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The effect of re- dosing of vasodilators on the intracavernosal pressure and on the Dunn A. New oral therapies for the treatment of Decter R M, Furness P D, Nguyen T A et al. Efficacy and safety of sildenafil citrate (Viagra) in men with erectile dysfunction and El-Sakka A I. Medical treatment of impotence with hypogonadism: Effect of testosterone replacement. Vasoactive intestinal nonresponse to intracavernous injection really polypeptide and phentolamine mesylate administered by indicates: a determination by quantitative analysis. Br autoinjector in the treatment of patients with erectile dysfunction J Urol 2002;167(1):192-196. Transurethral alprostadil as therapy for patients who withdrew from or failed prior Dizon M N, Vesely D L. Acupuncture in the treatment of psychogenic erectile dysfunction: first Doggrell S A. Comparison of clinical trials with sildenafil, results of a prospective randomized placebo-controlled vardenafil and tadalafil in erectile dysfunction. Erectile dysfunction in men under 40: Comparison of intraurethral liposomal and etiology and treatment choice. Int J Impot Res 1993;5(2):97 intracavernosal prostaglandin-E1 in the management 103. Br J Sex Med treatment of erectile dysfunction and benign prostate 2004;1(3):301-309. International Journal of Clinical Pharmacology & Therapeutics 2004;42(10):527-533. Impact of sildenafil on male hypopigmentation: Lichen sclerosus occurring after the initiation erectile disorder due to psychological factors. Evaluation and therapeutic in patients with benign prostatic hyperplasia, regulation of erectile dysfunction with visual stimulation test. Is sildenafil citrate an mellitus on the severity of erectile dysfunction and alternative agent in the evaluation of penile vascular system with response to treatment: analysis of data from tadalafil color Doppler ultrasound?. Relationship systematic review and meta-analysis of randomized clinical Between Vascular Damage Degrees and Endothelial trials. Sildenafil (Viagra) in endothelial progenitor cells and endothelial function kidney transplant recipients with erectile dysfunction. Sildenafil citrate does not reduce exercise tolerance in men with erectile Fazeli-Matin S, Montague D K, Angermeier K W et al. Management of erectile improves quality of life in men with heart failure and dysfunction in diabetic subjects: results from a survey of 400 erectile dysfunction. Classification of sexual dysfunction for management life satisfaction in male erectile dysfunction. Clinical efficacy and safety of erectile dysfunction: a systematic review and meta-analysis. Curr Ther is effective and well-tolerated for treating erectile Res Clin Exp 1996;57(9):700-710. Determination of changes in blood pressure during Giuliano F, Montorsi F, Mirone V et al. Switching administration of sildenafil (Viagra) in patients with spinal cord from intracavernous prostaglandin E1 injections to injury and erectile dysfunction. Proc Annu Clin Spinal Cord Inj oral sildenafil citrate in patients with erectile Conf 2006;44(5):301-308. Efficacy and safety of vardenafil in men with erectile dysfunction caused by spinal cord injury. Erectile dysfunction in a primary care setting: results of an observational, no-control Glina S, Sotomayor M, Gatchalian E et al. Timing of group, prospective study with sildenafil under routine conditions dose relative to sexual intercourse attempt in previous of use. Long-term efficacy of a new formulation of prostaglandin E1 as Gilbert R N, Graham C W, Regan J B. Br J Urol trial of testosterone enanthate in impotent men with low or low- 1996;155(3):915-917. J Assoc hemodynamic effects of sildenafil citrate: From basic science to Physicians India 2001;49871-872. Safety and efficacy of sildenafil citrate in the treatment of male erectile dysfunction. Sildenafil-dihydrocodeine interaction results study to assess the long-term safety of sildenafil citrate in prolonged erections. Medicated urethral system for efficacious in Black American and Hispanic men with erectile erection. Pharmacologically induced penile erections in the assessment Gupta N, Sawlani K K, Tripathi A K. Appropriate use and treatment of erectile impotence: a preliminary study of 100 of sildenafil citrate in male erectile dysfunction. Experience with triple-drug therapy in a pharmacological erection Gutierrez P, Hernandez P, Mas M. Penile rigidity in erectile dysfunction transurethral electrovaporization of the prostate and treated with alprostadil. Self intra-cavernous injections as a successful treatment in pure neurogenic impotence. Int J Impot Res treatment of neurogenic male sexual dysfunction: After the 2002;14(6):498-501. Does sildenafil diffusion of a novel therapy into clinical practice: the combined with testosterone gel improve erectile dysfunction in case of sildenafil. Arch Intern Med hypogonadal men in whom testosterone supplement therapy 2000;160(22):3401-3405. Sildenafil citrate: lessons learned Gross A J, Sauerwein D H, Kutzenberger J et al. Current treatment and future pharmacokinetics and hemodynamics of sildenafil citrate in perspectives for erectile dysfunction. Time versus intracavernous injection therapy: efficacy and preference dependent patient satisfaction with sildenafil for in patients on intracavernous injection for more than 1 year. Effect of tadalafil on sexual timing behavior patterns in men with erectile Hong J H, Ahn T Y. Different hemodynamic responses by color Doppler ultrasonography studies Hauck E W, Altinkilic B