxapine http://www.reutershealth.com/atoz/html/Amoxapine.htm
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Amphetamine http://www.reutershealth.com/atoz/html/Amphetamine.htm
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Amphetamine (Racemic Amphetamine Sulfate) http://www.reutershealth.com/atoz/html/Amphetamine_(Racemic_A mphetamine_Sulfate).htm
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Amyl Nitrite http://www.reutershealth.com/atoz/html/Amyl_Nitrite.htm
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Atenolol http://www.reutershealth.com/atoz/html/Atenolol.htm
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Atenolol Chlorthalidone http://www.reutershealth.com/atoz/html/Atenolol_Chlorthalidone.htm
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Atropine http://www.reutershealth.com/atoz/html/Atropine.htm
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Atropine Sulfate Scopolamine Hydrobromide Hyoscyamine Sulfate Phenobarbital http://www.reutershealth.com/atoz/html/Atropine_Sulfate_Scopolami ne_Hydrobromide_Hyoscyamine_Sulfate_Phenobarbital.htm
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Baclofen http://www.reutershealth.com/atoz/html/Baclofen.htm
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Basiliximab http://www.reutershealth.com/atoz/html/Basiliximab.htm
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Benzphetamine HCL http://www.reutershealth.com/atoz/html/Benzphetamine_HCL.htm
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Betaxolol HCl http://www.reutershealth.com/atoz/html/Betaxolol_HCl.htm
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Bisoprolol Fumarate http://www.reutershealth.com/atoz/html/Bisoprolol_Fumarate.htm
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Bupropion HCl http://www.reutershealth.com/atoz/html/Bupropion_HCl.htm
Researching Your Medications 191
·
Carbamazepine http://www.reutershealth.com/atoz/html/Carbamazepine.htm
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Carteolol HCl http://www.reutershealth.com/atoz/html/Carteolol_HCl.htm
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Chlorpromazine HCI http://www.reutershealth.com/atoz/html/Chlorpromazine_HCI.htm
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Chlorthalidone http://www.reutershealth.com/atoz/html/Chlorthalidone.htm
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Cimetidine http://www.reutershealth.com/atoz/html/Cimetidine.htm
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Citalopram http://www.reutershealth.com/atoz/html/Citalopram.htm
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Clofibrate http://www.reutershealth.com/atoz/html/Clofibrate.htm
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Clomipramine HCl http://www.reutershealth.com/atoz/html/Clomipramine_HCl.htm
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Clonidine HCl http://www.reutershealth.com/atoz/html/Clonidine_HCl.htm
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Delavirdine Mesylate http://www.reutershealth.com/atoz/html/Delavirdine_Mesylate.htm
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Desipramine HCl http://www.reutershealth.com/atoz/html/Desipramine_HCl.htm
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Dextroamphetamine Sulfate http://www.reutershealth.com/atoz/html/Dextroamphetamine_Sulfate .htm
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Dicyclomine HCl http://www.reutershealth.com/atoz/html/Dicyclomine_HCl.htm
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Diethylpropion HCI http://www.reutershealth.com/atoz/html/Diethylpropion_HCI.htm
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Disopyramide http://www.reutershealth.com/atoz/html/Disopyramide.htm
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Disulfiram http://www.reutershealth.com/atoz/html/Disulfiram.htm
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Doxepin HCl http://www.reutershealth.com/atoz/html/Doxepin_HCl.htm
192 Impotence
·
Enalapril Maleate Hydrochlorothiazide http://www.reutershealth.com/atoz/html/Enalapril_Maleate_Hydroch lorothiazide.htm
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Esmolol HCl http://www.reutershealth.com/atoz/html/Esmolol_HCl.htm
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Famotidine http://www.reutershealth.com/atoz/html/Famotidine.htm
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Finasteride http://www.reutershealth.com/atoz/html/Finasteride.htm
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Fluphenazine http://www.reutershealth.com/atoz/html/Fluphenazine.htm
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Fluvoxamine Maleate http://www.reutershealth.com/atoz/html/Fluvoxamine_Maleate.htm
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Gabapentin http://www.reutershealth.com/atoz/html/Gabapentin.htm
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Gemfibrozil http://www.reutershealth.com/atoz/html/Gemfibrozil.htm
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Glycopyrrolate http://www.reutershealth.com/atoz/html/Glycopyrrolate.htm
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Guanabenz Acetate http://www.reutershealth.com/atoz/html/Guanabenz_Acetate.htm
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Guanadrel http://www.reutershealth.com/atoz/html/Guanadrel.htm
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Guanethidine Monosulfate http://www.reutershealth.com/atoz/html/Guanethidine_Monosulfate. htm
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Guanfacine HCl http://www.reutershealth.com/atoz/html/Guanfacine_HCl.htm
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Haloperidol http://www.reutershealth.com/atoz/html/Haloperidol.htm
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Hydrochlorothiazide Triamterene(HCTZ Triamterene) http://www.reutershealth.com/atoz/html/Hydrochlorothiazide_Triamt erene(HCTZ_Triamterene).htm
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Hydrochlorothiazide(HCTZ) http://www.reutershealth.com/atoz/html/Hydrochlorothiazide(HCTZ) .htm
Researching Your Medications 193
·
Imipramine HCl http://www.reutershealth.com/atoz/html/Imipramine_HCl.htm
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Indapamide http://www.reutershealth.com/atoz/html/Indapamide.htm
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Isosorbide Dinitrate http://www.reutershealth.com/atoz/html/Isosorbide_Dinitrate.htm
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Isosorbide Mononitrate http://www.reutershealth.com/atoz/html/Isosorbide_Mononitrate.htm
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Itraconazole http://www.reutershealth.com/atoz/html/Itraconazole.htm
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Ketoconazole http://www.reutershealth.com/atoz/html/Ketoconazole.htm
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Labetalol HCL http://www.reutershealth.com/atoz/html/Labetalol_HCL.htm
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Leuprolide Acetate http://www.reutershealth.com/atoz/html/Leuprolide_Acetate.htm
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Maprotiline HCl http://www.reutershealth.com/atoz/html/Maprotiline_HCl.htm
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Megestrol Acetate http://www.reutershealth.com/atoz/html/Megestrol_Acetate.htm
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Methamphetamine HCl http://www.reutershealth.com/atoz/html/Methamphetamine_HCl.htm
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Methyldopa and Methyldopate HCl http://www.reutershealth.com/atoz/html/Methyldopa_and_Methyldo pate_HCl.htm
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Metoclopramide http://www.reutershealth.com/atoz/html/Metoclopramide.htm
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Metolazone http://www.reutershealth.com/atoz/html/Metolazone.htm
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Metoprolol http://www.reutershealth.com/atoz/html/Metoprolol.htm
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Mycophenolate Mofetil http://www.reutershealth.com/atoz/html/Mycophenolate_Mofetil.htm
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Nabumetone http://www.reutershealth.com/atoz/html/Nabumetone.htm
194 Impotence
·
Nadolol http://www.reutershealth.com/atoz/html/Nadolol.htm
·
Nefazodone Hydrochloride http://www.reutershealth.com/atoz/html/Nefazodone_Hydrochloride. htm
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Nitroglycerin http://www.reutershealth.com/atoz/html/Nitroglycerin.htm
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Nortriptyline HCl http://www.reutershealth.com/atoz/html/Nortriptyline_HCl.htm
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Oxybutynin Chloride http://www.reutershealth.com/atoz/html/Oxybutynin_Chloride.htm
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Papaverine HCl http://www.reutershealth.com/atoz/html/Papaverine_HCl.htm
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Paroxetine HCl http://www.reutershealth.com/atoz/html/Paroxetine_HCl.htm
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Penbutolol Sulfate http://www.reutershealth.com/atoz/html/Penbutolol_Sulfate.htm
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Perphenazine http://www.reutershealth.com/atoz/html/Perphenazine.htm
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Perphenazine Amitriptyline http://www.reutershealth.com/atoz/html/Perphenazine_Amitriptyline .htm
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Phentolamine http://www.reutershealth.com/atoz/html/Phentolamine.htm
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Pindolol http://www.reutershealth.com/atoz/html/Pindolol.htm
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Pramipexole Dihydrochloride http://www.reutershealth.com/atoz/html/Pramipexole_Dihydrochlori de.htm
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Prazosin http://www.reutershealth.com/atoz/html/Prazosin.htm
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Primidone http://www.reutershealth.com/atoz/html/Primidone.htm
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Prochlorperazine http://www.reutershealth.com/atoz/html/Prochlorperazine.htm
Researching Your Medications 195
·
Propantheline Bromide http://www.reutershealth.com/atoz/html/Propantheline_Bromide.htm
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Propranolol HCl http://www.reutershealth.com/atoz/html/Propranolol_HCl.htm
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Protriptyline HCl http://www.reutershealth.com/atoz/html/Protriptyline_HCl.htm
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Ritonavir http://www.reutershealth.com/atoz/html/Ritonavir.htm
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Ropinirole Hydrochloride http://www.reutershealth.com/atoz/html/Ropinirole_Hydrochloride.htm
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Sildenafil http://www.reutershealth.com/atoz/html/Sildenafil.htm
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Sirolimus http://www.reutershealth.com/atoz/html/Sirolimus.htm
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Sotalol HCl http://www.reutershealth.com/atoz/html/Sotalol_HCl.htm
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Terazosin http://www.reutershealth.com/atoz/html/Terazosin.htm
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Testosterone http://www.reutershealth.com/atoz/html/Testosterone.htm
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Thalidomide http://www.reutershealth.com/atoz/html/Thalidomide.htm
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Thioridazine HCl http://www.reutershealth.com/atoz/html/Thioridazine_HCl.htm
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Thiothixene http://www.reutershealth.com/atoz/html/Thiothixene.htm
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Timolol Maleate http://www.reutershealth.com/atoz/html/Timolol_Maleate.htm
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Topiramate http://www.reutershealth.com/atoz/html/Topiramate.htm
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Trazodone HCl http://www.reutershealth.com/atoz/html/Trazodone_HCl.htm
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Trifluoperazine HCl http://www.reutershealth.com/atoz/html/Trifluoperazine_HCl.htm
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Trihexyphenidyl HCl http://www.reutershealth.com/atoz/html/Trihexyphenidyl_HCl.htm
196 Impotence
·
Triptorelin Pamoate http://www.reutershealth.com/atoz/html/Triptorelin_Pamoate.htm
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Venlafaxine http://www.reutershealth.com/atoz/html/Venlafaxine.htm
Mosby’s GenRx Mosby’s GenRx database (also available on CD-Rom and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Information in Mosby’s GenRx database can be obtained at the following hyperlink: http://www.genrx.com/Mosby/PhyGenRx/group.html.
Physicians Desk Reference The Physicians Desk Reference database (also available in CD-Rom and book format) is a full-text drug database. The database is searchable by brand name, generic name or by indication. It features multiple drug interactions reports. Information can be obtained at the following hyperlink: http://physician.pdr.net/physician/templates/en/acl/psuser_t.htm.
Other Web Sites A number of additional Web sites discuss drug information. As an example, you may like to look at www.drugs.com which reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. which allows users to download articles on various drugs and therapeutics for a nominal fee: http://www.medletter.com/.
Contraindications and Interactions (Hidden Dangers) Some of the medications mentioned in the previous discussions can be problematic for patients with impotence--not because they are used in the treatment process, but because of contraindications, or side effects. Medications with contraindications are those that could react with drugs used to treat impotence or potentially create deleterious side effects in patients with impotence. You should ask your physician about any
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contraindications, especially as these might apply to other medications that you may be taking for common ailments. Drug-drug interactions occur when two or more drugs react with each other. This drug-drug interaction may cause you to experience an unexpected side effect. Drug interactions may make your medications less effective, cause unexpected side effects, or increase the action of a particular drug. Some drug interactions can even be harmful to you. Be sure to read the label every time you use a nonprescription or prescription drug, and take the time to learn about drug interactions. These precautions may be critical to your health. You can reduce the risk of potentially harmful drug interactions and side effects with a little bit of knowledge and common sense. Drug labels contain important information about ingredients, uses, warnings, and directions which you should take the time to read and understand. Labels also include warnings about possible drug interactions. Further, drug labels may change as new information becomes available. This is why it’s especially important to read the label every time you use a medication. When your doctor prescribes a new drug, discuss all over-thecounter and prescription medications, dietary supplements, vitamins, botanicals, minerals and herbals you take as well as the foods you eat. Ask your pharmacist for the package insert for each prescription drug you take. The package insert provides more information about potential drug interactions.
A Final Warning At some point, you may hear of alternative medications from friends, relatives, or in the news media. Advertisements may suggest that certain alternative drugs can produce positive results for patients with impotence. Exercise caution--some of these drugs may have fraudulent claims, and others may actually hurt you. The Food and Drug Administration (FDA) is the official U.S. agency charged with discovering which medications are likely to improve the health of patients with impotence. The FDA warns patients to watch out for42: ·
42
Secret formulas (real scientists share what they know)
This section has been adapted from http://www.fda.gov/opacom/lowlit/medfraud.html.
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·
Amazing breakthroughs or miracle cures (real breakthroughs don’t happen very often; when they do, real scientists do not call them amazing or miracles)
·
Quick, painless, or guaranteed cures
·
If it sounds too good to be true, it probably isn’t true.
If you have any questions about any kind of medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.
General References In addition to the resources provided earlier in this chapter, the following general references describe medications (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·
Complete Guide to Prescription and Nonprescription Drugs 2001 (Complete Guide to Prescription and Nonprescription Drugs, 2001) by H. Winter Griffith, Paperback 16th edition (2001), Medical Surveillance; ISBN: 0942447417; http://www.amazon.com/exec/obidos/ASIN/039952634X/icongroupinterna
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The Essential Guide to Prescription Drugs, 2001 by James J. Rybacki, James W. Long; Paperback - 1274 pages (2001), Harper Resource; ISBN: 0060958162; http://www.amazon.com/exec/obidos/ASIN/0060958162/icongroupinterna
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Handbook of Commonly Prescribed Drugs by G. John Digregorio, Edward J. Barbieri; Paperback 16th edition (2001), Medical Surveillance; ISBN: 0942447417; http://www.amazon.com/exec/obidos/ASIN/0942447417/icongroupinterna
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Johns Hopkins Complete Home Encyclopedia of Drugs 2nd ed. by Simeon Margolis (Ed.), Johns Hopkins; Hardcover - 835 pages (2000), Rebus; ISBN: 0929661583; http://www.amazon.com/exec/obidos/ASIN/0929661583/icongroupinterna
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Medical Pocket Reference: Drugs 2002 by Springhouse Paperback 1st edition (2001), Lippincott Williams & Wilkins Publishers; ISBN: 1582550964; http://www.amazon.com/exec/obidos/ASIN/1582550964/icongroupinterna
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·
PDR by Medical Economics Staff, Medical Economics Staff Hardcover 3506 pages 55th edition (2000), Medical Economics Company; ISBN: 1563633752; http://www.amazon.com/exec/obidos/ASIN/1563633752/icongroupinterna
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Pharmacy Simplified: A Glossary of Terms by James Grogan; Paperback 432 pages, 1st edition (2001), Delmar Publishers; ISBN: 0766828581; http://www.amazon.com/exec/obidos/ASIN/0766828581/icongroupinterna
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Physician Federal Desk Reference by Christine B. Fraizer; Paperback 2nd edition (2001), Medicode Inc; ISBN: 1563373971; http://www.amazon.com/exec/obidos/ASIN/1563373971/icongroupinterna
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Physician’s Desk Reference Supplements Paperback - 300 pages, 53 edition (1999), ISBN: 1563632950; http://www.amazon.com/exec/obidos/ASIN/1563632950/icongroupinterna
Vocabulary Builder The following vocabulary builder gives definitions of words used in this chapter that have not been defined in previous chapters: Amoxapine: The N-demethylated derivative of the antipsychotic agent loxapine that works by blocking the reuptake of norepinephrine, serotonin, or both. It also blocks dopamine receptors. [NIH] Amphetamine: A powerful central nervous system stimulant and sympathomimetic. Amphetamine has multiple mechanisms of action including blocking uptake of adrenergics and dopamine, stimulation of release of monamines, and inhibiting monoamine oxidase. Amphetamine is also a drug of abuse and a psychotomimetic. The l- and the d,l-forms are included here. The l-form has less central nervous system activity but stronger cardiovascular effects. The d-form is dextroamphetamine. [NIH] Amyl Nitrite: A vasodilator that is administered by inhalation. It is also used recreationally due to its supposed ability to induce euphoria and act as an aphrodisiac. [NIH] Atenolol: A cardioselective beta-adrenergic blocker possessing properties and potency similar to propranolol, but without a negative inotropic effect. [NIH]
Atropine: A toxic alkaloid, originally from Atropa belladonna, but found in other plants, mainly Solanaceae. [NIH] Carbamazepine: An anticonvulsant used to control grand mal and psychomotor or focal seizures. Its mode of action is not fully understood, but
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some of its actions resemble those of phenytoin; although there is little chemical resemblance between the two compounds, their three-dimensional structure is similar. [NIH] Famotidine: A competitive histamine H2-receptor antagonist. Its main pharmacodynamic effect is the inhibition of gastric secretion. [NIH] Finasteride: An orally active testosterone 5-alpha-reductase inhibitor. It is used as a surgical alternative for treatment of benign prostatic hyperplasia. [NIH]
Fluphenazine: A phenothiazine used in the treatment of psychoses. Its properties and uses are generally similar to those of chlorpromazine. [NIH] Gemfibrozil: A lipid-regulating agent that lowers elevated serum lipids primarily by decreasing serum triglycerides with a variable reduction in total cholesterol. These decreases occur primarily in the VLDL fraction and less frequently in the LDL fraction. Gemfibrozil increases HDL subfractions HDL2 and HDL3 as well as apolipoproteins A-I and A-II. Its mechanism of action has not been definitely established. [NIH] Glycopyrrolate: A muscarinic antagonist used as an antispasmodic, in some disorders of the gastrointestinal tract, and to reduce salivation with some anesthetics. [NIH] Indapamide: A sulfamyl diuretic with about 16x the effect of furosemide. It has also been shown to be an effective antihypertensive agent in the clinic. [NIH]
Isosorbide Dinitrate: A vasodilator used in the treatment of angina. Its actions are similar to nitroglycerin but with a slower onset of action. [NIH] Itraconazole: An antifungal agent that has been used in the treatment of histoplasmosis, blastomycosis, cryptococcal meningitis, and aspergillosis. [NIH]
Ketoconazole: Broad spectrum antifungal agent used for long periods at high doses, especially in immunosuppressed patients. [NIH] Metolazone: A potent, long acting diuretic useful in chronic renal disease. It also tends to lower blood pressure and increase potassium loss. [NIH] Metoprolol: Adrenergic beta-1-blocking agent with no stimulatory action. It is less bound to plasma albumin than alprenolol and may be useful in angina pectoris, hypertension, or cardiac arrhythmias. [NIH] Nadolol: A non-selective beta-adrenergic antagonist with a long half-life, used in cardiovascular disease to treat arrhythmias, angina pectoris, and hypertension. Nadolol is also used for migraine and for tremor. [NIH] Perphenazine: An antipsychotic phenothiazine derivative with actions and uses similar to those of chlorpromazine. [NIH] Ritonavir: An HIV protease inhibitor that works by interfering with the
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reproductive cycle of HIV. [NIH] Scopolamine: An alkaloid from Solanaceae, especially Datura metel L. and Scopola carniolica. Scopolamine and its quaternary derivatives act as antimuscarinics like atropine, but may have more central nervous system effects. Among the many uses are as an anesthetic premedication, in urinary incontinence, in motion sickness, as an antispasmodic, and as a mydriatic and cycloplegic. [NIH] Sirolimus: A macrolide compound obtained from Streptomyces hygroscopicus that acts by selectively blocking the transcriptional activation of cytokines thereby inhibiting cytokine production. It is bioactive only when bound to immunophilins. Sirolimus is a potent immunosuppressant and possesses both antifungal and antineoplastic properties. [NIH] Thalidomide: A pharmaceutical agent originally introduced as a nonbarbiturate hypnotic, but withdrawn from the market because of its known tetratogenic effects. It has been reintroduced and used for a number of immunological and inflammatory disorders. Thalidomide displays immunosuppresive and anti-angiogenic activity. It inhibits release of tumor necrosis factor alpha from monocytes, and modulates other cytokine action. [NIH]
Thiothixene: A thioxanthine used as an antipsychotic agent. Its effects are similar to the phenothiazine antipsychotics. [NIH] Triamterene: A pteridine that is used as a mild diuretic. [NIH]
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APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE Overview Complementary and alternative medicine (CAM) is one of the most contentious aspects of modern medical practice. You may have heard of these treatments on the radio or on television. Maybe you have seen articles written about these treatments in magazines, newspapers, or books. Perhaps your friends or doctor have mentioned alternatives. In this chapter, we will begin by giving you a broad perspective on complementary and alternative therapies. Next, we will introduce you to official information sources on CAM relating to impotence. Finally, at the conclusion of this chapter, we will provide a list of readings on impotence from various authors. We will begin, however, with the National Center for Complementary and Alternative Medicine’s (NCCAM) overview of complementary and alternative medicine.
What Is CAM?43 Complementary and alternative medicine (CAM) covers a broad range of healing philosophies, approaches, and therapies. Generally, it is defined as those treatments and healthcare practices which are not taught in medical schools, used in hospitals, or reimbursed by medical insurance companies. Many CAM therapies are termed “holistic,” which generally means that the healthcare practitioner considers the whole person, including physical, mental, emotional, and spiritual health. Some of these therapies are also known as “preventive,” which means that the practitioner educates and 43
Adapted from the NCCAM: http://nccam.nih.gov/nccam/fcp/faq/index.html#what-is.
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treats the person to prevent health problems from arising, rather than treating symptoms after problems have occurred. People use CAM treatments and therapies in a variety of ways. Therapies are used alone (often referred to as alternative), in combination with other alternative therapies, or in addition to conventional treatment (sometimes referred to as complementary). Complementary and alternative medicine, or “integrative medicine,” includes a broad range of healing philosophies, approaches, and therapies. Some approaches are consistent with physiological principles of Western medicine, while others constitute healing systems with non-Western origins. While some therapies are far outside the realm of accepted Western medical theory and practice, others are becoming established in mainstream medicine. Complementary and alternative therapies are used in an effort to prevent illness, reduce stress, prevent or reduce side effects and symptoms, or control or cure disease. Some commonly used methods of complementary or alternative therapy include mind/body control interventions such as visualization and relaxation, manual healing including acupressure and massage, homeopathy, vitamins or herbal products, and acupuncture.
What Are the Domains of Alternative Medicine?44 The list of CAM practices changes continually. The reason being is that these new practices and therapies are often proved to be safe and effective, and therefore become generally accepted as “mainstream” healthcare practices. Today, CAM practices may be grouped within five major domains: (1) alternative medical systems, (2) mind-body interventions, (3) biologicallybased treatments, (4) manipulative and body-based methods, and (5) energy therapies. The individual systems and treatments comprising these categories are too numerous to list in this sourcebook. Thus, only limited examples are provided within each. Alternative Medical Systems Alternative medical systems involve complete systems of theory and practice that have evolved independent of, and often prior to, conventional biomedical approaches. Many are traditional systems of medicine that are
44
Adapted from the NCCAM: http://nccam.nih.gov/nccam/fcp/classify/index.html.
