We Are Under Stress

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What Happens to Our Bodies When We Are Under Stress?

Studies also show that men and women handle stress differently. This may in part be due to biological reasons. Also, men often don’t have the strong social support networks that women have to turn to during times of stress. These social supports may help explain why women, in general, seem to be better able to cope with stress than men.

Modern life can be stressful and Irish men seem to have become increasingly susceptible to stress and other mental health problems. Large numbers of Irish men suffer from stress, but often in silence. Irish men are slow to seek help with mental health issues, including stress. This may be for many reasons, including ignorance, fear, embarrassment or the perception that admitting to being stressed in some way implies inadequacy or weakness. It goes back to the attitude that ‘real’ men don’t go to the doctor and that big boys don’t cry. Unfortunately this type of attitude does nothing to help Irish men or their loved ones. Check this product at http://www.hqcanadianpharmacy.com tretinoin no prescription.

Is Stress Harmful?

The precise mechanisms that govern the interactions between stress and ill-health remain poorly understood. However, it is felt that chronic stress can affect the quality of the immune system, causing the body’s own natural defences against illness to be lowered. One possible explanation for this is that prolonged job stress may affect the nervous system. Another possible reason for this is the fact that chronic stress may affect the body’s hormonal balance and result in a weakened immune system.

Chronic stress is a risk factor for heart disease. Research has found a link between chronic stress and the development of heart disease, type 2 diabetes and metabolic syndrome. Metabolic syndrome is the presence of three or more of the following five factors: high blood pressure, central obesity (excessive abdominal fat), raised blood fat (triglycerides), low HDL cholesterol and raised blood sugar.

Chronic stress is also associated with many other medical conditions, including:

  • Irritable bowel syndrome
  • Migraine
  • Psoriasis
  • Tension headaches
  • High blood pressure
  • Some cancers
  • Depression
  • Hair loss
  • Diabetes
  • Ulcers
  • Burnout
  • Heart disease and stroke

Stress and Heart Disease

Chronic stress – or rather distress – is thought to be a risk factor for heart disease in later life. Anger and hostility can be powerful emotions with the potential to trigger a heart attack.

The link between stress and heart disease is complex and not fully understood. If you feel stressed, your body will produce more stress hormones. Although they are useful in small quantities, too much of these hormones, continuously and over time, can damage your arteries and may lead to high blood pressure. Also, when life becomes pressurised, people are more likely to smoke more cigarettes, drink more caffeine, drink too much alcohol and be less physically active. All of these things can contribute to heart problems.


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Nicotine is the primary psychotropic substance in tobacco and its relevance for erections is that it disrupts a wide range of neurotransmitters, some of which are required for an erection. We will examine the chain reaction required for an erection to happen in Step 5, but for now, we can borrow from The Centers for Disease Control and Prevention of the USA that ED is approximately 85 percent higher in male smokers compared to non-smokers and increases the risk of ED more than 50 per cent in men in the 30-40 year age group.

Apart from the disruption to necessary neurotransmitters each puff also introduces millions of free radicals into a smoker’s body. These free radicals interfere with the desired effect of Nitric Oxide. So, you can forget all the cinematic marketing association of smoking with sex. It is a major source of ED Viagra Online Australia and unfortunately, its severe addiction properties is a major hindrance to the enjoyment of sex.

The most serious long term damage of smoking is artery disease. It is called Atherosclerosis and we have reviewed it in the Heart section above. It is worth repeating that it means a narrowing or blockage of the arteries and inhibits blood flow. It is so toxic for blood vessel health that even second hand smoking has been found to affect ED. Apart from ED, nicotine and other cigarette ingredients also cause reduced volume of ejaculation, low sperm count, and sperm problems. Need I say more?

Is it a lost cause? Whilst Atherosclerosis is not reversible, the good news is that on giving up smoking, risk of developing smoking related diseases like cardiovascular problems diminishes dramatically within a few years. But developed problems may be irreversible. Here is a summary of smoking effects on erections:

* Acute, Low Dose use: Possible decreased erection increasing with Age and Diabetes.

* Acute, High Dose use: Erection problems.

* Chronic use: Dose-driven ED problems.

* In Withdrawal mode: ED problems may be irreversible with long term use; possible return to normal function.

* Post Withdrawal phase: ED problems may be irreversible with long term use; possible return to normal function.

