Erectile impotence treated with an implantable, inflatable prosthesis. Five years of clinical experience.

Erectile impotence can now be treated with a device that mimics a natural erection. Between 1973 and 1977, we implanted an inflatable prosthesis in 245 men (235 with organic impotence and ten with psychogenic impotence). Of these, 234 are able to use the device to their satisfaction; no failures have occurred in the 152 cases treated in 1976 and 1977. The success of this treatment rests in part on the careful selection of patients by a team--a urologist, a sleep researcher, a psychologist, and a psychiatrist--each evaluating the patient independently. Our experience suggest that erectile impotence may be more common than generally believed and that impotence from organic causes may account for a greater percentage of cases than formerly thought.     

Erectile impotence precipitated by organic factors and perpetuated by performance anxiety.

A survey of 72 men with erectile impotence showed that for 14 the onset had been concurrent with the start of a temporary physical disability (in 8), temporary exposure to a chemical agent in doses thought to be significant (in 4) or the return of sexual opportunity after a long period of celibacy or near-celibacy (in 2 older men). After elimination of that possible cause the impotence had persisted owing to anxiety about sexual performance. In another 6 of the 72 there were persistent nonpsychic causes for the impotence. Thus, in 28% of the men surveyed the precipitating cause of erectile impotence was organic. A large proportion of the cases of erectile impotence participated by a temporary nonpsychic factor could probably have been prevented with appropriate professional advice--for example, at the time an antihypertensive drug capable of causing the dysfunction was first prescribed.     

Evaluation and treatment of sexual dysfunction in men with diabetes mellitus.

Sexual dysfunction is common among men with Type I and Type II diabetes. Tests of nocturnal penile tumescence (NPT) combined with waking tumescence and questionnaires can more accurately differentiate between primary organic and primary psychogenic impotence. This ability to differentiate the etiology of erectile dysfunction avoids the inappropriate use of penile injections and costly surgical procedures which are unnecessary in treatment of diabetic patients with primary psychogenic impotence. In patients with primary organic impotence, several new treatments are available which result in high patient satisfaction.     

谭新华教授从肝肾论治勃起功能障碍经验浅析

男性勃起功能障碍,中医称为阳痿,随着社会压力的增大,在年轻男性中发病率逐年上升.谭新华教授认为肝、肾二脏的功能失调是导致年轻男性勃起功能障碍的主要原因.治疗用药上常以肝肾为本、两者兼顾,寒温并用、通补兼施,以及注重对患者的心理疏导,各方面综合治疗,在临床治疗中均取得较好的疗效.     

阴茎勃起角度定量与勃起硬度的关系

测定２０例精神性阳萎和１０例血管性阳萎病人海绵体注射血管活性药物后阴茎勃起角度（ＰＥＡ）在２０°、４５°、６０°、９０°、１２０°时海绵体内压（ＩＣＰ），结果表明ＰＥＡ与ＩＣＰ有明显的直线正相关关系，回归方程为Ｙ＝２７．４１＋０．７８Ｘ，两组阳萎病人海绵体注药后ＰＥＡ、ＩＣＰ均有明显差别（Ｐ＜０．０１），本文对ＰＥＡ临床应用价值进行了讨论     

Radiation-associated impotence. A clinical study of its mechanism

External beam pelvic irradiation in men is frequently complicated by erectile dysfunction. We tested the erectile function in 23 patients (mean age, 65 years) who received radiation therapy for prostate cancer. Fifteen patients experienced changes in erectile potency following radiotherapy. Neurological, endocrine, and vascular testing revealed abnormalities in 0, 5, and 15 of these patients, respectively. In two, arteriography revealed bilateral occlusive disease in the distal internal pudendal and penile arteries overlying the pelvic radiation field. A significant difference with cigarette smoking was found among the 15 patients whose erectile capacity decreased and the four patients whose capacity remained unchanged. Vasculogenic impotence is the most consistent organic erectile abnormality in RAI.     