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practiced by individual cultures throughout the world, including a number of venerable Asian approaches. Traditional oriental medicine emphasizes the balance or disturbances of qi (pronounced chi) or vital energy in health and disease, respectively. Traditional oriental medicine consists of a group of techniques and methods including acupuncture, herbal medicine, oriental massage, and qi gong (a form of energy therapy). Acupuncture involves stimulating specific anatomic points in the body for therapeutic purposes, usually by puncturing the skin with a thin needle. Ayurveda is India’s traditional system of medicine. Ayurvedic medicine (meaning “science of life”) is a comprehensive system of medicine that places equal emphasis on body, mind, and spirit. Ayurveda strives to restore the innate harmony of the individual. Some of the primary Ayurvedic treatments include diet, exercise, meditation, herbs, massage, exposure to sunlight, and controlled breathing. Other traditional healing systems have been developed by the world’s indigenous populations. These populations include Native American, Aboriginal, African, Middle Eastern, Tibetan, and Central and South American cultures. Homeopathy and naturopathy are also examples of complete alternative medicine systems. Homeopathic medicine is an unconventional Western system that is based on the principle that “like cures like,” i.e., that the same substance that in large doses produces the symptoms of an illness, in very minute doses cures it. Homeopathic health practitioners believe that the more dilute the remedy, the greater its potency. Therefore, they use small doses of specially prepared plant extracts and minerals to stimulate the body’s defense mechanisms and healing processes in order to treat illness. Naturopathic medicine is based on the theory that disease is a manifestation of alterations in the processes by which the body naturally heals itself and emphasizes health restoration rather than disease treatment. Naturopathic physicians employ an array of healing practices, including the following: diet and clinical nutrition, homeopathy, acupuncture, herbal medicine, hydrotherapy (the use of water in a range of temperatures and methods of applications), spinal and soft-tissue manipulation, physical therapies (such as those involving electrical currents, ultrasound, and light), therapeutic counseling, and pharmacology.
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Mind-Body Interventions Mind-body interventions employ a variety of techniques designed to facilitate the mind’s capacity to affect bodily function and symptoms. Only a select group of mind-body interventions having well-documented theoretical foundations are considered CAM. For example, patient education and cognitive-behavioral approaches are now considered “mainstream.” On the other hand, complementary and alternative medicine includes meditation, certain uses of hypnosis, dance, music, and art therapy, as well as prayer and mental healing.
Biological-Based Therapies This category of CAM includes natural and biological-based practices, interventions, and products, many of which overlap with conventional medicine’s use of dietary supplements. This category includes herbal, special dietary, orthomolecular, and individual biological therapies. Herbal therapy employs an individual herb or a mixture of herbs for healing purposes. An herb is a plant or plant part that produces and contains chemical substances that act upon the body. Special diet therapies, such as those proposed by Drs. Atkins, Ornish, Pritikin, and Weil, are believed to prevent and/or control illness as well as promote health. Orthomolecular therapies aim to treat disease with varying concentrations of chemicals such as magnesium, melatonin, and mega-doses of vitamins. Biological therapies include, for example, the use of laetrile and shark cartilage to treat cancer and the use of bee pollen to treat autoimmune and inflammatory diseases.
Manipulative and Body-Based Methods This category includes methods that are based on manipulation and/or movement of the body. For example, chiropractors focus on the relationship between structure and function, primarily pertaining to the spine, and how that relationship affects the preservation and restoration of health. Chiropractors use manipulative therapy as an integral treatment tool. In contrast, osteopaths place particular emphasis on the musculoskeletal system and practice osteopathic manipulation. Osteopaths believe that all of the body’s systems work together and that disturbances in one system may have an impact upon function elsewhere in the body. Massage therapists manipulate the soft tissues of the body to normalize those tissues.
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Energy Therapies Energy therapies focus on energy fields originating within the body (biofields) or those from other sources (electromagnetic fields). Biofield therapies are intended to affect energy fields (the existence of which is not yet experimentally proven) that surround and penetrate the human body. Some forms of energy therapy manipulate biofields by applying pressure and/or manipulating the body by placing the hands in or through these fields. Examples include Qi gong, Reiki and Therapeutic Touch. Qi gong is a component of traditional oriental medicine that combines movement, meditation, and regulation of breathing to enhance the flow of vital energy (qi) in the body, improve blood circulation, and enhance immune function. Reiki, the Japanese word representing Universal Life Energy, is based on the belief that, by channeling spiritual energy through the practitioner, the spirit is healed and, in turn, heals the physical body. Therapeutic Touch is derived from the ancient technique of “laying-on of hands.” It is based on the premises that the therapist’s healing force affects the patient’s recovery and that healing is promoted when the body’s energies are in balance. By passing their hands over the patient, these healers identify energy imbalances. Bioelectromagnetic-based therapies involve the unconventional use of electromagnetic fields to treat illnesses or manage pain. These therapies are often used to treat asthma, cancer, and migraine headaches. Types of electromagnetic fields which are manipulated in these therapies include pulsed fields, magnetic fields, and alternating current or direct current fields.
Can Alternatives Affect My Treatment? A critical issue in pursuing complementary alternatives mentioned thus far is the risk that these might have undesirable interactions with your medical treatment. It becomes all the more important to speak with your doctor who can offer advice on the use of alternatives. Official sources confirm this view. Though written for women, we find that the National Women’s Health Information Center’s advice on pursuing alternative medicine is appropriate for patients of both genders and all ages.45
45
Adapted from http://www.4woman.gov/faq/alternative.htm.
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Is It Okay to Want Both Traditional and Alternative Medicine? Should you wish to explore non-traditional types of treatment, be sure to discuss all issues concerning treatments and therapies with your healthcare provider, whether a physician or practitioner of complementary and alternative medicine. Competent healthcare management requires knowledge of both conventional and alternative therapies you are taking for the practitioner to have a complete picture of your treatment plan. The decision to use complementary and alternative treatments is an important one. Consider before selecting an alternative therapy, the safety and effectiveness of the therapy or treatment, the expertise and qualifications of the healthcare practitioner, and the quality of delivery. These topics should be considered when selecting any practitioner or therapy.
Finding CAM References on Impotence Having read the previous discussion, you may be wondering which complementary or alternative treatments might be appropriate for impotence. For the remainder of this chapter, we will direct you to a number of official sources which can assist you in researching studies and publications. Some of these articles are rather technical, so some patience may be required. The Combined Health Information Database For a targeted search, The Combined Health Information Database is a bibliographic database produced by health-related agencies of the Federal Government (mostly from the National Institutes of Health). This database is updated four times a year at the end of January, April, July, and October. Check the titles, summaries, and availability of CAM-related information by using the “Simple Search” option at the following Web site: http://chid.nih.gov/simple/simple.html. In the drop box at the top, select “Complementary and Alternative Medicine.” Then type “impotence” (or synonyms) in the second search box. We recommend that you select 100 “documents per page” and to check the “whole records” options. The following was extracted using this technique: ·
Gingko Biloba. Common Name: Ginkgo, Maidenhair Tree (monograph) Source: Alternative Medicine Review. 3(1): 54-57. February 1998.
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Summary: This monograph on Ginkgo biloba, also known as Ginkgo or maidenhair tree, describes the plant, the constituents of Ginkgo biloba leaves, and the mechanisms of action of the active compounds present in standardized extracts of Ginkgo leaves. It reviews the clinical trials that have been done using Ginkgo extract. These studies were on age-related physical and mental deterioration and included Alzheimers Disease, senile dementia, cardiovascular disease, cerebral vascular insufficiency, and impaired cerebral performance. Other potential therapeutic applications include treating the symptoms of premenstrual syndrome, diabetes, impotence, intermittent claudication, liver fibrosis, macular degeneration, and tinnitus. Dosage, contraindications, side effects, drugnutrient interactions, and toxicity data are also reviewed. This monograph contains 1 illustration and 49 references. ·
Ginkgo Biloba L. (Ginkgoaceae) Source: Protocol Journal of Botanical Medicine. 2(1): 9-15. Summer 1996. Summary: This journal article describes the history, biology, and clinical research on the Ginkgo biloba tree. This tree is a monotypic, deciduous tree that is called a living fossil because it originated about 250 million years ago. Ginkgo was cultivated for centuries in China and Japan, and was eventually introduced to Europe. It has been used medicinally for several thousand years in Chinese medicine for treatment of cerebral insufficiency, peripheral vascular insufficiency, Alzheimer's disease, impotence, depression, and tinnitus. The author examines a number of in vitro and in vivo studies on these conditions that used a standardized extract of Ginkgo biloba leaf. Biochemical actions of the standardized extract include vasoregulating effects, antioxidant activity, inhibition of lipid peroxidation, and modulation of cerebral energy metabolism. Several studies are described, and the author concludes that use of Ginkgo biloba appears to be safe and has no known contraindications. There are some minimal side effects, such as gastrointestinal problems, headaches, dizziness, and cutaneous problems. This journal article contains 2 figures and 70 references.
National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov) has created a link to the National Library of Medicine’s databases to allow patients to search for articles that specifically relate to impotence and complementary medicine. To search the database, go to the following Web
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site: www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “impotence” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine (CAM) that are related to impotence: ·
100 cases of impotence treated by acupuncture and moxibustion. Author(s): Wu JZ, Zhang Q, Wu WC, Guo ZH, Yin FX, Yan CH, Zhou RL, Zhu LX. Source: J Tradit Chin Med. 1989 September; 9(3): 184-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2615452&dopt=Abstract
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A parallel study on the effects in treatment of impotence by tonifying the kidney with and that without improving blood circulation. Author(s): Guo J, Kong L, Gao X, Lu J, Pang J. Source: J Tradit Chin Med. 1999 June; 19(2): 123-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10681870&dopt=Abstract
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Can a urologic nurse contribute to management of secondary impotence in an office setting? Author(s): Boyarsky S, Lewis GS. Source: Urology. 1990 January; 35(1): 25-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2296811&dopt=Abstract
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Cavernous vein arterialization for vasculogenic impotence. An animal model. Author(s): Breza J, Aboseif SR, Lue TF, Tanagho EA. Source: Urology. 1990 June; 35(6): 513-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2353378&dopt=Abstract
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Clinical trial of mustong on secondary sexual impotence in male married diabetics. Author(s): Ojha JK, Roy CK, Bajpai HS. Source: J Med Assoc Thai. 1987 March; 70 Suppl 2: 228-30. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3298520&dopt=Abstract
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Gene expression profiling of an arteriogenic impotence model. Author(s): Lin CS, Ho HC, Gholami S, Chen KC, Jad A, Lue TF. Source: Biochemical and Biophysical Research Communications. 2001 July 13; 285(2): 565-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11444882&dopt=Abstract
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History of the prosthetic treatment of impotence. Author(s): Bretan PN Jr. Source: The Urologic Clinics of North America. 1989 February; 16(1): 1-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2644727&dopt=Abstract
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How is impotence treated with acupuncture? Author(s): Hu J. Source: J Tradit Chin Med. 1993 September; 13(3): 234-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8246606&dopt=Abstract
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Hypertensive crisis from herbal treatment of impotence. Author(s): Ruck B, Shih RD, Marcus SM. Source: The American Journal of Emergency Medicine. 1999 May; 17(3): 317-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10337904&dopt=Abstract
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Hypnotherapy of impotence. Author(s): Deabler HL. Source: Am J Clin Hypn. 1976 July; 19(1): 9-12. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=937220&dopt=Abstract
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Hypnotic techniques for smoking control and psychogenic impotence. Author(s): Crasilneck HB. Source: Am J Clin Hypn. 1990 January; 32(3): 147-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2296915&dopt=Abstract
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Impotence and perceived partner support. Author(s): Intili H.
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Source: Urologic Nursing : Official Journal of the American Urological Association Allied. 1998 December; 18(4): 279-80, 287. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9873353&dopt=Abstract ·
Impotence as a practical problem. Author(s): Reckless J, Geiger N. Source: Dis Mon. 1975 May; : 1-40. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1039921&dopt=Abstract
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Impotence in older men. A newly recognized problem. Author(s): Buczny B. Source: J Gerontol Nurs. 1992 May; 18(5): 25-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1583284&dopt=Abstract
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Lead poisoning due to Asian ethnic treatment for impotence. Author(s): Dolan G, Jones AP, Blumsohn A, Reilly JT, Brown MJ. Source: Journal of the Royal Society of Medicine. 1991 October; 84(10): 630-1. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1744857&dopt=Abstract
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Marital crisis intervention: hypnosis in impotence-frigidity cases. Author(s): Levit HI. Source: Am J Clin Hypn. 1971 July; 14(1): 56-60. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=5163567&dopt=Abstract
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Mechanisms and therapy of impotence associated with chronic renal failure and chronic dialysis. Author(s): Krumlovsky FA, Madsen JD. Source: J Dial. 1979; 3(4): 395-411. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=263961&dopt=Abstract
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New treatments for erectile impotence. Author(s): Gregoire A.
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Source: The British Journal of Psychiatry; the Journal of Mental Science. 1992 March; 160: 315-26. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1562858&dopt=Abstract ·
Nocturnal erections, differential diagnosis of impotence, and diabetes. Author(s): Karacan I, Scott FB, Salis PJ, Attia SL, Ware JC, Altinel A, Williams RL. Source: Biological Psychiatry. 1977 June; 12(3): 373-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=871489&dopt=Abstract
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Outpatient treatment of impotence. Author(s): Cooper AJ. Source: The Journal of Nervous and Mental Disease. 1969 October; 149(4): 360-71. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=5383605&dopt=Abstract
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Possible molecular mechanisms of cryoablation-induced impotence in a rat model. Author(s): El-Sakka A, Hassan MU, Bakircioglu ME, Pillarisetty RJ, Dahiya R, Lue TF. Source: Urology. 1998 December; 52(6): 1144-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9836574&dopt=Abstract
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Psychogenic impotence with a hypnotherapy. Case Illustration. Author(s): Schneck JM. Source: Psychosomatics. 1970 July-August; 11(4): 352-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=5459340&dopt=Abstract
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Psychological factors involved in impotence. A review of the literature. Author(s): Turnbull JM, Weinberg PC. Source: J Androl. 1983 January-February; 4(1): 59-66. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6341341&dopt=Abstract
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Some mythologic, religious, and cultural aspects of impotence before the present modern era. Author(s): van Driel MF, van de Wiel HB, Mensink HJ. Source: International Journal of Impotence Research : Official Journal of the International Society for Impotence Research. 1994 September; 6(3): 163-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7735361&dopt=Abstract
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Supernatural impotence: historical review with anthropological and clinical implications. Author(s): Margolin J, Witztum E. Source: The British Journal of Medical Psychology. 1989 December; 62 ( Pt 4): 333-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2597649&dopt=Abstract
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Surgical treatment of male impotence. Author(s): Farina R, Cury E, Ackel IA. Source: Aesthetic Plastic Surgery. 1982; 6(3): 165-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7180720&dopt=Abstract
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The effect of adeno-associated virus mediated brain derived neurotrophic factor in an animal model of neurogenic impotence. Author(s): Bakircioglu ME, Lin CS, Fan P, Sievert KD, Kan YW, Lue TF. Source: The Journal of Urology. 2001 June; 165(6 Pt 1): 2103-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11371936&dopt=Abstract
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The hypnotherapeutic treatment of impotence. Author(s): Ward WO. Source: Va Med. 1977 June; 104(6): 389-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=878571&dopt=Abstract
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The place of acupuncture in the management of psychogenic impotence. Author(s): Yaman LS, Kilic S, Sarica K, Bayar M, Saygin B.
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Source: European Urology. 1994; 26(1): 52-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7925530&dopt=Abstract ·
The treatment of functional impotence with hypnosis and ageregression. Author(s): Sexton RO, Maddock RC. Source: J Tenn Med Assoc. 1979 August; 72(8): 579-82. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=491575&dopt=Abstract
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The treatment of impotence by brietal relaxation therapy. Author(s): Friedman D. Source: Behaviour Research and Therapy. 1968 August; 6(3): 257-61. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=5734545&dopt=Abstract
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The use of hypnosis in the treatment of impotence. Author(s): Crasilneck HB. Source: Psychiatr Med. 1992; 10(1): 67-75. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1549753&dopt=Abstract
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Treating impotence with traditional Chinese medicine coordinated by acupuncture & moxibustion. Author(s): Li ZM, Ye CG. Source: J Tradit Chin Med. 1988 June; 8(2): 121-2. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3412008&dopt=Abstract
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Treatment of impotence by Chinese herbs and acupuncture. Author(s): Zhu Y, Ni L. Source: J Tradit Chin Med. 1997 September; 17(3): 226-37. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10437202&dopt=Abstract
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Treatment of impotence. Proven and promising methods. Author(s): Kudish HG.
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Source: Postgraduate Medicine. 1983 October; 74(4): 233-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6622313&dopt=Abstract ·
Treatment of phobic anxiety and psychogenic impotence by systematic desensitization employing methohexitone-induced relaxation. Author(s): Friedman DE, Lipsedge MS. Source: The British Journal of Psychiatry; the Journal of Mental Science. 1971 January; 118(542): 87-90. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=5576272&dopt=Abstract
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Treatments of premature ejaculation and psychogenic impotence: a critical review of the literature. Author(s): Kilmann PR, Auerbach R. Source: Archives of Sexual Behavior. 1979 January; 8(1): 81-100. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=369478&dopt=Abstract
Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: ·
Alternative Medicine Foundation, Inc.: http://www.herbmed.org/
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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats
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Chinese Medicine: http://www.newcenturynutrition.com/
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drkoop.comÒ: http://www.drkoop.com/InteractiveMedicine/IndexC.html
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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm
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Google: http://directory.google.com/Top/Health/Alternative/
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Healthnotes: http://www.thedacare.org/healthnotes/
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Open Directory Project: http://dmoz.org/Health/Alternative/
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TPN.com: http://www.tnp.com/
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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/
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WebMDÒHealth: http://my.webmd.com/drugs_and_herbs
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WellNet: http://www.wellnet.ca/herbsa-c.htm
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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,,00.html
The following is a specific Web list relating to impotence; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: ·
General Overview Impotence Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsLookups/Uses/im potence.html Impotence Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000294.html
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Alternative Therapy Myotherapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,931, 00.html
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Chinese Medicine Bajitian Alternative names: Morinda Root; Radix Morindae Officinalis Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Colla Cornus Cervi Alternative names: Deerhorn Glue; %Colla Cornus Cervi%% Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China
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Hyperlink: http://www.newcenturynutrition.com/cgilocal/patent_herbs_db/db.cgi?db=default&Chinese=Colla%20Cornus%2 0Cervi&mh=10&sb=---&view_records=View+Records Dingxiang Alternative names: Clove; Flos Caryophylli Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Dongchongxiacao Alternative names: Chinese Caterpillar Fungus; Cordyceps Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Fupenzi Alternative names: Palmleaf Raspberry Fruit; Fructus Rubi Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Fuzi Alternative names: Beivedere Fruit; Difuzi; Fructus Kochiae Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Gejie Alternative names: Tokay Gecko; Gecko Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Hailong Alternative names: Pipe Fish; Syngnathus Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Haima Alternative names: Sea-horse; Hippocampus Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Hetaoren Alternative names: English Walnut Seed; Semen Juglandis Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/
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Jiucaizi Alternative names: Tuber Onion Seed; Semen Allii Tuberosi Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Jiuxiangchong Alternative names: Stink-bug; Jiuxiangchong (Jiu Xiang Chong); Aspongopus Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Liuhuang Alternative names: Sulfur; Sulfur Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Lurong Alternative names: Hairy Deer-horn (Hairy Antler); Cornu Cervi Pantotrichum Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Qiangyang Baoshen Wan Alternative names: Qiangyang Baoshen Pills Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Hyperlink: http://www.newcenturynutrition.com/cgilocal/patent_herbs_db/db.cgi?db=default&Chinese=Qiangyang%20Bao shen%20Wan&mh=10&sb=---&view_records=View+Records Renshen Alternative names: Ginseng Leaf; Renshenye (Ren Shen Ye); Folium Ginseng Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Rougui Alternative names: Cassia Bark; Cortex Cinnamomi Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Shanzhuyu
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Alternative names: Asiatic Cornelian Cherry Fruit; Fructus Corni Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Shechuangzi Alternative names: Common Cnidium Fruit; Fructus Cnidii Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Taoren Alternative names: English Walnut Seed; Hetaoren; Semen Juglandis Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Tusizi Alternative names: Dodder Seed; Semen Cuseutae Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Xianmao Alternative names: Common Curculigo Rhizome; Rhizoma Curculiginis Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Yinyanghuo Alternative names: Epimedium Herb; Herba Epimedii Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Ziheche Alternative names: Human Placenta; Placenta Hominis Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ ·
Homeopathy Agnus castus Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Agnus_cast us.htm Argentum nitricum
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Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Argentum_ nitricum.htm Caladium Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Caladium.ht m Causticum Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Causticum. htm Lycopodium Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Lycopodiu m.htm Selenium metallicum Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Selenium_m etallicum.htm Staphysagria Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Homeo_Homeoix/Staphysagri a.htm ·
Herbs and Supplements Alanine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/BPH.htm Alanine Source: Integrative Medicine Communications; www.onemedicine.com
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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Benign ProstaticHyperplasiacc.html Antibiotics Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Prostat itiscc.html Arginine Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000097.html Arginine Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000294.html Asian Ginseng Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Ginseng_Asian.htm Asian Ginseng Alternative names: Panax ginseng Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/GinsengAsi anch.html Beta-Sitosterol Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/BPH.htm Beta-sitosterol Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,972, 00.html Damiana Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000142.html
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Dehydroepiandrosterone Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000294.html DHEA Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000294.html DHEA (Dehydroepiandrosterone) Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000146.html Finasteride Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/BPH.htm Finasteride Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Benign ProstaticHyperplasiacc.html Ginger Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000166.html Ginkgo Alternative names: Ginkgo biloba Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Ginkgo Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000294.html Ginkgo Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000167.html Ginkgo Biloba Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000294.html
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Ginkgo biloba Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,788, 00.html Ginseng Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000100.html Ginseng (Panax) Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,100 29,00.html Ginseng, Asian Alternative names: Panax ginseng Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/GinsengAsi anch.html Glutamic Acid Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/BPH.htm Glutamic Acid Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Benign ProstaticHyperplasiacc.html Glutamine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Glut aminecs.html Glycine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/BPH.htm
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Glycine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Benign ProstaticHyperplasiacc.html Grape seed extract Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,793, 00.html Herbal Medicine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Prostat itiscc.html L-Arginine Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000294.html Licorice Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000294.html Licorice Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000144.html Muira puama Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000294.html Muira puama Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,100 45,00.html Nettle Source: Healthnotes, Inc.; www.healthnotes.com
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Hyperlink: http://www.thedacare.org/healthnotes/Concern/BPH.htm Nettle Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Benign ProstaticHyperplasiacc.html Panax ginseng Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/GinsengAsi anch.html Pollen Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/BPH.htm Pollen Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Prostat itiscc.html Prozac Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000294.html Pumpkin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/BPH.htm Pygeum Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/BPH.htm Pygeum Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000224.html Pygeum africanum Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/BPH.htm
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Pygeum africanum Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,100 52,00.html Saw Palmetto Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/BPH.htm Saw Palmetto Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Prostat itiscc.html Saw Palmetto Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Benign ProstaticHyperplasiacc.html Saw palmetto Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,819, 00.html Serenoa Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/BPH.htm Serenoa repens Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/BPH.htm Siberian ginseng Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,821, 00.html
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Sildenafil Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Sildenafil.htm SSRIs Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000294.html Suma Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000239.html Urtica Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/BPH.htm Yohimbe Alternative names: Pausinystalia yohimbe Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Yohimbe.htm Yohimbe Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000251.html Yohimbe Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,830, 00.html Zingiber Alternative names: Ginger; Zingiber officinale Roscoe Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ ·
Related Conditions Alcoholism Source: Integrative Medicine Communications; www.onemedicine.com
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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Alcoho lismcc.html Amyloidosis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Amylo idosiscc.html Benign Prostatic Hyperplasia Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/BPH.htm Benign Prostatic Hyperplasia Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Benign ProstaticHyperplasiacc.html Blood Pressure, High Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypert ensioncc.html BPH Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Benign ProstaticHyperplasiacc.html Cancer, Prostate Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Cancer Prostatecc.html Canker Sores Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000262.html
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Depression Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Depres sioncc.html Diabetes Mellitus Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Diabet esMellituscc.html Erectile Dysfunction Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Erectile_Dysfunction. htm High Blood Pressure Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypert ensioncc.html Hypertension Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypert ensioncc.html Male Infertility Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Infertility_Male.htm Male Infertility Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000295.html Prostate Cancer Source: Integrative Medicine Communications; www.onemedicine.com
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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Cancer Prostatecc.html Prostate Enlargement Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Benign ProstaticHyperplasiacc.html Prostate Infection Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Prostat itiscc.html Prostatitis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Prostat itiscc.html Sexual Dysfunction Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Sexual Dysfunctioncc.html Sleep Apnea Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/SleepA pneacc.html Ulcers Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000286.html Viral Hepatitis Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000255.html
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General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at: www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources. The following additional references describe, in broad terms, alternative and complementary medicine (sorted alphabetically by title; hyperlinks provide rankings, information, and reviews at Amazon.com): · Alternative Medicine for Dummies by James Dillard (Author); Audio Cassette, Abridged edition (1998), Harper Audio; ISBN: 0694520659; http://www.amazon.com/exec/obidos/ASIN/0694520659/icongroupinterna ·
Complementary and Alternative Medicine Secrets by W. Kohatsu (Editor); Hardcover (2001), Hanley & Belfus; ISBN: 1560534400; http://www.amazon.com/exec/obidos/ASIN/1560534400/icongroupinterna
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Dictionary of Alternative Medicine by J. C. Segen; Paperback-2nd edition (2001), Appleton & Lange; ISBN: 0838516211; http://www.amazon.com/exec/obidos/ASIN/0838516211/icongroupinterna
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Eat, Drink, and Be Healthy: The Harvard Medical School Guide to Healthy Eating by Walter C. Willett, MD, et al; Hardcover - 352 pages (2001), Simon & Schuster; ISBN: 0684863375; http://www.amazon.com/exec/obidos/ASIN/0684863375/icongroupinterna
· Encyclopedia of Natural Medicine, Revised 2nd Edition by Michael T. Murray, Joseph E. Pizzorno; Paperback - 960 pages, 2nd Rev edition (1997), Prima Publishing; ISBN: 0761511571; http://www.amazon.com/exec/obidos/ASIN/0761511571/icongroupinterna ·
Herbs for the Urinary Tract: Herbal Relief for Kidney Stones, Bladder Infections and Other Problems of the Urinary Tract by Michael Moore; Paperback - 96 pages (June 1998), McGraw Hill - NTC; ISBN: 0879838159; http://www.amazon.com/exec/obidos/ASIN/0879838159/icongroupinterna
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Integrative Medicine: An Introduction to the Art & Science of Healing by Andrew Weil (Author); Audio Cassette, Unabridged edition (2001), Sounds True; ISBN: 1564558541; http://www.amazon.com/exec/obidos/ASIN/1564558541/icongroupinterna
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New Encyclopedia of Herbs & Their Uses by Deni Bown; Hardcover - 448 pages, Revised edition (2001), DK Publishing; ISBN: 078948031X; http://www.amazon.com/exec/obidos/ASIN/078948031X/icongroupinterna
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· Textbook of Complementary and Alternative Medicine by Wayne B. Jonas; Hardcover (2003), Lippincott, Williams & Wilkins; ISBN: 0683044370; http://www.amazon.com/exec/obidos/ASIN/0683044370/icongroupinterna For additional information on complementary and alternative medicine, ask your doctor or write to: National Institutes of Health National Center for Complementary and Alternative Medicine Clearinghouse P. O. Box 8218 Silver Spring, MD 20907-8218
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APPENDIX C. RESEARCHING NUTRITION Overview Since the time of Hippocrates, doctors have understood the importance of diet and nutrition to patients’ health and well-being. Since then, they have accumulated an impressive archive of studies and knowledge dedicated to this subject. Based on their experience, doctors and healthcare providers may recommend particular dietary supplements to patients with impotence. Any dietary recommendation is based on a patient’s age, body mass, gender, lifestyle, eating habits, food preferences, and health condition. It is therefore likely that different patients with impotence may be given different recommendations. Some recommendations may be directly related to impotence, while others may be more related to the patient’s general health. These recommendations, themselves, may differ from what official sources recommend for the average person. In this chapter we will begin by briefly reviewing the essentials of diet and nutrition that will broadly frame more detailed discussions of impotence. We will then show you how to find studies dedicated specifically to nutrition and impotence.