We can safely conclude that if you are a long term smoker and do suffer from ED then it is a contributory source of your ED and you need to look at giving up smoking as an initial step. Hard, I know, but we are talking about getting the most out of life’s most beautiful experiences here.

If you are hooked and just cannot give up, research has shown that high doses of vitamin С and E and other antioxidants can help restore some production of Nitric Oxide in smokers. We are talking about high doses here – lOOOmg of Vitamin С and 800iu of vitamin E and a high dosage of anything as a supplement usually has side effects and cannot be a good thing. Also Researchers at the Royal College of Surgeons in Ireland discovered that Taurine, an amino acid found in fish, helps heal nicotine damaged arteries. My recommended Nutrition advice in Step 6 incorporates normal inputs of these.

Even if there aren’t other sources and you do stop smoking, the Therapy exercises are still needed to get your mind (Step 8), body (Step 9), and favourable expression of your sexual needs (Step 10) to treat the resultant ED condition that has developed. Step 6: Lifestyle and Nutrition is a must for all smokers.

Enlargement of the Prostate or Benign Prostatic Hyperplasia (BPH)

What Causes the Prostate to Enlarge?

There may be genetic factors involved. There may also be dietary factors involved, such as eating a lot of saturated fat and eating only small quantities of fresh fruit. Obesity is associated with more severe BPH symptoms. Regular exercise is thought to protect against BPH, as can moderate amounts of alcohol. The same healthy lifestyle choices for optimal health discussed earlier also seem to apply to this condition.

How Common Is BPH?

Benign enlargement of the prostate is very common and is almost a normal part of ageing. Its incidence rises dramatically as you age.

As you can see above, after a certain age it would be unusual not to have symptoms of an enlarged prostate.

Symptoms and Signs of BPH

You may have BPH and no symptoms whatsoever. However, as the prostate enlarges, it eventually begins to squeeze the urethral tube going through its centre. The common symptoms of BPH can include some or all of the following:

  • The need to urinate more frequently
  • Nocturia – the inability to sleep through the night without having to get up to urinate. Getting up at night several times to pass urine would not be unusual.
  • Urgency – the sudden, intense and sometimes uncontrollable urge to urinate quickly.
  • Difficulty in starting urination, also known as hesitancy
  • Weak stream – the flow of urine may be slow or weak and urination may be characterised by a repeated start-stop pattern that requires additional straining.
  • Terminal dribbling
  • Leaking or dribbling of urine. In more severe cases, a patient may develop ‘urge incontinence’, or the inability to get to the bathroom before losing control of their bladder.
  • In severe cases, urine retention can occur, resulting in a complete inability to urinate (this is, however, rare).

These symptoms are known together as ‘prostatism’. They can vary widely from one individual to another and men cialis pills Australia with similar degrees of prostate enlargement may be affected quite differently. This is an important point as ultimately any treatment decision for BPH should be judged on whether the symptoms are affecting your quality of life sufficiently to justify active treatment.

Diagnosis of BPH in its earlier stages can lower the risk of developing complications. The American Urological Association has devised a useful scoring system for BPH. This can help assess the severity of BPH and the need for treatment. It can be a useful monitoring tool to see if your BPH is getting worse over time. Check out the questionnaire on the next page and see how you fare.

Medical complications from BPH are uncommon. Occasionally it can progress to cause retention of urine but this tends to happen slowly over time. Other recognised complications can include kidney damage, bladder damage, urinary tract infections and bladder stones.

Note that I said “we” because the basis of this Step by Step Therapy is to empower you to treat your ED condition with my guided help. Available treatments are:

1. My Step by Step Therapy including Lifestyle & Nutrition.
2. Visiting a Doctor or sex therapist.
3. Specialist medical help for” plumbing issues”.
4. Pharmaceutical interventions like Viagra, Cialis, Levitra et al.
5. Other Props:
a. Invasive Devices and Mechanical Interventions
b. Alternative Treatments: Viagra Australia Pharmacy

The treatment will depend on the source(s) of ED you will identify in Step 3. You will see that some of the Sources of ED come from medical conditions (what I like to call plumbing issues) that need an invasive procedure or specialist help. They have to be fixed separately and I will summarise what specialist help to seek in Step 4.

