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Effect of vardenail on blood pressure proile of on endothelial function of brachial and cavernous arteries. Vardenail improved erectile function in a “real-life” broad population study of men with moderate to 9. Real-life safety and eficacy of vardenail in the after repeated dosing for 7 days. This was a randomized, double- [54] Foresta C, Caretta N, Lana A, De Toni L, Biagioli A, Vinan-- blind, parallel-group, placebo-controlled, ixed-dose, zi C et al. Relationship between vascular damage degrees and endothelial progenitor cells in patients with erectile multicentre trial. Post-marketing surveillance study of the eficacy and experience before entering the study. Results are safety of vardenail among patients with erectile dysfunction in primary care. The most common adverse [56] Padma-Nathan H, Montorsi F, Giuliano F, Meuleman E, Auerbach S, Eardley I et al. At the time of writing, much of the data relating to [59] Zumbe J, Porst H, Sommer F, Grohmann W, Beneke udenail is available in abstract form only. Finally, a trial was conducted at ifteen sites in Korea to third study assessed the eficacy and safety of ude-- evaluate the eficacy and safety of the drug (level of nail 50 mg taken once daily [6]. Most adverse events were mild, while the plasma elimination half-life (T1/2) is 2. However, no de-- no clinically signiicant changes in laboratory values, tails are provided on adverse events that resulted electrocardiographic indings, or vital signs were in discontinuation in the different treatment groups. It is rapidly absorbed (Tmax rates increased signiicantly after mirodenail approximately 35 minutes) and has a short plasma treatment compared to placebo (68. It is a dimer formed by double-blind, placebo-controlled, parallel group, two lodenail molecules linked by a carbonate bridge. Lodenail carbonate 300 mg, taken 30 minutes before initiation of sexual has been shown to be more potent as an inhibitor activity [17]. The most common score between 7 and 24 were randomized to receive adverse event was headache. Metabolism and revealed the drug to be long lasting, maintaining excretion of 5-ethyl-2-{5-[4-(2-hydroxyethyl)piperazine- therapeutic levels for >24 hours in rats [20]. Eficacy and safety of oral adverse event while visual effects were noted at 80 mirodenail in the treatment of erectile dysfunction in men with diabetes: A multi -center, randomized, double blind, mg. At this time, four Phase 2a clinical studies have placebo-controlled, ixed dose, parallel group clinical trial. J Urol dosing: A randomized controlled trial J Sex Med 2006;3:180 2006;171:316 (abstract 1196). J [20] Sweetnam P, Campbell S, Grogan M, Kirk B, McGonigle Sex Med 2008;5:63 (abstract P-06-056). International Jour-- studies, and we have attempted to ensure that no nal of Impotence Research. Inter-- analyses in an attempt to identify relatively infrequent national Journal of Impotence Research. Cardiovascular safety of sublingual apomorphine in patients on stable doses of oral antihyper-- eficacious in the treatment of erectile dysfunction tensive agents and nitrates. American Journal of Cardiol-- in the broad population at doses of 2mg and 3mg ogy. There is a single level 2 study suggesting eficacy in the treatment of erectile dysfunction in men with erectile dysfunction secondary to diabetes [5]. The most common side effects are nausea, headache and dizziness, with small numbers of patients developing syncope. This latter side effect was particularly noted at doses higher than those licensed for use in Europe. In both studies, an erectile response intranasal placebo spray, or a placebo tablet plus an induced by bremelanotide administration was intranasal placebo spray in a randomized, crossover statistically signiicant at doses >7 mg compared design. The onset of the irst erection occurred demonstrated between combination therapy and in approximately 30 minutes. The combination treatment did not result in new adverse events or in an increase in the frequency common adverse events reported in both studies (up or severity of adverse events compared with sildenail to 33. Double-blind, max placebo-controlled evaluation of the safety, pharmacokinetic 1hour and mean t? ranged from 1. Major adverse events included nausea, emesis and blood pressure increases, and A number of studies have compared the eficacy and the discontinuation rates were dose-related and safety of the oral medications used in the treatment ranged from 4% in the placebo group to 53% in the of men with erectile dysfunction. Almost all the studies were pharmaceutically improved, but none reached statistical