Patients and Partners – about sexual problems

Viagra history goes 15 years back to 1997 when noteworthy side effects of sildenafil were discovered. Sildenafil was initially developed as a medicine for pulmonary heart disease, and until the present day the main medicinal component of Viagra is used for this condition in the composition of the drug called Revatio. Viagra has blood pressure lowering characteristics and therefore its use is contraindicated in persons with proneness to hypotension.

Asking sexual partners about each othera��s sexual function is often very useful. Women ranked a�?partner sexual difficultiesa�? as a common sexual concern. If both members of a couple are in the office, it becomes easy to introduce the topic by asking a�?How are you two doing together? How are you doing with sex?a�? If only one member of a couple is available, questions can still be asked about the present patient as well as the partner. When a sexual dysfunction is identified, talking to the partner can reveal a different picture that may substantially affect management and can also have a therapeutic effect. Relationships have a profound effect on sexual health and often need to be explored to amplify the likelihood of successful resolution of the problem.

If the patient or partner initiates discussion about sex or has a specific question, this requires attention equal to that of other patient complaints. If the clinician is lucky, the concern will be voiced early in the visit, allowing for some exploration of the issues. More often, if the patient or partner is not asked about sexual issues, they will discuss problems at the end of the visit. Although this may seem like an afterthought, for many, it may be one of the major (if not the major) reasons for the visit. An initial impression that their problem is being dismissed can considerably delay or prevent them from seeking further help.

Partner issues vary widely. Patients may be having sex with one partner, multiple part-ners, partners of the opposite sex, partners of the same sex, or a combination of these. Issues around partner choice, partner participation in sexual activity, and partner physiol-ogy may impact sexual function. All of the emotional components of a good relationship contribute to continued sexual satisfaction. Relationship factors often play a role in mena��s sexual problems. Early in relationships, partners try to please and be sensitive to one another. After time, these efforts may be abandoned and sex may become perfunctory in both form and function. Sildenafil citrate canadian pharmacy

Successful treatment of sexual problems is most likely to occur when couples have a good relationship and are able to communicate their positive and negative feelings to each other. Many men may prefer to be evaluated and treated for sexual problems alone, but when a partner is present, patient education may convince the man of the importance of including the partner in further management.

If inadequate time exists to discuss the issue, recognition should be made of the patienta��s problem or concern and another time should be scheduled to further discuss the issue. Merely spending time clarifying the nature of the problem can lead to more effective treatment and may, in itself, be therapeutic. Alternatively, the patient can be given a referral to another clinician if the primary care clinician is uncomfortable, but even a proper referral requires some further exploration.

Erectile Dysfunction in Australian Viagra

Now a�� trumpets and drum rolls a�� for Viagra, or sildenafil, the darling of TV and magazine advertising, stockholders and many men. Pharmaceutical giant Pfizer is also undoubtedly orgasmic with Viagra in Sydney about the dollars rolling in. However, whatever one mayere think of the profit motive which is so obviously behind it, Viagra has been a true advance in treating problems of potency, or erectile dysfunction, converting many a three-and-a-half-inch floppy to a hard drive.

Viagra acts in a complex biochemical way to restore the normal physiological response to sexual stimulation. It increases the level of a chemical called cyclic guanosine monophosphate (cGMP), which relaxes the smooth muscle in the walls of the blood vessels in the penis and restores the ability of those blood vessels to fill the spongy cylinders with blood. This is clearly very different from the previously available treatments. With implants or injections, the man was set to go even if he had no compelling interest a�� a hole in a woodpile would do, as they say. With Viagra, if he a�?has a headachea��, his little man will not stand up and beg.

Viagra also has the convenience of being orally administered in an average dose of 50 mg and being available in the bloodstream within an hour after swallowing. It remains active for about three to five hours after this. This means that a man can swallow his pill if things are looking promising, enjoy foreplay and be hot to trot. (With the cost of Subligual Viagra for Sale, though, sex may not be the final note in a pleasant evening a�� it may be the date.) It is interesting that in many countries the relevant committees were very quick to extend prescription coverage to Viagra, whereas many have held out against the birth control Pill for many years, and others took a long while to approve tibolone, a hormone replacement that improves lost libido in older women.