Assuming there are no plumbing issues that need fixing, there is no substitute to My Step by Step Therapy (i.e. Behavioural Therapy and Psychotherapy) and my advice on Lifestyle & Nutrition. This is the basis of my Steps 5-11 that follow. For some of the sources, Pharmaceuticals may also be relevant and at the end of this Step I provide all the information you need on Approved Pharmaceuticals so that you can make an informed decision should you require to access them.

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I strongly believe that through guided self help you will achieve your goal quicker than visiting a Doctor or good sex therapist which involves substantial cost and time to achieve the same result. Finally, absorbing my Therapy will give you the powerful knowledge for lifelong management of your ED condition. Not to mention the development of your sexual persona or prowess. Let’s repeat how my Step by Step Therapy works in a bit more detail:

– In the next Step 3, you will identify the Source(s) of your ED condition. You will also identify what I call any plumbing issues that need to be fixed and they have to be addressed with the relevant specialist first.

– Step 4 includes my algorithm to advise the primary and secondary targeted Therapy Steps. The primary Therapy is based on the identified source(s) of your ED condition from Step 3. The secondary recommended Steps will get you to absorb the remaining Steps because completing all the Steps will empower you for lifelong management of your ED condition and develop your sexual prowess. And, as you probably guessed, knowledge is power.

– As knowledge is power, you will find out all about erections and how they happen in Step 5.

– Steps 6-11 will provide all the Therapy you need and will develop your sexual persona and prowess whilst you are having fun treating your ED condition. What I mean by sexual persona and prowess is that there is a lot more to sex than just the Therapy resources that help to get your Dick erect. The Therapy treatment set out in Steps 6-11 is as follows:

Step 6: Lifestyle & Nutrition. This is relevant for everyone.
Step 7 will prepare you for the following exercises/workouts.
Step 8 will get you to bring The Correct Mindset to sex encounters.
Step 9 will get you Get to Know your Body.
Step 10 will get you to discover the Situation Condition Factors that uniquely work for you and express your sexual needs.

And if and when you have a Partner, Step 11 will get you together.

Sounds daunting? Well, we are talking about regaining control over one of life’s most beautiful experiences here and there is absolutely no reason why with a bit of application you shouldn’t continue to enjoy sex.

Getting back to what else is available, there have been great strides in the development of pharmaceuticals and, if they are right for you, I will provide you with all the information you need to make an informed choice. One recent development showing some promise but needing a lot more research is low-intensity shock wave therapy (LI-ESWT). This therapy uses sound waves normally used for breaking up kidney stones. These low intensity sound waves have been shown to improve blood flow to the heart and increase blood vessel growth. Because of this, researchers believed that the waves may help to increase the blood flow to the penis in patients with ED. It is early days and more work is needed to show how it improves blood flow and in what types of ED it might work for.

Finally, Other Props such as Invasive Devices and Mechanical Interventions are props best relegated to extreme situations and Alternative Treatments do not stand the test of proof that they work. As we have to cover all the bases let’s now review them. I am confident they will confirm my therapy as invaluable. If you want to Fast Track you can skip to the Map Fix: Other Props Conclusion later on in this Step.

Knowing of the advanced illness or mortality of a parent has a dramatic effect on the developing child. One study examined adolescent adjustment before and after an HIV-related parental death. Sexual risk behaviours increased after death and were sustained over the subsequent year and beyond. While the authors attribute this to adolescent developmental intimacy, it also may reflect the teens’ need to ‘connect’ in the face of such a loss and combat ongoing feelings of isolation and depression.

In cases where the parent is alive, there is often an enormous sense of guilt regarding transmission to the child and a strong need to protect the child from further harm:

I don’t want to talk with her about [sex] because I don’t want to give her any ideas. I don’t want her making the same mistakes I did. (Parent of child at Mount Sinai Hospital)

The worry is both about children having sex and, as a result, putting others at risk. However, not talking about it does not prevent the child or young person from having sex. Additionally, many parents of HIV-positive children do not want to talk about sex or HIV with other people in case the dialogue forces other disclosures about the parent’s past. It:

…opens a huge can of worms – I’m not ready to go there yet. I don’t want her knowing what I did. (Parent of child at Mount Sinai Hospital)

An HIV-positive teenager who was pregnant excitedly told her mother. Her mother said that, if she kept the child, she would kick her out of the house. The teen was forced to have an abortion. This is a situation in which the mother is also HIV-positive. The mother could not bear the thought of her own daughter having to live with the same guilt that she did. This places the child at emotional risk. How can she believe that her mother cares for her [as an HIV-positive teenager] when she demanded she abort a child because the child might be HIV-positive?