Impotence in medical clinic outpatients

One thousand one hundred eighty men in a medical outpatient clinic were screened as to the presence of impotence. Four hundred one men (34%) were impotent, and of those, 188 (47%) chose to be examined for their problem. After a comprehensive evaluation the following diagnoses were obtained: medication effect, 25%; psychogenic, 14%; neurological, 7%; urologic, 6%; primary hypogonadism, 10%; secondary hypogonadism, 9%; diabetes mellitus, 9%; hypothyroidism, 5%; hyperthyroidism, 1%; hyperprolactinemia, 4%; miscellaneous, 4%; and unknown causes, 7%. The mean age of the impotent patients was 59.4 years, and the prevalence of alcoholism was 7%. Luteinizing hormone, follicle-stimulating hormone, testosterone, thyroxine, triiodothyronine (T3), T3 resin uptake, and prolactin studies were necessary to diagnose individual cases. We conclude that erectile dysfunction is a common and often overlooked problem in middle-aged men followed in a medical clinic.     

Multidisciplinary survey of erectile impotence

A study was done of 220 men referred principally by family physicians to a multidisciplinary erectile dysfunction study group to determine the factors causing or contributing to impotence that had persisted for more than 2 months and for which no cause was apparent. The men were aged 21 to 79 (mean 50.3) years, and the duration of impotence was a few months to 15 years (mean 2.65 years). The men were to be assessed from general medical, endocrinologic/metabolic, psychiatric and urogenital viewpoints. The significance of the causal or contributory factors detected was scored by application of defined criteria and a four-point scale. The degree of loss of potency and of libido as well as level of concern were also scored by each specialist. Impotence was complete in 60%, and an associated decline in libido was reported by 38%. The level of concern was high--that is, normal--in 81% and slightly reduced in 9%. Full investigation by all the specialists was precluded by the severity of other conditions in 16 patients, by the return of potency following relief of anxiety/depression or genitourinary tract infection in 16 and for logistic or other reasons in 34. Although the cause of the impotence could be attributed in 186 of the patients, only 154 were fully assessed. Among these patients general medical factors were contributory in 46%, endocrinologic/metabolic factors in 44%, psychogenic factors (primary or secondary) in 60% and urogenital factors in 49%. Multiple contributing factors were identified in 65%, which underscores the importance of a multidisciplinary approach to assessing many cases of impotence.     

重庆城区男子性功能状况的初步调查

目的：研究重庆城区男子性功能状况，即勃起功能障碍和早泄的患病率、危险因素及性交频率。方法： 2001年7月～10月在重庆市某城区的社区进行随机抽样男子健康问卷调查，共访问18～69岁的男子990人。量表由北京大学人民医院设计，它包括一般情况和中国人勃起功能指数问卷（Chinese Index of Erectile Function ,CIEF）、性交频率及早泄。CIEF<22分为评分ED；受调查者自我评分的勃起功能障碍为自评ED。问卷调查表的结果用SPSS10.0统计学软件处理。结果：本调查评分ED的患病率为44.8%，自评ED为21.5%；大于40岁男子评分ED的患病率为 69.7%，自评ED为 37.4%；在高龄组的患病率高于低年龄组。早泄的患病率为8.1%。随着年龄增大，性交频率下降。影响ED患病的危险因素有躯体疾病和社会因素。结论： ED和早泄的患病率随年龄增高而增加，但性交频率随年龄增高而降低；躯体疾病和社会因素等是ED的危险因素。     

云南省曲靖市存在两性性伴的男男性行为者艾滋病高危行为调查分析

目的了解曲靖市存在两性性伴的男男性行为者艾滋病高危行为状况,确定干预工作的重点。方法采用"滚雪球"的方式接触目标人群,进行一对一问卷调查。结果存在两性性伴的男男性行为者,女性性伴数平均为(1.05±0.22)人,男性性伴数平均为(3.78±2.59)人。最近一次与男性性伴肛交时使用安全套的占72.7%;最近一次与女性发生性行为时,使用安全套的仅占22.0%。结论曲靖市存在两性性伴的男男性行为者,无保护性行为较常见,存在较大感染和传播艾滋病的风险。     

Will Australian men use male hormonal contraception? A survey of a postpartum population