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Food and Nutrition: General Principles What Are Essential Foods? Food is generally viewed by official sources as consisting of six basic elements: (1) fluids, (2) carbohydrates, (3) protein, (4) fats, (5) vitamins, and (6) minerals. Consuming a combination of these elements is considered to be a healthy diet: ·
Fluids are essential to human life as 80-percent of the body is composed of water. Water is lost via urination, sweating, diarrhea, vomiting, diuretics (drugs that increase urination), caffeine, and physical exertion.
·
Carbohydrates are the main source for human energy (thermoregulation) and the bulk of typical diets. They are mostly classified as being either simple or complex. Simple carbohydrates include sugars which are often consumed in the form of cookies, candies, or cakes. Complex carbohydrates consist of starches and dietary fibers. Starches are consumed in the form of pastas, breads, potatoes, rice, and other foods. Soluble fibers can be eaten in the form of certain vegetables, fruits, oats, and legumes. Insoluble fibers include brown rice, whole grains, certain fruits, wheat bran and legumes.
·
Proteins are eaten to build and repair human tissues. Some foods that are high in protein are also high in fat and calories. Food sources for protein include nuts, meat, fish, cheese, and other dairy products.
·
Fats are consumed for both energy and the absorption of certain vitamins. There are many types of fats, with many general publications recommending the intake of unsaturated fats or those low in cholesterol.
Vitamins and minerals are fundamental to human health, growth, and, in some cases, disease prevention. Most are consumed in your diet (exceptions being vitamins K and D which are produced by intestinal bacteria and sunlight on the skin, respectively). Each vitamin and mineral plays a different role in health. The following outlines essential vitamins: ·
Vitamin A is important to the health of your eyes, hair, bones, and skin; sources of vitamin A include foods such as eggs, carrots, and cantaloupe.
·
Vitamin B1, also known as thiamine, is important for your nervous system and energy production; food sources for thiamine include meat, peas, fortified cereals, bread, and whole grains.
·
Vitamin B2, also known as riboflavin, is important for your nervous system and muscles, but is also involved in the release of proteins from
Researching Nutrition 237
nutrients; food sources for riboflavin include dairy products, leafy vegetables, meat, and eggs. ·
Vitamin B3, also known as niacin, is important for healthy skin and helps the body use energy; food sources for niacin include peas, peanuts, fish, and whole grains
·
Vitamin B6, also known as pyridoxine, is important for the regulation of cells in the nervous system and is vital for blood formation; food sources for pyridoxine include bananas, whole grains, meat, and fish.
·
Vitamin B12 is vital for a healthy nervous system and for the growth of red blood cells in bone marrow; food sources for vitamin B12 include yeast, milk, fish, eggs, and meat.
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Vitamin C allows the body’s immune system to fight various diseases, strengthens body tissue, and improves the body’s use of iron; food sources for vitamin C include a wide variety of fruits and vegetables.
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Vitamin D helps the body absorb calcium which strengthens bones and teeth; food sources for vitamin D include oily fish and dairy products.
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Vitamin E can help protect certain organs and tissues from various degenerative diseases; food sources for vitamin E include margarine, vegetables, eggs, and fish.
·
Vitamin K is essential for bone formation and blood clotting; common food sources for vitamin K include leafy green vegetables.
·
Folic Acid maintains healthy cells and blood and, when taken by a pregnant woman, can prevent her fetus from developing neural tube defects; food sources for folic acid include nuts, fortified breads, leafy green vegetables, and whole grains.
It should be noted that one can overdose on certain vitamins which become toxic if consumed in excess (e.g. vitamin A, D, E and K). Like vitamins, minerals are chemicals that are required by the body to remain in good health. Because the human body does not manufacture these chemicals internally, we obtain them from food and other dietary sources. The more important minerals include: ·
Calcium is needed for healthy bones, teeth, and muscles, but also helps the nervous system function; food sources for calcium include dry beans, peas, eggs, and dairy products.
·
Chromium is helpful in regulating sugar levels in blood; food sources for chromium include egg yolks, raw sugar, cheese, nuts, beets, whole grains, and meat.
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·
Fluoride is used by the body to help prevent tooth decay and to reinforce bone strength; sources of fluoride include drinking water and certain brands of toothpaste.
·
Iodine helps regulate the body’s use of energy by synthesizing into the hormone thyroxine; food sources include leafy green vegetables, nuts, egg yolks, and red meat.
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Iron helps maintain muscles and the formation of red blood cells and certain proteins; food sources for iron include meat, dairy products, eggs, and leafy green vegetables.
·
Magnesium is important for the production of DNA, as well as for healthy teeth, bones, muscles, and nerves; food sources for magnesium include dried fruit, dark green vegetables, nuts, and seafood.
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Phosphorous is used by the body to work with calcium to form bones and teeth; food sources for phosphorous include eggs, meat, cereals, and dairy products.
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Selenium primarily helps maintain normal heart and liver functions; food sources for selenium include wholegrain cereals, fish, meat, and dairy products.
·
Zinc helps wounds heal, the formation of sperm, and encourage rapid growth and energy; food sources include dried beans, shellfish, eggs, and nuts.
The United States government periodically publishes recommended diets and consumption levels of the various elements of food. Again, your doctor may encourage deviations from the average official recommendation based on your specific condition. To learn more about basic dietary guidelines, visit the Web site: http://www.health.gov/dietaryguidelines/. Based on these guidelines, many foods are required to list the nutrition levels on the food’s packaging. Labeling Requirements are listed at the following site maintained by the Food and Drug Administration: http://www.cfsan.fda.gov/~dms/labcons.html. When interpreting these requirements, the government recommends that consumers become familiar with the following abbreviations before reading FDA literature:46 ·
DVs (Daily Values): A new dietary reference term that will appear on the food label. It is made up of two sets of references, DRVs and RDIs.
·
DRVs (Daily Reference Values): A set of dietary references that applies to fat, saturated fat, cholesterol, carbohydrate, protein, fiber, sodium, and potassium.
46
Adapted from the FDA: http://www.fda.gov/fdac/special/foodlabel/dvs.html.
Researching Nutrition 239
·
RDIs (Reference Daily Intakes): A set of dietary references based on the Recommended Dietary Allowances for essential vitamins and minerals and, in selected groups, protein. The name “RDI” replaces the term “U.S. RDA.”
·
RDAs (Recommended Dietary Allowances): A set of estimated nutrient allowances established by the National Academy of Sciences. It is updated periodically to reflect current scientific knowledge. What Are Dietary Supplements?47
Dietary supplements are widely available through many commercial sources, including health food stores, grocery stores, pharmacies, and by mail. Dietary supplements are provided in many forms including tablets, capsules, powders, gel-tabs, extracts, and liquids. Historically in the United States, the most prevalent type of dietary supplement was a multivitamin/mineral tablet or capsule that was available in pharmacies, either by prescription or “over the counter.” Supplements containing strictly herbal preparations were less widely available. Currently in the United States, a wide array of supplement products are available, including vitamin, mineral, other nutrients, and botanical supplements as well as ingredients and extracts of animal and plant origin. The Office of Dietary Supplements (ODS) of the National Institutes of Health is the official agency of the United States which has the expressed goal of acquiring “new knowledge to help prevent, detect, diagnose, and treat disease and disability, from the rarest genetic disorder to the common cold.”48 According to the ODS, dietary supplements can have an important impact on the prevention and management of disease and on the maintenance of health.49 The ODS notes that considerable research on the effects of dietary supplements has been conducted in Asia and Europe where the use of plant products, in particular, has a long tradition. However, the This discussion has been adapted from the NIH: http://ods.od.nih.gov/whatare/whatare.html. 48 Contact: The Office of Dietary Supplements, National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: (301) 435-2920, Fax: (301) 480-1845, E-mail:
[email protected]. 49 Adapted from http://ods.od.nih.gov/about/about.html. The Dietary Supplement Health and Education Act defines dietary supplements as “a product (other than tobacco) intended to supplement the diet that bears or contains one or more of the following dietary ingredients: a vitamin, mineral, amino acid, herb or other botanical; or a dietary substance for use to supplement the diet by increasing the total dietary intake; or a concentrate, metabolite, constituent, extract, or combination of any ingredient described above; and intended for ingestion in the form of a capsule, powder, softgel, or gelcap, and not represented as a conventional food or as a sole item of a meal or the diet.” 47
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overwhelming majority of supplements have not been studied scientifically. To explore the role of dietary supplements in the improvement of health care, the ODS plans, organizes, and supports conferences, workshops, and symposia on scientific topics related to dietary supplements. The ODS often works in conjunction with other NIH Institutes and Centers, other government agencies, professional organizations, and public advocacy groups. To learn more about official information on dietary supplements, visit the ODS site at http://ods.od.nih.gov/whatare/whatare.html. Or contact: The Office of Dietary Supplements National Institutes of Health Building 31, Room 1B29 31 Center Drive, MSC 2086 Bethesda, Maryland 20892-2086 Tel: (301) 435-2920 Fax: (301) 480-1845 E-mail:
[email protected] Finding Studies on Impotence The NIH maintains an office dedicated to patient nutrition and diet. The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.50 IBIDS is available to the public free of charge through the ODS Internet page: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. We recommend that you start with the Consumer Database. While you may not find references for the topics that are of most interest to you, check back periodically as this database is frequently updated. More studies can be Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.
50
Researching Nutrition 241
found by searching the Full IBIDS Database. Healthcare professionals and researchers generally use the third option, which lists peer-reviewed citations. In all cases, we suggest that you take advantage of the “Advanced Search” option that allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “impotence” (or synonyms) into the search box. To narrow the search, you can also select the “Title” field. The following is a typical result when searching for recently indexed consumer information on impotence: ·
Rigiscan evaluation of specific nervous impairment in patients with diabetes and erectile disorders. Author(s): Department of Internal Medicine, University of Padova, Italy.
[email protected] Source: Bax, G Marin, N Piarulli, F Lamonica, M Bellio, F Fedele, D Diabetes-Care. 1998 July; 21(7): 1159-61 0149-5992
The following information is typical of that found when using the “Full IBIDS Database” when searching using “impotence” (or a synonym): ·
100 cases of impotence treated by acupuncture and moxibustion. Source: Wu, J Z Zhang, Q Wu, W C Guo, Z H Yin, F X Yan, C H Zhou, R L Zhu, L X J-Tradit-Chin-Med. 1989 September; 9(3): 184-5 0254-6272
·
A parallel study on the effects in treatment of impotence by tonifying the kidney with and that without improving blood circulation. Author(s): Department of Urology, Guang'anmen Hospital, China Academy of Traditional Chinese Medicine, Beijing. Source: Guo, J Kong, L Gao, X Lu, J Pang, J J-Tradit-Chin-Med. 1999 June; 19(2): 123-5 0254-6272
·
Abnormally low serum zinc levels in diabetic patients with systemic complications, especially polyneuropathy and impotence. Source: Jameson, S. Brattberg, A. Fagius, J. Hellsing, K. Berne, C. Trace elements in man and animals : TEMA 5 : proceedings of the fifth International Symposium on Trace Elements in Man and Animals / editors C.F. Mills, I. Bremner, & J.K. Chesters. Farnham Royal, Slough : Commonwealth Agricultural Bureaux, c1985. page 757-760. ISBN: 085198553X
·
Asthma and impotence. The story of an unexpected connection. Author(s): Vermillion Medical Clinic, Vermillion, SD, USA. Source: Ollivier, J E JAAPA. 2000 June; 13(6): 59-62, 68, 70
·
Cavernous vein arterialization for vasculogenic impotence. An animal model. Author(s): Department of Urology, University of California School of Medicine, San Francisco.
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Source: Breza, J Aboseif, S R Lue, T F Tanagho, E A Urology. 1990 June; 35(6): 513-8 0090-4295 ·
Clinical trial of mustong on secondary sexual impotence in male married diabetics. Source: Ojha, J K Roy, C K Bajpai, H S J-Med-Assoc-Thai. 1987 March; 70 Suppl 2228-30 0125-2208
·
Diagnosis and treatment of impotence. Author(s): Agency for Health Care Policy and Research, Publications and Information Branch, Rockville, MD 20857. Source: Handelsman, H Health-Technol-Assess-Repage 1990; (2): 1-23 8755-9765
·
Diagnostic evaluation of impotence. Author(s): Mt Sinai School of Medicine, New York. Source: Whitehead, E D Klyde, B J Zussman, S Salkin, P Postgrad-Med. 1990 August; 88(2): 123-6, 129-36 0032-5481
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Factors in predicting initial in-office therapeutic dosages of alprostadil for the treatment of organic impotence. Author(s): Associate Health Service, Atlanta, GA, USA. Source: Intili, H Urol-Nurs. 1998 June; 18(2): 111-3 1053-816X
·
Hypogonadal impotence treated by transdermal testosterone. Author(s): Department of Urology, University of California, School of Medicine, San Francisco. Source: McClure, R D Oses, R Ernest, M L Urology. 1991 March; 37(3): 224-8 0090-4295
·
Intracavernous drug delivery system: an alternative to intracavernous injection in the treatment of impotence? Author(s): Department of Urology, University of Freiburg, FRG. Source: Stief, C G Wetterauer, U Kulvelis, F Popken, G Staubesand, J Sommerkamp, H Urol-Int. 1990; 45(6): 321-5 0042-1138
·
Intracavernous injection of prostaglandin E1: the application to cavernosography and penile blood flow measurement for the diagnosis of venogenic impotence. Author(s): Department of Urology, Yamagata University, School of Medicine, Japan. Source: Ishigooka, M Irisawa, C Watanabe, H Adachi, M Ishii, N Nakada, T Urol-Int. 1991; 46(2): 193-6 0042-1138
·
Medical treatment of impotence with papaverine and phentolamine intracavernosal injection. Author(s): Department of Genitourinary Medicine, Royal Victoria Hospital, Belfast.
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Source: Dinsmore, W W Ulster-Med-J. 1990 October; 59(2): 174-6 00416193 ·
Non invasive detection of venogenic impotence: real-time US evaluation of periprostatic (Santorini's) venous plexus after (PGE1) induced erection. Author(s): Divisione di Urologia, Ospedale San Paolo, Milano. Source: Castellani, R Avogadro, A Quadraccia, A Arch-Ital-Urol-NefrolAndrol. 1991 June; 63 Suppl 257-60 1120-8538
·
Outcome of managing impotence in clinical practice. Author(s): Medical Specialist Group, Mercy Specialist Centre, Auckland.
[email protected] Source: Braatvedt, G D N-Z-Med-J. 1999 July 23; 112(1092): 272-4 00288446
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Recent advances in the role of pharmaceutical agents in impotence. Author(s): Reproductive Medicine Research Institute, Queen Elizabeth II Medical Centre, Nedlands, Australia. Source: Keogh, E J Earle, C M Reprod-Fertil-Devolume 1989; 1(4): 387-90 1031-3613
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Recurrent fainting, dysesthesia, and impotence. Author(s): Department of Medicine, University of Tennessee, Memphis, USA. Source: Rayder, R Brewer, W Hamilton, R KuMarch, A Sebes, J Carbone, L Hosp-Pract-(Off-Ed). 1999 July 15; 34(7): 52c-52d 8750-2836
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The combined use of sex therapy and intrapenile injections in the treatment of impotence. Author(s): Human Sexuality Program, New York Hospital-Cornell Medical Center, NY. Source: Kaplan, H S J-Sex-Marital-Ther. 1990 Winter; 16(4): 195-207 0092623X
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The role of yohimbine for the treatment of erectile impotence. Author(s): Division of Urology, University of Michigan Medical Center, Ann Arbor 48109. Source: Sonda, L P Mazo, R Chancellor, M B J-Sex-Marital-Ther. 1990 Spring; 16(1): 15-21 0092-623X
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The use of prostaglandins for diagnosis and treatment of erectile impotence. Author(s): Department of Urology, University Clinic of Brussels, AZVUB. Source: Merckx, L Vanwaeyenbergh, J De Bruyne, R Braeckman, J Keuppens, F Acta-Urol-Belg. 1991; 59(3): 47-52 0001-7183
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Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: ·
healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0
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The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov
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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov
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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/
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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/
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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/
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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/
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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/
Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: ·
AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats
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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html
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Google: http://directory.google.com/Top/Health/Nutrition/
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Healthnotes: http://www.thedacare.org/healthnotes/
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Open Directory Project: http://dmoz.org/Health/Nutrition/
Researching Nutrition 245
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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/
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WebMDÒHealth: http://my.webmd.com/nutrition
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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,,00.html
The following is a specific Web list relating to impotence; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: ·
Vitamins Vitamin C and flavonoids Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,935, 00.html
·
Minerals Copper Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/BPH.htm Copper Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000294.html Zinc Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000128.html
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Food and Diet Beer Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Benign ProstaticHyperplasiacc.html
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Coffee Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Prostat itiscc.html Diabetes Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000294.html Pumpkin seeds Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/BPH.htm Rye Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/BPH.htm Seeds Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/BPH.htm Seeds Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Prostat itiscc.html Seeds Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Benign ProstaticHyperplasiacc.html Tea Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Benign ProstaticHyperplasiacc.html Tea Source: Integrative Medicine Communications; www.onemedicine.com
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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Prostat itiscc.html Water Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Benign ProstaticHyperplasiacc.html Water Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Prostat itiscc.html
Vocabulary Builder The following vocabulary builder defines words used in the references in this chapter that have not been defined in previous chapters: Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH]
Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Overdose: 1. to administer an excessive dose. 2. an excessive dose. [EU] Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver, kidney, heart, and leafy vegetables. The richest natural source is yeast. It occurs in the free form only in the retina of the eye, in whey, and in urine; its principal forms in tissues and cells are as FMN and FAD. [NIH] Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight 78.96. It is an essential micronutrient for mammals and other animals but is toxic in large amounts. Selenium protects intracellular structures against oxidative damage. It is an essential component of
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glutathione peroxidase. [NIH] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH] Transdermal: Entering through the dermis, or skin, as in administration of a drug applied to the skin in ointment or patch form. [EU]
Finding Medical Libraries 249
APPENDIX D. FINDING MEDICAL LIBRARIES Overview At a medical library you can find medical texts and reference books, consumer health publications, specialty newspapers and magazines, as well as medical journals. In this Appendix, we show you how to quickly find a medical library in your area.