signiicance. The ability to achieve an “intense Tolra et al, 2006 [5] sildenail, 20% preferred vardenail and long lasting” erection was the main driver for preference for all three drugs the drug attributes most important in determining preference related to the Dean et al, 2006 [7] See Eardley et al, 2005 duration of action of the medication, and the rigidity of the erection that was achieved 34. In 7/19 no statistical differences satisfaction Rubio-Aurioles et al, 2006 [6] Scale Individual Statistical advantage for vardenail in 4/11 individual preference questions. An study [1,7,8] with the other published studies suffering open-label, randomized, lexible-dose, crossover study to from biases such as inadequate duration, inadequate assess the comparative eficacy and safety of sildenail citrate and apomorphine hydrochloride in men with erectile washout, and biased dosing [2-6]. Comparative cross-over study of sildenail and apomorphine for treating erectile the authors consider that several trials comparing dysfunction. An open- with other published studies suffering from design label, randomized, lexible-dose, crossover study to assess the comparative eficacy and safety of sildenail citrate and limitations [13-15]. All Level 1 studies were all open apomorphine hydrochloride in men with erectile dysfunc-- label studies, but all were otherwise well designed tion. Eficacy of apo-- morphine and sildenail in men with nonarteriogenic erectile dysfunction. Switching patients with erectile dysfunction from sildenail citrate to tadalail: results of a European multicenter, open-label study of patient the dawn of the age of pharmacologic treatment be-- preference. Clin Ther 2003; 25: 2724–37 gan 25 years ago with the recognition that vasoactive [4] Von KeitzA, Rajfer J, Segal Set al. A multicenter, randomized, drugs when injected into the penile erectile tissue were double-blind, crossover study to evaluate patient preference capable of initiating and maintaining erection [1,2]. Comparing These were relegated to second line therapy after vardenail and sildenail in the treatment of men with erec-- tile dysfunction and risk factors for cardiovascular disease: the appearance of effective oral phosphodiesterase- a randomized, double-blind, pooled crossover study. J Sex Med 2006; 3: 650–61 to progression of their disease and thirdly are a small [8] Eardley I, Montorsi F, Jackson G et al. Several observational reports and extension examining the eficacy of intracavernosal two randomized clinical trials are available for review. In a second observational series, 52 men psychogenic, or mixed causes, alprostadil also dem-- received 30 micrograms vasoactive intestinal poly-- onstrated signiicant eficacy. In this label lexible dose self-injection study in 683 men, report all patients obtained erection suficient for 94 percent of patients had better erections after the penetration with a median duration of treatment was injections. This was followed with a placebo-controlled determine the optimal dose, these patients used al-- phase, during which 171 patients were subsequently prostadil (up to 40 µg) at home for up to 6 weeks. The combination of vasoactive intestinal polypeptide We are able to conclude, on the basis of this evi-- and phentolamine appears to be safe and well dence that intracavernosal prostaglandin E1 is an tolerated. Most commonly observed adverse effects effective treatment for men with erectile dysfunction were facial lushing and headache, characteristic (Grade of Recommendation = A). Some evidence exists to fective as intracavernosal pharmacotherapy for erec-- support the use of sympathomimetic drugs, such as tile dysfunction [2]. Both terbu-- en out of favor as monotherapy because of its high taline and pseudoephedrine performed better than rates of ibrosis. In one series 163,042 papaverine placebo, with detumescence resulting in 36%, 28% injections were administered to 1,748 patients. None re-- Priapism occurred in 106 (6%) of patients after 235 quired surgical intervention. Fibrosis or nodule forma-- (1994) showing detumescence in 42% of patients tion occurred in 187 (11%) of patients [12]. There is no treatment to reverse penile ibrosis, Combination therapies for intracavernosal injections though it sometimes regresses on its own.
Syndromes
- From another part of your body (usually around your pelvic bone). This is called an autograft. Your surgeon will make a small cut over your hip and remove some bone from the back of the rim of the pelvis.
- Has fallen down or been injured, especially if bleeding
- After menopause: 25.8 - 134.8 mIU/ml
- Decongestants help clear a runny nose and relieve postnasal drip.