AIM: To survey the attitudes of a population of Australian men to potential use of male hormonal contraception (MHC). DESIGN: Survey of male partners of women who had recently given birth. Men were approached while visiting their female partners on the ward. PARTICIPANTS: 118 out of 148 Australian-born English-speaking men who were approached. SETTING: Postnatal ward of Monash Medical Centre (a public teaching hospital in Melbourne), between October 2000 and April 2001. MAIN OUTCOME MEASURE: Attitudes towards potential use of MHC, rated on a five-point scale. RESULTS: 89/118 men surveyed (75.4%; 95% Cl, 67.7%-83.2%) indicated that they would consider trying MHC if it were available. The three most popular choices for method of administration of MHC were (in descending order) an oral pill, a three-monthly injection, or a two-yearly injection. A statistically significant association was found between acceptability of vasectomy and acceptability of MHC (70.5% of men who indicated they would try MHC [MHC "triers"] found vasectomy acceptable versus 44.5% of MHC "non-triers"; P = 0.011). Triers reported a higher rate of approval of MHC by their female partners than non-triers (79.8% v 13.8%, respectively; P < 0.0001). CONCLUSIONS: MHC appears to be acceptable to a majority of Australian men when surveyed in a postpartum context. Attitudes of men towards existing male contraception, as well as the attitudes of their partners, appear to exert a strong influence on acceptability of MHC.     

Surgeon's satisfaction on the use of invented needle magnet in reducing the risk of sharp injuries in the operating room

Background:

Healthcare workers, especially operating room personnel, are at increased risk for sharps injury and transmission of blood-borne pathogens as a result of their occupation. Infection with these pathogens occurs mainly by percutaneous or mucocutaneous exposure to blood-borne pathogens. This study evaluated the effectiveness of using invented needle magnet in reducing the risk of sharp injuries in the operating room.

Materials and Methods:

The needle magnet device is consisted of three parts: a cap, a magnet and a metal container. It was invented by the authors for the first time in Iran. The average weight of this device is 200 g and it can be easily placed near the surgery field or on the myostand. It has magnetic properties that attracts the sharp pointed particles during surgery and preserve them in a protected space. The device was used in surgical field by 33 surgeons during 90 surgical operations. Then, the satisfaction of participants and effectiveness of the device in protection against sharps injury was evaluated by a questionnaire.

Results:

Thirty-one surgeons (94%) believed that needle magnet reduces dispersion of sharp instruments; 79% of the participants suggested that our device reduces sharps injury during operation; 29 surgeons (88%) intended to use this device during operation. Thus, the use of needle magnet within surgical field may reduce the chances of sharps injury during surgery.

Conclusion:

The use of needle magnet within surgical field reduces the chance of sharp injury during surgery and the surgeons were satisfied with its use.     

Partner acceptance of health department notification of HIV exposure, South Carolina

To determine the acceptability of health department notification of sex and needle-sharing partners of persons infected with human immunodeficiency virus (HIV), we administered an anonymous questionnaire to partners notified of their exposure to HIV during the previous 2 years. Of the 202 partners notified, 132 (65%) were locatable and completed the questionnaire. Only 12 (9%) thought they may have been exposed to HIV before health department notification. When the 132 partners were asked if they thought the health department did the right thing in telling them about their exposure, 87% responded "yes;" when asked if the health department should keep notifying persons exposed to HIV, 92% responded "yes." Responses were similar for homosexual-bisexual men, heterosexuals, and intravenous drug users; men and women; and whites and blacks. We conclude that health department notification is acceptable to persons exposed to HIV in this rural South Carolina district.     

化学假体治疗阳萎32例分析

报告化学假体治疗阳萎32例，39人次，诊断为心理性阳萎。罂粟碱和酚妥拉明混合使用，除2例次用药只有5mg而无效外，余37例次效果均好，双方性生活满意。持续勃起时间最长22h，最短10－20min，平均2－4h。罂粟碱用药无剂量依赖关系，与个体敏感性和阳萎病程有关。对勃起时间超过12h者两侧分别注射肾上腺素和阿拉明后30min即恢复常态。     

