The "Trapped Nerve" series continues.

 

Another day another painkiller !

 

Discovered in the late 1950s by scientists at Merck; Amitriptyline is a tricyclic antidepressant primarily used to treat cyclic vomiting syndrome, major depressive disorder and a variety of pain syndromes from neuropathic pain to fibromyalgia to migraine and tension headaches. Due to the frequency and prominence of side effects, amitriptyline is generally considered a second-line therapy for these indications.

 

The most common side effects are dry mouth, drowsiness, dizziness, constipation, and weight gain. Of note is sexual dysfunction, observed primarily in men.

 

Just what I need constipation and weight gain!

 

Difficult to find any up to date figures but in 2015, 14 million prescriptions were issued for Amitriptyline in England.

 

The trapped nerve series:

www.flickr.com/photos/neilmoralee/albums/72177720300091523

Folkloric

- Red leaves are used to expel worms.

- Fruit is said to be purgative.

- Leaves mixed with oil are rubbed onto the breast to relieve mammary pain.

- Bark is used for gastric ailments, bilious diarrhea and dysentery.

- The sap of young leaves mixed with the kernel oil has been used for the treatment of leprosy.

- Bark decoction has been used for the treatment of gonorrhea and stomach cramps.

- Leaves are applied to rheumatic joints.

- Juice of young leaves used for scabies and other cutaneous diseases, headaches and colic.

- Leaves macerated in oil has been used for tonsillitis.

- In Sri Lankan folklore, juice of tender leaves used for pains, including headaches.

- In India, the bark is used as a diuretic and cardiotonic; leaves used for headache.

- In Nigeria, leaves macerated in palm oil used for tonsillitis; stems and bark used for sexual dysfunction.

- Seeds have been used for sexual dysfunction.

 

source: stuart xchange

Testosterone levels, hormones and other influences on female sex drive are discussed by The Medical Center for Female Sexuality’s Sexuality Counselor, Shannon Bertha on MensNetTV with host Mel Feit. For more information on the medical techniques for treatment of female sexual dysfunction, including painful intercourse and low sex drive to enable women achieve sexual health and satisfying female sexuality visit: www.centerforfemalesexuality.com

Offices in Purchase, NY and Manhattan, NY.

 

It might lie dormant but somehow we know what we are and a bit different from others but everyone is. Some might manage the imbalance of genes as just one of those things that make them who they are whilst others start to realise and grow into it as it is telling them something. I was an at times compulsive erotic artist trying to satisfy my sexual dysfunction through surreal drawings. I started seeing transgendered people about and not only did they start to figure in my art they fascinated me so much I felt a need to get closer indeed right into it. So my initiation as Jojo was a mixture of adventure and sexual excitement,. It started slowly and I have taken it slowly ever since and in a balanced way just enjoying it for what it is, and I can say is I feel much happier this way..

During the late 16th and 17th centuries in France, male impotence was considered a crime, as well as legal grounds for a divorce. The practice, which involved inspection of the complainants by court experts, was declared obscene in 1677. John R. Brinkley initiated a boom in male impotence cures in the U.S. in the 1920s and 1930s. His radio programs recommended expensive goat gland implants and "mercurochrome" injections as the path to restored male virility, including operations by surgeon Serge Voronoff. Modern drug therapy for ED made a significant advance in 1983, when British physiologist Giles Brindley dropped his trousers and demonstrated to a shocked Urodynamics Society audience his papaverine-induced erection. The drug Brindley injected into his penis was a non-specific vasodilator, an alpha-blocking agent, and the mechanism of action was clearly corporal smooth muscle relaxation. The effect that Brindley discovered established the fundamentals for the later development of specific, safe, and orally effective drug therapies.