- Seizures for the first time
- Adolescent pregnancy
These techniques and is often favoured by patients because premature ejaculation is unclear and its may improve premature ejaculation when spontaneity of sex is maintained; however, use as monotherapy is controversial. Common side effects are population, guidelines suggest treating use of acupuncture for the treatment fatigue, nausea, diarrhoea, dry mouth erectile dysfunction and assessing the of premature ejaculation. Doses of 25–62 mg were Anaesthetic aerosols and creams the treatment of premature ejaculation, well tolerated, compared with placebo, containing lignocaine, lignocaine/ they are not licenced for treatment of and were found to signifcantly increase prilocaine or herbal-derived anaesthetic this condition. These agents are often be off-label and incur costs to the results were more pronounced in patients recommended as treatments for patient, as they are not subsidised by the with severe premature ejaculation premature ejaculation. University of Queensland, School of Medicine, Prevalence of sexual dysfunction in Chinese men treatment optimisation, emphasis on key with chronic prostatitis. Provenance and peer review: Not commissioned, assistance may be sought from a sexual Disorders of orgasm and ejaculation in men. Screening for erectile dysfunction sex therapists or psychiatrists may also be References in men with lifelong premature ejaculation – Is the benefcial. Premature ejaculation is the most Premature ejaculation and erectile dysfunction new questionnaire to assess sexual satisfaction, prevalence and attitudes in the Asia-Pacifc region. Int J Impot likely to require multi-modal management comorbidities, and professional help-seeking. International of the premature ejaculation diagnostic tool and behavioural and psychological its association with intravaginal ejaculatory latency Society for Sexual Medicine’s guidelines for the components. Psychosocial interventions for premature seeking behaviour for sexual problems: the global ejaculation. Cochrane Database Syst Rev • Premature ejaculation is the most study of sexual attitudes and behaviors. Sexual therapy for premature ejaculation: Results of a especially in the younger age group. Clinical follow-up of couples interpersonal distress for the patient treated for sexual dysfunction. Premature ejaculation: A new • Premature ejaculation can be lifelong 2008;5:1296–307. J Sex of premature ejaculation: A randomized, placebo- behavioural and psychological therapies. Effcacy premature ejaculation: A double-blind, placebo- Male sexual dysfunction in Asia. Asian J Androl and tolerability of dapoxetine in treatment of controlled, fxed-dose, randomized study. Topical anaesthetic use with mild or no erectile dysfunction: Integrated Al-Ahwany A, Shamloul R. Treatment of premature for treating premature ejaculation: A double- analyses of two phase 3 dapoxetine trials. J Sex ejaculation by glans penis augmentation using blind, randomized, placebo-controlled study. Removal of foreskin Guidelines on male sexual dysfunction: Erectile phosphodiesterase inhibitors in the drug remnants in circumcised adults for treatment of dysfunction and premature ejaculation. Effcacy and safety of dapoxetine for the of vardenafl administration on intravaginal premature ejaculation. The importance of follow-up in patients analysis of results from fve phase 3 trials. It is designed Product Description: Malleable Penile Prosthesis for durability, ofering both excellent rigidity and Manufacturer: Boston Scientifc dependable concealment in a device that is natural to the touch. Yes packaging in accordance with hospital, administrative, What department(s) will use and/or be afected by this product? Per institution’s penile implant procedure protocol Is there any other equipment involved with the use of this product that will need to be leased, purchased, consigned or rented? Yes, penile implant procedure instruments Catalog Number 720080-01 720081-01 720082-01 Product Name Tactra Malleable Penile Prosthesis Tactra Malleable Penile Prosthesis Tactra Malleable Penile Prosthesis Product Description Malleable Penile Prosthesis Malleable Penile Prosthesis Malleable Penile Prosthesis Size (cm) 9. The fact that a hospital/facility chooses are commonly used codes and are not intended to be an T83. We recommend consulting your relevant devices) as “patient chargeable” will not in and of itself T83. It may also help in negotiations with private is not intended