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https://pharmacy.unc.edu/news/directory/drhoney/
Effect history of nonresponse to sildenafil: A time-from- of tadalafil on sexual timing behavior patterns in dosing descriptive analysis. Sustained depression-related improvement with vardenafil efficacy and tolerability with vardenafil over 2 for erectile response study. The esteem and self-confidence in patients with efficacy and safety of flexible-dose vardenafil severe erectile dysfunction. Int J Impot Res 2001 taken 8 hours before intercourse: a randomized, Aug;13(4):192-9. Efficacy erectile dysfunction patients: a RigiScan and and safety of flexible-dose vardenafil in men with pharmacokinetic study. Vardenafil and efficacy of vardenafil, a selective 20-mg demonstrated superior efficacy to 10-mg phosphodiesterase 5 inhibitor, in patients with in Japanese men with diabetes mellitus suffering erectile dysfunction and arterial hypertension from erectile dysfunction. Transplant Proc 2006 administered vardenafil for erectile dysfunction: Jun;38(5):1379-81. Vardenafil improves satisfaction rates, depressive symptomatology, and self- confidence 198. Efficacy results of a randomized, double-blind, 26-week and tolerability of vardenafil in men with mild placebo-controlled pivotal trial. Population dose-response model for tadalafil in the treatment of male erectile dysfunction. Visual loss associated with erectile following bilateral nerve sparing radical dysfunction drugs. Can J Ophthalmol 2007 retropubic prostatectomy: a randomized, double- Feb;42(1):10-2. Efficacy and cavernosum sodium/potassium adenosine treatment satisfaction with on-demand tadalafil triphosphatase activity. Effects A 6-month study of the efficacy and safety of of tadalafil on erectile dysfunction in men with tadalafil in the treatment of erectile dysfunction: diabetes. Diabetes Care 2002 Dec;25(12):2159- a randomised, double-blind, parallel-group, 64. Efficacy, treatment of men in canada with erectile safety, and treatment satisfaction of tadalafil dysfunction: A randomized, double-blind, versus placebo in patients with erectile parallel, placebo-controlled clinical trial. Chronic Comparison of efficacy, safety, and tolerability of treatment with tadalafil improves endothelial on-demand tadalafil and daily dosed tadalafil for function in men with increased cardiovascular the treatment of erectile dysfunction. Efficacy of sexual activity in patients treated with and safety of on-demand oral tadalafil in the 217 treatment of men with erectile dysfunction in 239. A Taiwan: A randomized, double-blind, parallel, randomized, double-blind, placebo-controlled, placebo-controlled clinical study. Int J Determining the earliest time within 30 minutes Radiat Oncol Biol Phys 2006 Oct 1;66(2):439-44. Taehan erectile function in hypogonadal men Pinyogikwa Hakhoe Chapchi 2006;47(8):852-8. Psychosocial outcomes and drug attributes affecting treatment choice in men receiving 232. J Sex function in men with erectile dysfunction: a pilot Med 2006 Jul;3(4):650-61. Tadalafil relieves lower urinary tract does not occur during 6 months of treatment: A symptoms secondary to benign prostatic randomized, double-blind, placebo-controlled hyperplasia. Int J Clin Pract 2006 men with severe erectile dysfunction in tertiary Jul;60(7):812-9. Efficacy and safety of on demand tadalafil in the treatment of East and Southeast Asian men with 245. Predictors of erectile dysfunction: a randomized double-blind, tadalafil efficacy in men with erectile parallel, placebo-controlled clinical study. Efficacy and a multicenter, randomized, double-blind, safety of two dosing regimens of tadalafil and placebo-controlled study. European multicentre study to evaluate the Intracavernosal injection therapy with and tolerability of apomorphine sublingual without sexological counselling in men with administered in a forced dose-escalation regimen erectile dysfunction. Int J Impot Res papaverine/phentolamine in erectile dysfunction 2005 Jan;17(1):80-5. A double Combination therapy for erectile dysfunction: a blind, placebo controlled study of intracavernosal randomized, double blind, unblinded active- vasoactive intestinal polypeptide and controlled, cross-over study of the phenotolamine mesylate in a novel auto-injector pharmacodynamics and safety of combined oral for the treatment of non-psychogenic erectile formulations of apomorphine