M, Schroeder-Printzen I et al. Prostaglandin E1 long-term self-injection programme for Asian J Androl 2007;9(1):129-133. Methylene blue as a means of treatment for priapism caused by He X Q, Hong B F, Wang X X et al. Evaluation of efficacy and intracavernous injection to combat erectile safety of oral sildenafil citrate therapy for men with erectile dysfunction. Int J Impot Res is effective for the treatment of erectile dysfunction in diabetic 1996;8(4):227-232. Recovery of erectile intracavernous injection of prostaglandin E1 for function by the oral administration of apomorphine. Vardenafil: a new approach to the treatment of testosterone on sexual function in men: results of a erectile dysfunction. Intracavernous intracavernous injection of prostaglandin E1 for neuropathic injections for erectile dysfunction in patients with erectile dysfunction. Sildenafil (Viagra): New data, new confidence in Kaplan S A, Reis R B, Kohn I J et al. Int J therapy using oral alpha-blockers and intracavernosal Clin Pract 2002;56(2):75 injection in men with erectile dysfunction. Hemodynamic effects of sildenafil citrate and isosorbide mononitrate in men with Karabulut A, Peskircioglu L, Ozkardes H et al. Br J Sex Med Objective penile vascular response to intraurethral 2005;2(3):407-414. Update on clinical trials of tadalafil demonstrates no increased risk of Kassouf W, Carrier S.
The document states that patients at high risk should not receive treatment for sexual dysfunction until their cardiac condition has stabilized erectile dysfunction ed treatment effective 100 mg kamagra oral jelly. Patients whose risk is indeterminate should undergo further evaluation by a cardiologist before receiving therapies for sexual dysfunction impotence over 60 order kamagra oral jelly mastercard. Chapter 3 provides the results of the evidence-based impotence 24 buy kamagra oral jelly 100 mg low cost, outcomes analyses of the noninvasive therapies to erectile dysfunction protocol foods cheap 100mg kamagra oral jelly free shipping the extent that the outcomes evidence was available. The following practice guideline statements are specific to the nonsurgical therapies. At this time, there is insufficient evidence to support the superiority of one agent over the others. At the time of our final literature search, studies directly comparing these drugs had not been published. This specific difference from the sildenafil clinical trials made comparisons invalid. Second, because many of the studies identified through the original literature search used mathematical models to compensate for patient variability in age, race, 17,18,19,20,21 smoking status, and baseline function, e. Although authors of previously published evidence-based reviews had obtained raw data directly from study investigators for meta-analytic purposes, the Panel believed that even if the raw data were obtained, useful comparisons still could not be made due to the incomparable patient populations. Sildenafil and vardenafil have very similar pharmacokinetic profiles with a time to achieve maximum serum levels (Tmax) of approximately 1 hour and a serum half-life of approximately 4 hours. In contrast, tadalafil has a Tmax of approximately 2 hours and a half-life of approximately 18 hours. All three drugs are Copyright @2005 American Urological Association Education and Research, Inc. All three medications have side effects due to peripheral vasodilation such as facial flushing, nasal congestion, headache, and dyspepsia. Back pain has been reported in a limited number of patients, especially those taking tadalafil, and the pathophysiology of this adverse effect is unknown. Standard: Phosphodiesterase type 5 inhibitors are contraindicated in patients who are taking organic nitrates. A suggested time interval has not been published for vardenafil, but additional blood pressure and heart rate changes were not detected when vardenafil was dosed 24 hours before nitrate administration (http://www. Thus, it is important to follow-up with each patient to ascertain whether the medication is still effective and that their cardiovascular health has not changed significantly. After re-education and counseling, which includes information on patient and partner expectations, proper drug administration, and titration to maximum dosing, evidence has shown that sildenafil therapy 28,29 becomes successful in some men who were not previously responders. Still, there are data to support the very realistic chance that more invasive therapies will be successful. Alprostadil Intra-urethral Suppositories Standard: The initial trial dose of alprostadil intra-urethral suppositories should be administered under healthcare provider supervision due to the risk of syncope. Despite the significantly greater efficacy of alprostadil intra-urethral suppositories in producing erections when compared to placebo in 31 randomized controlled trials, their use has produced less successful results in postmarketing 32,33 studies. Because hypotension has been reported to occur in approximately 3% of patients 31 after the first dose, it is recommended that the first dose be administered under supervision of a healthcare provider. The efficacy of alprostadil suppositories in combination with other treatment modalities recently has been evaluated. The combination of intra- Copyright @2005 American Urological Association Education and Research, Inc. As monotherapy, alprostadil is the most popular vasoactive agent; however, combination therapy with the other vasoactive drugs (bimix and