to imply, promote, or guarantee coverage T83. Dear Laura Kelly: Sincerely, We have reviewed your Section 510(k) premarket notification of intent to market the device referenced above and have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate commerce prior to May 28, 1976, the Mark R. Although this letter refers to your product as a device, please be aware that Director some cleared products may instead be combination products. The 510(k) Premarket Notification Database Division of Reproductive, Gastro-Renal, located at https://www. The general controls provisions of the Act include requirements for annual registration, Office of Device Evaluation listing of devices, good manufacturing practice, labeling, and prohibitions against misbranding and Center for Devices and Radiological Health adulteration. Existing major regulations affecting your device can be found in the Code of Federal Regulations, Title 21, Parts 800 to 898. Indications, contraindications, warnings and instructions for use can be found in the product labelling supplied with each device. Information for use only in countries with applicable health authority registrations. Prior to using these devices, please review the Instructions for Use for a complete listing of indications, contraindications, warnings, precautions, and potential adverse events. The Tactra™Malleable Penile Prosthesis is intended for use in the treatment of erectile dysfunction (impotence) in adult males. Implanting a penile prosthesis will damage or destroy any remaining natural ability to have a spontaneous erection, as well as make other treatment options impossible. Men with diabetes, spinal cord injuries, or skin infections may have an increased risk of infection. Potential adverse events may include device malfunction/failure leading to additional surgery, device/tissue erosion, infection, and pain/soreness. Please check availability with your local sales representative or customer service. Disclaimer: Health economic and reimbursement information provided by Boston Scientifc Corporation is gathered from third-party sources and is subject to change without notice as a result of complex and frequently changing laws, regulations, rules and policies. This information is presented for illustrative Boston Scientific Corporation purposes only and does not constitute reimbursement or legal advice. Boston Scientifc encourages providers to submit accurate and appropriate claims 300 Boston Scientific Way for services. Boston Scientifc recommends that you consult with your payers, reimbursement specialists and/or legal counsel regarding coding, coverage and reimbursement matters. Please ensure that you read the manufacturer’s leaflet that accompanies your supply of sildenafil for further details on the treatment. If you have any further questions or concerns, please speak to a doctor or nurse caring for you. Sildenafil does not change your sex drive and is only recommended for men with erectile dysfunction. Sildenafil can be taken with or without food, although if you take it with a heavy meal it could delay how quickly it works. Do not drink grapefruit juice when you take sildenafil, as this can affect how well the drug works. Possible side effects include: ? headache ? flushing ? dizziness ? indigestion ? nasal congestion ? temporary changes in your vision such as colour disturbance, blurred vision or increased perception of light. Please contact your doctor immediately and stop taking sildenafil if you experience a sudden decrease or loss of vision. Further information on side effects can be found in the manufacturer’s patient information leaflet that comes with the medicine. Things to avoid Sildenafil must not be taken in combination with long-acting nitrates, such as isosorbide ® ® ® mononitrate (sometimes known as Imdur , Ismo , Elantan ) or nicorandil, as this can cause a sudden and dangerous drop in blood pressure. If you have chest pain that does not go away with rest, go to hospital and tell them that you have taken sildenafil. Never take sildenafil with non-prescription drugs, such as amyl nitrate/nitrates (poppers). If you are unsure whether you take nitrates please consult with your doctor or nurse. Sildenafil may also interact with other medicines, so let your nurse know immediately if there are any changes to the medicines that you take (including those that you buy yourself or herbal/homeopathic medicines) so that they can make sure that this treatment is still appropriate.