hydrochloride, dysfunction. Double-blind safety of fixed-dose and dose-optimization multicenter study comparing alprostadil alpha- regimens of sublingual apomorphine versus cyclodextrin with moxisylyte chlorhydrate in placebo in men with erectile dysfunction. Appropriate use of Genital plus audiovisual sexual stimulation exercise testing prior to administration of drugs following intracavernous vasoactive injection for treatment of erectile dysfunction. Atropine role dosage of trimix ingredients and compare its in the pharmacological erection test: study of 228 efficacy and safety with prostaglandin E1. Is Recovery of spontaneous erectile function after there an optimal time for intracavernous nerve-sparing radical retropubic prostatectomy prostaglandin E1 rehabilitation following with and without early intracavernous injections nonnerve sparing radical prostatectomy? Evaluation of real-time Comparative study of papaverine plus RigiScan monitoring in pharmacological phentolamine versus prostaglandin E1 in erectile erection. Preliminary results of a comparative sterile powder formulation for intracavernous study with intracavernous sodium nitroprusside treatment of erectile dysfunction. Alkalization does not alleviate penile pain Prostaglandin E1 versus linsidomine chlorhydrate induced by intracavernous injection of in erectile dysfunction. Intracavernous injection of prostaglandin E1 plus Slow injection of prostaglandin E1 decreases procaine in the treatment of erectile dysfunction. Efficacy and safety of Treatment of erectile failure with prostaglandin intracavernosal alprostadil in men with erectile E1: a double-blind, placebo-controlled, dose- dysfunction. A prostaglandin E1 dose-response study in Prostaglandin E1 versus mixture of prostaglandin man. Prostaglandin E1 and the nitric oxide donor, in the treatment of human erectile donor linsidomine for erectile failure: a dysfunction: results of a double-blind cross over diagnostic comparative study of 40 patients. A study in patients with erectile dysfunction and side effects of intracavernous injections of comparing different formulations of moxisylyte in impotent patients: a dose-finding prostaglandin E1. Effect papaverine in treatment of erectile failure: of apomorphine on penile tumescence in men double-blind crossover study among Egyptian with psychogenic impotence. Intraurethrally infused capsaicin induces penile Melanocortin receptor agonists, penile erection, erection in humans. Scand J Urol Nephrol 1994 and sexual motivation: human studies with Dec;28(4):409-12. J Clin Double-blind, placebo-controlled evaluation of Endocrinol Metab 2003 Jun;88(6):2673-81. A Liposome encapsulated prostaglandin E1 in novel testosterone gel formulation normalizes erectile dysfunction: correlation between in vitro androgen levels in hypogonadal men, with delivery through foreskin and efficacy in patients. The effect of in the treatment of erectile failure: a prospective, topically applied vasoactive agents and randomized placebo-controlled trial. Psychosexual behavior in hypopituitary men: A controlled comparison of gonadotropin and 314. A double- erectile dysfunction: a placebo controlled clinical blind, placebo-controlled trial of testosterone trial. Effect of testosterone administration on sexual behavior 222 and mood in men with erectile dysfunction. Transdermal testosterone gel improves sexual function, mood, muscle strength, and body 338. J phentolamine as treatment for erectile Clin Endocrinol Metab 2000 Aug;85(8):2839-53. The function in partial testosterone-deficient ageing role of pentoxifylline in the treatment of erectile men treated with cream containing testosterone dysfunction due to borderline arterial and vasoactive agents. Double- testosterone, trazodone and hypnotic suggestion blind placebo-controlled study of testosterone in the treatment of non-organic male sexual patch therapy on bone turnover in men with dysfunction. Results of a pilot study analysis of alprostadil topical cream for the with naltrexone. Effects of oral phentolamine, taken before sleep, on nocturnal erectile activity: a double- 345. Dehydroepiandrosterone in the treatment of erectile dysfunction: a prospective, double-blind, 223 randomized, placebo-controlled study. Intracavernous Alprostadil Alfadex--an effective Tianeptine can be effective in men with and well tolerated treatment for erectile depression and erectile dysfunction.
