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The effect of vascular endothelial growth factor and adeno-associated virus mediated Giuliano F erectile dysfunction from stress purchase tadala_black 80 mg mastercard. Editorial Comment on: Peripheral brain derived neurotrophic factor on neurogenic and Mechanisms of Erectile Dysfunction in a Rat Model of vasculogenic erectile dysfunction induced by hyperlipidemia erectile dysfunction due to old age purchase 80mg tadala_black free shipping. Antiandrogen treatments in locally advanced prostate Hemodynamic interaction study between the alpha1 cancer: Are they all the same? erectile dysfunction remedy purchase cheap tadala_black on-line. Holmium laser resection v transurethral resection of the prostate: results of a Giuliano Francois weak erectile dysfunction treatment cheap tadala_black 80 mg amex, Rampin Olivier, E-Mail Address et randomized trial with 2 years of follow-up. Benign Unconsummated marriages: A separate and different clinical prostatic hyperplasia: Now we can begin to tailor entity. Prostate Cancer & Prostatic Diseases 2003;6(4):268 Giovannoni M P, Vergelli C, Biancalani C et al. Therapeutic strategies for reductase inhibitor dutasteride on localized prostate cancer - drug treatment of stress urinary incontinence. Low evidence of radiation therapy in treatment of erectile dysfunction in patients with prostate cancer: A plea for intensified scientific activity. Abdominal electric stimulation facilitates Archer S L, Gragasin F S, Webster L et al. Aetiology penile vibratory stimulation for ejaculation after spinal cord and management of male erectile dysfunction and injury: a single-subject trial. Archives of Physical Medicine & female sexual dysfunction in patients with Rehabilitation 2005;86(9):1879-1883. Italian Heart Journal: Official Journal of the Italian Federation of Cardiology Atala A, Amin M. The diabetes physician and an assessment and treatment programme for male erectile impotence. Erectile dysfunction: Expectations beyond phosphodiesterase Type 5 Anderson P C B, Gommersall L, Hayne D et al. Expert Opin Drug Saf 2004;3(5):457 for erectile dysfunction: evolving concepts with 470. Changing practice patterns in erectile dysfunction: a diagnostic algorithm for the new Beckman T J, bu-Lebdeh H S, Mynderse L A. Intracavernous pharmacotherapy for Core document on erectile dysfunction: Key aspects in erectile dysfunction. Contemporary intracavernous pharmacotherapy for erectile dysfunction in the aging male. Erectile dysfunction in uremic dialysis patients: Diagnostic evaluation in the Burns-Cox N, Gingell C. Psychosomatic aspects in the diagnosis and treatment Geriatrics 1994;49(10):27-32. Expert Opinion on Endocrinology & Metabolism Clinics of North Emerging Drugs 2004;9(1):179-189. Cardiac safety in clinical trials of European Urology Supplements 2002;1(8):12-18. Erectile dysfunction: Evaluation and new treatment Corbin J D, Francis S H, Webb D J. Transurethral therapy for the treatment of erectile dysfunction: Infant or dinosaur?. Cardiac safety in clinical trials of approach to erectile dysfunction in spinal cord injured phosphodiesterase 5 inhibitors. Erectile dysfunction and cardiovascular disease: potentially useful as peripheral vasodilator agents. Advanced Studies in Journal of Enzyme Inhibition & Medicinal Chemistry Medicine 2006;6(4):163-170. Rosen, Raymond C (Ed); Leiblum, Sandra Risa (Ed) 1992;(1992):378 Chaudhuri A, Wiles P. Do vardenafil and tadalafil have advantages over sildenafil in the treatment of erectile dysfunction?. How, why and when should Peet, Malcolm (Ed); Wilson, Catherine (Ed) urologists evaluate male sexual function?. The etiology of erectile dysfunction and mechanisms by which drugs improve Dunsmuir W D, Holmes S A. Nitric therapy for symptomatic late-onset hypogonadism with oxide pathway and phosphodiesterase inhibitors in transdermal testosterone gel. From 1998;59(10):777 informed consent through database lock: An interactive clinical trial conducted using the internet. Eur Heart J Suppl Levine, Stephen B (Ed); Risen, Candace B (Ed); Althof, Stanley 2002;4(H):H7-H12. Apomorphine: A sublingual dopamine agonist for the prostatic hyperplasia: Now we can begin to tailor treatment of erectile dysfunction. Sexual dysfunction in patients with Prostate Cancer & Prostatic Diseases 2003;6(4):268 hypertension: implications for therapy. Lecture 5: Sexual dysfunction in the Godschalk Michael F, Sison Alfredo, Mulligan Thomas. Patient preferences in treatment of erectile dysfunction: The continuing importance of Gonzalez R R, Kaplan S A. Clinical implications of antidepressant drug effects