Sexual arousal is an of interoceptive awareness, that is, the psychological emotional state [261] and, similar to other emotions, capacity to perceive internal physiological changes. The greater reliance on the degree to which the individual’s experience of external information suggests that women’s experi-- sexual arousal corresponds with her physiological ence of sexual arousal is more inluenced by their response (concordance) is a matter of interest to re-- attitudes, beliefs, and values regarding sexuality, as searchers and practitioners in sexual medicine, since well as immediate contextual factors such as sexual 0 comitte 22. This vari-- physiological sexual response, and psychological ability in women’s concordance estimates may re-- traits, like sexual orientation, also shows marked dis-- lect the multitude of psychological factors that inlu-- cordance in women. Gender differences have been ence women’s experience of sexual arousal more so observed in the relationship between self-reported than physiological factors, suggesting a role for in-- sexual attractions (toward males or females) and pat-- dividual differences in moderating concordance be-- terns of genital and self-reported sexual arousal to tween self-reported and genital sexual arousal. This female and male sexual stimuli; men’s sexual arous-- raises fascinating questions as to the origins of con-- al patterns are very strongly associated with their cordance among women and whether concordance self-reported sexual orientation, whereas women’s is a desired state (see next section). Cognitive models suggest that concordant sexual response is a desirable, or even necessary, state Women report increased sexual arousal to both pre-- for satisfactory sexual functioning [268]. The po-- ferred and non-preferred sexual stimuli [288,290- tential for concordance to vary with sexual function-- 292], which suggests that their cognitive and affec-- ing has been demonstrated in studies of sexually tive responses to sexual stimuli are not dependent dysfunctional women; women with sexual arousal upon their sexual preferences, such as sexual orien-- problems report lower subjective sexual arousal to tation. Sexual desire, as evidenced by masturbation sexual stimuli in the laboratory, but typically do not and partnered sexual behaviors, is also kindled by show signiicantly lower genital responses when exposure to both preferred and non-preferred sexual compared to women without sexual arousal prob-- stimuli [290] suggesting that, among heterosexual lems [269,270]. Studies comparing the concordance women, motivation for engaging in sexual behavior of sexual responses of sexually functional and dys-- is also less dependent upon sexual preferences. Using may be related to better sexual functioning, such still pictures of female and male nudes, Sylva et al. While orgasm fre-- heterosexual and lesbian women’s brain responses quency, particularly during heterosexual coitus, is an showed speciicity in areas associated with process-- inadequate means of determining women’s sexual ing of visual stimuli and motivation, that is, greater function, these studies do indicate an association response to stimuli matching a woman’s sexual ori-- between concordance and orgasmic frequency that entation. Hypothalamic response, however, did not suggests concordance may be a useful index of in-- show category-speciic response for either group. Flexibility bian women only; heterosexual women showed refers to a pattern of intraindividual variability in sex-- nonspeciic amygdalar responses. With tern of results from these different lines of research respect to sexual orientation and identity, women demonstrates that speciicity and nonspeciicity of are more likely than men to experience and express peripheral sexual responses are mirrored in central same-gender attractions and less likely to engage aspects of sexual functioning in women. Therefore, a woman’s sexual desire Figure 19: Heterosexual women’s and men’s mean genital responses, in standardized z-scores (top panel), and self-reported sexual responses, in percentage increase from baseline (bottom panel), to various categories of stimuli. The stimulus category “Intercourse” in the male and female panels represents responses to depictions of two men and two women, respectively, engaged in intercourse. Self-report data on the de-- velopment of female sexual orientation support this Gender differences exist in the relationships among proposition; women report that social and emotional psychological, behavioral, and psychophysiological factors are more salient than sexual arousal to the aspects of sexuality, with greater lexibility observed development of their sexual interests in either the in women. Low concordance between genital and same gender [305, 306] or opposite gender [309]. Nonetheless, there is some patterns of sexual arousal do not constrain women’s evidence that higher concordance may be associ-- sexual behavior, feelings, or identity. The potential for discordance the potency of stimuli depicting any sexual activity between physiological sexual response, psycho-- to evoke genital response, regardless of the actors logical states of sexual arousal, and psychological portrayed or context of the sexual activity [288] traits, such as sexual orientation, strongly suggests (figure 19) is also highlighted in studies where that objective measures of sexual response should women show physiological