Diseases
- Joseph disease
- Holmes Borden syndrome
- Chronic erosive gastritis
- Malonic aciduria
- Chromosome 8, trisomy 8p
- Chromosome 22 ring
- Epidermolytic palmoplantar keratoderma Vorner type
- Kallmann syndrome, type 1, X linked
Squalene derivatives such as longilene testosterone impotence from prostate removal best buy levitra super active, epitestosterone conversion of peroxidase erectile dysfunction pump as seen on tv purchase levitra super active line, teurilene impotence from prostate surgery order levitra super active without prescription, eurylene and 14- (T:E) ratio showed testosterone to erectile dysfunction san francisco discount 40mg levitra super active with visa ostrogen deacetylleurylene have also been isolated significant difference and may also involve between supplementation phosphodiestrase and placebo. Ginkgo inflow to arterial tissues albumen of the seed also contains neurotoxic 4’-O- biloba extract have been through arteries and methylpyridoxine (ginkgotoxin), etc used in traditional Chinese veins without medicine to improve blood obstructing systemic circulation. This constituents have a thinning enhanced supply of effect on the blood besides blood to sex organs is helping to improve the crucial in maintaining muscle tone in the walls of strong erection the blood vessels 12 Hibiscus sabdariffa Malvaceae Zobo, Pharmacology of the It decreases the Several compounds have been isolated from different Carotenoids, [42, 43] L. Spectroscopic analysis off the aqueous 12 weeks showed in extract of H sabdariffa L (Hs) have yielded citric significant change in the acids, hydroxycitric acid, hibiscus acid, malic acid absolute and relative and tartaric acids; oxalic acid as minor compounds. Isolation and characterization of the flower extract have yielded flavonoids such as hibiscetin-3- glucoside, (hibiscitrin), sabdaritin, gossytrin, quercetin, luteolin, chlorogenic acid, protocatechuic acid; sterols such as ?-sitosterol and ergosterol have been isolated. In a separate presence of arginine amino acids study, 1500 mg/kg or 3000 which boosts nitric mg/kg p. M tenuiflora is also composed of significant differences yuremanine and two chalcones; kukulkan A (2. M and morphology among the tenuiflora is also composed of the steroids sheep with or without M campesterol-3-O-?-D-glucopyranosyl, stigmasterol- tenuiflora. The result 3-O-?-D-glucopyranosyl and ?-sitosterol-3-O-?-D- indicated that M tenuiflora glucopyranosyl. Saponins such as mimonoside A, does not influence negatively mimonoside B, mimonoside C have been isolated. Increase in blood Saponins, alkaloids, plantain paradisiaca root on testicular Bromine, rubidium, strontium, saponins, function parameters on male norepinephrine, dopamine, serotonin, vitamin B6, vitamins, [51, 52] rats at 25, 50 and 100 mg/kg Circulation vitamin a, c and D and natural glucose, fructose. Meyer produced significant and acetylcholine-induced alkenes, sterols, fatty acids, carbohydrates, hydrocarbons, sustains increase in sexual and transmural nerve flavonoids, organic acids and vitamin flavonoids and activity of normal male rats. Indole alkaloids such as Harman, harmine, activity harmalol, and harmaline have also been isolated from P. The arousal and reduction mitragynine, rauwolscine, spegatrine, reserpine, and result showed that yohimbine of psychological rescinnamine, as well as ?-yohimbine, ?-yohimbine, is superior to placebo in the conditions by easing Pseudoyohimbine, Alloyohimbine, Ajmaline, treatment of erectile stress, mild depression ajmalicine, 19-Dehydroyohimbine, dysfunction. The presence of a new ?- organs involved in carboline alkaloid characterized as I-thioformyl-8-?- reproductive functions D-glucopyranoside-bis-2,3-duhydro- without affecting the isopyridinopyrrol and four new flavonoids including metabolic functions 7-O-rhamnoside, 7-O-6’’-O-glucosyl-2’’-O-(3’’- acetylrhamnosyl) glucoside, 7-O-(2’’-O-rhamnosyl- 2’’-O-glucosylglucoside) and glycoflavone 2’’-O- rhamnosyl-2’’-O-glucosylcytisoside (Sharaf M et al. Spectroscopic analysis of the seeds extract have led to the iusolation of two new anthraquinones glycoside such as 3,6-dihydoxy-8-methoxy-2- methylanthraquinone (peganone 1) and 8-hydroxy-7- methoxy-2-methylanthraquinone (peganone 2) 24 Piper guineense Piperaceae West African In a study to determine the The extract enhanced The chemistry of P. Several compounds and tannins adult male Sprague Dawley and ano-genital have been isolated including piperine, elemicine, rats, the result showed an behaviour myristicin and safrole which have strong increase in body weight and antimicrobial properties. The isolated compounds guineense at 200mg/kg for 4 are; N-pyrrolidyl-I-acetylamide, N-piperidyl-I- weeks and 8 weeks aceytlamide, N-isobutyl-2,4-octadienamide respectively had a positive (Pellitorine), N-piperidyl-Isobutyl-3,4- impact on male fertility dimethyoxybenzoic acid amide, N-pyrrolidyl-3- parameters and showed no methoxycinnamoylamide, N-Isobutyl-2,4- deleterious effects on male tetradecadienamide, N-piperidyl-2,4- fertility. In a separate study, dodecadienamide, N-Isobutyl-5- (3,4- the effects of Afromomum methylenedioxyphenol)-2-pentenamide, N-isobutyl- Melegueta and P. In high doses of presence of ursolic acid, Asiatic acid, squalene, but 3000 mg/kg, all determined no caffeine, flavonoids such as isovitexin, vitexin and sexual parametrs were rutin, gallic acid, hydrolysed tannins, puncalagin inhibited. Punicalin, terflavin A aphrodiasiac properties at and B, tergallagin, tercatain, chebulagic, geranin, low dosage grana to B and covilagin. Flavonoids such as Dawely rats on sexual and nitric oxide release kaempferol, kaempferol glycosides, quercetin, and behaviour and intracavernous from nerve endings of Fatty acids such as palmitic, steatric, oleic, and pressure showed increase in corpus cavernous tissue Linoleic acid; Tannis; Potassium salts have all been mount intromission and reported ejaculation latency representing an improvement in sexual character. They help to regulate sexual energy levels and sexual strength by increasing the percentage of free available testosterone levels for men and they even affect pregnenolone, progesterone, and estrogen 28 Turnera diffusa Turneraceae Damiana T diffusa extract at 80 mg/kg These effects can be T diffusa is composed of numerous phytochemicals. Major constituents are its activity was lower than pressure, a reliable monoterpenes such as ?-phillandiene,(+)-c amphene, Pasakbumni at 140 mg/kg positive index of cineole, ciral and borneol. In another study to erectile dysfunction hydrocarbons like zingiberene, ?-bisboline, ?- determine the effects of the farnesene and ar-curcumene as well as extracts of ginger as an sesquiphillandiene and the sesquiterpene alcohol aphrodisiac, there was zingiberol and gingerol which is responsible for its significant increase in pungency. It is significant that issues surrounding poor sexual performance and virility are unraveled in various economies of the world. Several plants have proven useful in the management of sexual disorders throughout history, even herbs and spices have been used to enhanced sexual activities in various parts of the world. There is great need for substances that are used to treat sexual dysfunction in humans. The use of aphrodisiacs is prominent in many countries of the world including Nigeria. Aphrodisiacs can be used directly or indirectly in the management of sexual dysfunction and improvement of virility. Demand for natural aphrodisiacs require further studies to properly understand their effects on human and safety profile, uses of aphrodisiacs can be harmful due to unavailable data on safety, mechanism of action and knowledge to support their extensive use in procreation. Isolation and characterization of the active constituents of plants used in improvement of sexual performance and virility can cause a dynamic change in the world today. It is pertinent that the phytochemistry of all plant used to treat sexual dysfunction and which also plays a significant role in the improvement of virility is studied. The aim of the leaflet is to provide you with detailed information about the condition. To view the online version of this leaflet, type the text below in to your web browser: http://www. But most urologists suspect that it is under-reported, and may affect as many as 1 in 10 men (10%). This begins as a localised inflammation, which may then mature in to a hardened scar. The scar is inelastic (stiff) and stops the penis stretching with erections, leading to the development of a curvature on erection. There are two erectile cylinders (corpora cavernosa) running along the penis (pictured). If the penis is abnormally squeezed or bent, the area where the septum attaches to the elastic fibres may over-stretch. In older men, reduced elasticity, disease of the arteries and diabetes all increase the likelihood of scarring after an injury to the penis. In most patients, the injury heals within a year and the plaque does not advance beyond its early inflammatory phase. In more persistent cases, the plaque is replaced by tough, fibrous tissue and may even form hard, calcium deposits. Peyronie’s disease can affect the penis by causing: • Curvature of the penis The inelasticity (rigidity) of the plaque means it cannot stretch as the rest of the penis does when you get an erection. A plaque on the top of the penis causes the penis to bend upward; on the underside, it causes a downward bend. In some cases, the plaque develops centrally, leading to indentation and shortening. Pain, bending, and emotional distress may then limit sexual intercourse; and • Erectile dysfunction (impotence) This occurs due the effect of the plaque reducing blood flow in the penis, but can also a loss of sexual confidence because of the change in shape of the penis. While most treatments can limit the effect of the condition on the penis, nothing can take the penis back to how it was before. The disease generally goes through two stages: • A painful, inflammatory phase This usually lasts for three to six months. There is no way to tell when the acute phase has ended, but easing of the pain usually heralds it; and • A chronic or stable phase You are usually in this phase at least 6 months after the pain has stopped. Two out of 10 men (20%) get a re-activation of the inflammatory phase, leading to more plaque development, and worsening curvature. In the remaining one out of 10 (10%), there may be spontaneous improvement in curvature without treatment. Although the plaque itself does not normally disappear completely, a new plaque can develop on the opposite side to the original one, leading to the penis straightening out. Peyronie’s disease sufferers usually seek medical attention in the acute phase because of painful erections or difficulty with intercourse. Providing education about the disease, and its likely course, is often all that is required. Nothing has been shown conclusively to make plaques disappear, or to limit their growth. Some tablets can, however, limit the pain in the early inflammatory phase, or improve the quality of the erection if that is the main problem. Most clinicians favour one type of medical therapy over another, although the evidence for all is weak. Potassium para?aminobenzoate (Potaba®) tablets have the best available evidence for improving pain, but are not very well tolerated. Tablets such as sildenafil, vardenafil, tadalafil and avanafil can help by improving erectile dysfunction in Peyronie’s disease, and this may be all the treatment that is required. Traction devices Traction devices have been used during the painful, inflammatory phase to limit the development and impact of curvature. Using a vacuum erection assistance device twice a day for 10 minutes (or a penile extender traction device for six hours each day) can, over a period of three to six months, help correct some of the curvature.
This aver-- age signal change for each parameter relative to erectile dysfunction pills review buy levitra super active online from canada the mean normalised activition over all scans is expressed as a percentage latest erectile dysfunction medications generic levitra super active 40mg fast delivery. With permission from [56] [62 erectile dysfunction treatment natural generic 40 mg levitra super active,63] erectile dysfunction causes n treatment discount generic levitra super active uk, or non-erotic stimulation of the penis [59,64]. Clinical indings hedonic experience, as it becomes activated with of temporal lobe lesions causing hypersexuality increasing satiation and subjective pleasantness, [67], and temporal lobe epilepsy-associated sexual and deactivated with feelings of satiety [78,79]. This switch in amygdala levels signiicantly determine sexual behavioral activity may be crucial for sexual encounters to take outcome. With permission from [56] Table 2: Comparison of major brain deactivation (v) and activation (^) sites in women during orgasm and clitoral stimulation. The left anterior lobe of the cerebellar vermis and Table 2 shows different brain areas which are acti-- adjacent deep cerebellar nuclei activate during or-- vated/deactivated during rest, clitoral stimulation or gasm, in men and women alike [56,58,70]. It is quite possible that orgasms are characterized by substantial cardio-- this correlation represents increased activation of 085 comitte 22. Thus, salient genital information lar, the hypothalamus plays a major part in the sex-- may still reach the brain. Similarly, sensory informa-- ual response of female rodents [8], while in women tion from the internal genitalia may be conveyed by hypothalamic function predicts sexual orientation the sympathetic nerves [95]. Perhaps, the neuronal events that who were able to achieve arousal and even orgasm might occur in the hypothalamus during sexual con-- with cervical self stimulation. The same explanation could hold true for the stimulation, possibly representing the nucleus of the absence of activation in the ventral striatum, a region solitary tract [98]. By contrast, women’s brain No information about the data analysis procedure or responses during orgasm did not differ signiicantly the signiicance of the effects was disclosed. This suggests that men and women use different cerebral strategies to Therefore, it was not obvious why certain “activa-- reach orgasm. Future research may elucidate how tions” were labeled as consistent effects, and