HIV-positive children and the experience of pregnancy

Pregnancy and the choices that people make in life about pregnancy can be complicated. In the case of children and young people who are HIV-positive, the choices about having a child may be conscious or unconscious, spoken or unspoken. There is research that suggests that those who lack emotional support and stability look to early sex and motherhood to pro-vide closeness. It has also been suggested that those with limited life options and choices are more likely to become pregnant.

In one situation there was a teenager who was quite aware that she was gravely ill. She wanted to do everything in a short time frame. For her, getting pregnant was a way of strengthening the connection to her boyfriend. She had a child about a year and a half before she died. The baby was not infected.

Erectile dysfunction in young men is a statement that seems far-fetched according to many people. It is believed that erectile dysfunction is a condition that normally affects old people i.e. people over the age of 40. This fact might have been true in earlier times, but not today. Nowadays, many young men suffer from ED all around the world. This statistic is even made worse by the fact that most of them do not seek medical advice for their condition. They prefer not to disclose this condition and live with it. Before we can continue with the causes and possible cures for erectile dysfunction in young men, let us look at this condition. ED is a sexual disorder that is common among men and is characterized by a person lacking the ability to achieve and sustain an erection during sexual intercourse. Young men are becoming susceptible to the condition because of their lifestyles.

Various reasons can cause ED in young men. Doctors often have a difficult time diagnosing the exact cause of erectile dysfunction in young men. However, research has shortlisted some potential causes of this disorder in young men around the world.

Some of those causes include:

Psychological issues: These issues play a large part in causing dysfunction according to many researchers. Some of these issues may include anxiety before sexual activity, especially if you are doing it for the first time, sexual issues which occurred at an early age and other mental issues. If the young man’s mind is not in a sexual state, sexual intercourse becomes very difficult because sex is a state of mind.

Health ailments: Health conditions that are poor can cause erectile dysfunction in young men. Obesity, heart disease, diabetes, and many more affect the man’s sexual function. Surgical procedures can also affect a young man’s ability to get an erection.

Lifestyles that are unhealthy: The lifestyles that most young men lead are very unhealthy and this makes them prone to sexual disorders like ED. Bad habits like binge drinking, smoking, hard drugs and stimulants are very common in college situations. College and high school students will often indulge in such behaviors so that they can fit in with their peers. What they do not know is that these habits have a direct impact on their health and especially their sexual health. Alcohol, cigarettes, stimulants and hard drugs affect the nervous system thus blocking brain signals responsible for sexual stimulation and arousal.

If you are a young man suffering from the erectile dysfunction, you can use certain treatments, which can help you deal with the condition.

They include:

Medical treatments: Oral pills are the most popular forms of medical treatments. It is no different with erectile dysfunction in young men. Most of these pills are PDE5 inhibitors like Viagra Australia, Levitra, Sildenafil and many more. Injections, pellets, prosthetic implants and surgery complete the list of ED medical treatments.

Natural treatments: This is by far the best form of ED treatment that you can indulge in. This is because the cures are not harmful to your health and do not have serious side effects unlike the medical treatments. Herbs, spices and aphrodisiacs fall into this category and have the power to cure erectile dysfunction. Other natural home remedies include eating plenty of green veggies, fresh and dry fruits. This will certainly go a long way in easing the symptoms of ED.

Psychological treatments: Seeking the services of a therapist might also cure the problem completely. Counseling will help determine the exact cause of the psychological problems causing ED. Erectile dysfunction in young men can be and is very serious condition, and none of the above treatments should be attempted before consulting a doctor.

The Common Male Worry—Sexual Boredom

Understanding these arousal styles helps you address a common male concern—sexual familiarity. You worry that sex with the same partner will become too familiar and arousal will become more difficult. If sex becomes too predictable, monotonous, boring, routine, the fear is that it will result in sexual dysfunction. Pornography producers understand this fear, which is why traditional magazines like Playboy or Penthouse are not one-time publications but monthly editions and why Internet sites have endless variety. Men who are burdened with this fear of boredom futilely demand excessive sexual variety from their partner or turn to pornography or sexual acting out.