sexual responses to not be used in isolation to draw conclusions about other clearly nonpreferred sexual stimuli, such as women’s sexuality. Genital response precedes subjective between physiological and psychological sexual arousal [316], is evident within seconds of aspects of sexual response the onset of a sexual stimulus [317], and can occur in the absence of subjective experience of sexual • Gender difference in speciicity of sexual arousal [287]. Reports of women’s genital lexibility in women’s sexual attractions response and orgasm during sexual assault [182] and research showing that women experience genital • Female genital response is a relexive responses to sexual threat stimuli suggests that response to exposure to any sexual stimulus genital response under conditions of nonpreferred depicting sexual activity, whether preferred sexual stimuli may be typical in women. For this or not reason, inferences regarding a woman’s sexual • Nonspeciic genital vasocongestion suggests desire and relative sexual attractions based solely that genital response is not a valid indicator on her genital responding would very likely be of sexual desire or sexual orientation inaccurate. Multi-subject studies will show which sites have high reproducibility and • Integration of central and are likely to be connected to the (sexual) peripheral mechanisms task, thus enhancing the power of the study. However, there are many limitations and potential • Validate the effectiveness of the chosen pitfalls that one should be aware of when planning stimuli (and the paradigm) outside the a study using these tools or even when reading a scanner in a separate group of subjects. Sexual consummation • Know your signal characteristics • Decide the type of genital stimulation to comitte 22. Requires Linux or Linux level of sexual arousal that may be used virtual machine (Vmware). Helen o’Connell, Prof Norm and rotational head motion can be easily Eizenberg and Anatomedia for the permission to measured and can be used to remove use their anatomical pictures. Helen O’Connell for her comments to correction software should be used to align the chapter. The evolution of human reproduction: a pri-- matological perspective Am J Phys Anthropol 2007;Suppl were nevertheless important during the 45:59-84. Mol Reprod Dev 1994 octo-- each other (network) rather than with the ber;39(2):184-93. Cellular and molecular mechanisms of female reproductive Analysis software behaviors. J Sex Med 2008 nisms mediating oestradiol modulation of the developing July;5(7):1559-71. Sexual differentiation of pheromone pro-- human brain activity during primary sensory stimulation. Sexual differences in visual attention to sexually explicit videos: a Differentiation of the Brain. Sex-speciic content preferences for vi-- diol mediates developmental masculinization of sex be-- sualsexualstimuli. Female sexual hancing glutamate release: a mechanism for organiza-- arousal: a behavioral analysis. Neuroanatomical correlates of visually evoked sexual [20] Pfaus J, Giuliano F, Gelez H. A rapid neuromodulatory Blood-oxygenation-level-dependent functional mag-- role for steroid hormones in the control of reproductive netic resonance imaging for evaluating cerebral re-- behavior. Evolutionary changes in physiological control of Hum Brain Mapp 2002 May;16(1):1-13. Brain processing Neurological control of human sexual behaviour: insights of visual sexual stimuli in human males. Attentional modulation of neural processing of [63] Lotze M, Wietek B, Birbaumer N, Ehrhardt J, Grodd W, shape, color, and velocity in humans. Neuropsychologia stimulation elicits left-hemisphere dominant activation in 1997 November;35(11):1437-44. Proc Natl Acad Sci U S A [66] Redoute J, Stoleru S, Pugeat M, Costes N, Lavenne F, 2002 January 8;99(1):523-8. A review of the effect of traumatic brain [51] Stark R, Schienle A, Girod C, Walter B, Kirsch P, Blecker injury on the human sexual response. Erotic and disgust-inducing pictures--differences in the hemodynamic responses of the brain. Speciic cerebral activation due Prominent differences during tactile genital stimulation, but to visual erotic stimuli in male-to-female transsexuals not during orgasm. Acute Hakun J, Jens W, Suh J, Listerud J, Marquez K, Franklin effects of cocaine on human brain activity and emotion. Biol Psychiatry 2000 May blood low changes associated with clitorally induced 1;47(9):769-76. The sensory cortical representation of the human penis: Proc Natl Acad Sci U S A 2001 January 16;98(2):676-82. Nat Rev Neurosci 2005 tion of cortical ields in the lateral sulcus of Homo sapiens: September;6(9):691-702. Somatotopy and attentional modulation of the Cereb Cortex 2003 october;13(10):1064-71. Segregation of visceral and somatosensory afferents: lates of conscious self-regulation of emotion. Ventral frontal deicits dence for a morphological sex difference within the me-- in psychopathy: neuropsychological test indings. Volume reduction in prefrontal gray matter in unsuc-- heterosexual and homosexual men. The nature of human orgasm: a criti-- the volume of a sexually dimorphic nucleus in the ovine cal review of major trends. Clin Psychol Rev 2001 Au-- medial preoptic area/anterior hypothalamus varies with gust;21(6):823-56. Sexual dimorphism and asymmetries in the gray-white composition of the human cerebrum. Smelling of odor-- ous sex hormone-like compounds causes sex-differenti-- [108] Savic I, Lindstrom P.