on sexual Greiner K A, Weigel J W. Current treatments and emerging therapeutic approaches in male erectile dysfunction. Factors in predicting initial in-office therapeutic dosages of alprostadil for the treatment of Heaton J P. Treatment for erectile dysfunction based future: a 7-year update of Viagra (sildenafil citrate). New perspectives in agents for self-injection programs and alternative application the pharmacotherapy of erectile dysfunction. Andropause: is androgen pharmaceutical profiles for clinical studies on erectile replacement therapy indicated for the aging male?. Gonadal tonic contraction in the treatment of erectile and erectile dysfunction in diabetics. Journal fur Urologie und Urogynakologie American Journal of Cardiovascular Drugs 2005;5(1):31-39. Testosterone therapy - What, when Journal of Diabetes & Vascular Disease 2004;4(6):383-386. Update on oral treatments for of sildenafil metabolism may promote nitrate-induced male erectile dysfunction. Sex and the patient with cardiovascular for the treatment of male erectile dysfunction. 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The vous system (pelvic nerves, hypogastric nerve, irst studies examining female genital function were paravertebral sympathetic chains) and by somatic focused on the estrous cycle and its relationship to nerves (pudendal nerve). Techniques developed during Effect of repeated electrical stimulations (6V, 10Hz, 1 ms) of the pelvic nerve on vaginal parameters including blood low in anesthertized female rat (15). Local administration of pa-- and temperature in multiple species and provided paverine hydrochloride and phentolamine increased the tools that were translated to monitoring changes vaginal wall pressure and vaginal blood low in rab-- of the genital organs during sexual responses. Further studies are required to understand the role of these neurotransmitters as well as exam-- the majority of these studies have used stimulation ining the role of speciic adrenergic receptors and of the pelvic nerve in the anesthetized model and neuropeptides in the regulation of genital arousal. Stimulation of the other models of genital arousal include monitoring pelvic nerve in the rabbit resulted in increases in the appearance of external genitalia in conscious rats vaginal length, pressure and blood low, and clito-- after apomorphine treatment in which engorgement ral blood low. Similar changes in vaginal and clitoral of the tissue surrounding the vagina and increased hemodynamics were elicited by pelvic nerve stimula-- introitus diameter occurred (lasted 2-3sec) [19]. Stimulus intensities re-- Little research has been conducted on the brain quired to increase vaginal blood low were signii-- mechanism regulating female genital arousal re-- cantly lower than those evoking rhythmic iring of the sponses; however one study demonstrated an in-- pudendal motor nerve or contraction of the vaginal crease in vaginal blood low upon electrical stimula-- smooth muscle. Some ovariectomy changes vaginal tissue morphology and of the physiological components are neurologically reduces blood low response to pelvic nerve stimu-- similar to those that occur during ejaculation/orgasm lation [32,36,46]. More research is also required to understand the pharmacological control of genital arousal responses. Intravenous administration of low doses of apomorphine caused an increase in pelvic nerve stimulation-induced peak 1. Int J Impot nerve induced increase in vaginal blood low, but did Res 1998;10 Suppl 1:S14-21. Laan E, Everaerd W: Physiological measures of vaginal line may not play a major role in vaginal engorge-- vasocongestion. Ann Neurol erties of afferent ibers supplying reproductive and other 2001;49:35-44. Silber M: Hormonal inluences in women, as relected in cog-- nitive function, libido, sexual behaviour and premenstrual 32. Int J Impot Res J, Morgan M, ogawa S: Estrogens, brain and behavior: 1997;9:27-37. Giuliano F, Rampin o, Allard J: Neurophysiology and phar-- and vaginal lubrication in the animal model. Sexual symptoms are reported often to pro-- nal sensory and autonomic nerve density in the rat. Int J Impot Altered clitoral or vaginal hemodynamics have been Res 2002;14:271-282. Vathy I, Marson L: Effects of prenatal morphine and co-- disease but although some postmenopausal patients caine exposure on spinal sexual relexes in male and fe-- with genital arousal disorder are reported to exhibit male rats. Marson L, Cai R, Makhanova N: Identiication of spinal stimuli, the relations to cardiovascular disease, hu-- neurons involved in the urethrogenital relex in the female rat. J Neurosci