oth-- these difference can best be understood, and if this ers were not. Because women activated the ventromedial hypothalamus task performance remained unchanged, the authors and preoptic area when smelling an androgen-like proposed that most eficient neural processing of substance, whereas heterosexual men smelling an sexually salient stimuli occurs when pregnancy is estrogen-like odor activated the (more posteriorly lo-- possible [112]. Likewise, testosterone administration cated) dorsomedial and paraventricular nucleus [90]. Similar con-- faces [113], indicating relatively automatic processing gruent activity has been found between homosexual of sexually salient stimuli under the inluence of men and heterosexual women in the preoptic area testosterone. Prefrontal activation dominates the and ventromedial hypothalamus [103], suggesting a response to female faces in this group, suggesting coupling between hypothalamic function and sexual less automatic processing of sexually irrelevant preference, irrespective of gender. Pictures consisted together with sexual dimorphism of basic structures of negative valence/high arousal images versus like the hypothalamus, might explain why women neutral/low arousal visual stimuli. Moreover, brainstem - a network of regions implicated in the sexual preference determined the functional con-- stress response. Heterosexual during late follicular but not in early follicular phase, women (and homosexual men) showed more wide-- suggesting less cortical control of amygdala during spread connections from the left than from the right early follicular phase, when arousal was increased. With permission from [115] Premenopausal women had greater global brain men [66] this underscores the importance of gonadal signal than menopausal women in response to hormones in mediating the sexual response. Results showed 2 signiicantly greater subjectively reported arousal T treatment phase. These studies suggest that both E and T act independently and in a complimentary response in the group without a history of sexual 2 dysfunction. They observed many similar areas fashion to increase the central arousal response in women. This type of genital central concluded that the increase in activation in the medi-- processing is much more prominent in women al frontal and the right inferior frontal gyri suggested than in men. Interestingly, patterns, and should be taken in to account if this study also compared simultaneous vaginal pho-- possible. The last years introduction and increased use of neuroimaging methods have enabled us to explore cerebral activation and deactivation during sexual F. The cerebral sexual response has been shown to be modulated by hormones, age and sexual orientation. In Appendix 1 a suggestion for internal genitalia (vagina, cervix, uterus, fallopian a guideline for female sexological brain activation tubes and the ovaries and external genitalia (vulva) studies is given. The cliToriS are the two prominent, fatty lateral boundaries of is unique in that the only known function is the the urogenital cleft. Anteriorly they meet creating the generation of sexual pleasure when stimulated by anterior commisur in front of the glans of the clitoris, touch or vibration. Its gross structure is like an iceberg in that only a Each labium has external pigmented hairy, slightly ifth is visible on the surface while the rest is hidden wrinkled skin and internally a smooth surface lined beneath the skin and deeper. Anteriorly they split in to two layers a thin ibrous capsule surrounded by large nerve forming the clitoral prepuce and the clitoral frenulum. Externally, the shaft is covered They consist of no subcutaneous fat, elastic skin by the prepuce and is capped by a glans some 20 and contain erectile tissue and appear from smooth mm in length and 30mm wide [124,125]. The erectile compartments consist of that the types of sensory nerve endings could be the clitoris and the clitoral bulbs. The functional and divided in to 4 main groups namely: histological distinction of the trabecular vascular tissue of the clitoris and the bulbs are alike indicating i) free nerve endings and arborizations; this type of tissue to be erectile vascular tissue ii) spray-like nerve endings; [122,126,127], very similar to the erectile tissue found in the penis. It has been further demonstrated iii) 7 types of ‘claw’ like endings; [128] that autonomic innervation of the clitoris and the clitoral bulbs show striking similarities iv) Pacinian corpuscles (only a few). The function of these study but the free nerve endings subserve pain while bulbs is unclear; one speculation is that when illed the Pacinian corpuscles subserve pressure and with blood they support the vaginal wall during the vibration, whilst the possible roles of the different thrusting of coition. Whether