Erectile dysfunction (ED), also known as impotence, is a type of sexual dysfunction characterized by the inability to develop or maintain an erection of the penis during sexual activity. Erectile dysfunction can have psychological consequences as it can be tied to relationship difficulties and self-image. The most important organic causes of impotence are cardiovascular disease and diabetes, neurological problems (for example, trauma from prostatectomy surgery), hormonal insufficiencies (hypogonadism) and drug side effects. Psychological impotence is where erection or penetration fails due to thoughts or feelings (psychological reasons) rather than physical impossibility; this is somewhat less frequent but can often be helped. In psychological impotence, there is a strong response to placebo treatment. Besides treating the underlying causes such as potassium deficiency or arsenic contamination of drinking water, the first line treatment of erectile dysfunction consists of a trial of PDE5 inhibitor (such as sildenafil). In some cases, treatment can involve prostaglandin tablets in the urethra, injections into the penis, a penile prosthesis, a penis pump or vascular reconstructive surgery. Erectile dysfunction is characterized by the regular or repeated inability to obtain or maintain an erection.

Causes

Medications (antidepressants, such as SSRIs, and nicotine[citation needed] are most common)

Neurogenic disorders

Cavernosal disorders (Peyronie's disease)

Hyperprolactinemia (e.g., due to a prolactinoma)

Psychological causes: performance anxiety, stress, and mental disorders

Surgery

Aging. It is four times more common in men aged in their 60s than those in their 40s.

Kidney failure

Diseases such as diabetes mellitus and multiple sclerosis (MS). While these two causes have not been proven they are likely suspects as they cause issues with both the blood flow and nervous systems. Lifestyle: smoking is a key cause of erectile dysfunction. Smoking causes impotence because it promotes arterial narrowing. Surgical intervention for a number of conditions may remove anatomical structures necessary to erection, damage nerves, or impair blood supply. Erectile dysfunction is a common complication of treatments for prostate cancer, including prostatectomy and destruction of the prostate by external beam radiation, although the prostate gland itself is not necessary to achieve an erection. As far as inguinal hernia surgery is concerned, in most cases, and in the absence of postoperative complications, the operative repair can lead to a recovery of the sexual life of patients with preoperative sexual dysfunction, while, in most cases, it does not affect patients with a preoperative normal sexual life. ED can also be associated with bicycling due to both neurological and vascular problems due to compression. The increase risk appears to be about 1.7-fold. Concerns that use of pornography can cause erectile dysfunction have not been substantiated in epidemiological studies according to a 2015 literature review. However, another review and case studies article maintains that use of pornography does indeed cause erectile dysfunction, and critiques the previously described literature review. Penile erection is managed by two mechanisms: the reflex erection, which is achieved by directly touching the penile shaft, and the psychogenic erection, which is achieved by erotic or emotional stimuli. The former uses the peripheral nerves and the lower parts of the spinal cord, whereas the latter uses the limbic system of the brain. In both cases, an intact neural system is required for a successful and complete erection. Stimulation of the penile shaft by the nervous system leads to the secretion of nitric oxide (NO), which causes the relaxation of smooth muscles of corpora cavernosa (the main erectile tissue of penis), and subsequently penile erection. Additionally, adequate levels of testosterone (produced by the testes) and an intact pituitary gland are required for the development of a healthy erectile system. As can be understood from the mechanisms of a normal erection, impotence may develop due to hormonal deficiency, disorders of the neural system, lack of adequate penile blood supply or psychological problems. Spinal cord injury causes sexual dysfunction including ED. Restriction of blood flow can arise from impaired endothelial function due to the usual causes associated with coronary artery disease, but can also be caused by prolonged exposure to bright light. It is analyzed in several ways: Obtaining full erections at some times, such as nocturnal penile tumescence when asleep (when the mind and psychological issues, if any, are less present), tends to suggest that the physical structures are functionally working. Other factors leading to erectile dysfunction are diabetes mellitus (causing neuropathy). There are no formal tests to diagnose erectile dysfunction. Some blood tests are generally done to exclude underlying disease, such as hypogonadism and prolactinoma. Impotence is also related to generally poor physical health, poor dietary habits, obesity, and most specifically cardiovascular disease such as coronary artery disease and peripheral vascular disease. Therefore, a thorough physical examination is helpful, in particular the simple search for a previously undetected groin hernia since it can affect sexual functions in men and is easily curable. A useful and simple way to distinguish between physiological and psychological impotence is to determine whether the patient ever has an erection. If never, the problem is likely to be physiological; if sometimes (however rarely), it could be physiological or psychological. The current diagnostic and statistical manual of mental diseases (DSM-IV) has included a listing for impotence.