Furthermore, clitoral and vulvar swelling and lubrica-- 2003;23:325-331. When convenient, mo-- ual medicine but also to deine relations to common lecular biological information, functional activities of health risk factors and to at earlier stages detect and isolated tissues, and in vivo genital responses are prevent progression of systemic metabolic and vas-- described for various mammals in relation to indings cular diseases. Stimuli from the structure and function of arteries change autonomic nerves and endothelium modify vascular throughout a lifetime. In general, changes in arterial compliance and local bloodlow, and the vascular function and structure with increasing age are simi-- endothelium per se has an important role to control lar across species (human, monkey, rodents) with cell integrity, nutrition, coagulation and inlammation respect to many parameters such as e. In addition, other dysfunction, intimal thickening and medial dysfunc-- factors such as hormones are linked to regulation tion, increased levels of inlammatory chemokines, of vascular hemostasis (Munnariz et al 2003, Orshal reduced availability of nitric oxide (No) and vascular and Khalil 2004, Traish and Kim 2005). Initial studies with testosterone in female rats report-- Corpus cavernosum tissue from aged humans, rab-- ed effects on vaginal secretory components (Kenne-- bits, monkeys, mice and rats have been evaluated dy and Armstrong 1976). More recent investigations with respect to ultrastructural changes, protein activi-- of peripheral actions of testosterone or dihydrotes-- ties, and nerve and endothelial functions. For the penile corpus els (Bornman et al 1985, Christ et al 1990, Ragazzi cavernosum, testosterone has also been described et al 1996, Carrier et al 1997, Champion et al 1999, to positively regulate the expression of phosphodi-- Dahiya et al 1999, Shen et al 2000, Bivalacqua et al esterase 5 (Zhang et al 2005). Supporting a role for 2000, 2003, 2007, Bakircioglu et al 2001, Anders-- testosterone in modifying the neurovascular func-- son 2001, Rajasekaran et al 2002, 2005, Jin et al tions of the penile vasculature and corpus caverno-- 2006, Numao et al 2007, yousif et al 2007). The rat sum tissue, erectile function of rats, mice, cats and rabbits recorded as in vivo intracorporal pressure has been the species of choice for investigations changes in response to intracorporal injection of va-- of the impact of age on erectile function in vivo. In soactive agents, stimulation of the cavernous nerve comparison to Doppler-veriied reduced penile blood or the medial preoptic area, or to administration of low in response to intracavernous administration of apomorphine or oxytocin were decreased in castrat-- prostaglandin E1 in aged men, numerous investiga-- ed rats, and improved by testosterone supplementa-- tors have described decreased erectile responses tion (Mills et al 1992, Giuliano et al 1993, Heaton et by direct measurement of intracavernous pressures al 1994, Melis et al 1994, Mills et al 1994, Lugg et al in response to intracorporeal injection of vasoactive 1995, Zvara et al 1995, Bivalacqua et al 1998, Pa-- drugs, stimulation of the cavernous or dorsal nerves lese et al 2003, Zhang et al 2005, Suzuki et al 2007). Further studies are neces-- tissue surrounding the vagina as well as an increase sary to understand if these indings relect differenc-- in the dimensions of the introitus that lasted for 23 es between species or in methodological approach. Compared to young rats (225 250 gr), only 40% of 18-month old female rats responded to the effects of antiandrogens or estrogens on erectile apomorphine and exhibited an approximately 50% responses have received little attention. In comparison in a small available androgen receptor antagonist, signiicantly study of 48 women, when analyzed by age, older decreased apomorphine-induced erections to less women (ages 55 - 67 y) had signiicantly lower basal than 50% over 12 hours with recovery of erectile clitoral, labial, urethral and vaginal blood velocities responsewithin48hours. In isolated evaluated pharmacotherapy for erectile dysfunc-- corpus cavernosum tissue, chronic treatment with tion or hypertension on erectile function or structure estradiol or daidzein decreased smooth muscle cell and function of the erectile tissue in hypertensive rat and elastic iber content of the erectile tissue, reduced models (Dorrance et al 2002, Tong 2000, Hale et relaxant responses to acetylcholine, nitroglycerin, or al 2002, Toblli et al 2004ab, 2006ab, 2007a, Behr- activation of nerves and potentiated noradrenalin- Roussel et al 2005, Mazza et al 2006, Hannan