they create any erotic types of ‘spray and claw nerve endings’ are unknown pleasure when stimulated by pressure has not been but they are unlikely to be only for pain. The term ‘periurethral glans’ [129] describes and delineates a triangular part of the vaginal vestibule that surrounds the urinary meatus, extending from below the clitoral glans to the vaginal introitus and laterally to the beginnings of the labia minorae. Contrasts exist, since the same area has been described in one study as part of the corpus spongiosum of the female which is far more widespread than in the male [130] and others have described the periurethral glans/corpus spongiosum/pars intermedia/root of the clitoris as the same structure [131] During coitus, the thrusting of the penis causes the area to be pushed in to and then dragged out of the vagina. As the area is an innervated mucous mem-- brane, this induced movement will create pleasur-- able erotic stimulation. When women are asked to list hierarchically their most pleasurable erotic sites Figure 12: A diagrammatic representation of the vulva highlighting many of its named features in re-- the periurethral glans area of the vaginal vestibule lation to the underlying structures it is “covering or is rated second after the clitoris. With permission from [131] and with the ity and density of innervation could be the answer courtesy of Dr. The clitoral nerves (also referred to as dorsal clitoral nerves) are high-- lighted in yellow. With permission from [131] and with the courtesy of With permission from [131] and with the courtesy of Dr. Remarkably, the area has in to the lumen), a lamina propria layer containing not been the focus of any biothesiometric study and connective tissue, blood vessels, nerves and is generally overlooked as a potentially important receptors, collagen, elastin ibres and inally a layer source of erotic pleasure during coitus for women. In the unaroused condition the vagina is a poten-- The vaginal microcirculation is supplied with tial space with its anterior and posterior walls col-- blood from at least 3 main arteries and drained by lapsed and resting together but they do not adhere numerous veins. Like all microcirculations it consists because the walls are covered with a thin ilm of luid of a circuit of arteries>arterioles>met-arterioles> (see, in this context, the speciic section dealing with capillaries>venules>veins. Its shape is complicated so no The vaginal vessels are richly innervated by single structure can describe it. The cross-section is adrenergic, cholinergic and vipergic nerves together similar to either a ‘H’ or ‘W’ while the longitudinal axis with neuropeptides like substance P (a sensory is like a greatly stretched out ‘S’ (length range 6-12 transmitter), neuropeptide y (a vasonconstrictor) and cm). The layered structure of the vagina consists of the Like other microcirculations it has a preferred path luminal stratiied squamous epithelium (a multi- for most of the blood low during quiescence (and cellular layer with new cells continually created in for the vagina that is quite often) which means that the basal layer by oestrogen-stimulated mitosis most of the time the capillaries are closed due to 09 comitte 22. Relations, if any, between and refreshing the local area with oxygen and vaginal vasomotion (147) and the slow oscillations nutrients. The cerVix only recently been observed and quantiied in the The cervix pierces the anterior vaginal wall normally vagina by photoplethysmography [147]. The degree at approximately right angles the longitudinal vaginal of vaginal vasomotion is a sensitive and useful index axis. Its central canal is high vasomotor tone of the arterial supply through some 3 mm in diameter and 2-3 cm in length and central sympathetic activation and a high level of is lined with a greatly folded epithelium of columnar vasomotion keep the blood low to the vagina at cells creating crypts (some 10,000) that look like minimal levels. The cells po of the vagina wall is basally at a low, hypoxic2 secrete mucus under the inluence of oestrogens level [136]. They also demonstrated that in humans and The innervation of the cervix is poor so that some rats the oscilation appear independent of vaginal minor surgery can be carried out without anaesthesia vasocongestion. It is more 2) the hypogastric and lumbosacral chain likely to be involved in the neuroimmunology of the issuing from level (T12 – L2) of the spinal cord cervix acting as an anti-inlammatory agent [150]. The clitoris is supplied by the conveyed by afferent pathways consisting of ileohypogastric pudendal arterial bed. After the pudendal, pelvic and hypogastric nerves and internal iliac artery has given off its last anterior the lumbosacral sympathetic chain.
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