Experiences and socialization of Jamaican men with multiple sex partners

One of the goals of the Acquired Immunodeficiency Syndrome (AIDS) control programme in Jamaica is to encourage persons to have a single sex partner. Before this can be achieved in men, it is important to identify the demographic characteristics as well as the sexual attitudes and socialization of men who have multiple sex partners. A national survey was conducted on sexual decision-making in Jamaica in which a random sample of 3,001 persons was selected for study and of 2,580 (86%) interviewed 979 were men. The following analyses included the 769 men who were sexually active. Thirty-four per cent (34%), 95% CI, 30.6-37.4%) of these men said that they were currently having sex with more than one woman. Although condom use was higher in men with multiple sex partners, 33% of them said that they never used condoms. Independent predictors of having multiple sex partners were: not being in a stable union; being raised by fathers only; and having a secondary school education. There was no significant association with church attendance or with occupation. Compared with other males, men who had multiple sex partners started having sex at an earlier age and were more likely to engage in high-risk sex behaviours such as having sex with prostitutes and abusing drugs prior to coitus. They were also more likely to believe in the use of sex as a means to control their partners and were less likely to think that being married or involved in a long-term relationship was important. These data must be taken into consideration by the AIDS control programme in Jamaica when formulating policies to promote monogamy. There may also be a need to implement parenting support or education programmes for single men who raise their sons.     

VIAGRA : IS IT A WONDER DRUG ?

Male erectile dysfunction is common and frustrating after the age of forty years. Erectile dysfunction is a cause of misery, relationship difficulties, and significantly reduced quality of life. Sildenafil citrate (Viagra) has shown promising results in recently published clinical trials. Sildenafil is a potent and competitive inhibitor of cGMp specific phosphodiesterase-5, predominant isoenzyme in the human corpus cavernosum. It is effective in erectile dysfunction of diverse origin, however it requires a patent vascular system to be effective. It is not effective in patients with endocrinal impotence, loss of libido, premature ejaculation or infertility. Its main adverse effects are headache, flushing, dyspepsia, diarrhoea, nasal congestion, indigestion, visual disturbances, dizziness and rash. Ventricular tachycardia and acute myocardial infraction have been reported in patients of ischaemic heart disease after consumption of sildenafil. Six deaths have been reported in patients taking nitrates. In India it is likely to be prescribed by a primary care physician without complete evaluation of patient on complaint of impotence. Hence the ethical question of who should prescribe this drug should be addressed by medical fraternity and proper guidelines formulated to avoid misuse of sildenafil. Phosphodiesterase is distributed in nerve, central nervous system, and systemic vasculature, hence long-term effects of drug on these tissues has to be ascertained. It should be made mandatory to report all adverse drug reactions to ADR monitoring centres. It is a wonder for those who require it, but has potentially dangerous adverse effects and drug interactions and hence is and not a wonder pill for all kinds of impotence.KEY WORDS: Erectile dysfunction, Impotence, Phosphodiesterase inhibitor, Sildenafil citrateMale erectile dysfunction has been defined as the persistent inability to attain and/or maintain penile erection sufficient for satisfactory sexual performance [1]. The prevalence of erectile dysfunction ranges from 52% in men aged 40-70 years to greater than 95% in men over 70 [2]. Improved understanding of peripheral and central mechanism for erection [3] has resulted in trials of various drugs [4, 5, 6, 7]. Dr Simon Campbell while working on newer molecules for angina discovered sildenafil citrate, which has shown promising results in recently published clinical trials [8, 9, 10]. This drug was approved in USA by the FDA on 27 March 98 [11] and licence was granted for sale in Europe by European Medicine Evaluation Agency in third week of September 98 [12]. In India various companies are exploring the possibilities of its sale [13].     