trimix) can either increase efficacy or reduce side effects. The advantage of monotherapy with either papaverine or alprostadil is that they are readily available at most pharmacies whereas bimix and trimix are only available from pharmacies that offer compounding services. Because the Panel believed that the new body of evidence on the efficacy and safety of intracavernous therapy would not substantially change the outcome estimates of the 1996 Report, the literature on this topic was not reviewed. Standard: The initial trial dose of intracavernous injection therapy should be administered under healthcare provider supervision. Education of the patient is particularly important to minimize frustration and to decrease the probability of untoward side effects. Effective training Copyright @2005 American Urological Association Education and Research, Inc. When appropriate, the patient should be able to adjust within specific bounds the total dose of medication injected to match the specific situation for which it is used. Vasoactive drug injection therapy should not be used more than once in a 24-hour period. Standard: Physicians who prescribe intracavernous injection therapy should (1) inform patients of the potential occurrence of prolonged erections, (2) have a plan for the urgent treatment of prolonged erections and (3) inform the patient of the plan. It is important that patients be advised that erections that last 4 hours after an intracavernous injection be reported promptly to the healthcare professional who prescribed intracavernous injection therapy or his surrogate. Priapism should be treated as rapidly as possible to avoid adverse sequelae including corporal tissue damage. The prolonged erections and priapism associated with injection therapy are often readily reversed with nonsurgical measures when intervention occurs early. Thus, it is imperative for the physician to both have a plan in place to manage this complication and to communicate to the patient the seriousness of this complication and the need for rapid intervention. Vacuum Constriction Devices Recommendation: Only vacuum constriction devices containing a vacuum limiter should be used whether purchased over-the-counter or procured with a prescription. Vacuum limiters avoid injury to the penis by preventing extremely high negative pressures. Because no new evidence on efficacy or safety was found on review of the literature, the Panel decided not to include a detailed discussion of the data in this guideline update. Treatment Modalities With Limited Data Trazodone Recommendation: The use of trazodone in the treatment of erectile dysfunction is not recommended. The mechanism by which trazodone exerts its effect on erectile function may be related to its antagonism of alpha2-adrenergic receptors. In penile vascular and corporal smooth muscle, this may relax the tissues and enhance arterial inflow, producing an 36 erection. Although trazodone appeared to have greater efficacy than placebo in some trials, differences in 36 pooled results were not statistically significant. Testosterone Recommendation: Testosterone therapy is not indicated for the treatment of erectile dysfunction in the patient with a normal serum testosterone level. Yohimbine Recommendation: Yohimbine is not recommended for the treatment of erectile dysfunction. In humans, yohimbine can cause elevations of blood pressure and heart rate, increased motor activity, irritability, and 38 tremor. Although yohimbine increases sexual motivation in rats, this enhanced 40 libido effect has not been confirmed in humans. There has only been one small study published to date that used acceptable efficacy outcome measures; thus, conclusions about efficacy and safety cannot be made. Other Herbal Therapies Recommendation: Herbal therapies are not recommended for the treatment of erectile dysfunction. The literature review of herbal therapies, excluding yohimbine, found three randomized controlled Copyright @2005 American Urological Association Education and Research, Inc. In only one of these studies did results show benefits that reached statistical significance. Based on this insufficiency of data, the Panel cannot make recommendations for the use of herbal therapies. The lack of regulation for the manufacture and distribution of herbal therapies has permitted disparities in the raw materials used, in variations in manufacturing procedures, and in poor identification of the potentially active agent. Based upon the limited studies available and expert consensus, there does not appear to be significant efficacy beyond that observed with intraurethral administration of alprostadil. The Panel discussion on penile prosthetic implantation was limited to inflatable penile prostheses because recent design changes have improved mechanical reliability. Inflatable penile prostheses provide the recipient with closer to normal flaccidity and erection, but in addition to mechanical failure, they are associated with complications such as pump displacement and auto-inflation. Although design modifications have lowered the 5-year mechanical failure rate of inflatable prostheses to the range of 6% to 16% depending on the type of device, limited information concerning the failure rate beyond 5 years is available. Currently available inflatable prostheses have been modified in an attempt to reduce the risk of infection. A recently published industry-sponsored study demonstrates a statistically significant reduction of infection rate using the antibiotic-coated device from Copyright @2005 American Urological Association Education and Research, Inc.