Smoking cessation by 40 years of age reduces that loss reproductive effects are now found to be attributable to approximately 90%. However, reduc- the embryo implants in the Fallopian tube or elsewhere ing the number of cigarettes smoked per day is much less outside the uterus. Ectopic pregnancy is very rarely a sur- effective than quitting entirely for avoiding the risks of vivable condition for the fetus and is a potentially fatal premature death from all smoking-related causes of death. This report fnds that mater- Much of this 50th anniversary Surgeon General’s nal smoking during early pregnancy is causal for orofa- report is devoted to examining evidence on the myriad cial clefts in infants, and evidence suggests that smoking health effects, avoidable diseases, and all-cause mortal- could be associated with certain other birth defects. Chapters highlight fndings on specifc report also fnds that the evidence is now suffcient to con- health topics from previous Surgeon General’s reports in clude that there is a causal relationship between smoking addition to presenting current information. The macula is the most sensitive part of the retina and is the part of the eye that supplies sharp vision. The evidence is suffcient to infer that nicotine acti- not appear for 20 or more years after smoking cessation. The evidence is suffcient to infer that nicotine expo- Prostate Cancer sure during fetal development, a critical window for 1. The evidence is suggestive of no causal relationship brain development, has lasting adverse consequences between smoking and the risk of incident prostate for brain development. The evidence is suggestive of a higher risk of death adversely affects maternal and fetal health dur- from prostate cancer in smokers than in nonsmokers. In men who have prostate cancer, the evidence is sug- gestive of a higher risk of advanced-stage disease and 5. The evidence is suggestive that nicotine exposure less-well-differentiated cancer in smokers than in during adolescence, a critical window for brain devel- nonsmokers, and—independent of stage and histo- opment, may have lasting adverse consequences for logic grade—a higher risk of disease progression. The evidence is inadequate to infer the presence or absence of a causal relationship between exposure to 1. The evidence is suggestive but not suffcient to infer Chapter 6: Cancer a causal relationship between tobacco smoke and breast cancer. The evidence is suggestive but not suffcient to infer of developing adenocarcinoma of the lung from ciga- a causal relationship between active smoking and rette smoking has increased since the 1960s. The evidence is suggestive but not suffcient to infer a increased risk of adenocarcinoma of the lung in causal relationship between exposure to secondhand smokers results from changes in the design and com- tobacco smoke and breast cancer. The evidence is not suffcient to specify which design and Survivors changes are responsible for the increased risk of ade- 1. In cancer patients and survivors, the evidence is suf- nocarcinoma, but there is suggestive evidence that fcient to infer a causal relationship between ciga- ventilated flters and increased levels of tobacco-spe- rette smoking and adverse health outcomes. In cancer patients and survivors, the evidence is suf- carcinoma follows the trend of declining smoking fcient to infer a causal relationship between cigarette prevalence. In cancer patients and survivors, the evidence is suf- ship between smoking and hepatocellular carcinoma. The evidence is suffcient to infer a causal relation- ship between smoking and colorectal adenomatous polyps and colorectal cancer. In cancer patients and survivors, the evidence is sug- Tuberculosis gestive but not suffcient to infer a causal relation- 1. The evidence is suffcient to infer a causal relation- ship between cigarette smoking and (1) the risk of ship between smoking and an increased risk of Myco- recurrence, (2) poorer response to treatment, and (3) bacterium tuberculosis disease. The evidence is suffcient to infer a causal relationship between smoking and mortality due to tuberculosis. The evidence is suggestive of a causal relationship Chronic Obstructive Pulmonary Disease between smoking and the risk of recurrent tubercu- losis disease. The evidence is suffcient to infer that smoking is the dominant cause of chronic obstructive pulmonary 4. The evidence is inadequate to infer the presence or absence of a causal relationship between exposure to 2. The evidence is suffcient to infer that severe a causal relationship between cigarette smoking and ?1-antitrypsin defciency and cutis laxa are genetic idiopathic pulmonary fbrosis. The evidence is suggestive but not suffcient to infer a causal relationship between active smoking and the 1. The evidence is suffcient to infer a causal relation- incidence of asthma in adolescents. The evidence