Preparation Before going to the library, highlight the references mentioned in this sourcebook that you find interesting. Focus on those items that are not available via the Internet, and ask the reference librarian for help with your search. He or she may know of additional resources that could be helpful to you. Most importantly, your local public library and medical libraries have Interlibrary Loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. NLM’s interlibrary loan services are only available to libraries. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.51
51
Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.
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Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.
Medical Libraries Open to the Public In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries that are generally open to the public and have reference facilities. The following is the NLM’s list plus hyperlinks to each library Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located):52 ·
Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/
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Alabama: Richard M. Scrushy Library (American Sports Medicine Institute), http://www.asmi.org/LIBRARY.HTM
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Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm
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California: Kris Kelly Health Information Center (St. Joseph Health System), http://www.humboldt1.com/~kkhic/index.html
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California: Community Health Library of Los Gatos (Community Health Library of Los Gatos), http://www.healthlib.org/orgresources.html
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California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html
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California: Gateway Health Library (Sutter Gould Medical Foundation)
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California: Health Library (Stanford University Medical Center), http://www-med.stanford.edu/healthlibrary/
52
Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.
Finding Medical Libraries 251
·
California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp
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California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html
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California: San José PlaneTree Health Library, http://planetreesanjose.org/
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California: Sutter Resource Library (Sutter Hospitals Foundation), http://go.sutterhealth.org/comm/resc-library/sac-resources.html
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California: University of California, Davis. Health Sciences Libraries
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California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System), http://www.valleycare.com/library.html
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California: Washington Community Health Resource Library (Washington Community Health Resource Library), http://www.healthlibrary.org/
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Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.exempla.org/conslib.htm
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Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/
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Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/
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Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital), http://www.waterburyhospital.com/library/consumer.shtml
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Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute), http://www.christianacare.org/health_guide/health_guide_pmri_health _info.cfm
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Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine), http://www.delamed.org/chls.html
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Georgia: Family Resource Library (Medical College of Georgia), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm
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Georgia: Health Resource Center (Medical Center of Central Georgia), http://www.mccg.org/hrc/hrchome.asp
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Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library), http://hml.org/CHIS/
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Idaho: DeArmond Consumer Health Library (Kootenai Medical Center), http://www.nicon.org/DeArmond/index.htm
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Illinois: Health Learning Center of Northwestern Memorial Hospital (Northwestern Memorial Hospital, Health Learning Center), http://www.nmh.org/health_info/hlc.html
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Illinois: Medical Library (OSF Saint Francis Medical Center), http://www.osfsaintfrancis.org/general/library/
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Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital), http://www.centralbap.com/education/community/library.htm
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Kentucky: University of Kentucky - Health Information Library (University of Kentucky, Chandler Medical Center, Health Information Library), http://www.mc.uky.edu/PatientEd/
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Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation), http://www.ochsner.org/library/
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Louisiana: Louisiana State University Health Sciences Center Medical Library-Shreveport, http://lib-sh.lsuhsc.edu/
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Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital), http://www.fchn.org/fmh/lib.htm
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Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center), http://www.cmmc.org/library/library.html
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Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare), http://www.emh.org/hll/hpl/guide.htm
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Maine: Maine Medical Center Library (Maine Medical Center), http://www.mmc.org/library/
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Maine: Parkview Hospital, http://www.parkviewhospital.org/communit.htm#Library
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Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center), http://www.smmc.org/services/service.php3?choice=10
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Maine: Stephens Memorial Hospital Health Information Library (Western Maine Health), http://www.wmhcc.com/hil_frame.html
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Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html
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Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre), http://www.deerlodge.mb.ca/library/libraryservices.shtml
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Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Md., Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp
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Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/
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Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://medlibwww.bu.edu/library/lib.html
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Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm
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Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital), http://www.nebh.org/health_lib.asp
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Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital), http://www.southcoast.org/library/
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Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html
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Massachusetts: UMass HealthNet (University of Massachusetts Medical School), http://healthnet.umassmed.edu/
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Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm
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Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/
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Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html
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Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center), http://www.cancer.med.umich.edu/learn/leares.htm
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Michigan: Sladen Library & Center for Health Information Resources Consumer Health Information, http://www.sladen.hfhs.org/library/consumer/index.html
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Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center), http://www.saintpatrick.org/chi/librarydetail.php3?ID=41
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National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html
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National: National Network of Libraries of Medicine (National Library of Medicine) - provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/
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National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/
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Nevada: Health Science Library, West Charleston Library (Las Vegas Clark County Library District), http://www.lvccld.org/special_collections/medical/index.htm
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New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/
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New Jersey: Consumer Health Library (Rahway Hospital), http://www.rahwayhospital.com/library.htm
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New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center), http://www.englewoodhospital.com/links/index.htm
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New Jersey: Meland Foundation (Englewood Hospital and Medical Center), http://www.geocities.com/ResearchTriangle/9360/
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New York: Choices in Health Information (New York Public Library) NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html
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New York: Health Information Center (Upstate Medical University, State University of New York), http://www.upstate.edu/library/hic/
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New York: Health Sciences Library (Long Island Jewish Medical Center), http://www.lij.edu/library/library.html
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New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/
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Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm
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Oklahoma: Saint Francis Health System Patient/Family Resource Center (Saint Francis Health System), http://www.sfhtulsa.com/patientfamilycenter/default.asp
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Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center), http://www.mcmc.net/phrc/
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Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center), http://www.hmc.psu.edu/commhealth/
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Pennsylvania: Community Health Resource Library (Geisinger Medical Center), http://www.geisinger.edu/education/commlib.shtml
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Pennsylvania: HealthInfo Library (Moses Taylor Hospital), http://www.mth.org/healthwellness.html
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Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System), http://www.hsls.pitt.edu/chi/hhrcinfo.html
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Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml
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Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System), http://www.shscares.org/services/lrc/index.asp
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Pennsylvania: Medical Library (UPMC Health System), http://www.upmc.edu/passavant/library.htm
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Quebec, Canada: Medical Library (Montreal General Hospital), http://ww2.mcgill.ca/mghlib/
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South Dakota: Rapid City Regional Hospital - Health Information Center (Rapid City Regional Hospital, Health Information Center), http://www.rcrh.org/education/LibraryResourcesConsumers.htm
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Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/
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Texas: Matustik Family Resource Center (Cook Children’s Health Care System), http://www.cookchildrens.com/Matustik_Library.html
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Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/
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Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center), http://www.swmedctr.com/Home/
NIH Consensus Statement on Impotence 257
APPENDIX E. IMPOTENCE
NIH
CONSENSUS
STATEMENT
ON
Overview NIH Consensus Development Conferences are convened to evaluate available scientific information and resolve safety and efficacy issues related to biomedical technology. The resultant NIH Consensus Statements are intended to advance understanding of the technology or issue in question and to be useful to health professionals and the public.53 Each NIH consensus statement is the product of an independent, non-Federal panel of experts and is based on the panel’s assessment of medical knowledge available at the time the statement was written. Therefore, a consensus statement provides a “snapshot in time” of the state of knowledge of the conference topic. The NIH makes the following caveat: “When reading or downloading NIH consensus statements, keep in mind that new knowledge is inevitably accumulating through medical research. Nevertheless, each NIH consensus statement is retained on this website in its original form as a record of the NIH Consensus Development Program.”54 The following concensus statement was posted on the NIH site and not indicated as “out of date” in March 2002. It was originally published, however, in December, 1992.55
53 This paragraph is adapted from the NIH: http://odp.od.nih.gov/consensus/cons/cons.htm. 54 Adapted from the NIH: http://odp.od.nih.gov/consensus/cons/consdate.htm. 55 Impotence. NIH Consens Statement Online 1992 Dec 7-9 [cited 2002 February 20];10(4):131. http://consensus.nih.gov/cons/091/091_statement.htm.
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Abstract The National Institutes of Health Consensus Development Conference on Impotence was convened to address (1) the prevalence and clinical, psychological, and social impact of erectile dysfunction; (2) the risk factors for erectile dysfunction and how they might be used in preventing its development; (3) the need for and appropriate diagnostic assessment and evaluation of patients with erectile dysfunction; (4) the efficacies and risks of behavioral, pharmacological, surgical, and other treatments for erectile dysfunction; (5) strategies for improving public and professional awareness and knowledge of erectile dysfunction; and (6) future directions for research in prevention, diagnosis, and management of erectile dysfunction. Following 2 days of presentations by experts and discussion by the audience, a consensus panel weighed the evidence and prepared their consensus statement. Among their findings, the panel concluded that (1) the term “erectile dysfunction” should replace the term “impotence”; (2) the likelihood of erectile dysfunction increases with age but is not an inevitable consequence of aging; (3) embarrassment of patients and reluctance of both patients and health care providers to discuss sexual matters candidly contribute to underdiagnosis of erectile dysfunction; (4) many cases of erectile dysfunction can be successfully managed with appropriately selected therapy; (5) the diagnosis and treatment of erectile dysfunction must be specific and responsive to the individual patient’s needs and that compliance as well as the desires and expectations of both the patient and partner are important considerations in selecting appropriate therapy; (6) education of health care providers and the public on aspects of human sexuality, sexual dysfunction, and the availability of successful treatments is essential; and (7) erectile dysfunction is an important public health problem deserving of increased support for basic science investigation and applied research. The full text of the consensus panel’s statement follows.
What Is Impotence? The term “impotence,” as applied to the title of this conference, has traditionally been used to signify the inability of the male to attain and maintain erection of the penis sufficient to permit satisfactory sexual intercourse. However, this use has often led to confusing and uninterpretable results in both clinical and basic science investigations. This,
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together with its pejorative implications, suggests that the more precise term “erectile dysfunction” be used instead to signify an inability of the male to achieve an erect penis as part of the overall multifaceted process of male sexual function. This process comprises a variety of physical aspects with important psychological and behavioral overtones. In analyzing the material presented and discussed at this conference, this consensus statement addresses issues of male erectile dysfunction, as implied by the term “impotence.” However, it should be recognized that desire, orgasmic capability, and ejaculatory capacity may be intact even in the presence of erectile dysfunction or may be deficient to some extent and contribute to the sense of inadequate sexual function. Erectile dysfunction affects millions of men. Although for some men erectile function may not be the best or most important measure of sexual satisfaction, for many men erectile dysfunction creates mental stress that affects their interactions with family and associates. Many advances have occurred in both diagnosis and treatment of erectile dysfunction. However, its various aspects remain poorly understood by the general population and by most health care professionals. Lack of a simple definition, failure to delineate precisely the problem being assessed, and the absence of guidelines and parameters to determine assessment and treatment outcome and long-term results, have contributed to this state of affairs by producing misunderstanding, confusion, and ongoing concern. That results have not been communicated effectively to the public has compounded this situation. Cause-specific assessment and treatment of male sexual dysfunction will require recognition by the public and the medical community that erectile dysfunction is a part of overall male sexual dysfunction. The multifactorial nature of erectile dysfunction, comprising both organic and psychologic aspects, may often require a multidisciplinary approach to its assessment and treatment. This consensus report addresses these issues, not only as isolated health problems but also in the context of societal and individual perceptions and expectations. Erectile dysfunction is often assumed to be a natural concomitant of the aging process, to be tolerated along with other conditions associated with aging. This assumption may not be entirely correct. For the elderly and for others, erectile dysfunction may occur as a consequence of specific illnesses or of medical treatment for certain illnesses, resulting in fear, loss of image and self-confidence, and depression.
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For example, many men with diabetes mellitus may develop erectile dysfunction during their young and middle adult years. Physicians, diabetes educators, and patients and their families are sometimes unaware of this potential complication. Whatever the causal factors, discomfort of patients and health care providers in discussing sexual issues becomes a barrier to pursuing treatment. Erectile dysfunction can be effectively treated with a variety of methods. Many patients and health care providers are unaware of these treatments, and the dysfunction thus often remains untreated, compounded by its psychological impact. Concurrent with the increase in the availability of effective treatment methods has been increased availability of new diagnostic procedures that may help in the selection of an effective, causespecific treatment. This conference was designed to explore these issues and to define the state of the art. To examine what is known about the demographics, etiology, risk factors, pathophysiology, diagnostic assessment, treatments (both generic and causespecific), and the understanding of their consequences by the public and the medical community, the National Institute of Diabetes and Digestive and Kidney Diseases and the Office of Medical Applications of Research of the National Institutes of Health, in conjunction with the National Institute of Neurological Disorders and Stroke and the National Institute on Aging, convened a consensus development conference on male impotence on December 7-9, 1992. After 1 1/2 days of presentations by experts in the relevant fields involved with male sexual dysfunction and erectile impotence or dysfunction, a consensus panel comprised of representatives from urology, geriatrics, medicine, endocrinology, psychiatry, psychology, nursing, epidemiology, biostatistics, basic sciences, and the public considered the evidence and developed answers to the questions that follow.
Prevalence and Association with Age Estimates of the prevalence of impotence depend on the definition employed for this condition. For the purposes of this consensus development conference statement, impotence is defined as male erectile dysfunction, that is, the inability to achieve or maintain an erection sufficient for satisfactory sexual performance. Erectile performance has been characterized by the degree of dysfunction, and estimates of prevalence (the number of men with the condition) vary depending on the definition of erectile dysfunction used.
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Appallingly little is known about the prevalence of erectile dysfunction in the United States and how this prevalence varies according to individual characteristics (age, race, ethnicity, socioeconomic status, and concomitant diseases and conditions). Data on erectile dysfunction available from the 1940’s applied to the present U.S. male population produce an estimate of erectile dysfunction prevalence of 7 million. More recent estimates suggest that the number of U.S. men with erectile dysfunction may more likely be near 10-20 million. Inclusion of individuals with partial erectile dysfunction increases the estimate to about 30 million. The majority of these individuals will be older than 65 years of age. The prevalence of erectile dysfunction has been found to be associated with age. A prevalence of about 5 percent is observed at age 40, increasing to 15-25 percent at age 65 and older. One-third of older men receiving medical care at a Department of Veterans’ Affairs ambulatory clinic admitted to problems with erectile function. Causes contributing to erectile dysfunction can be broadly classified into two categories: organic and psychologic. In reality, while the majority of patients with erectile dysfunction are thought to demonstrate an organic component, psychological aspects of self-confidence, anxiety, and partner communication and conflict are often important contributing factors. The 1985 National Ambulatory Medical Care Survey indicated that there were about 525,000 visits for erectile dysfunction, accounting for 0.2 percent of all male ambulatory care visits. Estimates of visits per 1,000 population increased from about 1.5 for the age group 25-34 to 15.0 for those age 65 and above. The 1985 National Hospital Discharge Survey estimated that more than 30,000 hospital admissions were for erectile dysfunction.
Clinical, Psychological, and Social Impact Very little is known about variations in prevalence of erectile dysfunction across geographic, racial, ethnic, socioeconomic, and cultural groups. Anecdotal evidence points to the existence of racial, ethnic, and other cultural diversity in the perceptions and expectation levels for satisfactory sexual functioning. These differences would be expected to be reflected in these groups’ reaction to erectile dysfunction, although few data on this issue appear to exist. One report from a recent community survey concluded that erectile failure was the leading complaint of males attending sex therapy clinics. Other
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studies have shown that erectile disorders are the primary concern of sex therapy patients in treatment. This is consistent with the view that erectile dysfunction may be associated with depression, loss of self-esteem, poor selfimage, increased anxiety or tension with one’s sexual partner, and/or fear and anxiety associated with contracting sexually transmitted diseases, including AIDS. Male/Female Perceptions and Influences The diagnosis of erectile dysfunction may be understood as the presence of a condition limiting choices for sexual interaction and possibly limiting opportunity for sexual satisfaction. The impact of this condition depends very much on the dynamics of the relationship of the individual and his sexual partner and their expectation of performance. When changes in sexual function are perceived by the individual and his partner as a natural consequence of the aging process, they may modify their sexual behavior to accommodate the condition and maintain sexual satisfaction. Increasingly, men do not perceive erectile dysfunction as a normal part of aging and seek to identify means by which they may return to their previous level and range of sexual activities. Such levels and expectations and desires for future sexual interactions are important aspects of the evaluation of patients presenting with a chief complaint of erectile dysfunction. In men of all ages, erectile failure may diminish willingness to initiate sexual relationships because of fear of inadequate sexual performance or rejection. Because males, especially older males, are particularly sensitive to the social support of intimate relationships, withdrawal from these relationships because of such fears may have a negative effect on their overall health.
Physiology of Erection The male erectile response is a vascular event initiated by neuronal action and maintained by a complex interplay between vascular and neurological events. In its most common form, it is initiated by a central nervous system event that integrates psychogenic stimuli (perception, desire, etc.) and controls the sympathetic and parasympathetic innervation of the penis. Sensory stimuli from the penis are important in continuing this process and in initiating a reflex arc that may cause erection under proper circumstances and may help to maintain erection during sexual activity. Parasympathetic input allows erection by relaxation of trabecular smooth muscle and dilation of the helicine arteries of the penis. This leads to
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expansion of the lacunar spaces and entrapment of blood by compressing venules against the tunica albuginea, a process referred to as the corporal veno-occlusive mechanism. The tunica albuginea must have sufficient stiffness to compress the venules penetrating it so that venous outflow is blocked and sufficient tumescence and rigidity can occur. Acetylcholine released by the parasympathetic nerves is thought to act primarily on endothelial cells to release a second nonadrenergicnoncholinergic carrier of the signal that relaxes the trabecular smooth muscle. Nitric oxide released by the endothelial cells, and possibly also of neural origin, is currently thought to be the leading of several candidates as this nonadrenergic-noncholinergic transmitter; but this has not yet been conclusively demonstrated to the exclusion of other potentially important substances (e.g., vasoactive intestinal polypeptide). The relaxing effect of nitric oxide on the trabecular smooth muscle may be mediated through its stimulation of guanylate cyclase and the production of cyclic guanosine monophosphate (cGMP), which would then function as a second messenger in this system. Constriction of the trabecular smooth muscle and helicine arteries induced by sympathetic innervation makes the penis flaccid, with blood pressure in the cavernosal sinuses of the penis near venous pressure. Acetylcholine is thought to decrease sympathetic tone. This may be important in a permissive sense for adequate trabecular smooth muscle relaxation and consequent effective action of other mediators in achieving sufficient inflow of blood into the lacunar spaces. When the trabecular smooth muscle relaxes and helicine arteries dilate in response to parasympathetic stimulation and decreased sympathetic tone, increased blood flow fills the cavernous spaces, increasing the pressure within these spaces so that the penis becomes erect. As the venules are compressed against the tunica albuginea, penile pressure approaches arterial pressure, causing rigidity. Once this state is achieved, arterial inflow is reduced to a level that matches venous outflow.
Erectile Dysfunction Because adequate arterial supply is critical for erection, any disorder that impairs blood flow may be implicated in the etiology of erectile failure. Most of the medical disorders associated with erectile dysfunction appear to affect the arterial system. Some disorders may interfere with the corporal venoocclusive mechanism and result in failure to trap blood within the penis, or produce leakage such that an erection cannot be maintained or is easily lost.
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Damage to the autonomic pathways innervating the penis may eliminate “psychogenic” erection initiated by the central nervous system. Lesions of the somatic nervous pathways may impair reflexogenic erections and may interrupt tactile sensation needed to maintain psychogenic erections. Spinal cord lesions may produce varying degrees of erectile failure depending on the location and completeness of the lesions. Not only do traumatic lesions affect erectile ability, but disorders leading to peripheral neuropathy may impair neuronal innervation of the penis or of the sensory afferents. The endocrine system itself, particularly the production of androgens, appears to play a role in regulating sexual interest, and may also play a role in erectile function. Psychological processes such as depression, anxiety, and relationship problems can impair erectile functioning by reducing erotic focus or otherwise reducing awareness of sensory experience. This may lead to inability to initiate or maintain an erection. Etiologic factors for erectile disorders may be categorized as neurogenic, vasculogenic, or psychogenic, but they most commonly appear to derive from problems in all three areas acting in concert.
Risk Factors Little is known about the natural history of erectile dysfunction. This includes information on the age of onset, incidence rates stratified by age, progression of the condition, and frequency of spontaneous recovery. There also are very limited data on associated morbidity and functional impairment. To date, the data are predominantly available for whites, with other racial and ethnic populations represented only in smaller numbers that do not permit analysis of these issues as a function of race or ethnicity. Erectile dysfunction is clearly a symptom of many conditions, and certain risk factors have been identified, some of which may be amenable to prevention strategies. Diabetes mellitus, hypogonadism in association with a number of endocrinologic conditions, hypertension, vascular disease, high levels of blood cholesterol, low levels of high density lipoprotein, drugs, neurogenic disorders, Peyronie’s disease, priapism, depression, alcohol ingestion, lack of sexual knowledge, poor sexual techniques, inadequate interpersonal relationships or their deterioration, and many chronic diseases, especially renal failure and dialysis, have been demonstrated as risk factors. Vascular surgery is also often a risk factor. Age appears to be a strong indirect risk factor in that it is associated with an increased likelihood of direct risk factors. Other factors require more extensive study. Smoking has
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an adverse effect on erectile function by accentuating the effects of other risk factors such as vascular disease or hypertension. To date, vasectomy has not been associated with an increased risk of erectile dysfunction other than causing an occasional psychological reaction that could then have a psychogenic influence. Accurate risk factor identification and characterization are essential for concerted efforts at prevention of erectile dysfunction. Prevention Although erectile dysfunction increases progressively with age, it is not an inevitable consequence of aging. Knowledge of the risk factors can guide prevention strategies. Specific antihypertensive, antidepressant, and antipsychotic drugs can be chosen to lessen the risk of erectile failure. Published lists of prescription drugs that may impair erectile functioning often are based on reports implicating a drug without systematic study. Such studies are needed to confirm the validity of these suggested associations. In the individual patient, the physician can modify the regimen in an effort to resolve the erectile problem. It is important that physicians and other health care providers treating patients for chronic conditions periodically inquire into the sexual functioning of their patients and be prepared to offer counsel for those who experience erectile difficulties. Lack of sexual knowledge and anxiety about sexual performance are common contributing factors to erectile dysfunction. Education and reassurance may be helpful in preventing the cascade into serious erectile failure in individuals who experience minor erectile difficulty due to medications or common changes in erectile functioning associated with chronic illnesses or with aging.