For females who have not yet gone through menopause, removing the ovaries will cause periods to stop and you will be unable to have children naturally (see pages 62–65). If you have a radical cystectomy, you will need another way to collect and store urine (called a urinary diversion). Ofen the urine will drain into a bag attached to the outside of the abdomen, which may afect your body image. Hysterectomy – Tis removes the uterus, and sometimes the cervix, fallopian tubes and ovaries. It may be used to treat gynaecological cancers, such as cancer of the cervix, ovary, uterus (womb) and endometrium (lining of the uterus), and sometimes the vagina. A hysterectomy may shorten the top part of the vagina, but this doesn’t change your ability to have sex. Te clitoris and the lining of the vagina will remain sensitive, so you will usually still be able to feel sexual pleasure and reach orgasm. If the uterus was removed, contractions in the uterus will no longer happen during orgasm, and this can afect sexual pleasure for some. Your speech will be afected and this may afect your self-esteem and ability to express yourself during sex. Oophorectomy – If both ovaries are removed (bilateral oophorectomy) and you haven’t already been through menopause, you will no longer have your monthly periods or be able to become pregnant (see pages 62–63). If only one ovary has been removed, the other should continue to release eggs and produce hormones. You will still have periods and may be able to become pregnant if your uterus wasn’t removed. Orchidectomy or orchiectomy – If only one testicle is removed, there should be no lasting efects on your ability to have sex or your fertility. Unless there are unrelated fertility issues, your remaining testicle will make enough testosterone and sperm for you to be able to father a child. Te scrotum’s appearance can be improved and maintained with an artifcial testicle (prosthesis, see pages 58–59). Treatment side effects and sexuality 21 Having both testicles removed (bilateral orchidectomy), which is rarely required, causes permanent infertility because you will no longer produce sperm. Your body will also produce less testosterone, which may afect your sex drive, but this can be improved with testosterone replacement therapy. Te part of the penis that remains may still get erect with arousal and may be long enough for penetration. It is sometimes possible to have a penis reconstructed afer surgery, but this is still considered experimental and would require another major operation. Side efects may include: • erection problems (see pages 44–45) • not ejaculating semen during climax (dry orgasm, see page 46) • semen going backwards into the bladder instead of forwards (retrograde ejaculation, see page 46) • leaking urine during sex (see page 46) • loss of pleasure (see page 41) • pain during orgasm (see pages 52–53) • penile shortening. A vaginal reconstruction may be an option, but afer surgery scar tissue can form and make intercourse painful and difcult. Cancer Australia’s resource Intimacy and sexuality for women with gynaecological cancer – starting a conversation can help you talk with your doctors. Vulva (vulvectomy) – Removing part or all of the vulva will change the look and feel of your genital area, and can afect your body image, self-esteem and how you enjoy sex. If the clitoris has been removed, it may still be possible to have an orgasm through stimulation of other sensitive areas of your body, such as your breasts or inner thigh. However, it will take time for you and your partner to adjust to these changes (see pages 32–33 for tips). Radiation therapy Radiation therapy (also called radiotherapy) uses a controlled dose of radiation to kill cancer cells or damage them so they cannot grow, multiply or spread. Side efects ofen relate to the part of the body treated, and may include: • fatigue – your body uses a lot of energy dealing with the efects of radiation. Many people feel very tired during and afer treatment • skin – may be very sensitive or painful to touch • appetite loss – you may lose your appetite and lose weight • hair loss – you may lose some or all hair – on your scalp, face or body – during treatment. Treatment side effects and sexuality 23 Radiation therapy to the pelvic area – May be used for cancer of the bladder, bowel, cervix, ovary, uterus, vulva, prostate, or rectum. Te radiation oncologist will try to avoid the ovaries, especially if you have not yet been through menopause. Your periods may return afer treatment is over, but sometimes infertility will be permanent (see pages 64–65). Pelvic radiation therapy can cause short-term infammation of the vagina and vulva. Scar tissue from treatment can make the vagina shorter and narrower (vaginal stenosis). Sexual intercourse may be painful, but using vaginal dilators or vibrators afer treatment ends can help (see pages 48–50). Radiation therapy to the breast – Tis can cause the skin to become red and dry and develop a sunburnt look. Radiation therapy to the armpit may increase the chance of developing lymphoedema in the arm. Some people develop fuid in the breast that can last up to 12 months, or in some cases, up to fve years. If you’re unhappy with how the breast looks, talk to your doctor about your options (e. I don’t think anyone can tell you what the pain, discomfort and exhaustion will do to you. Donna Radiation therapy to the testicles – Tis can damage the blood vessels and