et induced contraction (Srilatha and Adaikan 2004, al 2006, Shamloul and Wang 2006, Ushiyama et al Huang et al 2008). To our knowl-- fects were observed on the functional properties of edge, functional in vivo data on female genital blood isolated clitoral tissue in response to an No-donor low in hypertensive models are lacking. The majority of studies of diabetic erectile Roussel et al 2003, Mayoux et al 2004, Hannan et al dysfunction have been conducted in animals with 2006). Decreased erectile responses upon of the cavernous nerve, intracorporeal administration electrical stimulation of the major pelvic ganglion of vasoactive drugs or systemic administration of Comittee 7. Information is scarce on ished endothelium-dependent relaxation and endo-- the impact of type 2 diabetes on erectile function thelial NoS levels, altered adrenergic tonus-gener-- in preclinical models. Similar to indings in diabetic erectile type 2 diabetes because of an impaired glucose tissue, varying responses to No-donors have been tolerance associated with obesity (Vernet et al 1995, described for isolated corpus cavernosum from hy-- Wingard et al 2007). Studying temporal changes in the erectile tis-- to a No-donor, whereas no changes in NoS activities sue from rabbits with hypercholesterolemia, Xie et al were observed (Wingard et al 2007). A study by Behr-Roussel et al (2002) showed that function, only animals with type 1 diabetes have the atherosclerotic changes related to erectile dys-- been used. In these investigations, histological and function were distinct from ageing-related processes functional studies of isolated vaginal and clitoral in cholesterol-fed rabbits. In vivo, the vaginal blood low response to vasoactive agents have been shown to be reduced pelvic nerve stimulation was signiicantly reduced in rats, rabbits or monkeys with diet-induced hyper-- in diabetic rats and mean baseline laccid and cholesterolemia (Azadzoi et al 1996, Behr-Roussel peak clitoral cavernous blood low was signiicantly et al 2002, Park et al 2006, Christ et al 2009). In the decreased in the diabetic rabbits compared with the hypercholesterolemic atherosclerotic apolipoprotein control groups (Park et al. E knock-out mouse, erectile responses to cavernous In comparison, premenopausal women with insulin- nerve stimulation have also been described to be re-- treated diabetes have been shown to exhibit lower duced (Behr-Roussel et al 2006). Various pharmacotherapies, protein therapies or gene transfer procedures have been investigated in diet-induced arterial disease of rats, rabbits, and monkeys to overcome erectile dysfunction (Byrne et al 2001, Firoozi et al 2005, Kang et al 2006, Ruy et al 2006b, Christ et al 2009). No information is available on the effects of a high cholesterol diet alone on female genital vascular responses. Surprisingly, after chronic ethanol consump-- vaginal and clitoral hemodynamic insuficiency in tion (5% in drinking water for 6 weeks) corpus caver-- response to pelvic nerve stimulation have been nosum tissue from rabbits exhibited increased relax-- described (Park et al 1997). Histological examination ations induced by ield stimulation or bethanechol, of the clitoris and vagina in these animals revealed whereas relaxations to sodium nitroprusside were atherosclerotic changes of pelvic and clitoral arteries, not changed (Saito et al 1994ab). In contrast, in a reduced smooth muscle content and ibrosis (Park et more recent investigation using continuous ethanol al 1997, 2000). In support and reduced endothelium-dependent relaxations of a role for ethanol under the current experimental of clitoral cavernosal tissue from ovariectomised condition as a risk factor for penile corpus caverno-- rabbits and proposed chronic estrogen deiciency- sum endothelial damage, electron microscopy of the induced hypercholesterolemia as a risk factor for erectile tissue from the above mice described nucle-- female endothelial dysfunction. Epidemiological data link cigarette smoking and erec-- tile dysfunction and it is shown that tobacco smoke Central effect of cocaine on sexual behavior and in general has negative effects on endothelial cells, erectile function has been documented (Chang et decreased eNoS activity, impair endothelium-de-- al 2000). In preclinical investigations, recently peripheral mechanisms of erectile function the effect of smoking on peripheral genital responses in a rat model of triple-binge cocaine administration has only been studied in models for erectile function were evaluated (Kendrici et al 2007). In rats, irrespective of age, daily erectile responses as measured by