Evaluation and Diagnosis The appropriate evaluation of all men with erectile dysfunction should include a medical and detailed sexual history (including practices and techniques), a physical examination, a psycho-social evaluation, and basic laboratory studies. When available, a multidisciplinary approach to this evaluation may be desirable. In selected patients, further physiologic or invasive studies may be indicated. A sensitive sexual history, including expectations and motivations, should be obtained from the patient (and sexual partner whenever possible) in an interview conducted by an interested physician or another specially trained professional. A written
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patient questionnaire may be helpful but is not a substitute for the interview. The sexual history is needed to accurately define the patient’s specific complaint and to distinguish between true erectile dysfunction, changes in sexual desire, and orgasmic or ejaculatory disturbances. The patient should be asked specifically about perceptions of his erectile dysfunction, including the nature of onset, frequency, quality, and duration of erections; the presence of nocturnal or morning erections; and his ability to achieve sexual satisfaction. Psychosocial factors related to erectile dysfunction should be probed, including specific situational circumstances, performance anxiety, the nature of sexual relationships, details of current sexual techniques, expectations, motivation for treatment, and the presence of specific discord in the patient’s relationship with his sexual partner. The sexual partner’s own expectations and perceptions should also be sought since they may have important bearing on diagnosis and treatment recommendations.
Medical History The general medical history is important in identifying specific risk factors that may account for or contribute to the patient’s erectile dysfunction. These include vascular risk factors such as hypertension, diabetes, smoking, coronary artery disease, peripheral vascular disorders, pelvic trauma or surgery, and blood lipid abnormalities. Decreased sexual desire or history suggesting a hypogonadal state could indicate a primary endocrine disorder. Neurologic causes may include a history of diabetes mellitus or alcoholism with associated peripheral neuropathy. Neurologic disorders such as multiple sclerosis, spinal injury, or cerebrovascular accidents are often obvious or well defined prior to presentation. It is essential to obtain a detailed medication and illicit drug history since an estimated 25 percent of cases of erectile dysfunction may be attributable to medications for other conditions. Past medical history can reveal important causes of erectile dysfunction, including radical pelvic surgery, radiation therapy, Peyronie’s disease, penile or pelvic trauma, prostatitis, priapism, or voiding dysfunction. Information regarding prior evaluation or treatment for “impotence” should be obtained. A detailed sexual history, including current sexual techniques, is important in the general history obtained. It is also important to determine if there have been previous psychiatric illnesses such as depression or neuroses.
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Physical Examination Physical examination should include the assessment of male secondary sex characteristics, femoral and lower extremity pulses, and a focused neurologic examination including perianal sensation, anal sphincter tone, and bulbocavernosus reflex. More extensive neurologic tests, including dorsal nerve conduction latencies, evoked potential measurements, and corpora cavernosal electromyography lack normative (control) data and appear at this time to be of limited clinical value. Examination of the genitalia includes evaluation of testis size and consistency, palpation of the shaft of the penis to determine the presence of Peyronie’s plaques, and a digital rectal examination of the prostate with assessment of anal sphincter tone.
Laboratory Testing Endocrine evaluation consisting of a morning serum testosterone is generally indicated. Measurement of serum prolactin may be indicated. A low testosterone level merits repeat measurement together with assessment of luteinizing hormone (LH), follicle-stimulating hormone (FSH), and prolactin levels. Other tests may be helpful in excluding unrecognized systemic disease and include a complete blood count, urinalysis, creatinine, lipid profile, fasting blood sugar, and thyroid function studies. Although not indicated for routine use, nocturnal penile tumescence (NPT) testing may be useful in the patient who reports a complete absence of erections (exclusive of nocturnal “sleep” erections) or when a primary psychogenic etiology is suspected. Such testing should be performed by those with expertise and knowledge of its interpretation, pitfalls, and usefulness. Various methods and devices are available for the evaluation of nocturnal penile tumescence, but their clinical usefulness is restricted by limitations of diagnostic accuracy and availability of normative data. Further study regarding standardization of NPT testing and its general applicability is indicated. Diagnosis After the history, physical examination, and laboratory testing, a clinical impression can be obtained of a primarily psychogenic, organic, or mixed etiology for erectile dysfunction. Patients with primary or associated psychogenic factors may be offered further psychologic evaluation, and patients with endocrine abnormalities may be referred to an endocrinologist to evaluate the possibility of a pituitary lesion or hypogonadism. Unless
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previously diagnosed, suspicion of neurologic deficit may be further assessed by complete neurologic evaluation. No further diagnostic tests appear necessary for those patients who favor noninvasive treatment (e.g., vacuum constrictive devices, or pharmacologic injection therapy). Patients who do not respond satisfactorily to these noninvasive treatments may be candidates for penile implant surgery or further diagnostic testing for possible additional invasive therapies. A rigid or nearly rigid erectile response to intracavernous injection of pharmacologic test doses of a vasodilating agent (see below) indicates adequate arterial and veno-occlusive function. This suggests that the patient may be a suitable candidate for a trial of penile injection therapy. Genital stimulation may be of use in increasing the erectile response in this setting. This diagnostic technique also may be used to differentiate a vascular from a primarily neuropathic or psychogenic etiology. Patients who have an inadequate response to intracavernous pharmacologic injection may be candidates for further vascular testing. It should be recognized, however, that failure to respond adequately may not indicate vascular insufficiency but can be caused by patient anxiety or discomfort. The number of patients who may benefit from more extensive vascular testing is small, but includes young men with a history of significant perineal or pelvic trauma, who may have anatomic arterial blockage (either alone or with neurologic deficit) to account for erectile dysfunction. Studies to further define vasculogenic disorders include pharmacologic duplex grey scale/color ultrasonography, pharmacologic dynamic infusion cavernosometry/ cavernosography, and pharmacologic pelvic/penile angiography. Cavernosometry, duplex ultrasonography, and angiography performed either alone or in conjunction with intracavernous pharmacologic injection of vasodilator agents rely on complete arterial and cavernosal smooth muscle relaxation to evaluate arterial and veno-occlusive function. The clinical effectiveness of these invasive studies is severely limited by several factors, including the lack of normative data, operator dependence, variable interpretation of results, and poor predictability of therapeutic outcomes of arterial and venous surgery. At the present time these studies might best be done in referral centers with specific expertise and interest in investigation of the vascular aspects of erectile dysfunction. Further clinical research is necessary to standardize methodology and interpretation, to obtain control data on normals (as stratified according to age), and to define what constitutes normality in order to assess the value of these tests in their diagnostic accuracy and in their ability to predict treatment outcome in men with erectile dysfunction.
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Treatment Considerations Because of the difficulty in defining the clinical entity of erectile dysfunction, there have been a variety of entry criteria for patients in therapeutic trials. Similarly, the ability to assess efficacy of therapeutic interventions is impaired by the lack of clear and quantifiable criteria of erectile dysfunction. General considerations for treatment follow: ·
Psychotherapy and/or behavioral therapy may be useful for some patients with erectile dysfunction without obvious organic cause, and for their partners. These may also be used as an adjunct to other therapies directed at the treatment of organic erectile dysfunction. Outcome data from such therapy, however, have not been well-documented or quantified, and additional studies along these lines are indicated.
·
Efficacy of therapy may be best achieved by inclusion of both partners in treatment plans.
·
Treatment should be individualized to the patient’s desires and expectations.
·
Even though there are several effective treatments currently available, long-term efficacy is in general relatively low. Moreover, there is a high rate of voluntary cessation of treatment for all currently popular forms of therapy for erectile dysfunction. Better understanding of the reasons for each of these phenomena is needed.
Psychotherapy and Behavioral Therapy Psychosocial factors are important in all forms of erectile dysfunction. Careful attention to these issues and attempts to relieve sexual anxieties should be a part of the therapeutic intervention for all patients with erectile dysfunction. Psychotherapy and/or behavioral therapy alone may be helpful for some patients in whom no organic cause of erectile dysfunction is detected. Patients who refuse medical and surgical interventions also may be helped by such counseling. After appropriate evaluation to detect and treat coexistent problems such as issues related to the loss of a partner, dysfunctional relationships, psychotic disorders, or alcohol and drug abuse, psychological treatment focuses on decreasing performance anxiety and distractions and on increasing a couple’s intimacy and ability to communicate about sex. Education concerning the factors that create normal sexual response and erectile dysfunction can help a couple cope with sexual difficulties. Working with the sexual partner is useful in improving the outcome of therapy. Psychotherapy and behavioral therapy have been
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reported to relieve depression and anxiety as well as to improve sexual function. However, outcome data of psychological and behavioral therapy have not been quantified, and evaluation of the success of specific techniques used in these treatments is poorly documented. Studies to validate their efficacy are therefore strongly indicated.
Medical Therapy An initial approach to medical therapy should consider reversible medical problems that may contribute to erectile dysfunction. Included in this should be assessment of the possibility of medication-induced erectile dysfunction with consideration for reduction of polypharmacy and/or substitution of medications with lower probability of inducing erectile dysfunction. For some patients with an established diagnosis of testicular failure (hypogonadism), androgen replacement therapy may sometimes be effective in improving erectile function. A trial of androgen replacement may be worthwhile in men with low serum testosterone levels if there are no other contraindications. In contrast, for men who have normal testosterone levels, androgen therapy is inappropriate and may carry significant health risks, especially in the situation of unrecognized prostate cancer. If androgen therapy is indicated, it should be given in the form of intramuscular injections of testosterone enanthate or cypionate. Oral androgens, as currently available, are not indicated. For men with hyperprolactinemia, bromocriptine therapy often is effective in normalizing the prolactin level and improving sexual function. A wide variety of other substances taken either orally or topically have been suggested to be effective in treating erectile dysfunction. Most of these have not been subjected to rigorous clinical studies and are not approved for this use by the Food and Drug Administration (FDA). Their use should therefore be discouraged until further evidence in support of their efficacy and indicative of their safety is available.
Drug Therapy Drugs for treating impotence can be taken orally or injected directly into the penis or inserted into the urethra at the tip of the penis. Oral testosterone can reduce impotence in some men with low levels of natural testosterone. Patients also have claimed effectiveness of other oral drugs--including yohimbine hydrochloride, dopamine and serotonin agonists, and trazodone-but no scientific studies have proved the effectiveness of these drugs in
NIH Consensus Statement on Impotence 271
relieving impotence. Some observed improvements following their use may be examples of the placebo effect, that is, a change that results simply from the patient’s believing that an improvement will occur. Many men gain potency by injecting drugs into the penis, causing it to become engorged with blood. Drugs such as papaverine hydrochloride, phentolamine, and alprostadil (marked as Caverject) widen blood vessels. These drugs may create unwanted side effects, however, including persistent erection (known as priapism) and scarring. Nitroglycerin, a muscle relaxant, sometimes can enhance erection when rubbed on the surface of the penis. A system for inserting a pellet of alprostadil into the urethra is marketed as MUSE. The system uses a pre-filled applicator to deliver the pellet about an inch deep into the urethra at the tip of the penis. An erection will begin within 8 to 10 minutes and may last 30 to 60 minutes. The most common side effects of the preparation are aching in the penis, testicles, and area between the penis and rectum; warmth or burning sensation in the urethra; redness of the penis due to increased blood flow; and minor urethral bleeding or spotting.
Intracavernosal Injection Therapy Injection of vasodilator substances into the corpora of the penis has provided a new therapeutic technique for a variety of causes of erectile dysfunction. The most effective and well-studied agents are papaverine, phentolamine, and prostaglandin E[sub 1]. These have been used either singly or in combination. Use of these agents occasionally causes priapism (inappropriately persistent erections). This appears to have been seen most commonly with papaverine. Priapism is treated with adrenergic agents, which can cause life-threatening hypertension in patients receiving monoamine oxidase inhibitors. Use of the penile vasodilators also can be problematic in patients who cannot tolerate transient hypotension, those with severe psychiatric disease, those with poor manual dexterity, those with poor vision, and those receiving anticoagulant therapy. Liver function tests should be obtained in those being treated with papaverine alone. Prostaglandin E[sub 1] can be used together with papaverine and phentolamine to decrease the incidence of side effects such as pain, penile corporal fibrosis, fibrotic nodules, hypotension, and priapism. Further study of the efficacy of multitherapy versus monotherapy and of the relative complications and safety of each approach is indicated. Although these agents have not received FDA approval for this indication, they are in widespread clinical use. Patients treated with these agents should give full
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informed consent. There is a high rate of patient dropout, often early in the treatment. Whether this is related to side effects, lack of spontaneity in sexual relations, or general loss of interest is unclear. Patient education and followup support might improve compliance and lessen the dropout rate. However, the reasons for the high dropout rate need to be determined and quantified.
Vacuum/Constrictive Devices Vacuum constriction devices may be effective at generating and maintaining erections in many patients with erectile dysfunction and these appear to have a low incidence of side effects. As with intracavernosal injection therapy, there is a significant rate of patient dropout with these devices, and the reasons for this phenomenon are unclear. The devices are difficult for some patients to use, and this is especially so in those with impaired manual dexterity. Also, these devices may impair ejaculation, which can then cause some discomfort. Patients and their partners sometimes are bothered by the lack of spontaneity in sexual relations that may occur with this procedure. The patient is sometimes also bothered by the general discomfort that can occur while using these devices. Partner involvement in training with these devices may be important for successful outcome, especially in regard to establishing a mutually satisfying level of sexual activity.
Vascular Surgery Surgery of the penile venous system, generally involving venous ligation, has been reported to be effective in patients who have been demonstrated to have venous leakage. However, the tests necessary to establish this diagnosis have been incompletely validated; therefore, it is difficult to select patients who will have a predictably good outcome. Moreover, decreased effectiveness of this approach has been reported as longer term follow-ups have been obtained. This has tempered enthusiasm for these procedures, which are probably therefore best done in an investigational setting in medical centers by surgeons experienced in these procedures and their evaluation. Arterial revascularization procedures have a very limited role (e.g., in congenital or traumatic vascular abnormality) and probably should be restricted to the clinical investigation setting in medical centers with experienced personnel. All patients who are considered for vascular surgical therapy need to have appropriate preoperative evaluation, which may
NIH Consensus Statement on Impotence 273
include dynamic infusion pharmaco-cavernosometry and cavernosography (DICC), duplex ultrasonography, and possibly arteriography. The indications for and interpretations of these diagnostic procedures are incompletely standardized; therefore, difficulties persist with using these techniques to predict and assess the success of surgical therapy, and further investigation to clarify their value and role in this regard is indicated.
Penile Prostheses Three forms of penile prostheses are available for patients who fail with or refuse other forms of therapy: semirigid, malleable, and inflatable. The effectiveness, complications, and acceptability vary among the three types of prostheses, with the main problems being mechanical failure, infection, and erosions. Silicone particle shedding has been reported, including migration to regional lymph nodes; however, no clinically identifiable problems have been reported as a result of the silicone particles. There is a risk of the need for reoperation with all devices. Although the inflatable prostheses may yield a more physiologically natural appearance, they have had a higher rate of failure requiring reoperation. Men with diabetes mellitus, spinal cord injuries, or urinary tract infections have an increased risk of prosthesisassociated infection. This form of treatment may not be appropriate in patients with severe penile corporal fibrosis, or severe medical illness. Circumcision may be required for patients with phimosis and balanitis.
Staging of Treatment The patient and partner must be well informed about all therapeutic options including their effectiveness, possible complications, and costs. As a general rule, the least invasive or dangerous procedures should be tried first. Psychotherapy and behavioral treatments and sexual counseling alone or in conjunction with other treatments may be used in all patients with erectile dysfunction who are willing to use this form of treatment. In patients in whom psychogenic erectile dysfunction is suspected, sexual counseling should be offered first. Invasive therapy should not be the primary treatment of choice. If history, physical, and screening endocrine evaluations are normal and nonpsychogenic erectile dysfunction is suspected, either vacuum devices or intracavernosal injection therapy can be offered after discussion with the patient and his partner. These latter two therapies may also be useful when combined with psychotherapy in those with psychogenic erectile dysfunction in whom psychotherapy alone has failed. Since further diagnostic testing does not reliably establish specific diagnoses or predict
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outcomes of therapy, vacuum devices or intracavernosal injections often are applied to a broad spectrum of etiologies of male erectile dysfunction. The motivation and expectations of the patient and his partner and education of both are critical in determining which therapy is chosen and in optimizing its outcome. If single therapy is ineffective, combining two or more forms of therapy may be useful. Penile prostheses should be placed only after patients have been carefully screened and informed. Vascular surgery should be undertaken only in the setting of clinical investigation and extensive clinical experience. With any form of therapy for erectile dysfunction, long-term followup by health professionals is required to assist the patient and his partner with adjustment to the therapeutic intervention. This is particularly true for intracavernosal injection and vacuum constriction therapies. Followup should include continued patient education and support in therapy, careful determination of reasons for cessation of therapy if this occurs, and provision of other options if earlier therapies are unsuccessful.
Improving Impotence
Public
and
Professional
Knowledge
about
Despite the accumulation of a substantial body of scientific information about erectile dysfunction, large segments of the public -- as well as the health professions -- remain relatively uninformed, or -- even worse -misinformed, about much of what is known. This lack of information, added to a pervasive reluctance of physicians to deal candidly with sexual matters, has resulted in patients being denied the benefits of treatment for their sexual concerns. Although they might wish doctors would ask them questions about their sexual lives, patients, for their part, are too often inhibited from initiating such discussions themselves. Improving both public and professional knowledge about erectile dysfunction will serve to remove those barriers and will foster more open communication and more effective treatment of this condition.
Strategies for Improving Public Knowledge To a significant degree, the public, particularly older men, is conditioned to accept erectile dysfunction as a condition of progressive aging for which little can be done. In addition, there is considerable inaccurate public information regarding sexual function and dysfunction. Often, this is in the
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form of advertisements in which enticing promises are made, and patients then become even more demoralized when promised benefits fail to materialize. Accurate information on sexual function and the management of dysfunction must be provided to affected men and their partners. They also must be encouraged to seek professional help, and providers must be aware of the embarrassment and/or discouragement that may often be reasons why men with erectile dysfunction avoid seeking appropriate treatment. To reach the largest audience, communications strategies should include informative and accurate newspaper and magazine articles, radio and television programs, as well as special educational programs in senior centers. Resources for accurate information regarding diagnosis and treatment options also should include doctors’ offices, unions, fraternal and service groups, voluntary health organizations, State and local health departments, and appropriate advocacy groups. Additionally, since sex education courses in schools uniformly address erectile function, the concept of erectile dysfunction can easily be communicated in these forums as well.
Strategies for Improving Professional Knowledge ·
Provide wide distribution of this statement to physicians and other health professionals whose work involves patient contact.
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Define a balance between what specific information is needed by the medical and general public and what is available, and identify what treatments are available.
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Promote the introduction of courses in human sexuality into the curricula of graduate schools for all health care professionals. Because sexual wellbeing is an integral part of general health, emphasis should be placed on the importance of obtaining a detailed sexual history as part of every medical history.
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Encourage the inclusion of sessions on diagnosis and management of erectile dysfunction in continuing medical education courses.
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Emphasize the desirability for an interdisciplinary approach to the diagnosis and treatment of erectile dysfunction. An integrated medical and psychosocial effort with continuing contact with the patient and partner may enhance their motivation and compliance with treatment during the period of sexual rehabilitation.
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Encourage the inclusion of presentations on erectile dysfunction at scientific meetings of appropriate medical specialty associations, State
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and local medical societies, and similar organizations of other health professions. ·
Distribute scientific information on erectile dysfunction to the news media (print, radio, and television) to support their efforts to disseminate accurate information on this subject and to counteract misleading news reports and false advertising claims.
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Promote public service announcements, lectures, and panel discussions on both commercial and public radio and television on the subject of erectile dysfunction.
Directions for Future Research This consensus development conference on male erectile dysfunction has provided an overview of current knowledge on the prevalence, etiology, pathophysiology, diagnosis, and management of this condition. The growing individual and societal awareness and open acknowledgment of the problem have led to increased interest and resultant explosion of knowledge in each of these areas. Research on this condition has produced many controversies, which also were expressed at this conference. Numerous questions were identified that may serve as foci for future research directions. These will depend on the development of precise agreement among investigators and clinicians in this field on the definition of what constitutes erectile dysfunction, and what factors in its multifaceted nature contribute to its expression. In addition, further investigation of these issues will require collaborative efforts of basic science investigators and clinicians from the spectrum of relevant disciplines and the rigorous application of appropriate research principles in designing studies to obtain further knowledge and to promote understanding of the various aspects of this condition. The needs and directions for future research can be considered as follows: ·
Development of a symptom score sheet to aid in the standardization of patient assessment and treatment outcome.
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Development of a staging system that may permit quantitative and qualitative classification of erectile dysfunction.
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Studies on perceptions and expectations associated with racial, cultural, ethnic, and societal influences on what constitutes normal male erectile function and how these same factors may be responsible for the development and/or perception of male erectile dysfunction.
NIH Consensus Statement on Impotence 277
·
Studies to define and characterize what is normal erectile function, possibly as stratified by age.
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Additional basic research on the physiological and biochemical mechanisms that may underlie the etiology, pathogenesis, and response to treatment of the various forms of erectile dysfunction.
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Epidemiological studies directed at the prevalence of male erectile dysfunction and its medical and psychological correlates, particularly in the context of possible racial, ethnic, socioeconomic, and cultural variability.
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Additional studies of the mechanisms by which risk factors may produce erectile dysfunction.
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Studies of strategies to prevent male erectile dysfunction.
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Randomized clinical trials assessing the effectiveness of specific behavioral, mechanical, pharmacologic, and surgical treatments, either alone or in combination.
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Studies on the specific effects of hormones (especially androgens) on male sexual function; determination of the frequency of endocrine causes of erectile dysfunction (e.g., hypogonadism and hyperprolactinemia) and the rates of success of appropriate hormonal therapy.
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Longitudinal studies in well-specified populations; evaluation of alternative approaches for the systematic assessment of men with erectile dysfunction; cost-effectiveness studies of diagnostic and therapeutic approaches; formal outcomes research of the various approaches to the assessment and treatment of this condition.
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Social/psychological studies of the impact of erectile dysfunction on subjects, their partners, and their interactions, and factors associated with seeking care.
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Development of new therapies, including pharmacologic agents, and with emphasis on oral agents, that may address the cause of male erectile dysfunction with greater specificity.
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Long-term followup studies to assess treatment effects, patient compliance, and late adverse effects.
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Studies to characterize the significance of erectile function and dysfunction in women.
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Conclusions ·
The term “erectile dysfunction” should replace the term “impotence” to characterize the inability to attain and/or maintain penile erection sufficient for satisfactory sexual performance.
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The likelihood of erectile dysfunction increases progressively with age but is not an inevitable consequence of aging. Other age-related conditions increase the likelihood of its occurrence.
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Erectile dysfunction may be a consequence of medications taken for other problems or a result of drug abuse.
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Embarrassment of patients and the reluctance of both patients and health care providers to discuss sexual matters candidly contribute to underdiagnosis of erectile dysfunction.
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Contrary to present public and professional opinion, many cases of erectile dysfunction can be successfully managed with appropriately selected therapy.
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Men with erectile dysfunction require diagnostic evaluations and treatments specific to their circumstances. Patient compliance as well as patient and partner desires and expectations are important considerations in the choice of a particular treatment approach. A multidisciplinary approach may be of great benefit in defining the problem and arriving at a solution.
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The development of methods to quantify the degree of erectile dysfunction objectively would be extremely useful in the assessment both of the problem and of treatment outcomes.