The mistake is to believe that sexual arousal is solely dependent on variety and freshness. This reflects an overreliance on partner interaction arousal. When a man learns that sexual function with his partner is easier and more reliable with sensual self-entrancement and this can be supplemented with role-enactment arousal, his worry of sexual boredom and dysfunction is calmed. Healthy sexuality blends the multiple purposes for sex and multiple arousal styles.

Value Your Partner as Your Sexual Friend and Be an Intimate Team

In a one-night stand or a paid sexual encounter, the focus is on erotic sexuality; intimacy can interfere with sexual response. However, in a sexual friendship, serious relationship, or marriage, sex is part of an intimate relationship. Sex exists in the context of your real life activities, including dealing with chores, parenting, and conflicts.

Men traditionally pursue connection and emotional intimacy through sex. Sexuality for both men and women includes desire, arousal, orgasm, and satisfaction. At a minimum, being an intimate team means not treating sex as a power struggle or being coercive. Ideally, it means seeing your partner as your intimate and erotic friend, where touching and sexuality can serve a number of positive emotional and physical roles, and where you share positive as well as disappointing experiences without blaming.

Integrate Sex Into Your Real Life and Your Real Life Into Your Sex Life

Your sex life changes as you age and grow. The role and meaning of sex is very different when you are a 15-year-old living at home, a 25-year-old young adult on your own, a 35-year-old man intent on conceiving his second child, a 45-year-old man feeling burdened with responsibility, a 55-year-old man who has launched his last child into college, a newly retired 65-year-old man, a 75-year-old man who is intent on beating the odds and maintaining physical health and sexual vitality, and an 85-year-old man who is enjoying a broad-based, flexible sexuality. The integration of varying life events into lovemaking recognizes the multiple purposes of sex. This can involve sex for anxiety release through orgasm, for emotional healing, for romance and emotional intimacy, and as a spiritual experience while sharing sadness about a parent’s death. Sexuality has many roles and meanings in a man’s life.

Realize That Good-Enough Sex Rather Than Settling for Mediocrity Is Genuine, Satisfying, and High Quality

This is such a central concept that we have devoted an entire chapter to it. Men worry that accepting Good-Enough Sex will somehow feminize them or means settling for second best. What nonsense. Theoretically, clinically, and personally we believe that the Good-Enough Sex model is the healthy, freeing, and realistic approach to male and couple sexuality. You are a sexual man, not a sexual robot/machine. Physically, emotionally, and relation-ally accepting sexual variability and flexibility is much superior to clinging to the traditional male model of perfect intercourse performance.

Closing Thoughts

It is crucial to establish a solid foundation for healthy male sexuality based on core concepts from the latest scientific findings and clinically relevant guidelines. Most of these new findings contradict the traditional macho sex role and perfect performance norm. Being a wise, confident, and strong sexual man entails awareness of healthy male (and couple) sexuality and adopting positive, realistic sexual expectations. You want to learn and adopt healthy thinking for healthy sexuality as a man.

Erectile dysfunction is a word that defines the inability of the males at the time of sexual association when they find themselves difficult to hold erection after having sexual stimulation. It is the situation which is different from other sexual incapability which also influences adversely the sexual relationship. Sometimes erectile dysfunction trouble leads to the broken relationship of the couples. It occurs due to many reasons that have made it most common ailment ever in the world but with the medication of kamagra Australia, a generic form of Viagra it is now possible to experience pleasurable and satisfying sexual life.

It is necessary to have patience when taking treatment of erectile dysfunction with any impotence drug but with the usage of Viagra or kamagra drug there is no need to have any wait for its outcomes. This unique medication initiates its tasks very soon as within 25 to 30 minutes after consuming it. This medication is manufactured with the Sildenafil citrate that impacts very finely to reduce the effects of PDE 5 enzyme. PDE 5 is an enzyme that is produced by male body when they are sexually arousal which raises interruption in the task of cylic GMP. Being a PDE 5 inhibitor Sildenafil citrate works by calming the tissues of penis and also by enhancing the blood flow in that area. After reaching the blood towards the penile region erection can be achieved by the males.