nerves that help produce erections, causing temporary or permanent erectile dysfunction (see pages 44–45). It may also make the urethra infamed, so ejaculating might be painful for some weeks. Reduced sperm production is common afer radiation therapy, and it may be temporary or permanent. If you think you might want to father a child in the future, ask about storing sperm before starting treatment. Te drugs are called cytotoxics and they particularly afect fast- growing cells such as cancer cells. Other cells that grow quickly, such as the cells involved in hair growth, can also be damaged. Te side efects of chemotherapy vary depending on the individual and the type and dose of drugs given. Most side efects are short- term and gradually improve once treatment stops, but sometimes chemotherapy causes long-term side efects. Common side efects include tiredness, nausea, vomiting, diarrhoea, constipation, hair loss and mouth ulcers – all of which may afect your self-esteem and reduce your desire to have sex. Treatment side effects and sexuality 25 Chemotherapy can also afect the hormones linked to libido. For some females, this causes periods to become irregular, but they ofen return to normal afer treatment. Chemotherapy for ovarian or colon cancer can be given as liquid directly into the abdominal cavity. Tis can cause the belly to swell a little, which may afect your body image, but the liquid will drain away afer a short time. Another common side efect in females having chemotherapy (especially if they are taking steroids or antibiotics to prevent infection) is thrush, which can cause vaginal dryness, itching or burning and a whitish discharge (see page 51 for tips). Chemotherapy for vulvar cancer may make any skin soreness caused by radiation therapy worse. In males, chemotherapy drugs may lower the number of sperm produced and their ability to move (motility). Some chemotherapy drugs can afect the nerves needed for the penis to become erect, but this is usually temporary. Chemotherapy – Use protection after treatment as the drugs may Internal radiation – Avoid be released into your body fuids. Te aim of hormone therapy (also called endocrine therapy or androgen deprivation therapy) is to lower the amount of hormones the tumour receives. Anti-oestrogen drugs (such as tamoxifen, goserelin and aromatase inhibitors) are used in hormone therapy to treat oestrogen-sensitive cancers. Some people Treatment side effects and sexuality 27 have no side efects from these drugs, while others experience symptoms similar to menopause, including vaginal dryness or discharge, pain during intercourse, hot fushes, weight gain, decrease in sex drive and arousal, night sweats, urinary problems and mood swings.
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Desc: organic 77% erectile dysfunction medications purchase kamagra oral jelly with a visa, psychogenic 10% erectile dysfunction causes and symptoms cheap kamagra oral jelly 100mg with visa, mixed 13% zantac causes erectile dysfunction buy 100mg kamagra oral jelly overnight delivery, diabetes 15% erectile dysfunction urinary tract infection discount kamagra oral jelly 100 mg overnight delivery, post- Rx: Placebo 125 prostatectomy 10%, hypertension 26%, ischemic heart disease 8%, Discontinued: /36/216 Discont. Desc: organic 55%, psychogenic 14%, mixed 31%, diabetes 8%, post- Rx: sildenafil [25,100]T prostatectomy 9%, hypertension 24%, ischemic heart disease 15%, Discontinued: /9/163 Discont. Desc: mixed 100%, Rx: Copyright © 2005 American Urological Association Education and Research, Inc. Desc: organic 63%, psychogenic 16%, mixed 22%, diabetes 11%, post- Rx: prostatectomy 11%, hypertension 28%, ishcemic heart disease 8%, Discontinued: /13/166 Discont. Desc: Rx: Placebo 100 Copyright © 2005 American Urological Association Education and Research, Inc. Desc: diabetes 0%, hypogonadism 0%, post-prostatectomy 0%, spinal cord Rx: tadalafil 10 injury 0%, severe cardiac events in last 6 mo. Desc: diabetes 0%, hypogonadism 0%, post-prostatectomy 0%, spinal cord Rx: tadalafil 25 injury 0%, severe cardiac event in last 6 mo. Desc: diabetes 0%, hypogonadism 0%, post-prostatectomy 0%, peyronies 0%, Rx: tadalafil 50 serious cardiac event in last 6 mo. Desc: diabetes 0%, hypogonadism 0%, post-prostatectomy 0%, spinal cord Rx: tadalafil 100 injury 0%, serious cardiac event in last 6 mo. Desc: diabetes 0%, hypogonadism 0%, post-prostatectomy 0%, peyronies 0%, Rx: Placebo serious cardiac event in last 6 mo. Desc: diabetes 0%, hypogonadism 0%, post-prostatectomy 0%, Rx: tadalafil [2,25] Grp: 1. Desc: Rx: tadalafil 25 Copyright © 2005 American Urological Association Education and Research, Inc. Desc: Rx: tadalafil 10 Grp: 4 20mg Tadalafil age: 59(31,80) duration: Pts: 258 Pt. Desc: Rx: tadalafil 10 Copyright © 2005 American Urological Association Education and Research, Inc. Desc: Rx: Placebo Copyright © 2005 American Urological Association Education and Research, Inc. Desc: Rx: testosterone followed by polypharmacy cream Grp: 4 Polypharmacy cream then testosterone cream age: duration: Pts: 21 Pt. Effects of testosterone undecanoate on sexual potency and the hypothalamic-pituitary- gonadal axis of impotent males. Desc: Rx: Grp: 1 Experimental (testosterone) age: (45,75) duration: (1,) Pts: 18 Pt. Desc: organic 38%, psychogenic 50%, mixed 12%, diabetes 16%, neurogenic Rx: trazodone 150 3%, peyronies 3%, Grp: 1. Desc: psychogenic 100%, Rx: trazodone 150 Grp: 90 Placebo treated age: [55](39,81) duration: Pts: 37 Pt. Desc: organic 35%, psychogenic 54%, mixed 