is suggestive but not suffcient to infer a causal relationship between active smoking and exac- 2. The estimated increase in risk for stroke from expo- erbation of asthma among children and adolescents. The evidence is suffcient to infer a causal relation- a causal relationship between active smoking and the ship between the implementation of a smokefree law incidence of asthma in adults. The evidence is suffcient to infer a causal relation- ship between active smoking and exacerbation of 4. The evidence is suggestive but not suffcient to infer Spontaneous Abortion a causal relationship between the implementation of 1. The evidence is suggestive but not suffcient to infer a a smokefree law or policy and a reduction in other causal relationship between maternal active smoking heart disease outcomes, including angina and out-of- and spontaneous abortion. The evidence is suffcient to infer a causal relation- Chapter 9: Reproductive Outcomes ship between smoking and erectile dysfunction. The evidence is suffcient to infer a causal relation- Chapter 10: Other Specifc ship between maternal smoking in early pregnancy and orofacial clefts. The evidence is suggestive but not suffcient to infer Eye Disease: Age-Related Macular Degeneration a causal relationship between maternal smoking in 1. The evidence is suffcient to infer a causal relation- early pregnancy and clubfoot, gastroschisis, and atrial ship between cigarette smoking and neovascular and septal heart defects. The evidence is suggestive but not suffcient to infer a that smoking cessation reduces the risk of advanced causal relationship between maternal prenatal smok- age-related macular degeneration. The evidence is insuffcient to infer the presence or causal relationship between active cigarette smoking absence of a causal relationship between maternal and dental caries. The evidence is suggestive but not suffcient to infer a causal relationship between exposure to tobacco 3. The evidence is insuffcient to infer the presence or smoke and dental caries in children. The evidence is suggestive but not suffcient to infer a causal relationship between cigarette smoking and 4. The evidence is suffcient to infer that cigarette smok- absence of a causal relationship between maternal ing is a cause of diabetes. The risk of developing diabetes is 30–40% higher for active smokers than nonsmokers. The evidence is suffcient to infer a causal relation- the number of cigarettes smoked and the risk of devel- ship between maternal active smoking and ectopic oping diabetes. The evidence is suggestive but not suffcient to infer cigarette smoke impact components of the immune a causal relationship between cigarette smoking and system. The evidence is suffcient to infer that cigarette smok- causal relationship between cigarette smoking and a ing compromises the immune system and that altered protective effect for ulcerative colitis. The evidence is suffcient to infer that cigarette smoke Chapter 11: General Morbidity and compromises immune homeostasis and that altered immunity is associated with an increased risk for sev- All-Cause Mortality eral disorders with an underlying immune diathesis. The evidence is suffcient to infer a causal relation- ship between smoking and diminished overall health. The evidence is suffcient to infer a causal relationship smokers include self-reported poor health, increased between cigarette smoking and rheumatoid arthritis. The evidence is suffcient to infer that cigarette smok- ing reduces the effectiveness of the tumor necrosis 2. Section 3: Tracking and Ending the Epidemic the fnal section of the 50th anniversary Surgeon economic waste that have fowed from the manufacture, General’s report on smoking and health covers the human marketing, sale, and consumption of combustible tobacco and economic costs of the smoking epidemic in the United products. In this half-century, nearly 25 trillion cigarettes States, current trends in tobacco use and tobacco control, have been consumed, despite a signifcant drop in con- the status of interventions and programs that address the sumption per smoker (Figure 2). The annual costs attrib- smoking epidemic, and a vision for a future that is free of uted to smoking in the United States are between $289 death and disease caused by tobacco use. Accumulated data from the past 50 years billion for lost productivity from premature death due to graphically illustrate the devastating loss of life and the exposure to secondhand smoke (Chapter 12). Executive Summary 11 Surgeon General’s Report 12 Executive Summary the Health Consequences of Smoking—50 Years of Progress Despite decades of warnings on the dangers of smok- prevalence of current smoking among high school-aged ing, nearly 42 million adults (Chapter 13) and more than youth has declined, the total number of youth and young 3.
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