The online pharmacies are also progressive to give its users more and more benefits in the treatment of male erectile dysfunction. It is the best mode to buy this medication at very reasonable price as cheap kamagra can be obtained through the online services. Without any shipping charges it delivers your order at your doorstep in the midnight that assists to keep secrecy about the treatment of male impotence. Along with this medication is a symbol of reliability that has fetched more and more patients for applying this medication without any hesitation.

Thus Viagra online is not only a pharmacy but it is also remarked as the good companion of males who are facing the trouble of male impotence or erectile dysfunction. To select the best one pharmacy shop of online services is also a complex job but after getting the relevant Viagra online it will provide all the possible benefits to them not only just for treating themselves but also for making their sexual life more satisfying and congenial. Viagra and its generic form kamagra have solved this sexual problem of millions of people.

Vasoactive Medications

The penis is composed of two twin erectile chambers, the corpora cavernosa, which are surrounded by an elastic membrane called the tunica albuginea that stretches with an erection until the cavities become three times larger in size as this covering reaches its limit of stretch. The components of these two cavities are numerous cul-de-sacs, or endothelial-lined spaces surrounded by smooth muscle. For further information on the anatomy and physiology of the penis, see the chapters in Part I of this volume.

Agents that cause relaxation of this smooth muscle are very effective in allowing blood to flow into the penis, expanding the sinusoids and compressing subtunical venules to hold blood in the penis and to generate an erection. Conversely, agents that cause contraction of the smooth muscle are effective in reducing a prolonged erection (priapism). In recent years, a number of agents have emerged in various forms that affect the smooth muscle surrounding the sinusoids. As with many muscle cells elsewhere in the body, when the calcium content of the cell is lowered, the penile smooth muscle will relax. There are various transmitter substances, which, when released from nerve endings, will diffuse across the intercellular space to stimulate the enzyme systems within these smooth-muscle cells, eventually resulting in the loss of calcium from the cell and producing muscle relaxation. Nitric oxide has recently been discovered as one of the major transmitters that affects this action in penile smooth-muscle cells.

Oral Medications

The recent introduction of sildenafil citrate new zealand (Viagra) and subsequently vardenafil (Levitra) and tadalafil (Cialis) has revolutionized the treatment of erectile dysfunction. These compounds are type V phosphodiesterase inhibitors, and under the influence of sexual stimulation, have been found to be beneficial in enhancing and prolonging erections. When nitric oxide is released from nerve terminals, it diffuses across the interspace to the penile smooth-muscle cell, where it influences the guanyl cyclase enzyme system. This converts GTP to cyclic GMP, which results in decreased intracellular calcium concentration and smooth-muscle relaxation. Type V phosphodiesterase is the enzyme that degrades cyclic GMP to its metabolite. When this enzyme is inhibited by these compounds, cyclic GMP levels stay high, calcium stays out of the cell, and the smooth muscle stays relaxed.

For the three available type V phosphodiesterase inhibitors to work effectively, sexual stimulation is necessary and the penile nerves need to be intact in order to release nitric oxide. Absorption of these agents in the gastrointestinal tract is relatively rapid, and effects are sometimes seen in as short a time as 20 minutes after ingestion. Peak absorption occurs at 0.8 hours, and the drug’s half-life is between four and five hours for sildenafil and vardenafil. The window of opportunity for sexual activity with both of these agents is usually even beyond the five-hour half-life noted. By 24 hours, they are completely gone from the body. Tadalafil has a longer half-life of 17 hours and may be effective for up to 36 hours after ingestion. Overall, the success rate with the type V phosphodiesterase inhibitors has been 80% in psychogenic impotence and about 60% in organic erectile dysfunction.

Generally, the two groups of patients who do not respond as well to phosphodiesterase inhibitors are those with diabetes mellitus and those who have had radical prostatectomy. In clinical trials, the response in the latter group was 43%.

– If bilateral nerve-sparing prostatectomy has been performed, the response rate with sildenafil in patients who were previously potent is 72%.

– If only one nerve was spared during the prostate ablative procedure, the response rate with sildenafil falls to the range of 50%.

– If both nerves were removed during the prostatectomy, only a 15% positive response is seen.

These drugs have also been effective to some degree in patients whose erections have been diminished following brachytherapy or external beam radiation.