11%, diabetes 19%, peyronies Rx: Placebo 150 3%, vascular mixed or unspec. Trazodone: a double-blind, placebo- controlled, randomized study of its effects in patients with erectile dysfunction without major organic findings. Oral trazodone is not effective therapy for erectile dysfunction: a double-blind, placebo controlled trial. Desc: psychogenic 100%, Rx: Placebo T Copyright © 2005 American Urological Association Education and Research, Inc. Desc: diabetes 0%, hypogonadism 0%, post-prostatectomy 0%, spinal cord Rx: vardenafil 20 injury 0%, Grp: 2 40 mg vardenafil age: 44. Desc: diabetes 0%, hypogonadism 0%, post-prostatectomy 0%, spinal cord Rx: vardenafil 40 injury 0%, Grp: 90 Placebo age: 44. Desc: diabetes 0%, hypogonadism 0%, post-prostatectomy 0%, spinal cord Rx: Placebo 20 injury 0%, 758008 Porst, H. Desc: diabetes 0%, hypogonadism 0%, neurogenic 0%, post-prostatectomy Rx: vardenafil 10 0%, spinal cord injury 0%, Grp: 2 20 mg Vardenafil age: 34. Desc: diabetes 0%, hypogonadism 0%, neurogenic 0%, post-prostatectomy Rx: vardenafil 20 0%, spinal cord injury 0%, Grp: 90 Placebo age: 34. Desc: diabetes 0%, hypogonadism 0%, neurogenic 0%, post-prostatectomy Rx: Placebo 10 0%, spinal cord injury 0%, 796006 Thadani, U. Vardenafil for treatment of men with erectile dysfunction: efficacy and safety in a randomized, double-blind, placebo-controlled trial. Desc: organic 61%, psychogenic 7%, mixed 33%, diabetes 16%, Rx: vardenafil 5 Grp: 1 Vardenafil 5 mg age: 57(18,) duration: 3. Desc: organic 61%, psychogenic 7%, mixed 33%, diabetes 16%, Rx: vardenafil 5 Lost: /22/ Discontinued: /77/ Discont. Desc: organic 59%, psychogenic 7%, mixed 34%, diabetes 18%, Rx: vardenafil 10 Lost: /20/ Discontinued: /55/ Discont. Desc: organic 59%, psychogenic 7%, mixed 34%, diabetes 18%, Rx: vardenafil 10 Grp: 2. Desc: Rx: vardenafil 10 Copyright © 2005 American Urological Association Education and Research, Inc. Desc: organic 60%, psychogenic 7%, mixed 33%, diabetes 20%, Rx: vardenafil 20 Grp: 3 Vardenafil 20 mg age: 58(18,) duration: 4. Desc: organic 60%, psychogenic 7%, mixed 33%, diabetes 20%, Rx: vardenafil 20 Lost: /14/ Discontinued: /59/ Discont. Desc: organic 54%, psychogenic 9%, mixed 37%, diabetes 19%, Rx: Placebo Lost: /28/ Discontinued: /106/ Discont. Yohimbine for erectile dysfunction: a systematic review and meta- analysis of randomized clinical trials. Therapeutic effects of high dose yohimbine hydrochloride on organic erectile dysfunction. Desc: organic 100%, Rx: yohimbine 100T Grp: 90 Placebo age: 58(28,69) duration: Pts: 22 Pt. Double-blind, placebo-controlled safety and efficacy trial with yohimbine hydrochloride in the treatment of nonorganic erectile dysfunction. Desc: psychogenic 100%, Rx: yohimbine 18 Grp: 90 Placebo age: (18,70) duration: Pts: 19 Pt. Desc: organic 100%, Rx: yohimbine 18 Grp: 2 Placebo pts who subsequently got yohimbine age: (18,70) duration: Pts: Pt. Desc: organic 100%, Rx: yohimbine 18 Copyright © 2005 American Urological Association Education and Research, Inc. Desc: organic 100%, diabetes 38%, Rx: yohimbine Grp: 4 Pts who had no response age: 54. Desc: organic 100%, diabetes 32%, Rx: yohimbine Grp: 90 Placebo age: 55(18,70) duration: Pts: Pt. Desc: psychogenic 100%, diabetes 9%, Rx: Placebo [5,10] Grp: 92 "Normal controls" on placebo age: 39. Desc: organic 56%, psychogenic 44%, Rx: Grp: 1 All patients on yohimbine age: duration: Pts: 82 Pt. Desc: Rx: yohimbine Copyright © 2005 American Urological Association Education and Research, Inc. Desc: psychogenic 23%, diabetes 5%, Rx: Afrodex T Grp: 90 All patients on placebo age: 51. Desc: psychogenic 100%, hypogonadism 0%, Rx: Grp: 1 Yohimbine age: duration: Pts: Pt. Efficacy and safety of a novel combination of L-arginine glutamate and yohimbine hydrochloride: a new oral therapy for erectile dysfunction. Desc: organic 100%, diabetes 66%, Hypertension 33%, Alcoholism 25%, Rx: yohimbine 16. Percent Erectile Function 750019 1 4 Erectile Function sildenafil [25,100]T 14 10. Percent Erectile Function 756003 1 3 Erectile Function tadalafil 10 60 26 756003 2 3 Erectile Function tadalafil 25 58 25 756003 3 3 Erectile Function tadalafil 50 59 27 756003 4 3 Erectile Function tadalafil 100 59 26 756003 90 3 Erectile Function Placebo 58 19 756005 1. Percent % of attempts resulting in intercourse (part surv) 795500991 1 4 % of attempts resulting in Apomorphine 3 194 ** 24. Scale)[0,100] Copyright © 2005 American Urological Association Education and Research, Inc. Percent Sexual encounter profile 750054 1 999 Sexual encounter profile[0,6] 40mg phentolamine + 6 mg 36 1.
The work of the various committees was indeed very hard and was witnessed by the exchange of a huge number of emails aimed at discussing the contents of the various chapters. We are very pleased to inform you that we were always able to touch with our hands the enthusiasm and passion for science shown by the chairs and members of the com-- mittees. Sometimes there were strong views which would be contrasting but at the end it was always possible to ind a general consensus and the inal editing of the chapters text was overall very smooth. In Paris, the presentations of the committees were really top quality and it was clear to the audience that a huge amount of work was behind the slides that were shown. The discussion sessions were always very lively and many ideas that came out of these were used to improve the inal text of the chapters. In the end, we believe that our objective to create and update a set of standards from evidence based studies