Many scientific studies have been done evaluating such things as visual sexual stimuli (i.e. the Playboy response), and scoring responses by the International Index of Erectile Function. These tests were conducted with several hundred men and did not differentiate between different causes of erectile difficulty. The results have been reported in such distinguished journals as the Lancet of London and the Journal of the American Medical Association. The outcome is that Viagra is significantly better than a placebo in improving the frequency of vaginal penetration, maintenance of the erection, orgasmic satisfaction, satisfaction from the act of intercourse and a�?overall satisfactiona��, according to the men surveyed. (Ita��s not clear what the partners of these men felt about all this; questionnaires were provided for the partners but only 25 per cent filled them out.)

Other Concerns of Men in Australia

Relationship Concerns

Partner Problems That Subvert Sex. Be aware that your sexual health is essentially influenced by your partnera��s sexual health a�� physically, emotionally, and interpersonally. When your partner has a health problem that subverts her sexual health, it is essential that you become her support person so you can adapt together. Be an intimate team and utilize flexible sexual scenarios in dealing with depression, anxiety, menopause, cancer treatment, or arthritis. Her problems are yours, and yours are hers a�� you are an intimate team.

Relational Problems That Can Subvert Sexuality. When a marriage works well, it meets the mana��s needs for intimacy and security better than any other relationship. Healthy sexuality plays a 15a��20% role in couple satisfaction. However, couple problems can subvert sex, and sexual problems can subvert couple satisfaction. Relationship problems can play an inordinately powerful role in sexual dissatisfaction and dysfunction, and sexual dynamics play an inordinately powerful role in relationship dissatisfaction and alienation.

The major problems are dissatisfaction with your partner, not valuing the relationship, or not valuing couple sex. Our recommendation in all these areas is to see this as a couple issue and to seek couple therapy when the problem is still acute rather than waiting until the problem is chronic and severe.

Healthy relationships involve a strong identity as a couple, the ability to recognize and address differences and conflicts, and the ability to communicate with and influence your mate. This includes acknowledging your partnera��s strengths as well as vulnerabilities and feeling respectful and loving in spite of the problems. Also important is maintaining a commitment to the vitality and security of the relationship. The couple bond involves respect, trust, and intimacy. Communication often breaks down to gooda��bad power struggles: a�?Ia��m right, youa��re wrong.a�? You view your partner as your worst critic.

We propose a very different communication/problem-solving model, a four-phase process. The first phase is listening to each othera��s feelings and perceptions in a respectful, caring manner. The second phase is generating practical and emotional alternatives to resolve the problem. The third phase is reaching an understanding/agreement that ideally resolves the problem in a manner that meets both your needs but at a minimum that each of you can live with. The fourth phase is to implement the agreement and if necessary make changes so that it really is helpful. A crucial concept in dealing with personal and relational problems is that about 30% of problems are resolvable, 50a��60% are modifiable, and 10a��20% need to be accepted and lived with. Contrary to pop psychology, few problems have a perfect resolution. With genuine intimacy and communication, these realities are acceptable.

Premature Ejaculation: Treatment Part

Therapies for PE include psychological, behavioral, and pharmacological approaches. In general, men with lifelong PE likely have lower ejaculatory thresholds compared to unaffected men, and thus may benefit most from medical therapies.

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In contrast, men with a history or acquired PE are more likely to be better treated with cognitive or behavioral therapy. Among the psychological approaches, psychotherapy has been reported as a primary therapy, but there is a lack of well-designed clinical trials assessing the efficacy of this intervention.

The ICSD recognized three pharmacologic treatment options for PE:

  1. Topical anesthetics (lidocaine or prilocaine);
  2. Daily treatment with serotonergic antidepressants (paroxetine 20a��40 mg, sertraline 50a��100 mg, fluoxetine 20a��40 mg, or clomipramine 10a��50 mg);
  3. On-demand treatment with antidepressants.