Side effects of these medications include headache, flushing, and dyspepsia. These side effects are uncommon and usually very well tolerated. They also tend to diminish with time as patients continue to take the medication. There have been a number of deaths reported in conjunction with the use of these drugs, but more recent studies have shown that they have no significant effect on the heart. A study of patients with cardiac disease measured cardiac dynamics before and after ingestion of sildenafil and found no difference— i.e., no effect of this medication on the heart muscle and function.

It should be noted, however, that there has been some synergy of type V phosphodiesterase inhibitors with nitrates in lowering the blood pressure, and for this reason, the American College of Cardiology has recommended that nitrates and these medications not be used simultaneously. In addition, phosphodiesterase inhibitors should be used with extreme caution in patients with congestive heart failure, myocardial disease, or in those on a complex antihypertensive regimen. In one set of clinical trials, no priapism was seen in patients using sildenafil; this was, however, a controlled group, and the medications that patients were taking in addition to the trial drug were limited. Now that these compounds are readily available, patients are using cocktails or mixtures with other treatments that enhance erections. In addition, they may be using these medications combined with other medicines that predispose to priapism, such as thioridazine (Mellaril), trazodone, or the phenothiazine compounds. Under these circumstances, prolonged, painful, and unwanted erections have been seen. The advent of sildenafil in 1998 has broadened the awareness of erectile dysfunction as a problem related to various disease processes. This awareness has brought many new patients into the clinic for treatment. Before the introduction of sildenafil, yohimbine (Yocon) was the most commonly prescribed treatment for erectile dysfunction. Most studies, however, have failed to demonstrate any significant benefit of yohimbine over placebo in the treatment of poor erections. A number of other oral preparations are now under study and in clinical trials for the treatment of erectile dysfunction. Intracorporal Injections – viagra sydney australia.

At the American Urological Association meeting in Las Vegas in 1983, Dr. Giles Brindley, a British pharmacologist, dramatically and memorably illustrated the effectiveness of intracorporal injections of papaverine by demonstrating to the audience his own erection induced by this medication. Following this graphic display, the use of this agent and other intracorporal injections rapidly gained popularity. Now, papaverine, phentolamine, and prostaglandin E1 (PGE1) (Caverject) (EDEX) alone or in combination are used effectively in generating an erection with up to 80% success. Both papaverine and PGE1 act directly on penile smooth-muscle cells via the cyclic AMP pathway to cause smooth-muscle relaxation by decreasing intracellular calcium. When injected into one portion of the penis, this effect is rapidly spread throughout the entire length of both corporal bodies by gap junction or cell-to-cell transmission. Phentolamine is a selective α-adrenergic adrenoceptor blocker that inhibits sympathomimetic amines such as norepinephrine and blocks contraction of penile smooth-muscle cells. It acts synergistically with papaverine and PGE1, but has not been practically effective by itself in generating an erection by intracorporal injection.

Almost 90% of patients following nerve-sparing radical prostatectomy will respond to intracavernosal PGE1, in contrast to only 66% of patients who have had non–nerve-sparing procedures. In addition, nearly 25% of the nervesparing prostatectomy patients who have responded did so at a low dose of PGE1, in contrast to those with non–nerve-sparing procedures, who required high doses of the same medication.

PGE1 may result in pain in some patients, and this is particularly distressing in cases of neurapraxia, which may be seen following prostatectomy. Montorsi et al. have shown that instituting intracavernous injections of PGE1 very shortly (two months) after performing radical prostatectomy will result in a return of spontaneous erections without medication at one year in 67% of patients. In a controlled group that was not treated with intracavernous injections of PGE1, only 20% of patients noted the spontaneous return of erections by that time interval. The exact mechanism for this is unknown, but it may be related to the prevention of a buildup of transforming growth factor in the low oxygen states associated with reduced penile blood flow. This leads to the occurrence of fibrosis in penile muscles. In the aging patient, it is well known that the more erections are used, the better they tend to work. Abstinence from sexual activity for a period of time as is necessitated by a surgical procedure and the subsequent recovery period is certainly contributory to sexual dysfunction in this regard. When approaching patients who are impotent before nerve-sparing prostatectomy, the surgeon should be aware that pharmacotherapy afterward will be more effective if the nerves have been spared. Priapism or prolonged painful erection has been seen about 7% of the time with papaverine and phentolamine and about 1% of the time using PGE1. Such erections are usually easily reversed using dilute sympathomimetic amine solutions such as epinephrine or phenylephrine injected intracorporally. The incidence of development of corporal fibrosis (i.e., penile plaques) varies from 1.9% to 16% in patients using a pharmacologic erection program. This can be minimized by less frequent use (less than twice a week), varying the site of injection, and compressing the site of injection for a period of about 30 seconds to prevent internal bleeding. Long-term follow-up studies with patients on intracorporal injections show a relatively high dropout rate in the range of 70% over three years. Reasons for discontinuation of therapy include a desire for a permanent treatment alternative, fear of injections with needles, poor response, lack of a suitable partner, comorbid health conditions precluding comfortable positions for intercourse, and loss of sexual spontaneity.