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Education of physicians and other health professionals in aspects of human sexuality is currently inadequate, and curriculum development is urgently needed.
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Education of the public on aspects of sexual dysfunction and the availability of successful treatments is essential; media involvement in this effort is an important component. This should be combined with information designed to expose “quack remedies” and protect men and their partners from economic and emotional losses.
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Important information on many aspects of erectile dysfunction is lacking; major research efforts are essential to the improvement of our understanding of the appropriate diagnostic assessments and treatments of this condition.
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Erectile dysfunction is an important public health problem deserving of increased support for basic science investigation and applied research.
NIH Consensus Statement on Impotence 279
Vocabulary Builder Acetylcholine: A neurotransmitter. Acetylcholine in vertebrates is the major transmitter at neuromuscular junctions, autonomic ganglia, parasympathetic effector junctions, a subset of sympathetic effector junctions, and at many sites in the central nervous system. It is generally not used as an administered drug because it is broken down very rapidly by cholinesterases, but it is useful in some ophthalmological applications. [NIH] Androgens: A class of sex hormones associated with the development and maintenance of the secondary male sex characteristics, sperm induction, and sexual differentiation. In addition to increasing virility and libido, they also increase nitrogen and water retention and stimulate skeletal growth. [NIH] Angiography: Radiography of blood vessels after injection of a contrast medium. [NIH] Arteriography: Roentgenography of arteries after injection of radiopacque material into the blood stream. [EU] Balanitis: Inflammation of the glans penis; it is usually associated with phimosis. [EU] Concomitant: Accompanying; accessory; joined with another. [EU] Confusion: Disturbed orientation in regard to time, place, or person, sometimes accompanied by disordered consciousness. [EU] Electromyography: Recording of the changes in electric potential of muscle by means of surface or needle electrodes. [NIH] FSH: A gonadotropic hormone found in the pituitary tissues of mammals. It regulates the metabolic activity of ovarian granulosa cells and testicular Sertoli cells, induces maturation of Graafian follicles in the ovary, and promotes the development of the germinal cells in the testis. [NIH] Hypotension: Abnormally low blood pressure; seen in shock but not necessarily indicative of it. [EU] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Infusion: The therapeutic introduction of a fluid other than blood, as saline solution, solution, into a vein. [EU] Ingestion: The act of taking food, medicines, etc., into the body, by mouth. [EU]
Intramuscular: Within the substance of a muscle. [EU] Lipoprotein: Any of the lipid-protein complexes in which lipids are transported in the blood; lipoprotein particles consist of a spherical hydrophobic core of triglycerides or cholesterol esters surrounded by an
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amphipathic monolayer of phospholipids, cholesterol, and apolipoproteins; the four principal classes are high-density, low-density, and very-lowdensity lipoproteins and chylomicrons. [EU] Monotherapy: A therapy which uses only one drug. [EU] Palpation: Application of fingers with light pressure to the surface of the body to determine consistence of parts beneath in physical diagnosis; includes palpation for determining the outlines of organs. [NIH] Phimosis: The inability to retract the foreskin over the glans penis due to tightness of the prepuce. [NIH] Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Testis: Either of the paired male reproductive glands that produce the male germ cells and the male hormones. [NIH] Ultrasonography: The visualization of deep structures of the body by recording the reflections of echoes of pulses of ultrasonic waves directed into the tissues. Use of ultrasound for imaging or diagnostic purposes employs frequencies ranging from 1.6 to 10 megahertz. [NIH] Venules: The minute vessels that collect blood from the capillary plexuses and join together to form veins. [NIH]
Online Glossaries 281
ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries and glossaries. The National Library of Medicine has compiled the following list of online dictionaries: ·
ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html
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MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp
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Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/
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Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html
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On-line Medical Dictionary (CancerWEB): http://www.graylab.ac.uk/omd/
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Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm
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Terms and Definitions (Office of Rare Diseases): http://rarediseases.info.nih.gov/ord/glossary_a-e.html
Beyond these, MEDLINEplus contains a very user-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia Web site address is http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a) and drkoop.com (http://www.drkoop.com/). Topics of interest can be researched by using keywords before continuing elsewhere, as these basic definitions and concepts will be useful in more advanced areas of research. You may choose to print various pages specifically relating to impotence and keep them on file. The NIH, in particular, suggests that patients with impotence visit the following Web sites in the ADAM Medical Encyclopedia:
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·
Basic Guidelines for Impotence Impotence Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003164.htm Impotence and age Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002105.htm
·
Signs & Symptoms for Impotence Anemia Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000560.htm Anxiety Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003211.htm Depression Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003213.htm Fatigue Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003088.htm Impotence Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003164.htm Stress Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003211.htm
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Diagnostics and Tests for Impotence Blood glucose Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003482.htm
Online Glossaries 283
Nerve conduction tests Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003927.htm Testosterone Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003707.htm Thyroid function tests Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003444.htm Voiding cystourethrogram Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003784.htm ·
Surgery and Procedures for Impotence Prostatectomy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002996.htm
·
Background Topics for Impotence Alcohol consumption Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001944.htm Chronic Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002312.htm Cigarettes Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001992.htm Cigars Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002775.htm
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Hormone levels Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003445.htm Penis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002279.htm Physical examination Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002274.htm Prosthesis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002286.htm Radiation therapy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001918.htm Safe sex practices Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001949.htm Smoking Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002032.htm
Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries and glossaries: ·
Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical
·
MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html
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Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/
Online Glossaries 285
·
Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine
Glossary 287
IMPOTENCE GLOSSARY The following is a complete glossary of terms used in this sourcebook. The definitions are derived from official public sources including the National Institutes of Health [NIH] and the European Union [EU]. After this glossary, we list a number of additional hardbound and electronic glossaries and dictionaries that you may wish to consult. Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Acetylcholine: A neurotransmitter. Acetylcholine in vertebrates is the major transmitter at neuromuscular junctions, autonomic ganglia, parasympathetic effector junctions, a subset of sympathetic effector junctions, and at many sites in the central nervous system. It is generally not used as an administered drug because it is broken down very rapidly by cholinesterases, but it is useful in some ophthalmological applications. [NIH] Acetylcysteine: The N-acetyl derivative of cysteine. It is used as a mucolytic agent to reduce the viscosity of mucous secretions. It has also been shown to have antiviral effects in patients with HIV due to inhibition of viral stimulation by reactive oxygen intermediates. [NIH] Adenosine: A nucleoside that is composed of adenine and d-ribose. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA. Adenosine itself is a neurotransmitter. [NIH] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alprostadil: A potent vasodilator agent that increases peripheral blood flow. It inhibits platelet aggregation and has many other biological effects such as bronchodilation, mediation of inflammation, etc. [NIH] Amoxapine: The N-demethylated derivative of the antipsychotic agent loxapine that works by blocking the reuptake of norepinephrine, serotonin, or both. It also blocks dopamine receptors. [NIH] Amphetamine: A powerful central nervous system stimulant and sympathomimetic. Amphetamine has multiple mechanisms of action including blocking uptake of adrenergics and dopamine, stimulation of release of monamines, and inhibiting monoamine oxidase. Amphetamine is
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also a drug of abuse and a psychotomimetic. The l- and the d,l-forms are included here. The l-form has less central nervous system activity but stronger cardiovascular effects. The d-form is dextroamphetamine. [NIH] Amyl Nitrite: A vasodilator that is administered by inhalation. It is also used recreationally due to its supposed ability to induce euphoria and act as an aphrodisiac. [NIH] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Anastomosis: An opening created by surgical, traumatic or pathological means between two normally separate spaces or organs. [EU] Androgens: A class of sex hormones associated with the development and maintenance of the secondary male sex characteristics, sperm induction, and sexual differentiation. In addition to increasing virility and libido, they also increase nitrogen and water retention and stimulate skeletal growth. [NIH] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH]
Aneurysm: A sac formed by the dilatation of the wall of an artery, a vein, or the heart. The chief signs of arterial aneurysm are the formation of a pulsating tumour, and often a bruit (aneurysmal bruit) heard over the swelling. Sometimes there are symptoms from pressure on contiguous parts. [EU]
Angiography: Radiography of blood vessels after injection of a contrast medium. [NIH] Angioplasty: Endovascular reconstruction of an artery, which may include the removal of atheromatous plaque and/or the endothelial lining as well as simple dilatation. These are procedures performed by catheterization. When reconstruction of an artery is performed surgically, it is called endarterectomy. [NIH] Anorexia: Lack or loss of the appetite for food. [EU] Anthropology: The science devoted to the comparative study of man. [NIH] Antidepressant: An agent that stimulates the mood of a depressed patient, including tricyclic antidepressants and monoamine oxidase inhibitors. [EU] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized Tlymphocytes, or both. Antigens may be soluble substances, such as toxins
Glossary 289
and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antihistamine: A drug that counteracts the action of histamine. The antihistamines are of two types. The conventional ones, as those used in allergies, block the H1 histamine receptors, whereas the others block the H2 receptors. Called also antihistaminic. [EU] Antihypertensive: An agent that reduces high blood pressure. [EU] Antioxidant: One of many widely used synthetic or natural substances added to a product to prevent or delay its deterioration by action of oxygen in the air. Rubber, paints, vegetable oils, and prepared foods commonly contain antioxidants. [EU] Anxiety: The unpleasant emotional state consisting of psychophysiological responses to anticipation of unreal or imagined danger, ostensibly resulting from unrecognized intrapsychic conflict. Physiological concomitants include increased heart rate, altered respiration rate, sweating, trembling, weakness, and fatigue; psychological concomitants include feelings of impending danger, powerlessness, apprehension, and tension. [EU] Apomorphine: A derivative of morphine that is a dopamine D2 agonist. It is a powerful emetic and has been used for that effect in acute poisoning. It has also been used in the diagnosis and treatment of parkinsonism, but its adverse effects limit its use. [NIH] Aqueous: Watery; prepared with water. [EU] Arginine: An essential amino acid that is physiologically active in the Lform. [NIH] Argon: Argon. A noble gas with the atomic symbol Ar, atomic number 18, and atomic weight 39.948. It is used in fluorescent tubes and wherever an inert atmosphere is desired and nitrogen cannot be used. [NIH] Arrhythmia: Any variation from the normal rhythm of the heart beat, including sinus arrhythmia, premature beat, heart block, atrial fibrillation, atrial flutter, pulsus alternans, and paroxysmal tachycardia. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Arteriography: Roentgenography of arteries after injection of radiopacque material into the blood stream. [EU] Arthralgia: Pain in a joint. [EU] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Asymptomatic: Showing or causing no symptoms. [EU]
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Atenolol: A cardioselective beta-adrenergic blocker possessing properties and potency similar to propranolol, but without a negative inotropic effect. [NIH]
Atrophy: A wasting away; a diminution in the size of a cell, tissue, organ, or part. [EU] Atropine: A toxic alkaloid, originally from Atropa belladonna, but found in other plants, mainly Solanaceae. [NIH] Autonomic: Self-controlling; functionally independent. [EU] Balanitis: Inflammation of the glans penis; it is usually associated with phimosis. [EU] Bereavement: Refers to the whole process of grieving and mourning and is associated with a deep sense of loss and sadness. [NIH] Bethanidine: A guanidinium antihypertensive agent that acts by blocking adrenergic transmission. The precise mode of action is not clear. [NIH] Bilateral: Having two sides, or pertaining to both sides. [EU] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biopsy: The removal and examination, usually microscopic, of tissue from the living body, performed to establish precise diagnosis. [EU] Blindness: The inability to see or the loss or absence of perception of visual stimuli. This condition may be the result of eye diseases; optic nerve diseases; optic chiasm diseases; or brain diseases affecting the visual pathways or occipital lobe. [NIH] Brachytherapy: A collective term for interstitial, intracavity, and surface radiotherapy. It uses small sealed or partly-sealed sources that may be placed on or near the body surface or within a natural body cavity or implanted directly into the tissues. [NIH] Bromocriptine: A semisynthetic ergot alkaloid that is a dopamine D2 agonist. It suppresses prolactin secretion and is used to treat amenorrhea, galactorrhea, and female infertility, and has been proposed for Parkinson disease. [NIH] Bronchoscopy: Endoscopic examination, therapy or surgery of the bronchi. [NIH]
Buccal: Pertaining to or directed toward the cheek. In dental anatomy, used to refer to the buccal surface of a tooth. [EU] Bulbar: Pertaining to a bulb; pertaining to or involving the medulla oblongata, as bulbar paralysis. [EU] Calcitonin: A peptide hormone that lowers calcium concentration in the blood. In humans, it is released by thyroid cells and acts to decrease the
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formation and absorptive activity of osteoclasts. Its role in regulating plasma calcium is much greater in children and in certain diseases than in normal adults. [NIH] Calculi: An abnormal concretion occurring mostly in the urinary and biliary tracts, usually composed of mineral salts. Also called stones. [NIH] Calmodulin: A heat-stable, low-molecular-weight activator protein found mainly in the brain and heart. The binding of calcium ions to this protein allows this protein to bind to cyclic nucleotide phosphodiesterases and to adenyl cyclase with subsequent activation. Thereby this protein modulates cyclic AMP and cyclic GMP levels. [NIH] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Captopril: A potent and specific inhibitor of peptidyl-dipeptidase A. It blocks the conversion of angiotensin I to angiotensin II, a vasoconstrictor and important regulator of arterial blood pressure. Captopril acts to suppress the renin-angiotensin system and inhibits pressure responses to exogenous angiotensin. [NIH] Carbamazepine: An anticonvulsant used to control grand mal and psychomotor or focal seizures. Its mode of action is not fully understood, but some of its actions resemble those of phenytoin; although there is little chemical resemblance between the two compounds, their three-dimensional structure is similar. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, poly- and heterosaccharides. [EU] Cardiology: The study of the heart, its physiology, and its functions. [NIH] Cataract: An opacity, partial or complete, of one or both eyes, on or in the lens or capsule, especially an opacity impairing vision or causing blindness. The many kinds of cataract are classified by their morphology (size, shape, location) or etiology (cause and time of occurrence). [EU] Catheterization: The employment or passage of a catheter. [EU] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Chronic: Persisting over a long period of time. [EU] Cimetidine:
A histamine congener, it competitively inhibits histamine
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binding to H2 receptors. Cimetidine has a range of pharmacological actions. It inhibits gastric acid secretion, as well as pepsin and gastrin output. It also blocks the activity of cytochrome P-450. [NIH] Cirrhosis: Liver disease characterized pathologically by loss of the normal microscopic lobular architecture, with fibrosis and nodular regeneration. The term is sometimes used to refer to chronic interstitial inflammation of any organ. [EU] Claudication: Limping or lameness. [EU] Coitus: Sexual connection per vaginam between male and female. [EU] Colitis: Inflammation of the colon. [EU] Concomitant: Accompanying; accessory; joined with another. [EU] Conduction: The transfer of sound waves, heat, nervous impulses, or electricity. [EU] Confusion: Disturbed orientation in regard to time, place, or person, sometimes accompanied by disordered consciousness. [EU] Congestion: Excessive or abnormal accumulation of blood in a part. [EU] Conjugated: Acting or operating as if joined; simultaneous. [EU] Constipation: Infrequent or difficult evacuation of the faeces. [EU] Constriction: The act of constricting. [NIH] Contraception: The prevention of conception or impregnation. [EU] Contractility: stimulus. [EU]
Capacity for becoming short in response to a suitable
Copulation: Sexual contact of a male with a receptive female usually followed by emission of sperm. Limited to non-human species. For humans use coitus. [NIH] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Cryosurgery: The use of freezing as a special surgical technique to destroy or excise tissue. [NIH] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Cystitis: Inflammation of the urinary bladder. [EU] Cystoscopy: Direct visual examination of the urinary tract with a cystoscope. [EU] Debrisoquin: An adrenergic neuron-blocking drug similar in effects to guanethidine. It is also noteworthy in being a substrate for a polymorphic cytochrome P-450 enzyme. Persons with certain isoforms of this enzyme are
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unable to properly metabolize this and many other clinically important drugs. They are commonly referred to as having a debrisoquin 4hydroxylase polymorphism. [NIH] Defecation: The normal process of elimination of fecal material from the rectum. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Dementia: An acquired organic mental disorder with loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning. The dysfunction is multifaceted and involves memory, behavior, personality, judgment, attention, spatial relations, language, abstract thought, and other executive functions. The intellectual decline is usually progressive, and initially spares the level of consciousness. [NIH] Desensitization: The prevention or reduction of immediate hypersensitivity reactions by administration of graded doses of allergen; called also hyposensitization and immunotherapy. [EU] Diaphragm: The musculofibrous partition that separates the thoracic cavity from the abdominal cavity. Contraction of the diaphragm increases the volume of the thoracic cavity aiding inspiration. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diathermy: Heating of the body tissues due to their resistance to the passage of high-frequency electromagnetic radiation, electric currents, or ultrasonic waves. In medical d. (thermopenetration) the tissues are warmed but not damaged; in surgical d. (electrocoagulation) tissue is destroyed. [EU] Dilatation: The condition, as of an orifice or tubular structure, of being dilated or stretched beyond the normal dimensions. [EU] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Distention: The state of being distended or enlarged; the act of distending. [EU]
Dizziness: An imprecise term which may refer to a sense of spatial disorientation, motion of the environment, or lightheadedness. [NIH] Dorsal: 1. pertaining to the back or to any dorsum. 2. denoting a position more toward the back surface than some other object of reference; same as posterior in human anatomy; superior in the anatomy of quadrupeds. [EU] Dyspareunia: Difficult or painful coitus. [EU] Dyspepsia: Impairment of the power of function of digestion; usually applied to epigastric discomfort following meals. [EU]
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Ejaculation: A sudden act of expulsion, as of the semen. [EU] Elastic: Susceptible of resisting and recovering from stretching, compression or distortion applied by a force. [EU] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Electromyography: Recording of the changes in electric potential of muscle by means of surface or needle electrodes. [NIH] Electrophoresis: An electrochemical process in which macromolecules or colloidal particles with a net electric charge migrate in a solution under the influence of an electric current. [NIH] Electrophysiological: Pertaining to electrophysiology, that is a branch of physiology that is concerned with the electric phenomena associated with living bodies and involved in their functional activity. [EU] Emphysema: A pathological accumulation of air in tissues or organs; applied especially to such a condition of the lungs. [EU] Endocrinology: A subspecialty of internal medicine concerned with the metabolism, physiology, and disorders of the endocrine system. [NIH] Endogenous: Developing or originating within the organisms or arising from causes within the organism. [EU] Endoscopy: Visual inspection of any cavity of the body by means of an endoscope. [EU] Endothelium: The layer of epithelial cells that lines the cavities of the heart and of the blood and lymph vessels, and the serous cavities of the body, originating from the mesoderm. [EU] Enterotoxins: Substances that are toxic to the intestinal tract causing vomiting, diarrhea, etc.; most common enterotoxins are produced by bacteria. [NIH] Enuresis: Involuntary discharge of urine after the age at which urinary control should have been achieved; often used alone with specific reference to involuntary discharge of urine occurring during sleep at night (bedwetting, nocturnal enuresis). [EU] Enzyme: A protein molecule that catalyses chemical reactions of other substances without itself being destroyed or altered upon completion of the reactions. Enzymes are classified according to the recommendations of the Nomenclature Committee of the International Union of Biochemistry. Each enzyme is assigned a recommended name and an Enzyme Commission (EC) number. They are divided into six main groups; oxidoreductases, transferases, hydrolases, lyases, isomerases, and ligases. [EU] Epidemiological: Relating to, or involving epidemiology. [EU]
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Epidural: Situated upon or outside the dura mater. [EU] Erection: The condition of being made rigid and elevated; as erectile tissue when filled with blood. [EU] Erythromycin: A bacteriostatic antibiotic substance produced by Streptomyces erythreus. Erythromycin A is considered its major active component. In sensitive organisms, it inhibits protein synthesis by binding to 50S ribosomal subunits. This binding process inhibits peptidyl transferase activity and interferes with translocation of amino acids during translation and assembly of proteins. [NIH] Erythropoietin: Glycoprotein hormone, secreted chiefly by the kidney in the adult and the liver in the fetus, that acts on erythroid stem cells of the bone marrow to stimulate proliferation and differentiation. [NIH] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Extraction: The process or act of pulling or drawing out. [EU] Extremity: A limb; an arm or leg (membrum); sometimes applied specifically to a hand or foot. [EU] Facial: Of or pertaining to the face. [EU] Famotidine: A competitive histamine H2-receptor antagonist. Its main pharmacodynamic effect is the inhibition of gastric secretion. [NIH] Fatal: Causing death, deadly; mortal; lethal. [EU] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH] Ferritin: An iron-containing protein complex that is formed by a combination of ferric iron with the protein apoferritin. [NIH] Fibrosis: The formation of fibrous tissue; fibroid or fibrous degeneration [EU] Filtration: The passage of a liquid through a filter, accomplished by gravity, pressure, or vacuum (suction). [EU] Finasteride: An orally active testosterone 5-alpha-reductase inhibitor. It is used as a surgical alternative for treatment of benign prostatic hyperplasia. [NIH]