The ICSD Guidelines state that none of the above drugs have been approved for the treatment of

PE by regulatory agencies, and the majority of studies to assess their efficacy are limited by inadequate design.

Behavioral Techniques

Behavioral techniques include the a�?stop and start techniquea�? and the a�?squeeze technique.a�? With the a�?stop and start technique,a�? patients are instructed to manually stimulate themselves in a controlled fashion and involve their partner in the manual stimulation once controlled arousal has been achieved. The couple then proceeds onto intercourse. The a�?squeeze techniquea�? is very similar to the a�?stop and start technique,a�? except the penis is manually squeezed during the times when stimulation is stopped. The obvious advantage of behavioral techniques is that they are nonpharmacologic and thus avoid possible side effects associated with medical therapies. While some authors report success with behavioral approaches, these treatment modalities are overall poorly studied and lack long-term efficacy.

Pharmacological Therapies

A number of pharmacological therapies have been utilized to lengthen IELT for men with PE.

These therapies include both topical and oral agents, and dosing varies from on-demand to daily schedules.

Topical Therapies

Topical therapies address the issue of a�?penile hypersensitivity.a�? Local anesthetic medications are available in topical gel, cream, or spray forms. Busato et al. conducted a double-blind, randomized, placebo-controlled study assessing topical lidocainea��prilocaine; they reported a significant increase in IELT from 1.49 to 8.45 min in the treatment group versus 1.67a��1.95 min in the placebo group. In this particular study, no systemic side effects were reported. Possible side effects do include skin irritation or numb-ness and erectile dysfunction. Additionally, transfer of these topical medications from the treated male to his partner is another possible bothersome side effect potentially limiting the use of this mode of therapy. Hence, the ICSD noted that while topical therapy is moderately effective, penile hypoesthesia is a significant adverse side effect in the male. In the female, transvaginal absorption with possible vaginal numbness and female anorgasmia may limit efficacy for the couple if a condom is not used.

Quantification of Erectile Dysfunction After Prostate Cancer Treatment

Determining if a man has erectile dysfunction (ED) seems like an innocuous task. However, this seemingly straightforward determination is fraught with peril, especially when applied to the reporting of erectile function after prostate cancer treatment. Is the wide range in ED outcomes following prostate cancer treatment really due to inherent biologic variability, or are there biases or other factors at work confounding the data? The goal of this chapter is to detail the specific difficulties for the quantification of ED in the context of challenges inherent to all scientific research: optimization of a studya��s internal and external validity. Only through the understanding of the factors that influence the quantification of ED can consistent, standardized outcomes be obtained to advance the field of study.

Introduction

Determining if a man has erectile dysfunction (ED) seems like an innocuous task. Erectile dysfunction? forget about with www.healthcaremallcanadian.com – canadian health care mall online. However, this seemingly straightforward determination is fraught with peril, especially when applied to the reporting of erectile function after prostate cancer treatment. This point is well illustrated by the drastic variance of ED rates following prostate cancer treatment found in the scientific literature of 9a��100%. Indeed, experts have recently stated that the data on erectile function outcomes after prostate cancer treatment are often poorly interpretable, inconsistent, and yield widely disparate results. Is the wide range in ED outcomes following prostate cancer treatment really due to inherent biologic variability, or are there biases or other factors at work confounding the data? The goal of this chapter is to detail the specific difficulties for the quantification of ED in the context of challenges inherent to all scientific research: optimization of a studya��s internal and external validity. Only through the understanding of the factors that influence the quantification of ED can consistent, standardized outcomes be obtained to advance the field of study.

