Pathophysiology of diabetic sexual dysfunction.

Sexual dysfunction is common in patients with diabetes mellitus. Vascular, neurological and hormonal alterations are involved in this complication. Many studies showed altered endothelium-dependent and neurogenic relaxations in corpus cavernosum from diabetic patients with erectile dysfunction (ED). This finding has been associated with a lack of nitric oxyde (NO) production and a significant increase in NO synthase (NOS) binding sites in penile tissues, induced by diabetes. Advanced glycation endproducts (AGEs) concur to diabetic vascular complications by quenching NO activity and by increasing the expression of mediators of vascular damage such as vascular endothelial growth factor (VEGF), possessing permeabilizing and neoangiogenic effects, and endothelin-1 (ET-1), with vaso-constricting and mitogenic action. Moreover, the differential gene expression for various growth factors in penile tissues may be involved in the pathophysiology of ED associated with diabetes. Neuropathy is also likely to be an important cause of diabetic ED: morphological alterations of autonomic nerve fibers in cavernosal tissue of patients with diabetic ED have been demonstrated. Finally, androgens enhance nNOS gene expression in the penile corpus cavernosum of rats, suggesting that they play a role in maintaining NOS activity. However, sexual dysfunctions in women with diabetes has received less attention in clinical research. Several studies suggest an increased prevalence of deficient vaginal lubrication, making sexual intercourse unpleasant. Sexual dysfunction is associated with lower overall quality of marital relation and more depressive symptoms in diabetic women.

Erectile dysfunction: why drug therapy isn't always enough.

We increasingly recognize that erectile dysfunction (ED) usually arises from a mix of organic and psychogenic causes, yet management of this condition too often neglects the complexity of most cases of ED. While therapy with Sildenafil Citrate ( Viagra ) and similar investigational drugs can play an important role in many cases of ED, physicians should recognize and try to address the psychological and interpersonal context in which ED exists in their patients. erectile dysfunction Penile fractures: controversy of surgical vs. conservative treatment

This paper reviews the current status of information on diagnostic and therapeutic management of penile fractures, focusing on the controversy between surgical vs. conservative treatment of this uncommon injury. Penile fracture, commonly defined as a rupture of the tunica albuginea and corpus cavernosum, is a serious urological disorder demanding surgical management. The diagnostic procedure classically consists of history taking, physical examination and urinary status. Determination of the extent of severity and location of the rupture in the tunica albuginea takes foremost priority and requires additional imaging procedures, such as ultrasound or cavernosography, which will impart enough diagnostic information for the correct choice of treatment. In some cases, the urethra is injured as well. Immediate surgical repair offers complete recovery for patients with penile fracture in most cases, even in the presence of urethral injury. Although penile fracture is easily recognized and can therefore be classified as a "first-look diagnosis", therapy remains controversial to date. The correct therapeutical approach is a vital factor in management, as the associated significant morbidity can result in complete loss of erectile function, painful erections or penis deviation. Early surgical treatment is strongly recommended because of the excellent results, shorter hospitalization, less morbidity and an early return to sexual activity. erection problems Advance in calcium channel blockers relaxing corpus cavernosum smooth muscle

Calcium channels exist extensively in the membrane of cardiac, skeletal, smooth muscle cell and neuron. Calcium channel blockers (CCB) were widely used for the treatment of cardiovascular diseases because they could relax vascular smooth muscle. Experimental researches on calcium channel blockers relaxing corpus cavernosum smooth muscle have been reported recently. Whether the blockers can be used for the clinical diagnosis and treatment of erectile dysfunction still need to be further investigated. premature ejaculation The false organic-psychogenic distinction and related problems in the classification of erectile dysfunction.

The traditional distinction between organic and psychogenic erectile dysfunction (ED) was maintained in the recent report of the Nomenclature Committee of the International Society for Sexual and Impotence Research. Among the major problems with this distinction are that it is based on an obsolete view of mind-body distinctions, does not take into account knowledge of the neurobiology of 'psychological' disorders, disregards the fundamental meaning of 'psychosomatic,' is too often diagnosed by exclusion, and may imply to the patient that his ED is 'all in the mind.' As a result, the distinction has become counterproductive in the diagnosis, classification, and treatment of ED, and in research into the causes of ED. An alternative taxonomy, based on that proposed by the Nomenclature Committee, reclassifies as organic several of the causes of ED now considered to be psychogenic, and considers others as situational ED, a class reserved for episodic occurrences of ED clearly due to particular attributes of sexual encounters. erectile dysfunction Cardiovascular effects of Tadalafil ( Cialis ) in patients on common antihypertensive therapies.

Tadalafil is a potent, selective, reversible phosphodiesterase 5 inhibitor under investigation for the treatment of erectile dysfunction (ED). Because some oral agents for ED have vasodilator properties, interaction studies were performed between Tadalafil ( Cialis ) and commonly prescribed antihypertensive agents. In addition, cardiovascular safety assessments were made from a safety database of phase 3 studies comparing patients who were and who were not receiving antihypertensives. In patients receiving concomitant antihypertensive therapy, Tadalafil ( Cialis ) administration may result in a reduction in blood pressure, which is, in general, mild and not likely to be of clinical concern. In the phase 3 studies, no statistically significant differences were observed between Tadalafil ( Cialis ) and placebo in the mean changes in blood pressure from baseline in patients taking >or=2 antihypertensive agents. The incidence rates of cardiovascular events were comparable between patients who were and were not treated with concomitant antihypertensive therapy, with the exception of events recorded as hypertension, which would be expected to occur periodically in this patient population despite treatment. Hypotension or postural hypotension was not reported in any Tadalafil ( Cialis ) -treated patient, compared with 1 report of each in the placebo-treated patients. Syncope was reported in 1 Tadalafil ( Cialis ) -treated patient (0.1%) who was not on concomitant antihypertensive medication and in 2 patients (1.9%) who received placebo with concomitant antihypertensive agents. The data presented herein suggest that Tadalafil ( Cialis ) is safe in patients receiving >or=1 concomitant antihypertensive agent.