男-男性行为者的行为特征分析

目的 通过对男-男性行为者(men who have sex with men,MSM)行为监测,了解该群体与艾滋病相关的行为特征,为评估艾滋病在该人群的流行趋势提供依据。方法 2003年9月至12月,同时在成都和南充两市进行监测,采用专门设计的问卷收集行为资料,采用方便样本法和“滚雪球”法,从5类MSM最常活动的场所中抽取调查对象。结果 大部分MSM的性伴类型为男性性伴,最常见的性行为方式是肛交、口交和相互手淫。多性伴情况普遍存在,肛交和口交的性伴数中位数分别为4．4人和4．2人。近6个月性活动中,有491人(84．7％)与男性性伴发生过肛交,其中与不付费的固定和非固定性伴发生肛交的比例分别是68．6％和66．2％,明显高于与商业性性伴肛交的比例(20．4％)。与不付费固定和非固定、以及付费性伴肛交时坚持使用安全套的比例分别为15．8％、16．3％和32．3％。MSM中最近1年曾经有过毒品注射的人为1．9％,曾经自愿检测过HIV的人为18．3％。结论 MSM群体中HIV传播的危险行为是广泛存在的,这些行为包括多性伴、无保护肛交、商业性性活动、以及注射吸毒行为等。     

性病门诊男性就诊者艾滋病哨点监测结果分析

目的:了解性病门诊男性就诊者艾滋病流行状况和流行因素,为制定相应防控措施提供科学依据。方法:2012年4月至6月对首次到眉山市人民医院性病相关门诊就诊的400名年龄在15周岁及以上的男性就诊者进行面对面问卷调查,并采集血样进行艾滋病、梅毒、丙肝检测。结果:艾滋病知识总知晓率87.00%;14.25%的调查对象承认在最近3个月有商业性行为;10.75%的调查对象承认最近3个月与临时性伴发生过性行为;0.25%的人承认与同性发生过肛交性行为;16.50%的被调查者最近1年接受过有关预防艾滋病性病服务;0.50%最近1年做过艾滋病病毒(HIV)检测并知晓检测结果。HIV抗体检出率2.25%;梅毒抗体检出率3.75%;丙肝抗体检出率0.75%。结论:性病门诊就诊者存在知识和行为分离的现象;应对性病门诊就诊者开展针对性的行为干预,控制艾滋病经高危人群向一般人群扩散。     

性活跃男性患者膀胱癌根治+回肠膀胱术后25例勃起功能现状调查

目的调查性活跃男性患者行腹腔镜膀胱癌根治+回肠膀胱术后勃起功能的现状,为进一步采取医疗干预措施提供参考和依据。方法 2010年8月—2012年3月接受腹腔镜膀胱癌根治+回肠膀胱术的25例已婚男性患者,术前性功能全部正常,定义其为性活跃男性,其中10例接受保留性神经膀胱癌根治+回肠膀胱术,15例接受非保留性神经膀胱癌根治+回肠膀胱术。对25例患者术前采用国际勃起功能问卷(IIEF-5)进行勃起功能评估,术后结合IIEF-5并参考男子性功能问卷(O'Leary 1995)自行设计调查问卷进行术后勃起功能及相关情况调查。结果与术前比较,25例患者术后12个月均无法达到可以插入阴道的勃起。IIEF-5总分:保留性神经组10例患者从术前(20.60±2.22)分降至术后(1.90±1.73)分,非保留性神经组15例患者从术前(18.73±3.83)分降至术后(3.20±4.87)分,2组术前与术后比较差异均有统计学意义(P<0.01)。2组术后自行设计量表总分比较差异无统计学意义(6.40±0.84 vs.6.20±0.78,P>0.05)。结论膀胱癌根治+回肠膀胱术后男性勃起功能障碍的发生率较高。     

Human immunodeficiency virus infection, hepatitis B virus infection, and sexual behaviour of women attending a genitourinary medicine clinic

During the six months immediately after a public information campaign about the acquired immune deficiency syndrome 1115 women who attended a genitourinary medicine clinic in west London were tested for antibodies to the human immunodeficiency virus (HIV). Three women (0.27%) were positive, and all three were regular sexual partners of men with high risk lifestyles--two intravenous drug users and one bisexual. A consecutive series of 647 women from the cohort was tested for antibodies for hepatitis B core antigen: 27 were positive, of whom six had been born in the United Kingdom and were not known to have been at risk. The two women who were seropositive for HIV who completed a questionnaire on their sexual behaviour before they were tested reported both anal and oral receipt of semen and were in the upper fifth percentile for lifetime sexual partners. More than half (53%) of 424 women who reported that they had non-regular sexual partners never used a condom. It is concluded that heterosexual women in London are at a low risk of becoming infected with HIV.