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    • 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...

    • Problems: scary symptoms Canadian Health Care Mall

      Any moles or freckles which have been present and unchanging for a long time are benign, but keep an eye on them for any change of colour or increase in size, as is recommended for the rest of your skin. Report any such changes to your doctor, and certainly get all newly appearing lesions checked out, as well as anything that hurts, bleeds, oozes or itches — there are some changes that are precancerous which can occur in the skin of the penis. Especially in warm climates, in the folds of the skin such as the groin, a bacterium called Corynebacterium minutissimum thrives and causes a velvety brown appearance to the skin. This may cause itching and can be treated...

    • Condoms: getting it on Canadian healthcare viagra

      An even more compelling reason for using a condom in today’s sexual scene is that it is about the only thing we have that allows us to have sex but protects us to some extent from sexually transmitted diseases (STDs). In the 1960s, liberation from the fear of pregnancy by the Pill was celebrated by a couple of generations of free love — free of fear and responsibility. That was all changed as HIV and other nasties hit the scene in the 1980s. Canadian viagra store Irene is a young high school teacher. She had lived with the same partner throughout her college years, but it all broke up just after her final exams when he took up with someone...

    • Canadian Health&Care Mall – Premature ejaculation: ‘Roger and Out’

      There are a few products around designed to be applied to or smeared on the upstanding member in order to prevent premature ejaculation. The common ingredient of all of these is a local anaesthetic intended to diminish sensation in the skin. Our colleague Dr Cohen assures us that he has had success in prescribing this treatment, with the gel being smeared on thinly as soon as Oscar begins to strut his stuff. A word of warning: the emphasis is on thinly. Sex under anaesthesia? Seems to us it could be a case of throwing the baby out with the bathwater, particularly if some gets smeared on the female partner as well... Canadian health and care mall The only methods that...

    • Erectile Dysfunction: having a hard time Canadian HealthCare Mall

      Sam and Barbara are both in their early sixties, with three grown children and six grandchildren. They were enjoying the freedom of these ‘mature years’ until, two years ago, Sam discovered that he had diabetes and high blood pressure. Last year he had to have a coronary bypass. Until the decline in Sam’s health, he and Barbara had enjoyed sex at least once a week. All Sam had to do was to start thinking about sex with Barbara and there was old Willie, ready and able. Now Sam can’t get an erection at all. He feels old, useless and depressed. David and Belinda are in their thirties, and have been married for five years. Last year they had their first...

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