ED Quantification, Biological Variability, and Study Validity

Sexual dysfunction exists as one of the most significant detractors to the quality of life measures in patients treated for localized cancer of the prostate (CAP). A study in 2003 found that even as long as 92 months after radical retropubic prostatectomy (RRP), more than 75% of the treated men were sad or tearful about ED and over 70% felt that the quality of life was adversely affected. ED is an unfortunate consequence that accompanies CAP treatment.

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After an extensive abstraction process, an AUA prostate cancer guideline update panel task force attempted to establish ED prevalence rates after RRP, XRT, and brachytherapy, with non-specific results from 31 articles. The article noted that sub categorization of results according to specific variables was not feasible due to imprecise or absent descriptions of these variables in the original articles. In an attempt to develop a basic source for patients and physicians to look up the likelihood of the developing ED after the various prostate cancer treatments stratified by risk factors that were listed, we summarize the 31 articles previously abstracted in addition to articles commenting on cryotherapy, androgen ablation, and prostate cancer treatment comparison studies. In selecting these articles, we placed importance on studies with high power, or those that elaborated on important patient factors (age, medical comorbidities, and preoperative erectile status) and those that used consistent ED definitions and validated ED information collection tools. Our experience was similar to that of the Review of literature reveals that 9a��100% of men have erectile dysfunction following prostate cancer treatment. Substratification of the different prostate cancer treatment approaches leads to a similarly disturbing wide range of ED prevalence: 24a��87% after RRP; 13a��70% after radiation therapy (brachytherapy [BT] or external beam radiation [XRT]); 53a��95% after cryotherapy (CT); and 45a��92% in patients undergoing hormonal androgen ablation (AA). Do these wide ED prevalence rates represent truth from biological variability, or are different factors at play? Although there is likely some biologic variability in the preservation of erectile factors after prostate cancer treatment insult (genetics, nutrition, age, wound healing, etc.), flawed study methodology of ED quantification studies likely lies at the heart of the matter.

Cardiovascular Issues in the Treatment of Erectile Dysfunction

The cardiovascular response to sexual activity worries a lot of men and women, particularly if a coronary or vascular event has already occurred. The fear of inducing another cardiac episode is fuelled by many myths including the assumption that sex is an extreme stress to the heart, driven to some extent by media/internet distortion. Adding the anxiety that treating ED may increase cardiac risk, and we have a recipe for relationship stress or breakdown and couple frustration. Many agree with the concept that ED is a�?a mana��s problem but a couplea��s concerna�? because it invariably is, though at times is not managed as such. Though this chapter addresses an organic condition, it is important not to compartmentalize ED too rigidly a�� men with organic ED may, and often do, have psychological problems as well, and men with a predominantly psychological etiology may also have organic issues.

Introduction

The link between erectile dysfunction (ED) and cardiovascular disease (CVD), specifically coronary artery disease (CAD), is now well established. We recognize that ED may be a marker for silent CAD as the common denominator in the majority of men over 30 years of age is endothelial dysfunction. In addition, up to 75% of men with CAD have some degree of ED, often presenting before the coronary event. The Second PrincetonA�Consensus Conference, which focused on sexual dysfunction and cardiovascular risk, concluded that ED is a warning sign of vascular disease with the practical recommendation that a man with ED and no cardiac symptoms is a cardiac or vascular patient until proven otherwise. From these observations came the idea that ED in the absence of CAD symptoms offered an opportunity to reduce the risk of a coronary or vascular event by addressing the recognized CAD risk factors shared by ED and CAD. This proposal was strengthened by a series of publications pointing to an average time window of 3 years between ED and a CAD event.

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The cardiovascular response to sexual activity worries a lot of men and women, particularly if a coronary or vascular event has already occurred. The fear of inducing another cardiac episode is fuelled by many myths including the assumption that sex is an extreme stress to the heart, driven to some extent by media/internet distortion. Adding the anxiety that treating ED may increase cardiac risk, and we have a recipe for relationship stress or breakdown and couple frustration. I have always liked the concept that ED is a�?a mana��s problem but a couplea��s concerna�? because it invariably is, though at times is not managed as such.