Duplex ultrasound

Duplex ultrasound is used to evaluate blood flow, venous leak, signs of atherosclerosis, and scarring or calcification of erectile tissue. Injecting prostaglandin, a hormone-like stimulator produced in the body, induces the erection. Ultrasound is then used to see vascular dilation and measure penile blood pressure.

Penile nerves function

Tests such as the bulbocavernosus reflex test are used to determine if there is sufficient nerve sensation in the penis. The physician squeezes the glans (head) of the penis, which immediately causes the anus to contract if nerve function is normal. A physician measures the latency between squeeze and contraction by observing the anal sphincter or by feeling it with a gloved finger inserted past the anus.

Nocturnal penile tumescence (NPT)

It is normal for a man to have five to six erections during sleep, especially during rapid eye movement (REM). Their absence may indicate a problem with nerve function or blood supply in the penis. There are two methods for measuring changes in penile rigidity and circumference during nocturnal erection: snap gauge and strain gauge. A significant proportion of men who have no sexual dysfunction nonetheless do not have regular nocturnal erections.

Penile biothesiometry

This test uses electromagnetic vibration to evaluate sensitivity and nerve function in the glans and shaft of the penis.

Dynamic infusion cavernosometry (DICC)

technique in which fluid is pumped into the penis at a known rate and pressure. It gives a measurement of the vascular pressure in the corpus cavernosum during an erection.

Corpus cavernosometry

Cavernosography measurement of the vascular pressure in the corpus cavernosum. Saline is infused under pressure into the corpus cavernosum with a butterfly needle, and the flow rate needed to maintain an erection indicates the degree of venous leakage. The leaking veins responsible may be visualized by infusing a mixture of saline and x-ray contrast medium and performing a cavernosogram.[20] In Digital Subtraction Angiography (DSA), the images are acquired digitally.

Magnetic resonance angiography (MRA)

This is similar to magnetic resonance imaging. Magnetic resonance angiography uses magnetic fields and radio waves to provide detailed images of the blood vessels. Doctors may inject a "contrast agent" into the patient's bloodstream that causes vascular tissues to stand out against other tissues. The contrast agent provides for enhanced information regarding blood supply and vascular anomalies.

 

en.wikipedia.org/wiki/Erectile_dysfunction

Difficulties in female orgasm, masturbating and pornography are discussed by The Medical Center for Female Sexuality’s Sexuality Counselor, Shannon Bertha on MensNetTV with host Mel Feit. For more information on the medical techniques for treatment of female sexual dysfunction, including painful intercourse and low sex drive to enable women achieve sexual health and satisfying female sexuality visit: www.centerforfemalesexuality.com

Offices in Purchase, NY and Manhattan, NY.

 

Recent study reveals that yoga may help couples who are struggling with sexual dysfunction in their lives. Researchers believe that the physical and emotional benefits offered by yoga, may add more fun and meaning to the sexual relationship with your partner.

Scientists said that this form of yoga basically uses mutually beneficial postures, massage and breathing exercises, those can easily perform by couples. . They increase blood flow to the pelvis and engage all the muscles of pelvic floors, which strengthen the muscles that play vital role in orgasm

.