intracavernous passive smoking for 8 wks (enclosed cage, 1 hour, pressure changes in vivo were observed after 5 days per week) reduced penile neuronal NoS ac-- cocaine-treatment. Animals exhibited increased tivity, whereas no reduction in the amount of endo-- plasma levels of big-endothelin-1, and the erectile thelial NoS was observed (Xie et al 1997). In vivo, tissue was shown to contain increased expression the authors did not ind reduced erectile functions of endothelin-A receptors and myeloperoxidase, in response to activation of the cavernous nerve in decreased eNoS expression and No production, smoke exposed rats compared to controls (Xie et al and also to exhibit reduced endothelium-dependent 1997). In contrast, Bivalacqua et al (2009) reported relaxant responses and nerve-induced relaxations reduced erectile responses in vivo to cavernous (Kendrici et al 2007). Mice that were exposed to smoke also exhibited impaired endothelium dependent erectile overall, good evidence of the role for ageing, hyper-- responses to Ach and the erectile tissue from these tension, testosterone, type 1 diabetes or hypercho-- animals showed increased superoxide anion activity, lesterolemia / athersoclerosis on erectile function is decreased constitutive nitric oxide synthase activity, available in several strains or species, and contain and increased inducible nitric oxide synthase activ-- information from molecular biological analyses, func-- ity, reactive oxygen species generation and nitrotyro-- tional responses of isolated tissue and in vivo mod-- sine formation (Bivalacqua et al 2009). Additional studies in models for type 2 diabetes and models for the use of recreational drugs seem No studies are available that have investigated the important for penile erection and erectile dysfunction. Dose-dependent negative effects of betes or hypercholesterolemia / atherosclerosis on acute administration of ethanol on apomorphine-in-- the female genital vascular responses is found in at duced rat erections have been reported (Heaton and least one strain or species, and contain data from in Varrin 1991).
Subtype speciic regulation Sep;164(3 Pt 1):868-75 of human vascular alpha(1)-adrenergic receptors by vessel bed and age erectile dysfunction blogs cheap tadala_black 80mg mastercard. Alternatively spliced neuronal nitric oxide synthase me-- responsible for the contractile response in the rat corpus diates penile erection erectile dysfunction age group order cheap tadala_black line. Functional characteriza-- tion of nonadrenergic noncholinergic neurotransmitter re-- 89 smoking causes erectile dysfunction through vascular disease order tadala_black 80 mg on line. Simonsen U erectile dysfunction treatment options exercise generic 80mg tadala_black with visa, Prie to D, Hernandez M, Saenz de Tejada I, lease via endocannabinoids: an in vitro study in rabbit cor-- Garcia-Sacristan A. Alpha(1A)- gic nerves and No-induced relaxation in the rat isolated cor-- adrenoceptors mediate contractions to phenylephrine in pus cavernosum. Endothelin: localization, synthesis, activity, types in human corpus cavernosum and in cultured smooth and receptor types in human penile corpus cavernosum. Systemic and cavernosal plasma levels of en-- cavernosum tissue via nicotinic acetylcholine receptors. Kendirci M, Pradhan L, Trost L, Gur S, Chandra S, Agrawal corporal cavernosal tissue. Peripheral mechanisms of erectile dys-- 9 function in a rat model of chronic cocaine use. Role of chloride channels in the acetylcholine and vasoactive intestinal polypeptide on ca-- regulation of corpus cavernosum tone: a potential thera-- nine penile erection. C-type natriuretic peptide eral modulation of dopaminergic receptors affects erectile hyperpolarizes and relaxes human penile resistance arter-- responses in rats. Adenosine: tility changes of the deep dorsal penile vein due to sero-- a new agent in the diagnosis of impotence. Corpus cavernosum from men with tic implications from erectile dysfunction to priapism. Prostaglandins phosphorylation of endothelial nitric-oxide synthase medi-- Leukot Essent Fatty Acids. Ef-- collagen synthesis by transforming growth factor-beta 1 in fect of lithium on endothelium-dependent and neurogenic human corpus cavernosum smooth muscle. Role of the nitric oxide thromboxane receptor-mediated responses and impaired pathway and the endocannabinoid system in neurogenic endothelium-dependent relaxation in human corpus caver-- relaxation of corpus cavernosum from biliary cirrhotic rats. The potential role of the heme oxygenase/car-- laxation of the corpus cavernosum in diabetic rats: involve-- bon monoxide system