and years of research has been reached. This gratifying accomplishment could not have been made without the support from the previously mentioned organizations, the various sponsors and the ambitious staff of the Consultation. We are grateful to everyone involved and especially to Ira Sharlip who was instrumental in maintaining the necessary geographical balance when identifying the top experts and also in obtaining funding for the meeting; to Tom Lue and all the Vice Chairs who were extremely active during all the preparatory phases and to David Casalod and his team who were the responsible persons for the very eficient logistics. We are convinced that these contributions will be key in advancing our knowledge in the ield of sexual medicine and ultimately in improving the care of our patients. These consultations have looked at the level (strength) of evidence provided by an individual published evidence and produced recommendations at four study depends on the ability of the study design to minimise levels; highly recommended, recommended, optional and not the possibility of bias and to maximise attribution. It - Expert opinion is highly desirable that the recommendations made by the • how well the study was designed and carried out Consultations follow an accepted grading system supported by explicit levels of evidence. The use of standard check lists is recommended to insure that all relevant aspects are considered and that a consistent 1. The analysis of the literature is an important step in preparing • how well the study was reported recommendations and their guarantee of quality. The the levels of evidence scales vary between types of studies relevant committee members can then ‘peer review’ the (ie therapy, diagnosis, differential diagnosis/symptom data, and if the data conirms the details in the abstract, prevalence study). This is a complex issue – it may actually increase the Oxford Center for Evidence-Based Medicine Website: publication bias as “uninteresting” abstracts commonly do http://minerva. This requires the exercise of judgement based on It is expected that the highly experienced and expert clinical experience as well as knowledge of the evidence and committee members provide additional assurance that no the methods used to generate it. Evidence based medicine important study would be missed using this review process. Where there is disparity of evidence, for example evidence, practice quickly becomes out of date. However, a Grade A recom-- the levels of evidence shown below have again been mendation needs a greater body of evidence if based on modiied in the light of previous consultations. Levels of Evidence and Grades of recommendation studies or ‘majority evidence’ from level 2/3 studies or Dephi Therapeutic Interventions processed expert opinion. All interventions should be judged by the body of evidence • Grade D “No recommendation possible” would be used for their eficacy, tolerability, safety, clinical effectiveness and where the evidence is inadequate or conlicting and when cost effectiveness. It is accepted that at present little data expert opinion is delivered without a formal analytical exists on cost effectiveness for most interventions. Levels of Evidence and Grades of recommendation for Methods of Assessment and Investigation Firstly, it should be stated that any level of evidence may be positive (the therapy works) or negative (the therapy doesn’t From initial discussions with the oxford group it is clear that work). Does the test have good therapeutic performance, that is, others from within the original cohort group. There can be does the use of the test alter clinical management, does parallel cohorts, where those with the condition in the irst the use of the test improve outcome? For the third component (therapeutic performance) the same • Level 3 evidence (incorporates oxford 3a, 3b and 4) approach can be used as for section 6. In the Delphi process a series of There are aspects to the icuD system that require further questions are posed to a panel; the answers are collected research and development, particularly diagnostic into a series of ‘options’; the options are serially ranked; performance and cost effectiveness, and also factors if a 75% agreement is reached then a Delphi consensus such as patient preference. After its transfer to human sexuality the term was primarily reserved for the Today we have a clear concept of sexual medicine aspect of reproduction and not for sexual desire and how to deine this medical discipline. Even Paolo Mantegazza was still historically the uniication of sexuality and medicine talking of love (amore) when he was referring to the was not a given condition. He never used the focused on human reproduction and how to prevent terms sexual or sexuality. Therefore, we a book entitled “Sexology as the philosophy of life: have chosen this period as the starting point for this implying social organization and government” written article and only included the respective development by Elizabeth Osgood Goodrich Willard and published before that time in some aspects. It is a parafeministic monography with religious fundamentalistic tendency We would like to point out that his article can only relecting the human female and male interaction. More-- Sexualwissenschaft was popularized by the over, the focus is on the medical perspective rather dermatologist Iwan Bloch from Berlin in his famous than on the interdisciplinary aspect that deines the book “Das Sexualleben unserer Zeit (The sexual discipline