Flaccid: Weak, lax and soft. [EU] Fluphenazine: A phenothiazine used in the treatment of psychoses. Its properties and uses are generally similar to those of chlorpromazine. [NIH] Flushing: A transient reddening of the face that may be due to fever, certain drugs, exertion, stress, or a disease process. [NIH] Frigidity: Coldness; especially, lack of sexual response in the female. [EU]
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FSH: A gonadotropic hormone found in the pituitary tissues of mammals. It regulates the metabolic activity of ovarian granulosa cells and testicular Sertoli cells, induces maturation of Graafian follicles in the ovary, and promotes the development of the germinal cells in the testis. [NIH] Ganglion: 1. a knot, or knotlike mass. 2. a general term for a group of nerve cell bodies located outside the central nervous system; occasionally applied to certain nuclear groups within the brain or spinal cord, e.g. basal ganglia. 3. a benign cystic tumour occurring on a aponeurosis or tendon, as in the wrist or dorsum of the foot; it consists of a thin fibrous capsule enclosing a clear mucinous fluid. [EU] Gangrene: Death of tissue, usually in considerable mass and generally associated with loss of vascular (nutritive) supply and followed by bacterial invasion and putrefaction. [EU] Gastritis: Inflammation of the stomach. [EU] Gastroduodenal: Pertaining to or communicating with the stomach and duodenum, as a gastroduodenal fistula. [EU] Gastrointestinal: Pertaining to or communicating with the stomach and intestine, as a gastrointestinal fistula. [EU] Gemfibrozil: A lipid-regulating agent that lowers elevated serum lipids primarily by decreasing serum triglycerides with a variable reduction in total cholesterol. These decreases occur primarily in the VLDL fraction and less frequently in the LDL fraction. Gemfibrozil increases HDL subfractions HDL2 and HDL3 as well as apolipoproteins A-I and A-II. Its mechanism of action has not been definitely established. [NIH] Genitourinary: Pertaining to the genital and urinary organs; urogenital; urinosexual. [EU] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Glucose: D-glucose, a monosaccharide (hexose), C6H12O6, also known as dextrose (q.v.), found in certain foodstuffs, especially fruits, and in the normal blood of all animals. It is the end product of carbohydrate metabolism and is the chief source of energy for living organisms, its utilization being controlled by insulin. Excess glucose is converted to glycogen and stored in the liver and muscles for use as needed and, beyond that, is converted to fat and stored as adipose tissue. Glucose appears in the urine in diabetes mellitus. [EU] Glycopyrrolate: A muscarinic antagonist used as an antispasmodic, in some disorders of the gastrointestinal tract, and to reduce salivation with some anesthetics. [NIH] Glycoside: Any compound that contains a carbohydrate molecule (sugar),
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particularly any such natural product in plants, convertible, by hydrolytic cleavage, into sugar and a nonsugar component (aglycone), and named specifically for the sugar contained, as glucoside (glucose), pentoside (pentose), fructoside (fructose) etc. [EU] Groin: The external junctural region between the lower part of the abdomen and the thigh. [NIH] Guanabenz: An alpha-2 selective adrenergic agonist used as an antihypertensive agent. [NIH] Gynecology: A medical-surgical specialty concerned with the physiology and disorders primarily of the female genital tract, as well as female endocrinology and reproductive physiology. [NIH] Happiness: Highly pleasant emotion manifestations of gratification; joy. [NIH]
characterized
by
outward
Heartburn: Substernal pain or burning sensation, usually associated with regurgitation of gastric juice into the esophagus. [NIH] Helicobacter: A genus of gram-negative, spiral-shaped bacteria that is pathogenic and has been isolated from the intestinal tract of mammals, including humans. [NIH] Hematology: A subspecialty of internal medicine concerned with morphology, physiology, and pathology of the blood and blood-forming tissues. [NIH] Hematuria: Presence of blood in the urine. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hemostasis: The process which spontaneously arrests the flow of blood from vessels carrying blood under pressure. It is accomplished by contraction of the vessels, adhesion and aggregation of formed blood elements, and the process of blood or plasma coagulation. [NIH] Hepatitis: Inflammation of the liver. [EU] Hepatomegaly: Enlargement of the liver. [EU] Homeostasis: A tendency to stability in the normal body states (internal environment) of the organism. It is achieved by a system of control mechanisms activated by negative feedback; e.g. a high level of carbon dioxide in extracellular fluid triggers increased pulmonary ventilation, which in turn causes a decrease in carbon dioxide concentration. [EU] Homosexuality: Sexual attraction or relationship between members of the same sex. [NIH] Hormones: Chemical substances having a specific regulatory effect on the activity of a certain organ or organs. The term was originally applied to substances secreted by various endocrine glands and transported in the
298 Impotence
bloodstream to the target organs. It is sometimes extended to include those substances that are not produced by the endocrine glands but that have similar effects. [NIH] Hyperlipidaemia: A general term for elevated concentrations of any or all of the lipids in the plasma, including hyperlipoproteinaemia, hypercholesterolaemia, etc. [EU] Hyperplasia: The abnormal multiplication or increase in the number of normal cells in normal arrangement in a tissue. [EU] Hypertension: Persistently high arterial blood pressure. Various criteria for its threshold have been suggested, ranging from 140 mm. Hg systolic and 90 mm. Hg diastolic to as high as 200 mm. Hg systolic and 110 mm. Hg diastolic. Hypertension may have no known cause (essential or idiopathic h.) or be associated with other primary diseases (secondary h.). [EU] Hypogonadism: A condition resulting from or characterized by abnormally decreased functional activity of the gonads, with retardation of growth and sexual development. [EU] Hypotension: Abnormally low blood pressure; seen in shock but not necessarily indicative of it. [EU] Iatrogenic: Resulting from the activity of physicians. Originally applied to disorders induced in the patient by autosuggestion based on the physician's examination, manner, or discussion, the term is now applied to any adverse condition in a patient occurring as the result of treatment by a physician or surgeon, especially to infections acquired by the patient during the course of treatment. [EU] Immunohistochemistry: Histochemical localization of immunoreactive substances using labeled antibodies as reagents. [NIH] Implantation: The insertion or grafting into the body of biological, living, inert, or radioactive material. [EU] Impotence: The inability to perform sexual intercourse. [NIH] Incision: 1. cleft, cut, gash. 2. an act or action of incising. [EU] Incontinence: Inability to control excretory functions, as defecation (faecal i.) or urination (urinary i.). [EU] Indapamide: A sulfamyl diuretic with about 16x the effect of furosemide. It has also been shown to be an effective antihypertensive agent in the clinic. [NIH]
Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Infarction: 1. the formation of an infarct. 2. an infarct. [EU] Infertility:
The diminished or absent ability to conceive or produce an
Glossary 299
offspring while sterility is the complete inability to conceive or produce an offspring. [NIH] Infiltration: The diffusion or accumulation in a tissue or cells of substances not normal to it or in amounts of the normal. Also, the material so accumulated. [EU] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Influenza: An acute viral infection involving the respiratory tract. It is marked by inflammation of the nasal mucosa, the pharynx, and conjunctiva, and by headache and severe, often generalized, myalgia. [NIH] Infusion: The therapeutic introduction of a fluid other than blood, as saline solution, solution, into a vein. [EU] Ingestion: The act of taking food, medicines, etc., into the body, by mouth. [EU]
Inhalation: The drawing of air or other substances into the lungs. [EU] Innervation: 1. the distribution or supply of nerves to a part. 2. the supply of nervous energy or of nerve stimulus sent to a part. [EU] Insomnia: Inability to sleep; abnormal wakefulness. [EU] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulindependent diabetes mellitus. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intestines: The section of the alimentary canal from the stomach to the anus. It includes the large intestine and small intestine. [NIH] Intramuscular: Within the substance of a muscle. [EU] Invasive: 1. having the quality of invasiveness. 2. involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH]
300 Impotence
Irrigation: Washing by a stream of water or other fluid. [EU] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Isosorbide Dinitrate: A vasodilator used in the treatment of angina. Its actions are similar to nitroglycerin but with a slower onset of action. [NIH] Itraconazole: An antifungal agent that has been used in the treatment of histoplasmosis, blastomycosis, cryptococcal meningitis, and aspergillosis. [NIH]
Jaundice: A clinical manifestation of hyperbilirubinemia, consisting of deposition of bile pigments in the skin, resulting in a yellowish staining of the skin and mucous membranes. [NIH] Jurisprudence: The application of the principles of law and justice to health and medicine. [NIH] Ketoacidosis: Acidosis accompanied by the accumulation of ketone bodies (ketosis) in the body tissues and fluids, as in diabetic acidosis. [EU] Ketoconazole: Broad spectrum antifungal agent used for long periods at high doses, especially in immunosuppressed patients. [NIH] Kinetic: Pertaining to or producing motion. [EU] Lamivudine: A reverse transcriptase inhibitor and zalcitabine analog in which a sulfur atom replaces the 3' carbon of the pentose ring. It is used to treat HIV disease. [NIH] Laparoscopes: Endoscopes for examining the interior of the abdomen. [NIH] Laparoscopy: Examination, therapy or surgery of the abdomen's interior by means of a laparoscope. [NIH] Lesion: Any pathological or traumatic discontinuity of tissue or loss of function of a part. [EU] LH: A small glycoprotein hormone secreted by the anterior pituitary. LH plays an important role in controlling ovulation and in controlling secretion of hormones by the ovaries and testes. [NIH] Libido: Sexual desire. [EU] Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU] Ligation: Application of a ligature to tie a vessel or strangulate a part. [NIH] Lipid: Any of a heterogeneous group of flats and fatlike substances characterized by being water-insoluble and being extractable by nonpolar (or fat) solvents such as alcohol, ether, chloroform, benzene, etc. All contain as a major constituent aliphatic hydrocarbons. The lipids, which are easily stored in the body, serve as a source of fuel, are an important constituent of cell structure, and serve other biological functions. Lipids may be considered to
Glossary 301
include fatty acids, neutral fats, waxes, and steroids. Compound lipids comprise the glycolipids, lipoproteins, and phospholipids. [EU] Lipoprotein: Any of the lipid-protein complexes in which lipids are transported in the blood; lipoprotein particles consist of a spherical hydrophobic core of triglycerides or cholesterol esters surrounded by an amphipathic monolayer of phospholipids, cholesterol, and apolipoproteins; the four principal classes are high-density, low-density, and very-lowdensity lipoproteins and chylomicrons. [EU] Lobe: A more or less well-defined portion of any organ, especially of the brain, lungs, and glands. Lobes are demarcated by fissures, sulci, connective tissue, and by their shape. [EU] Locomotor: Of or pertaining to locomotion; pertaining to or affecting the locomotive apparatus of the body. [EU] Lubrication: The application of a substance to diminish friction between two surfaces. It may refer to oils, greases, and similar substances for the lubrication of medical equipment but it can be used for the application of substances to tissue to reduce friction, such as lotions for skin and vaginal lubricants. [NIH] Malaise: A vague feeling of bodily discomfort. [EU] Malformation: A morphologic defect resulting from an intrinsically abnormal developmental process. [EU] Malignant: Tending to become progressively worse and to result in death. Having the properties of anaplasia, invasion, and metastasis; said of tumours. [EU] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Medicament: A medicinal substance or agent. [EU] Medullary: Pertaining to the marrow or to any medulla; resembling marrow. [EU] Membrane: A thin layer of tissue which covers a surface, lines a cavity or divides a space or organ. [EU] Menopause: Cessation of menstruation in the human female, occurring usually around the age of 50. [EU] Menstruation: The cyclic, physiologic discharge through the vagina of blood and mucosal tissues from the nonpregnant uterus; it is under
302 Impotence
hormonal control and normally recurs, usually at approximately four-week intervals, in the absence of pregnancy during the reproductive period (puberty through menopause) of the female of the human and a few species of primates. It is the culmination of the menstrual cycle. [EU] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Metoclopramide: A dopamine D2 antagonist that is used as an antiemetic. [NIH]
Metolazone: A potent, long acting diuretic useful in chronic renal disease. It also tends to lower blood pressure and increase potassium loss. [NIH] Metoprolol: Adrenergic beta-1-blocking agent with no stimulatory action. It is less bound to plasma albumin than alprenolol and may be useful in angina pectoris, hypertension, or cardiac arrhythmias. [NIH] Microcirculation: The flow of blood in the entire system of finer vessels (100 microns or less in diameter) of the body (the microvasculature). [EU] Microsomal: Of or pertaining to microsomes : vesicular fragments of endoplasmic reticulum formed after disruption and centrifugation of cells. [EU]
Micturition: The passage of urine; urination. [EU] Mobility: Capability of movement, of being moved, or of flowing freely. [EU] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Monotherapy: A therapy which uses only one drug. [EU] Morphogenesis: The development of the form of an organ, part of the body, or organism. [NIH] Mutagenesis: Process of generating genetic mutations. It may occur spontaneously or be induced by mutagens. [NIH] Myopathy: Any disease of a muscle. [EU] Nadolol: A non-selective beta-adrenergic antagonist with a long half-life, used in cardiovascular disease to treat arrhythmias, angina pectoris, and hypertension. Nadolol is also used for migraine and for tremor. [NIH] Narcotic: 1. pertaining to or producing narcosis. 2. an agent that produces insensibility or stupor, applied especially to the opioids, i.e. to any natural or synthetic drug that has morphine-like actions. [EU] Nausea: An unpleasant sensation, vaguely referred to the epigastrium and abdomen, and often culminating in vomiting. [EU] Neoplasms: New abnormal growth of tissue. Malignant neoplasms show a greater degree of anaplasia and have the properties of invasion and metastasis, compared to benign neoplasms. [NIH]
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Nephrology: A subspecialty of internal medicine concerned with the anatomy, physiology, and pathology of the kidney. [NIH] Nephropathy: Disease of the kidneys. [EU] Neural: 1. pertaining to a nerve or to the nerves. 2. situated in the region of the spinal axis, as the neutral arch. [EU] Neuralgia: Paroxysmal pain which extends along the course of one or more nerves. Many varieties of neuralgia are distinguished according to the part affected or to the cause, as brachial, facial, occipital, supraorbital, etc., or anaemic, diabetic, gouty, malarial, syphilitic, etc. [EU] Neurologic: Pertaining to neurology or to the nervous system. [EU] Neuromuscular: Pertaining to muscles and nerves. [EU] Neuronal: Pertaining to a neuron or neurons (= conducting cells of the nervous system). [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neuropathy: A general term denoting functional disturbances and/or pathological changes in the peripheral nervous system. The etiology may be known e.g. arsenical n., diabetic n., ischemic n., traumatic n.) or unknown. Encephalopathy and myelopathy are corresponding terms relating to involvement of the brain and spinal cord, respectively. The term is also used to designate noninflammatory lesions in the peripheral nervous system, in contrast to inflammatory lesions (neuritis). [EU] Neurophysiology: The scientific discipline concerned with the physiology of the nervous system. [NIH] Neurotransmitter: Any of a group of substances that are released on excitation from the axon terminal of a presynaptic neuron of the central or peripheral nervous system and travel across the synaptic cleft to either excite or inhibit the target cell. Among the many substances that have the properties of a neurotransmitter are acetylcholine, norepinephrine, epinephrine, dopamine, glycine, y-aminobutyrate, glutamic acid, substance P, enkephalins, endorphins, and serotonin. [EU] Neutrophil: Having an affinity for neutral dyes. [EU] Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Nicotine: Nicotine is highly toxic alkaloid. It is the prototypical agonist at nicotinic cholinergic receptors where it dramatically stimulates neurons and
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ultimately blocks synaptic transmission. Nicotine is also important medically because of its presence in tobacco smoke. [NIH] Nitrates: Inorganic or organic salts and esters of nitric acid. These compounds contain the NO3- radical. [NIH] Nitroglycerin: A highly volatile organic nitrate that acts as a dilator of arterial and venous smooth muscle and is used in the treatment of angina. It provides relief through improvement of the balance between myocardial oxygen supply and demand. Although total coronary blood flow is not increased, there is redistribution of blood flow in the heart when partial occlusion of coronary circulation is effected. [NIH] Obstetrics: A medical-surgical specialty concerned with management and care of women during pregnancy, parturition, and the puerperium. [NIH] Oral: Pertaining to the mouth, taken through or applied in the mouth, as an oral medication or an oral thermometer. [EU] Orgasm: The apex and culmination of sexual excitement. [EU] Orthopaedic: Pertaining to the correction of deformities of the musculoskeletal system; pertaining to orthopaedics. [EU] Osteoarthritis: Noninflammatory degenerative joint disease occurring chiefly in older persons, characterized by degeneration of the articular cartilage, hypertrophy of bone at the margins, and changes in the synovial membrane. It is accompanied by pain and stiffness, particularly after prolonged activity. [EU] Osteoporosis: Reduction in the amount of bone mass, leading to fractures after minimal trauma. [EU] Outpatients: Persons who receive ambulatory care at an outpatient department or clinic without room and board being provided. [NIH] Overdose: 1. to administer an excessive dose. 2. an excessive dose. [EU] Palpation: Application of fingers with light pressure to the surface of the body to determine consistence of parts beneath in physical diagnosis; includes palpation for determining the outlines of organs. [NIH] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the islets of langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Papaverine: An alkaloid found in opium but not closely related to the other opium alkaloids in its structure or pharmacological actions. It is a directacting smooth muscle relaxant used in the treatment of impotence and as a vasodilator, especially for cerebral vasodilation. The mechanism of its
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pharmacological actions is not clear, but it apparently can inhibit phosphodiesterases and it may have direct actions on calcium channels. [NIH] Pediatrics: A medical specialty concerned with maintaining health and providing medical care to children from birth to adolescence. [NIH] Penicillamine: 3-Mercapto-D-valine. The most characteristic degradation product of the penicillin antibiotics. It is used as an antirheumatic and as a chelating agent in Wilson's disease. [NIH] Penis: The male organ of copulation and of urinary excretion, comprising a root, body, and extremity, or glans penis. The root is attached to the descending portions of the pubic bone by the crura, the latter being the extremities of the corpora cavernosa, and beneath them the corpus spongiosum, through which the urethra passes. The glans is covered with mucous membrane and ensheathed by the prepuce, or foreskin. The penis is homologous with the clitoris in the female. [EU] Percutaneous: Performed through the skin, as injection of radiopacque material in radiological examination, or the removal of tissue for biopsy accomplished by a needle. [EU] Perforation: 1. the act of boring or piercing through a part. 2. a hole made through a part or substance. [EU] Perianal: Located around the anus. [EU] Perphenazine: An antipsychotic phenothiazine derivative with actions and uses similar to those of chlorpromazine. [NIH] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Phentolamine: A nonselective alpha-adrenergic antagonist. It is used in the treatment of hypertension and hypertensive emergencies, pheochromocytoma, vasospasm of Raynaud's disease and frostbite, clonidine withdrawal syndrome, impotence, and peripheral vascular disease. [NIH]
Phimosis: The inability to retract the foreskin over the glans penis due to tightness of the prepuce. [NIH] Phobia: A persistent, irrational, intense fear of a specific object, activity, or situation (the phobic stimulus), fear that is recognized as being excessive or unreasonable by the individual himself. When a phobia is a significant source of distress or interferes with social functioning, it is considered a mental disorder; phobic disorder (or neurosis). In DSM III phobic disorders are subclassified as agoraphobia, social phobias, and simple phobias. Used as a word termination denoting irrational fear of or aversion to the subject indicated by the stem to which it is affixed. [EU]
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Pigmentation: 1. the deposition of colouring matter; the coloration or discoloration of a part by pigment. 2. coloration, especially abnormally increased coloration, by melanin. [EU] Piperoxan: A benzodioxane alpha-adrenergic blocking agent with considerable stimulatory action. It has been used to diagnose pheochromocytoma and as an antihypertensive agent. [NIH] Plexus: A network or tangle; a general term for a network of lymphatic vessels, nerves, or veins. [EU] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Porphyria: A pathological state in man and some lower animals that is often due to genetic factors, is characterized by abnormalities of porphyrin metabolism, and results in the excretion of large quantities of porphyrins in the urine and in extreme sensitivity to light. [EU] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Prazosin: A selective adrenergic alpha-1 antagonist used in the treatment of heart failure, hypertension, pheochromocytoma, Raynaud's syndrome, prostatic hypertrophy, and urinary retention. [NIH] Premenstrual: Occurring before menstruation. [EU] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Priapism: Persistent abnormal erection of the penis, usually without sexual desire, and accompanied by pain and tenderness. It is seen in diseases and injuries of the spinal cord, and may be caused by vesical calculus and certain injuries to the penis. [EU] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Prolactinoma: A pituitary adenoma which secretes prolactin, leading to hyperprolactinemia. Clinical manifestations include amenorrhea; galactorrhea; impotence; headache; visual disturbances; and cerebrospinal fluid rhinorrhea. [NIH]
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Prostaglandins: A group of compounds derived from unsaturated 20carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway. They are extremely potent mediators of a diverse group of physiological processes. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Prosthesis: An artificial substitute for a missing body part, such as an arm or leg, eye or tooth, used for functional or cosmetic reasons, or both. [EU] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychosomatic: Pertaining to the mind-body relationship; having bodily symptoms of psychic, emotional, or mental origin; called also psychophysiologic. [EU] Psychotherapy: A generic term for the treatment of mental illness or emotional disturbances primarily by verbal or nonverbal communication. [NIH]
Psychotropic: Exerting an effect upon the mind; capable of modifying mental activity; usually applied to drugs that effect the mental state. [EU] Pulmonary: Pertaining to the lungs. [EU] Radiology: A specialty concerned with the use of x-ray and other forms of radiant energy in the diagnosis and treatment of disease. [NIH] Rantes: A chemokine that is a chemoattractant for eosinophils, monocytes, and lymphocytes. It is a potent and selective eosinophil chemotaxin that is stored in and released from platelets and activated T-cells. [NIH] Receptor: 1. a molecular structure within a cell or on the surface characterized by (1) selective binding of a specific substance and (2) a specific physiologic effect that accompanies the binding, e.g., cell-surface receptors for peptide hormones, neurotransmitters, antigens, complement fragments, and immunoglobulins and cytoplasmic receptors for steroid hormones. 2. a sensory nerve terminal that responds to stimuli of various kinds. [EU] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Reflex: 1; reflected. 2. a reflected action or movement; the sum total of any particular involuntary activity. [EU] Regeneration: The natural renewal of a structure, as of a lost tissue or part. [EU]
Reoperation: A repeat operation for the same condition in the same patient.