in male sexual dysfunctions. Morelli A, Filippi S, Mancina R, Luconi M, Vignozzi L, rat resulting in return of erectile function. The effect of vascular endothelial growth factor on a rat of vasculogenic erectile dysfunction in a rat model. Effect of insulin-like growth factor-1 man corpus cavernosum smooth muscle in the presence of and insulin-like growth factor binding protein-3 complex bladder outlet obstruction. The effect modulatory molecules for the treatment of neurogenic erec-- of intracavernosal growth differentiation factor-5 therapy tile dysfunction caused by cavernous nerve injury. Neurotrophic immunophilin ligands stimulate structural Intracavernosal basic ibroblast growth factor improves va-- and functional recovery in neurodegenerative animal mod-- soreactivity in the hypercholesterolemic rabbit. Curr Hyper-- motes erection recovery after nerve-sparing radical retro-- tens Rep. Expression of messen-- Sexual dysfunction in hypertensive patients treated with ger ribonucleic acid splice variants for vascular endothelial losartan. Downregulation of angiogenic factors and function: results of the irst human trial. Hum Gene Ther 17: their downstream target molecules affects the deterioratt 1165-1176, 2006 tion of erectile function in a rat model of hyperchott 220. Erectile dysfunction: cardiovascular risk and the role of The successful long-term treatment of age related erectile the cardiologist. The effect of vascular endothelial growth neurotrophic factor gene therapy in diabetic rats. Endothelial cell transplan-- therapy prevent and reverse venogenic erectile dysfunction tation in to the corpus cavernosum: moving towards cell- in rats. Progenitor cells in the kidney: biology and thera-- poietin-1 and vascular endothelial growth factor gene trans-- peutic perspectives. J Tissue tide on the cyclic nucleotide monophosphates in smooth Eng Regen Med 1: 83-96, 2007. Gene transfer of prepro-calcitonin acellular bladder matrix maintains corporal tissue function. Acta mation of corporal tissue architecture in vivo using human Psychiat Scand 1981;63 (suppl 290):7990. 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A review and reevaluation of the role of se-- ing premature ejaculation: a double-blind, randomized, pla-- rotonin in the modulation of lordosis behavior in the female cebo-controlled study. The selective se-- tocin-induced contractions within rat and rabbit ejaculatory rotonin reuptake inhibitor luoxetine reduces sexual motiva-- tissues are mediated by vasopressin V1A receptors and not tion in male rats. A new combination treatment for prema-- ture ejaculation: A sex therapists perspective. Borsini F, Evans K, Jason K, Rohde F, Alexander B, Pol-- Brain Res 2004;155:301-306. Smith W, Grainger D, Marbury T, Patel P, Boland K, Ha-- tocin-induced yawning and penile erection. Effect of estradiol versus estradiol and tes-- Stimulation of dopamine receptors in the paraventricular tosterone on brain-activation patterns in postmenopausal nucleus of the hypothalamus of male rats induces penile women. Estrogen alters the diurnal rhythm cleus accumbens: Involvement of central oxytocin. 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About 33% of primary infertility cases are due to impotence clinic generic tadala_black 80mg visa male factors erectile dysfunction vacuum pump medicare buy generic tadala_black, 33% are due to erectile dysfunction at 18 buy cheap tadala_black 80mg line female factors erectile dysfunction hypertension cheap 80mg tadala_black free shipping, and 33% are due to combined factors. Endocrinologic pro- files and detailed semen analysis are the cornerstones of laboratory investigations per- formed after history taking and physical examination findings. Because spermatogenesis takes approximately 74 days, it is important to review events from the past three months. Primary gonadal deficiency is an important cause of in- fertility, involving 30% to 40% of cases of male infertility. When taking the clients history, ask about previous testicular disorders (torsion, cryptorchidism, trauma), infections (mumps orchitis, urethritis, epididymitis), heat-related issues (e. When performing the physical examination, pay particular attention to features of hypo- gonadism. It may be classified according to whether it is due to insufficient gonadotropin secretion by the pituitary (hypogonadotropic hypogonadism) or to pathology in the testes themselves (hypergonadotropic hypogonadism). Signs and symptoms may include diminished libido and erections, as well as decreased body hair growth. Conditions causing infertility due to primary testicular causes are