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    • Treatment – Erectile Dysfunction

      In the Cross-National Survey on Male Health Issues, the aim was to describe the motivators and barriers influencing treatment-seeking behavior in men with ED. Screening included 32,644 men. Follow-up questionnaires were completed by 2831 men who suffered from ED. Men were recruited in waiting rooms in general practice offices. Treatment-seeking among men who suffered from ED was highest among Spanish men (48%) and lowest for German and Italian men (27 and 28%, respectively). Rate of cur-rent ED medication use among men suffering from ED was quite low across all countries, ranging from only 8% in France and Italy to 14% in the United States. The top three barriers to seeking ED treatment were the belief that ED was a normal...

    • Treatment – Seeking Behavior

      In a study using questionnaires sent to 108 patients, 100 (93%) responded. Researchers looked at hospital records and data from the survey. Only 32% continued self-injection treatment, about half of those (56%) discontinued within the first year, and patients who stopped therapy were significantly older and had poor initial impressions of therapy. Similarly to other studies, the authors concluded that dropout had little to do with side effects or etiology. In a study of 195 men comparing treatment compliance and treat-ment choice with marital satisfaction using the Maudsley Marital Questionnaire, no dif-ferences were found between the four groups tested: patients on intracavernosal injection treatment, patients who dropped out during the trial-dose phase, patients on other treat-ment, and patients who renounced...

    • Erectile Dysfunction – Economical

      An attempt was made to estimate the economical impact of ED in the United Kingdom. In this study (conducted from 1997 to 1998) on the cost of ED in the National Health Service (NHS), it was estimated that £53 million was spent to manage 113,600 patients with ED. The main cost driver was outpatient visits, which accounted for 65% of the cost. Drugs accounted for 25% and genito-urinary consultations, and pros-theses accounted for only 4% of the cost. It was estimated that the NHS managed 35% of the population with ED. Assuming that this was representative, the total population of individuals in the United Kingdom was estimated to be approximately 325,600. It has been further estimated that these men incur...

    • Impact of Erectile Dysfunction

      ED is highly prevalent, the incidence is strongly age-related, and it is progressive and undertreated. The word population is rapidly aging. In 2000, 13% of the world’s population was older than 65 yr, and it is estimated that by 2020, this population will increase to 20%. The projections made in 1998—namely, that a fourfold increase in the ED industry would occur by 2002, from about $0.9 to $5 billion—have been proven. The impact of a condition with such escalating proportions seems obvious. The economical impact of a medical condition or disease is not limited by the cost of diag-nosis and treatment, but it includes the impact on the patient and society in various ways, such as loss of time at...

    • Risk Factors for Erectile Dysfunction (Part 2)

      Other important factors include heavy alcohol consumption, obesity, and physical activity. Chronic, heavy alcohol consumption may have an irreversible effect on erectile function because of neurological damage; specifically, changes in drinking habits may not influence erectile function. Chronic drug abuse, especially combined with alcohol consumption, can lead to erectile disorders, specifically because of behavioral changes. The link between ED and the use of certain medications is underestimated. A close link exists between ED and pelvic surgery, with rates ranging up to 80%. In this case, radical prostatectomy, cystectomy, and radical pelvic surgery are considered. Trans-urethral resection of the prostate plays an unclear role. The rise in the prevalence of worldwide ED, coupled with the new high-profile medi-cal treatments, is raising...

    • Risk Factors for Erectile Dysfunction (Part 1)

      The link between cigarette smoking and ED is not clearly understood. The MMAS sample did not show a significant difference in cases of ED between current smokers and nonsmokers. However, the association of ED with certain risk factors was greatly amplified in current smokers. According to MMAS data analysis, the age-adjusted probability of complete ED in subjects treated for heart disease was 56% for current smokers compared to 21% for nonsmokers. Furthermore, the Vietnam Experience Study found that the prevalence of ED was 1.5-fold greater in current smokers copared to non-smokers. A cross-sectional study conducted in Italy comparing nonsmokers and current smokers and exsmokers in 2010 men older than age 18 yr presented an odds ratio of ED of 1.7...

    • Nocturnal Erections

      Multiple areas throughout the brain participate in the sleep–wake cycle. The waking state is maintained by a diffuse collection of neurons within the medulla, pons, midbrain, and diencephalons known as the reticular activating system. Electrical stimulation within the reticular activating system leads to a change in electroencephalogram pattern from the sleep state to that of the waking state—that is, cortical arousal. The sleep state does not result from the passive withdrawal of arousal but from two sleep centers that exist within the brain. One sleep center is responsible for producing slow-wave sleep, whereas the other produces rapid eye movement (REM) sleep. The slow-wave sleep center is located within the medulla, in a midline area containing the raphe nuclei. Neurons within...

    • Reflexic (Spinal) Erection

      Reflexic erections are mediated by a spinal reflex pathway whereby sensory informa-tion from the penis and genitalia is transmitted by the dorsal nerve of the penis and contin-ues via the pudendal nerve to reach the sacral spinal cord. This constitutes the afferent limb of the sacral reflex arc. The efferent limb arises in the sacral parasympathetic center and contributes fibers to the pelvic nerve, which, in turn, enters the erectile tissue as the cavernosal nerve. These terminal parasympathetic fibers release ACh, VIP, and NO as well as additional vasorelaxant neuropeptides (substance P and calcitonin gene-related peptide). Pudendal afferent pathways terminate in the dorsal commissure and medial dorsal horn. In addition to activating the sacral preganglionic neurons that initiate erection, interneu-rons...

    • Calcium Sensitization and the RhoA/Rho Kinase Pathway

      In addition to calcium-dependent mechanisms of activation, recent studies have dem-onstrated the presence of a calcium-independent pathway that further regulates corporal smooth muscle contraction. Originally described in other smooth muscle types, this pro-cess, termed calcium sensitization, is regulated by the small, monomeric G protein RhoA and its immediate downstream target Rho-kinase (ROK). Following its activation, ROK inhibits MLC phosphatase (or smooth muscle myosin phosphatase) through phospho-rylation of its regulatory subunit (smooth muscle myosin phosphatase-1M), leading to sensitization of myofilaments to Ca2+. Both RhoA and ROK have been demon-strated in the corpora of several animal species as well as human corporal tissue. Furthermore, intracavernosal injection as well as topical application of the ROK inhibi-tor Y-27632 resulted in an increased erectile response,...

    • Process Penile Erection

      SMOOTH MUSCLE CONTRACTION AND RELAXATION IS REGULATED BY Ca2+-INDUCED MYOSIN PHOSPHORYLATION AND DEPHOSPHORYLATION. The primary stimulus for corporal smooth muscle contraction (penile flaccidity) again depends on the concentration of intracellular calcium. When the intracellular concentra-tion of calcium increases to 10.5 mol/L, Ca2+ forms an active complex with the calcium- binding protein calmodulin. The Ca2+–calmodulin complex then activates a Ca2+–cal-modulin-dependent myosin light chain kinase (MLCK). The activated MLCK phospho-rylates the regulatory MLC20, leading to smooth muscle contraction. A decrease in intracellular calcium to basal levels (<10.5 mol/L) inactivates MLCK and allows for dephosphorylation of the MLC20 by a Ca2+-independent MLC phosphatase, lowering the actin-activated ATPase activity of myosin. This allows for the myosin to detach from actin and leads to corporal...

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