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It includes reoperation for reexamination, reoperation for disease progression or recurrence, or reoperation following operative failure. [NIH] Resection: Excision of a portion or all of an organ or other structure. [EU] Resorption: The loss of substance through physiologic or pathologic means, such as loss of dentin and cementum of a tooth, or of the alveolar process of the mandible or maxilla. [EU] Retinopathy: 1. retinitis (= inflammation of the retina). 2. retinosis (= degenerative, noninflammatory condition of the retina). [EU] Retrograde: 1. moving backward or against the usual direction of flow. 2. degenerating, deteriorating, or catabolic. [EU] Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver, kidney, heart, and leafy vegetables. The richest natural source is yeast. It occurs in the free form only in the retina of the eye, in whey, and in urine; its principal forms in tissues and cells are as FMN and FAD. [NIH] Rigidity: Stiffness or inflexibility, chiefly that which is abnormal or morbid; rigor. [EU] Ritonavir: An HIV protease inhibitor that works by interfering with the reproductive cycle of HIV. [NIH] Sclerosis: A induration, or hardening; especially hardening of a part from inflammation and in diseases of the interstitial substance. The term is used chiefly for such a hardening of the nervous system due to hyperplasia of the connective tissue or to designate hardening of the blood vessels. [EU] Scopolamine: An alkaloid from Solanaceae, especially Datura metel L. and Scopola carniolica. Scopolamine and its quaternary derivatives act as antimuscarinics like atropine, but may have more central nervous system effects. Among the many uses are as an anesthetic premedication, in urinary incontinence, in motion sickness, as an antispasmodic, and as a mydriatic and cycloplegic. [NIH] Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight 78.96. It is an essential micronutrient for mammals and other animals but is toxic in large amounts. Selenium protects intracellular structures against oxidative damage. It is an essential component of glutathione peroxidase. [NIH] Serine: A non-essential amino acid occurring in natural form as the Lisomer. It is synthesized from glycine or threonine. It is involved in the biosynthesis of purines, pyrimidines, and other amino acids. [NIH] Serum: The clear portion of any body fluid; the clear fluid moistening serous membranes. 2. blood serum; the clear liquid that separates from blood on clotting. 3. immune serum; blood serum from an immunized animal used for passive immunization; an antiserum; antitoxin, or antivenin. [EU]
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Siderosis: The deposition of iron in a tissue. In the eye, the iron may be deposited in the stroma adjacent to the Descemet's membrane. [NIH] Sirolimus: A macrolide compound obtained from Streptomyces hygroscopicus that acts by selectively blocking the transcriptional activation of cytokines thereby inhibiting cytokine production. It is bioactive only when bound to immunophilins. Sirolimus is a potent immunosuppressant and possesses both antifungal and antineoplastic properties. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Sphincter: A ringlike band of muscle fibres that constricts a passage or closes a natural orifice; called also musculus sphincter. [EU] Spotting: A slight discharge of blood via the vagina, especially as a sideeffect of oral contraceptives. [EU] Sterility: 1. the inability to produce offspring, i.e., the inability to conceive (female s.) or to induce conception (male s.). 2. the state of being aseptic, or free from microorganisms. [EU] Sterilization: 1. the complete destruction or elimination of all living microorganisms, accomplished by physical methods (dry or moist heat), chemical agents (ethylene oxide, formaldehyde, alcohol), radiation (ultraviolet, cathode), or mechanical methods (filtration). 2. any procedure by which an individual is made incapable of reproduction, as by castration, vasectomy, or salpingectomy. [EU] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Suppository: A medicated mass adapted for introduction into the rectal, vaginal, or urethral orifice of the body, suppository bases are solid at room temperature but melt or dissolve at body temperature. Commonly used bases are cocoa butter, glycerinated gelatin, hydrogenated vegetable oils, polyethylene glycols of various molecular weights, and fatty acid esters of polyethylene glycol. [EU] Symptomatic: 1. pertaining to or of the nature of a symptom. 2. indicative
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(of a particular disease or disorder). 3. exhibiting the symptoms of a particular disease but having a different cause. 4. directed at the allying of symptoms, as symptomatic treatment. [EU] Synaptic: Pertaining to or affecting a synapse (= site of functional apposition between neurons, at which an impulse is transmitted from one neuron to another by electrical or chemical means); pertaining to synapsis (= pairing off in point-for-point association of homologous chromosomes from the male and female pronuclei during the early prophase of meiosis). [EU] Synergistic: Acting together; enhancing the effect of another force or agent. [EU]
Systemic: Pertaining to or affecting the body as a whole. [EU] Taboo: Any negative tradition or behavior that is generally regarded as harmful to social welfare and forbidden within a cultural or social group. [NIH]
Testis: Either of the paired male reproductive glands that produce the male germ cells and the male hormones. [NIH] Thalidomide: A pharmaceutical agent originally introduced as a nonbarbiturate hypnotic, but withdrawn from the market because of its known tetratogenic effects. It has been reintroduced and used for a number of immunological and inflammatory disorders. Thalidomide displays immunosuppresive and anti-angiogenic activity. It inhibits release of tumor necrosis factor alpha from monocytes, and modulates other cytokine action. [NIH]
Thermoregulation: Heat regulation. [EU] Thiothixene: A thioxanthine used as an antipsychotic agent. Its effects are similar to the phenothiazine antipsychotics. [NIH] Threonine: An essential amino acid occurring naturally in the L-form, which is the active form. It is found in eggs, milk, gelatin, and other proteins. [NIH]
Thrombosis: The formation, development, or presence of a thrombus. [EU] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH] Tinnitus: A noise in the ears, as ringing, buzzing, roaring, clicking, etc. Such sounds may at times be heard by others than the patient. [EU] Topical: Pertaining to a particular surface area, as a topical anti-infective applied to a certain area of the skin and affecting only the area to which it is applied. [EU] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology:
The science concerned with the detection, chemical
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composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Transcutaneous: Transdermal. [EU] Transdermal: Entering through the dermis, or skin, as in administration of a drug applied to the skin in ointment or patch form. [EU] Transplantation: The grafting of tissues taken from the patient's own body or from another. [EU] Transurethral: Performed through the urethra. [EU] Triamterene: A pteridine that is used as a mild diuretic. [NIH] Tricyclic: Containing three fused rings or closed chains in the molecular structure. [EU] Tyrosine: A non-essential amino acid. In animals it is synthesized from phenylalanine. It is also the precursor of epinephrine, thyroid hormones, and melanin. [NIH] Ulcer: A local defect, or excavation, of the surface of an organ or tissue; which is produced by the sloughing of inflammatory necrotic tissue. [EU] Ultrasonography: The visualization of deep structures of the body by recording the reflections of echoes of pulses of ultrasonic waves directed into the tissues. Use of ultrasound for imaging or diagnostic purposes employs frequencies ranging from 1.6 to 10 megahertz. [NIH] Urethritis: Inflammation of the urethra. [EU] Urinalysis: Examination of urine by chemical, physical, or microscopic means. Routine urinalysis usually includes performing chemical screening tests, determining specific gravity, observing any unusual color or odor, screening for bacteriuria, and examining the sediment microscopically. [NIH] Urology: A surgical specialty concerned with the study, diagnosis, and treatment of diseases of the urinary tract in both sexes and the genital tract in the male. It includes the specialty of andrology which addresses both male genital diseases and male infertility. [NIH] Vaginal: 1. of the nature of a sheath; ensheathing. 2. pertaining to the vagina. 3. pertaining to the tunica vaginalis testis. [EU] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasoactive: Exerting an effect upon the calibre of blood vessels. [EU] Vasoconstriction: The diminution of the calibre of vessels, especially constriction of arterioles leading to decreased blood flow to a part. [EU] Vegetarianism: Dietary practice of consuming only vegetables, grains, and nuts. [NIH]
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Veins: The vessels carrying blood toward the heart. [NIH] Venules: The minute vessels that collect blood from the capillary plexuses and join together to form veins. [NIH] Venus: The second planet in order from the sun. It has no known natural satellites. It is one of the four inner or terrestrial planets of the solar system. [NIH]
Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] Viscera: Any of the large interior organs in any one of the three great cavities of the body, especially in the abdomen. [NIH] Withdrawal: 1. a pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) a substancespecific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU] Xenobiotics: Chemical substances that are foreign to the biological system. They include naturally occurring compounds, drugs, environmental agents, carcinogens, insecticides, etc. [NIH] Yohimbine: A plant alkaloid with alpha-2-adrenergic blocking activity. Yohimbine has been used as a mydriatic and in the treatment of impotence. It is also alleged to be an aphrodisiac. [NIH]
General Dictionaries and Glossaries While the above glossary is essentially complete, the dictionaries listed here cover virtually all aspects of medicine, from basic words and phrases to more advanced terms (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·
Dictionary of Medical Acronymns & Abbreviations by Stanley Jablonski (Editor), Paperback, 4th edition (2001), Lippincott Williams & Wilkins Publishers, ISBN: 1560534605, http://www.amazon.com/exec/obidos/ASIN/1560534605/icongroupinterna
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Dictionary of Medical Terms : For the Nonmedical Person (Dictionary of Medical Terms for the Nonmedical Person, Ed 4) by Mikel A. Rothenberg, M.D, et al, Paperback - 544 pages, 4th edition (2000), Barrons Educational Series, ISBN: 0764112015, http://www.amazon.com/exec/obidos/ASIN/0764112015/icongroupinterna
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A Dictionary of the History of Medicine by A. Sebastian, CD-Rom edition (2001), CRC Press-Parthenon Publishers, ISBN: 185070368X, http://www.amazon.com/exec/obidos/ASIN/185070368X/icongroupinterna
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Dorland’s Illustrated Medical Dictionary (Standard Version) by Dorland, et al, Hardcover - 2088 pages, 29th edition (2000), W B Saunders Co, ISBN: 0721662544, http://www.amazon.com/exec/obidos/ASIN/0721662544/icongroupinterna
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Dorland’s Electronic Medical Dictionary by Dorland, et al, Software, 29th Book & CD-Rom edition (2000), Harcourt Health Sciences, ISBN: 0721694934, http://www.amazon.com/exec/obidos/ASIN/0721694934/icongroupinterna
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Dorland’s Pocket Medical Dictionary (Dorland’s Pocket Medical Dictionary, 26th Ed) Hardcover - 912 pages, 26th edition (2001), W B Saunders Co, ISBN: 0721682812, http://www.amazon.com/exec/obidos/ASIN/0721682812/icongroupinterna /103-4193558-7304618
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Melloni’s Illustrated Medical Dictionary (Melloni’s Illustrated Medical Dictionary, 4th Ed) by Melloni, Hardcover, 4th edition (2001), CRC PressParthenon Publishers, ISBN: 85070094X, http://www.amazon.com/exec/obidos/ASIN/85070094X/icongroupinterna
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Stedman’s Electronic Medical Dictionary Version 5.0 (CD-ROM for Windows and Macintosh, Individual) by Stedmans, CD-ROM edition (2000), Lippincott Williams & Wilkins Publishers, ISBN: 0781726328, http://www.amazon.com/exec/obidos/ASIN/0781726328/icongroupinterna
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Stedman’s Medical Dictionary by Thomas Lathrop Stedman, Hardcover 2098 pages, 27th edition (2000), Lippincott, Williams & Wilkins, ISBN: 068340007X, http://www.amazon.com/exec/obidos/ASIN/068340007X/icongroupinterna
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Tabers Cyclopedic Medical Dictionary (Thumb Index) by Donald Venes (Editor), et al, Hardcover - 2439 pages, 19th edition (2001), F A Davis Co, ISBN: 0803606540, http://www.amazon.com/exec/obidos/ASIN/0803606540/icongroupinterna
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INDEX A Abdomen ..14, 75, 97, 131, 134, 145, 297, 300, 302, 309, 312 Abdominal........37, 58, 119, 130, 293, 304 Acetylcholine .................................75, 303 Acetylcysteine........................................92 Adenosine................................61, 71, 287 Agonist....71, 73, 130, 145, 289, 290, 297, 303 Algorithms............................................105 Alprostadil........16, 91, 116, 120, 242, 271 Anastomosis ........................................118 Androgens ...........................264, 270, 277 Anemia ..................90, 106, 108, 157, 173 Anesthesia...................................125, 130 Aneurysm ................................14, 35, 288 Angiography ........................................268 Angioplasty ............................................85 Anorexia ..............................................122 Antidepressant.....................................265 Antigen ..........................75, 139, 140, 301 Antihypertensive .......59, 71, 73, 97, 200, 265, 290, 297, 298, 306 Antioxidant...........................................209 Anxiety..13, 15, 30, 80, 91, 122, 137, 158, 167, 216, 261, 262, 264, 265, 266, 268, 269 Apomorphine ...........................54, 55, 107 Aqueous ................................................86 Arrhythmia ...................................161, 289 Arterial ..31, 35, 36, 37, 60, 80, 84, 90, 93, 96, 167, 263, 268, 288, 291, 298, 304 Arteries .12, 13, 15, 17, 18, 19, 30, 72, 80, 87, 90, 94, 125, 137, 166, 167, 262, 263, 279, 289, 292 Arteriography .......................................273 Assay.....................................................62 Atrophy ................................................173 Atropine .......................................201, 308 Autonomic....................104, 264, 279, 287 B Balanitis ...............................................273 Bereavement .......................................129 Bilateral..................................................64 Biochemical ...................................68, 277 Biopsy............................................97, 305 Blindness .....................101, 122, 130, 291 Bromocriptine ......................................270 Bronchitis ...............................................92 Bronchoscopy........................................92 Buccal ......................................83, 96, 290
Bulbar.......................................... 177, 290 C Calcitonin .............................................. 85 Calculi ................................. 105, 107, 141 Capsules ............................................. 239 Captopril................................................ 92 Carbohydrate ................ 96, 131, 238, 296 Cardiac................................ 125, 200, 302 Cardiovascular ... 117, 123, 138, 139, 199, 200, 209, 288, 302 Cataract ...................................... 130, 291 Catheterization...................... 95, 125, 288 Causal................................................. 260 Cerebral ........................ 37, 129, 209, 304 Cervical ............................................... 121 Cholesterol... 93, 102, 120, 200, 236, 238, 264, 279, 296, 301 Chronic... 13, 35, 64, 65, 80, 84, 103, 127, 129, 157, 200, 212, 264, 265, 292, 302 Cimetidine ............................................. 13 Circumcision ....................................... 105 Cirrhosis.............................................. 119 Claudication ............................ 60, 87, 209 Coitus...................... 86, 96, 131, 292, 293 Colitis .................................................. 118 Concomitant................................ 259, 261 Conduction............................ 55, 267, 283 Confusion............................................ 259 Congestion...................................... 59, 81 Conjugated............................................ 85 Constipation ........................ 100, 119, 120 Constriction .. 97, 103, 124, 136, 145, 272, 274, 300, 311 Contraception ..................................... 117 Copulation............................... 38, 91, 305 Coronary ............................... 37, 266, 304 Cyclic ... 61, 65, 69, 72, 82, 132, 263, 291, 301 Cystitis .......................................... 42, 105 Cystoscopy ........................................... 92 D Debrisoquin................................... 72, 293 Defecation............................. 49, 118, 298 Degenerative .. 75, 82, 133, 237, 304, 308 Dementia............................................. 209 Desensitization ................................... 216 Diaphragm .......................... 121, 130, 293 Diarrhea .................. 59, 73, 119, 236, 294 Diathermy............................................ 125 Dilatation ......................... 35, 95, 168, 288 Distal ........................... 38, 64, 76, 87, 307
Index 315
Dorsal ......................................62, 64, 267 Dyspareunia ........................................118 Dyspepsia..............................................59 E Ejaculation ....11, 13, 27, 64, 83, 125, 128, 136, 140, 156, 216, 272 Elastic ..............................................16, 82 Electrolyte..............................76, 107, 306 Electromyography................................267 Electrophysiological.........................64, 65 Emphysema...........................................92 Endocrinology..........63, 68, 145, 260, 297 Endogenous ..........................................84 Endoscopy.............................................92 Endothelium...........................................62 Enterotoxins...................................73, 294 Enuresis...............................105, 131, 294 Enzyme........36, 66, 72, 87, 120, 292, 294 Erythromycin........................................120 Erythropoietin ......................................106 Exogenous.......................83, 96, 291, 295 Extremity..........................31, 38, 267, 305 F Facial ...................................133, 139, 303 Fatal.......................................................54 Fatigue.......................35, 43, 90, 119, 289 Femoral .........................................87, 267 Fibrosis ............35, 94, 209, 271, 273, 292 Filtration.......................................133, 309 Flaccid ...................................30, 167, 263 Flushing .........................................59, 139 Frigidity ..........................................71, 212 G Ganglion ................................................62 Gangrene.............................................117 Gastroduodenal .............................73, 296 Gastrointestinal.....92, 101, 117, 200, 209, 296 Genital .....39, 73, 105, 145, 296, 297, 311 Genitourinary .................68, 107, 124, 144 Genotype .......................................76, 305 Glucose ..74, 96, 100, 120, 121, 122, 123, 127, 131, 136, 137, 282, 296, 297, 299 Groin ....................................................108 H Happiness............................................118 Heartburn.....................................102, 119 Hematology ...........................................10 Hematuria ....................................105, 107 Hemorrhage.........................................125 Hemostasis..........................................125 Hepatitis...............................................119 Hormonal ..13, 14, 30, 63, 83, 87, 89, 127, 132, 277, 302 Hormones ...63, 68, 76, 97, 121, 138, 277, 279, 280, 288, 300, 307, 310
Hyperplasia ...... 31, 39, 42, 68, 105, 108, 114, 123, 125, 140, 156, 168, 200, 295, 308 Hypertension.. 31, 38, 58, 59, 76, 93, 101, 123, 129, 200, 264, 266, 271, 302, 305, 306 Hypogonadism ..... 30, 58, 63, 83, 93, 264, 267, 270, 277 I Iatrogenic .............................................. 89 Immunohistochemistry.......................... 62 Implantation .............. 55, 56, 85, 124, 127 Incision.......................................... 37, 299 Incontinence ...... 42, 57, 104, 105, 107, 108, 123, 125, 129, 140, 168, 201, 308 Indicative...... 39, 77, 270, 279, 298, 309, 311 Infertility ....... 39, 102, 105, 108, 114, 115, 129, 130, 141, 143, 290, 311 Infiltration .............................................. 94 Inflammation .. 35, 38, 132, 133, 287, 292, 299, 308 Influenza ............................................. 102 Infusion ....................................... 268, 273 Ingestion ............................. 239, 264, 306 Inhalation ...................... 89, 199, 288, 306 Innervation .......................... 262, 263, 264 Insomnia ............................................. 100 Insulin....... 61, 62, 74, 100, 120, 123, 131, 296, 299 Intermittent .......................................... 209 Interstitial.. 35, 38, 42, 105, 161, 290, 292, 308 Intestines............................................. 119 Intramuscular ...................................... 270 Invasive.. 15, 59, 124, 126, 158, 166, 243, 265, 268, 273 Irrigation ................................................ 87 Ischemia................................................ 85 J Jaundice.............................................. 119 K Ketoacidosis ............................... 100, 101 L Lamivudine.......................................... 119 Laparoscopy ......................................... 92 Lesion ................................................. 267 Libido ..... 59, 91, 100, 127, 128, 136, 279, 288 Ligament ................................. 38, 86, 307 Ligation ............................. 18, 26, 27, 272 Lipid . 14, 74, 88, 101, 200, 209, 266, 267, 279, 296, 299, 301 Lipoprotein .......................... 264, 279, 301 Lobe .................................................... 125 Locomotor ............................................. 64
316 Impotence
Lubrication ...........................121, 132, 301 M Malignant ...............................................67 Mediator.................................................61 Medicament ...........................................88 Medullary ...............................................64 Membrane ...11, 38, 39, 76, 304, 305, 309 Menopause.100, 101, 102, 105, 121, 132, 302 Menstruation................121, 132, 301, 306 Mental .....12, 36, 38, 76, 86, 98, 133, 137, 203, 206, 209, 259, 293, 295, 305, 307 Metoclopramide ...................................120 Microcirculation......................................84 Micturition ........................................64, 67 Molecular ..10, 61, 66, 68, 72, 76, 92, 134, 164, 170, 172, 213, 291, 307, 309, 311 Monotherapy........................................271 Morphogenesis ......................................67 Myopathy ...............................................55 N Narcotic ...............................................120 Nausea ..........................................54, 119 Neoplasms...........................107, 132, 302 Nephropathy ........................100, 136, 157 Neural ..............................64, 67, 237, 263 Neuralgia .............................102, 133, 303 Neurologic .............57, 124, 136, 267, 268 Neuromuscular ......................43, 279, 287 Neuronal ......................................262, 264 Neurons ...................62, 77, 145, 303, 310 Neuropathy .......55, 65, 67, 100, 101, 103, 104, 120, 136, 137, 157, 264, 266 Neurotransmitter 68, 71, 75, 279, 287, 303 Niacin...................................................237 Nicotine................................................137 Nitrates ..................................59, 139, 151 O Oral ..... 15, 19, 25, 26, 27, 32, 37, 39, 54, 55, 59, 90, 103, 123, 124, 126, 128, 142, 166, 167, 247, 270, 277, 291, 304 Orgasm ....................11, 13, 121, 128, 136 Osteoarthritis .......................................100 Osteoporosis ...............................100, 102 Overdose .............................................237 P Palpation..............................267, 280, 304 Pancreas ...............................74, 100, 299 Papaverine ..........16, 69, 89, 90, 242, 271 Particle.................................................273 Pelvic ..38, 43, 62, 64, 118, 167, 266, 268, 307 Penicillamine .........................................92 Percutaneous ........................................88 Perianal ...............................................267 Perineal .........................................64, 268
Phenotype..................................... 76, 305 Phentolamine ...... 16, 19, 55, 69, 242, 271 Phimosis ............................. 273, 279, 290 Phobia................................. 122, 133, 305 Pigmentation ....................................... 119 Piperoxan.............................................. 93 Plexus ........................................... 80, 243 Poisoning .............................. 71, 212, 289 Polypeptide ......................................... 263 Postnatal ....................................... 67, 105 Postoperative ................................ 57, 125 Potassium ................... 155, 200, 238, 302 Prazosin ................................................ 55 Premenstrual .............................. 121, 209 Prevalence . 25, 59, 83, 93, 122, 141, 258, 260, 261, 276, 277 Priapism .... 16, 91, 93, 116, 264, 266, 271 Progressive ................... 58, 124, 274, 293 Prolactinoma............................... 107, 127 Prostaglandins .............................. 87, 243 Prostate...... 13, 42, 49, 57, 100, 105, 108, 123, 125, 139, 140, 166, 168, 267, 270 Prostatitis ...................... 42, 139, 167, 266 Prosthesis .. 27, 28, 29, 56, 124, 142, 143, 144, 167, 273 Proximal ........................................ 72, 293 Psychiatric..................... 55, 122, 266, 271 Psychiatry ........................................... 260 Psychic...................... 37, 76, 86, 302, 307 Psychogenic ...... 55, 125, 211, 214, 216, 262, 264, 265, 267, 268, 273 Psychology.......................................... 260 Psychotherapy . 19, 55, 84, 122, 126, 136, 273 Psychotropic ....................................... 122 R Receptor . 65, 68, 120, 145, 200, 289, 295 Rectal............ 30, 134, 140, 167, 267, 309 Recurrence ................................... 77, 308 Reflex.................................... 64, 262, 267 Regeneration .......................... 35, 61, 292 Relaxant.................. 16, 37, 140, 271, 304 Reoperation .................... 56, 76, 273, 308 Resection .................................... 125, 140 Respiratory...................... 57, 92, 132, 299 Retinopathy......................... 100, 123, 136 Retrograde .......................... 125, 128, 140 Riboflavin ............................................ 236 Rigidity .................. 18, 80, 86, 89, 94, 263 S Sclerosis ......... 13, 90, 117, 129, 173, 266 Selenium ............................................. 238 Serum .. 77, 101, 200, 241, 267, 270, 296, 308 Species .... 77, 91, 96, 132, 292, 302, 309, 312
Index 317
Spectrum .......10, 123, 200, 274, 276, 300 Sphincter .................64, 77, 118, 267, 309 Spotting .........................................16, 271 Stabilization .................................106, 155 Sterility.........................................132, 299 Sterilization ..........................................121 Stomach ........................73, 120, 139, 296 Suppository..........................107, 134, 309 Symptomatic..................................77, 310 Synaptic ...................65, 75, 145, 303, 304 Systemic .......14, 30, 58, 85, 88, 117, 138, 241, 267 T Taboo ..................................................158 Testicular .....................108, 270, 279, 296 Testis ...........................267, 279, 296, 311 Thermoregulation ................................236 Thrombosis..........................................125 Thyroxine.............................................238 Tinnitus ........................................100, 209 Topical .....26, 27, 39, 84, 85, 90, 153, 310 Toxicity ..........................................85, 209 Toxicology .....................................10, 165 Transdermal ........................................242 Transplantation............100, 107, 119, 141
Transurethral .... 30, 87, 90, 125, 140, 156 Tricyclic ................................. 35, 120, 288 U Ulcer...................................................... 13 Ultrasonography ......................... 268, 273 Urethritis.............................................. 105 Urinalysis ........................ 14, 39, 267, 311 Urogenital.......................... 64, 67, 73, 296 Urology....... 10, 60, 63, 67, 105, 107, 114, 116, 123, 124, 260 V Vaginal ........ 120, 121, 132, 134, 301, 309 Vasoactive ........ 87, 88, 90, 107, 138, 263 Vegetarianism ..................................... 102 Veins ...... 12, 13, 15, 17, 18, 19, 97, 137, 166, 280, 306, 312 Venous....... 26, 27, 37, 80, 125, 167, 243, 263, 268, 272, 304 Venus.................................................... 80 Virulence ....................................... 98, 310 Viscera .................................................. 64 W Withdrawal ............................ 38, 262, 305 Y Yohimbine ..... 15, 26, 55, 59, 83, 243, 270
318 Impotence