Therefore the cardiovascular issues that need to be addressed are:

  • Is sex safe statistically, but more importantly for the individual being counseled?
  • Can ED be safely treated in cardiac patients?
  • Can ED be a means of preventing subsequent CVD?

Though this chapter addresses an organic condition, it is important not to compartmentalize ED too rigidly a�� men with organic ED may, and often do, have psychological problems as well, and men with a predominantly psychological etiology may also have organic issues.

What am I going to do about my erection?

That is an age old question that has a new age answer. When men first experience erectile dysfunction, it is important to identify the reason and seek out a treatment plan. In most cases, erectile dysfunction is treatable, but the cause has to be known. It may seem to be an embarrassing problem, but if ignored it will only get worse.

A satisfying sex life is directly proportional to a mana��s ability to achieve an erection. It is not a hard and fast rule, it is a fact of life. When an erection does not occur, it is time to find out why. There is a lot of information available that will assist in self diagnosis, but it is always a good idea to obtain a professional opinion. There are a number of self help treatment plans available that can also be implemented, but it is always a good idea to undertake a medically approved treatment plan.

Sometimes, it might be necessary to identify the problem of erectile dysfunction through a complete medical exam to eliminate a medical condition as the source of the problem. If erectile dysfunction is found to be caused by a medical condition, treating the disease will almost always cure the dysfunction.

Men may develop erectile dysfunction while being treated for a medical condition and treating the condition may not always help the dysfunction. A combination of reasons will require a combination of treatments and that is where a medical professional will be mana��s best friend.

Properly addressing the cause is key to finding the right remedy and following the treatment as prescribed is essential to solving the problems erectile dysfunction will bring. Sometimes, there is no cure for erectile dysfunction. Accepting that conclusion may require some counseling, as well as a search for alternative methods.

Maintaining an erection can sometimes be a challenge and suffering erectile dysfunction can sometimes be extraordinarily tough to accept. That is why is it always better to seek out a professional opinion and help when wrestling with the devastation of erectile dysfunction. It is something that can be treated and remedied.

Causes of Erectile Dysfunction

The male sexual arousal system is a complex and involves several areas of the human body including hormones, the brain, nerves, muscles and blood vessels. Erectile dysfunction can be the result when one of the elements malfunctions. Mental health and stress issues and problems can be the cause or the effect of erectile dysfunction. A combination of psychological issues can also cause erectile dysfunction. Click here to order Cheap Viagra online.

A minor physical problem that slows sexual response may cause anxiety about maintaining an erection. The end result could be performance anxiety and the onset of erectile dysfunction or the worsening of erectile dysfunction.

The most common reason for erectile dysfunction includes atherosclerosis (hardening of the arteries), heart disease, high blood pressure and cholesterol, obesity, diabetes and metabolic syndrome, which is a condition that involves high insulin levels, high blood pressure and body fat around the waist.

Other causes of erectile dysfunction include Parkinsona��s disease, multiple sclerosis, low testosterone, certain prescription medications, smoking, alcohol and substance abuse and treatment for prostate cancer and surgeries and injuries affecting the pelvic area and spinal cord. Viagra in Australia information

As a man ages, it takes longer to generate an erection and the firmness may not be the same as when younger. An erection may require more direct touching to achieve and maintain an erection. This isna��t always a result of getting older; it is sometimes the result of an underlying physical condition.

Diabetes and heart disease are the top two contributing factors to erectile dysfunction. Smoking restricts flow to the veins and arteries and as a result less blood is delivered to the penis. Smoking can also lead to other health problems that will also lead to erectile dysfunction.

Body weight is a definite contributing factor to erectile dysfunction, especially if classified as obese. Radiation treatment for cancer or prostate surgery is also contributing factors to erectile dysfunction as is injuries that damage the nerves that control erections.

Using prescription medications such as antihistamines, antidepressants and treatments for high blood pressure, pain or prostate cancer, will render an erection useless quicker than anything else and long term use could lead to serious and long term erectile dysfunction.