As men age or undergo surgical procedures that result in the loss of erection, ejaculation is usually preserved. This function consists of two components: “emission,” or the placement of semen in the prostatic urethra, and “ejaculation,” or the forceful expulsion of semen to the urethra and out the urethral meatus in a rhythmic fashion. During emission, the bladder neck or internal sphincter closes, and the prostatic muscles contract with the resultant expressing of semen or prostatic fluid into the prostatic urethra. During the ejaculatory phase, the rhythmic contraction of the vas deferens propels sperm to the prostatic urethra to mix with the seminal fluid and the rhythmic contraction of the bulbocavernosus and ischiocavernosus muscles propels the semen in spurts along the urethra and out the meatus.

With radical prostatectomy, the emission phase is lost, since there is no prostate to expel semen into the urethra and the vas deferens has been ligated. The ejaculatory phase, however, may be preserved and patients following radical prostatectomy will frequently reach climax – female viagra canada with adequate sexual stimulation. There is a feeling of pleasure and relief with the rhythmic contractions of the bulbous muscles but no elimination of fluid.

Other forms of treatment for prostate cancer, such as external beam therapy and brachytherapy do not significantly affect ejaculation per se. Premature ejaculation does not seem to be age dependent because it appears to be equally prevalent in younger and older men. Less direct, tactile stimulation prior to penetration, the use of distracting maneuvers such as the squeeze technique , and biofeedback exercises have all been used in the past with modest success. Recently, it has been found that the selective serotonin reuptake inhibitors (SSRIs) such as Paxil (paroxetine) 20 mg, given two to four hours prior to ejaculation, have been effective in 80% of the cases in prolonging ejaculatory latency.


As mentioned previously, prostate cancer is a disease of aging and is almost unheard of before the age of 40. As men reach this milestone, erections become less reliable. It should be noted, however, that each man’s particular environmental circumstance plays a major role in whether erection can be satisfactorily achieved. For example, if the patient is rested, erections will be easier to produce than when he is tired. Similarly, if the patient is distracted by pain, career or financial worries, or other such concerns, he will be unable to focus on sexual activity. This is in contrast to a man’s younger years—i.e., the teens and twenties—during which concentration is not very necessary to achieve an erection. In young men, only slight stimulation is necessary to achieve a complete erection rapidly. Also, as one ages, the importance of a partner’s participation becomes greater, and with the partner’s help, an erection will be more readily achieved. In addition to these environmental influences, comorbid features such as smoking, obesity, diabetes mellitus, hypertension, and hyper lipidemia that may further contribute to erectile dysfunction should be discussed and appropriate treatment and a change in lifestyle advised. Even though the treatments of prostate cancer may have a detrimental effect on erections, such counseling may be very beneficial in improving marginal erectile function. To fight erectile dysfunction buy Kamagra Australia.

Male Hormone Replacement

Male hormone, testosterone, is below the normal level in 7% of men below age 60 and 20% of men above age 60. The gradual decline of testosterone levels with age, termed “andropause,” occurs at about 1% per year. If this circumstance occurs, sex drive may be low, erections may be problematic, and energy level or enthusiasm for the activities of life may be reduced. Replacement of the male hormone may improve each of these three problems. As previously discussed, one treatment of advanced prostate cancer is the reduction/removal of testosterone. To date, such a study has never been done, but by inference, testosterone in the normal range—or even in the supraphysiologic range, which may occur with intramuscular replacement—may stimulate the growth of prostate cancer. Hence, it is recommended that patients with known prostate cancer not be given testosterone replacement as a treatment for sexual dysfunction unless the cancer is considered cured and it is believed that the individual patients in question would comply completely with follow-up evaluations.