of sexology. However, Sigmund Freud had used the same term earlier Sexuality: Before the 18th century only the adjective in 1898 in an essay dealing with the importance sexual (Latin: sexualis) was used in the sense of of sexual events for the development of neurosis, “belonging to the sex or gender”. To our knowledge but without earning the same or even any public the noun sexuality appeared after 1800 in the ield recognition. Spiritual and Physical Advice to those who have “Sexualwissenschaft” was initially translated literally already injured themselves by this abominable as “Sexual Science” but was rapidly transformed practice. The subsequent translations and resulted in a irst public awareness development of sexology after 1907 and reference for a new medical entity, i. This publication was indeed the not only in terms of terminology is the journal beginning of an anti-masturbation campaign that “Zeitschrift fur Sexualwissenschaft (Journal for lasted until the mid- 20th Century. Neither socio-cultural and religious issue but increasingly the introducing article “Uber Sexualwissenschaft gained interest of medical doctors. Sexual Medicine: However, the above mentioned irst issue of the journal “Zeitschrift fur Sexualwissenschaft” does contain an article entitled “Forensische Sexualmedizin (Forensic Sexual Medicine)” written by the lawyer Joh. The article is only reviewing legal cases that include some kind of sexual act or misconduct. Therefore, the modern deinition of sexual medicine is in no way indicated in this publication. Although aspects of sexuality in medicine were addressed by many physicians and sexologists in the following decades the term sexual medicine was not established before the 1970?s. It is quite dificult to identify the exact time or even person who deserves the credit for introducing the term in its modern deinition. In 1972 Volkmar Sigusch from Germany published a book “Ergebnisse zur Sexualmedizin (Results for Sexual With this writing the young medical doctor from Medicine)” in which he deines this new academic Lausanne became the most inluential medical speciality but also complains about the fact that propagandist of the alleged dangers of masturbation. As German journal “Sexualmedizin” and one year later outlined above Tissot was not the irst to imagine the “British Journal of Sexual Medicine” were the irst that nocturnal emissions and masturbation were a periodicals literally dedicated to the new discipline medical problem, but he deinitely anthologized and and several monographies and textbooks including summarized earlier thoughts on this subject. Tissot’s the term sexual medicine in their title were published work helped reshape medicine’s attitude towards in the 2nd half of the 1970?s [7]. His highly original argument was Around 1712 an anonymous author, most likely carefully constructed and supported by references the quack doctor and medical pornographer John to earlier authorities, such as Galen, Aretaeus, Marten [8], published the pamphlet “Onania; or, the Celsus, Boerhaave, Gaubius, Koempf, Sennert, Heinous Sin of Self Pollution, and all its Frightful Regis, Craanem, Zimmermann, G. Tissot had a major impact on the development of the professional anti-masturbation movement from the second half of the eighteenth century onwards. Physicians adopted his theories and invented a wide array of severe surgical, medical, dietary, and behavioral therapies for the prevention of masturbation over the next 150 years. Some Closure of the introitus vaginae as part of “female authors conclude that “extremist religion, and circumcision” procedures is also called inibulation extreme anti-sexualism and anti-phallacism provided and done with the intention to alter women?s sexual a fertile ground for the acceptance of an obviously activity. This procedure is still practiced in some anti-phallic, intentionally destructive surgery” [9]. Maladies Produites par la Masturbation” resulted in It experienced a revival during the Victorian Era the fact that medical doctors for the irst time became as another clinical weapon in the medical war increasingly engaged in issues of human sexuality. Although circumcision was the Although inglorious in many aspects this part of most commonly employed means of preventing history must be considered as one origin of sexual masturbation in the United States and Britain, medicine. However many scientists and a 19 year male who had complained of excessive thinkers brought up new ideas about sexuality during masturbation. Following the surgery, the patient is this period and in the irst part of 20 century. However Paolo Mantegazza (1831-1910) were not only focused on male children, adolescents (Fig. He scientiic belief at that time, Krafft-Ebing was one had tried gonad transplantations in frogs and he had of the irst authors to point out that homosexuals did measured the blood low and temperature increase not suffer from mental illness or perversion [15]. Through the discovery and development of psycho-- Even before Mantegazza, scientists in Europe stud-- analysis as an important psychotherapeutic school ied sexual function without considering this as a new Sigmund Freud (1856-1939) (Fig. One outstand-- had also great inluence on sexology, and his famous ing representative is Conrad Eckhard (1822-1905), “Three Essays on the Theory of Sexuality” from 1905 a German physiologist from Giessen, who followed is considered as his boldest and most impressing the transformation that scientiic medicine underwent contribution.