presented below. Cause: Age ______________________________________________________________ History/Physical Examination Findings Usually no physical findings Comments A client who is age 64 or older can experience a decline in semen quality. Cause: Bilateral anorchia __________________________________________________ History/Physical Examination Findings Absent testes (a congenital disorder) EngenderHealth Mens Reproductive Health Problems 1. Cause: Chemotherapy _____________________________________________________ History/Physical Examination Findings History of treatment for testicular cancer or other cancers Comments Chemotherapy drugs are often most toxic to actively dividing cells, spermatogonia, and spermatocytes. Cause: Chromosomal abnormalities (Klinefelters syndrome) _____________________ History/Physical Examination Findings Gynecomastia Small testes Eunuch-like body proportions caused by delayed puberty Comments This condition is associated with an extra X chromosome. Cause: Cryptorchidism ____________________________________________________ History/Physical Examination Findings Possible history of surgery during childhood to correct cryptorchidism Testes that are not palpable in the scrotum Undescended testes that may be palpable as a mass in the inguinal canal Testes that may be retractile 1. Once in a while, when the inner thigh is stroked longitudinally, a retractile testicle can be brought back up in to the inguinal canal by a hyperactive cremaster reflex (see page 1. Cryptorchidism also leads to a high risk of developing testicular cancer later in life. Cause: Environmental toxins _______________________________________________ History/Physical Examination Findings The client may provide helpful information during the history taking. Comments Cigarettes and marijuana lead to a decrease in sperm density, motility, and morphology. Cause: Granulomatous disease______________________________________________ History/Physical Examination Findings The client has manifestations of the disease, including skin changes and lung problems. Comments Leprosy and sarcoidosis may infiltrate the testicle and lead to testicular failure. Management The condition is potentially treatable with cessation of use of medication. Cause: Myotonic dystrophy _________________________________________________ History/Physical Examination Findings Weakness Cardiac abnormalities Cataracts Comments This condition is an inherited disorder characterized by delayed onset of impaired motor function, cataracts, premature balding, mild mental retardation, and infertility. Cause: Occupational exposure ______________________________________________ History/Physical Examination Findings History of occupational exposures to toxins Comments The client may have worked in a factory, on a farm, in a mine, or in industry. It is also caused by the mumps virus in postadolescent males, by tubercu- losis, and by syphilis (see page 1. Cause: Radiation _________________________________________________________ History/Physical Examination Findings History of treatment for cancer or occupational exposure to radiation Comments Radiation can impair sperm production. Cause: Sertoli-cell-only syndrome (germinal cell aplasia) ________________________ History/Physical Examination Findings Small or normal-sized testes Azoospermia (see page 1. Cause: Testicular trauma __________________________________________________ History/Physical Examination Findings History of testicular trauma, including testicular torsion Comments Testicular trauma is the second most common acquired cause of infertility. Cause: Varicocele_________________________________________________________ History/Physical Examination Findings Scrotal swelling, usually chronic and on the left side Scrotum that feels like a bag of worms because of its prominent, slippery vessels Small bag of worms felt just above the testicle, along the spermatic cord 1. The epididymis is an important site for sperm maturation and an essential part of the sperm transport system. The vasa deferentia trans- port sperm from the epididymides to the urethra (see page A. Disorders of the sperm transport system account for 10% to 20% of male infertility, and are described below. Cause: Absence of the vasa deferentia ________________________________________ History/Physical Examination Findings Absent vasa deferentia during palpation History of cystic fibrosis associated with respiratory and gastrointestinal problems (which cause poor sperm motility) Comments The client may have a congenital absence of a vas deferens. Cause: Immotile cilia syndrome _____________________________________________ History/Physical Examination Findings Respiratory tract trouble Frequent infections Comments This condition is caused by a defect in the functioning of cilia. Cause: Retrograde ejaculation ______________________________________________ History/Physical Examination Findings Surgeries Medications Comments This condition is caused by dysfunction of the internal urethral sphincter or an open bladder neck during ejaculation. Other Causes of Infertility Other causes of infertility include: Psychological/emotional factors. These include depression, marital disharmony or emotional conflict about intimacy, and sexual relations or parental roles, which can di- rectly affect endocrine (hormonal/glandular) function and such physiological processes as normal libido, erection, and ejaculation (and, in women, ovulation). Fur- thermore, fertility is affected by psychic factors such as frequency, duration, and timing of sexual intercourse, phobic avoidance of intercourse, and painful intercourse. However, if they are not diagnosed and treated in time, some of these diseases can cause irreversible damage, such as infertility, inflammation of the testes, pneumonia and other infections in infants, and, in extreme cases, death. Although these infections cannot be cured, in some settings they can be managed by relieving or reducing their symptoms. If possible, all partners of an infected client should be notified about their exposure to the infection and should be encouraged to seek treatment. Notification of partners can be done by the client, staff, or public health authorities. Service providers should suspect these conditions when treating clients, especially those who engage in high-risk behavior. Hepatitis (Hepatitis A, B, or C) Signs and Symptoms Some of the symptoms that men with viral hepatitis may have include: Fatigue, malaise Loss of appetite Upper abdominal pain Jaundice Dark urine Physical Examination Findings Tenderness in the upper abdomen Comments The client may present with such systemic signs as fever and general weakness. Counseling such clients is directed at changing risky sexual behaviors, main- taining/improving personal hygiene, offering nutritional advice, and encouraging positive living. It consists of obtaining the clients sexual and reproductive health history, which includes prior illnesses, surgeries, and inherited traits, and performing a routine genital examination. The information obtained during the assessment is the foundation for providing effective, effi- cient reproductive health care. This information, along with the findings from the physi- cal examination, will enable you to determine how to help the client. Because men visit health care facilities infrequently, service providers often take the opportunity to screen for mens sexual and reproductive health conditions when they come in with other concerns. This chapter discusses sexual and reproductive health history taking; performing a genital examination is discussed in Chapter 3. Importance of Taking a Sexual and Reproductive Health History Taking a sexual and reproductive health history is a critical component of providing sexual and reproductive health care for men. Inaccurate or incomplete histories can result in inad- equate screening or in the inadequate treatment of potentially life-threatening conditions. As a service provider, you must be prepared to hear a wide range of sexual and reproduc- tive health concerns. A kind and straightforward assessment is not only essential and professional, but also compassionate. When a client does not have any specific sexual or reproductive health concerns, the questions you ask can be open-ended questions to screen for possible problems, and then narrowed for in- depth questioning whenever the clients answer raises additional issues. On the other hand, when a client has a specific, acute problem, a narrowly focused history may be required. Giving a client an opportunity to discuss sexual and reproductive health does not mean EngenderHealth Mens Reproductive Health Problems 2. A subsequent visit (or referral) can be scheduled in order to explore a subject in more depth once it has been raised. An Effective Step-by-Step Approach It is essential to provide an atmosphere of acceptance for the client so that he feels comfortable discussing his history, fears, concerns, current symptoms, and future expec- tations. In an environment in which a useful sexual and reproductive health history is obtained, respect the clients right to his own values, attitudes, and behavior, even if you do not agree with them.
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