Yoga, apart from working wonders for your mind and soul, also enriches your sex life yoga helps you become aware of your sexual core proper breathing is essential for sexual arousal. Asanas, mudras, pranayamas, and meditation are the new way to better sexuality. As more and more people are discovering that practicing yoga leads to better sex life whether you practice yoga or sex for both you need some practice and training. The yoga system of treatment requires Proper diet and daily practice of yoga.

Good sex makes our skin glow, firms up our abs, beats the blues and above all as a great stress buster.

THE POWER OF GARLIC: Garlic is antibacterial, antifungal and antiviral properties. It Can be useful in treating a number of reproductive – tract problems. Be cause by consuming garlic in food or as tablets will help the body wards off all sorts of other diseases and disorders.

WATERING YOUR MOOD: Take a bath or shower to adjust your moods from excitement to relaxation or vice versa. Cold water definitely get you going, warm water will let you relax before sleep.

NO SMOKING: Nicotine is a powerful vasoconstrictor; men who daily smoke a pack of cigarettes drastically reduce the Blood circulation in their penile Arteries. It makes difficult to achieve an erection.

TRY TO BEAT THE HEAT: Infertility cases trace to problems with a man’s sperm count or function. High temperature in the testicles can temporarily reduce sperm production. If you are trying to father a child, avoid Hot Baths, and tight under wear and jeans.

ODORS: Pleasant odors always have played their part, as they appear to stimulate the nervous system which, in turn stimulates, the sexual system. The sexual persuasion of odors in not confined to human beings, it is equally operative among after animals and insects; female’s dogs, wolves, foxes and butterfly release their own sexually conditioned smells. The best perfumes are the natural ones like sandalwood, roses, jasmine, violets and other flowers.

VAJROLI MUDRA: Sit in any comfortable meditative posture with eyes closed head and spine straight. Now inhales hold the breath in and try to draw the urethra upward. This action is similar to holding back on urge to urinate. Hold the contraction for as long as your feel comfortable. Then exhale while releasing the contraction. Do this Vajroli mudra minimum 10 to 15 rounds.

BENEFITS: This mudra regulates and tones the entire uro-genital system, Vajroli mudra balances testosterone levels and sperm count and gives control over premature ejaculation. Problems like prostates hypertrophy are prevented.

SHAVASANA: Lie down on the floor on your back, keep the legs straight on the floor with feet apart by about your shoulder width. Keep the arms straight by your sides with hands placed about six inches away from the body. The head ad spine should be in a straight line. Close your eyes gently. Make the whole body loose and stop all physical movement, mentally watch your breathing and allow it to become rhythmic and relaxed.

BENEFITS: This asana leads to remove physical and mental fatigue. The breathing becomes more regulated and controlled naturally. This asana improves optimum capacity of lungs and intake of oxygen. Relaxation helps to open up blocked arteries and thus helps to improve cardiac functions.

VATAYANASANA METHOD: Stand with feet together bends the right knee and place the foot on the left thigh in the half padamasan position. Then place the hand in Namaskar position. Maintain the balance and hold the position for a short duration. Release the right leg repeat the practice with the opposite leg, breathing normal. Do it two times on each side. BENEFITS: This asana develops the ability to retain seminal fluid and regulates the reproductive system and prevent early ejaculation. It also strengthens the leg muscle and knee joints. CAUTION: Try to do it slowly after some practice one can do it. This asana require more coordination then muscular strength.

ASWANI MUDRA: Stand in comfortable position closes eyes and breathing normal. Take your attention to the anus area. Contract the anal muscles for a few seconds without feeling any strain. Then relax for a few seconds. Repeat the contraction and relax the anal muscles. Make the contractions more rapid. BENEFITS: It is very helpful to prevents early ejaculation. The inflammation of prostate gland is also cured by this mudra. It helps to alleviate piles, constipation and prevents the escape of pranic energy from the body. To know more log on www.yogagurusuneelsingh.com Pic by Vijay Gautam

there were multiple inspirations for this creation..

 

the design is from an osho tartot card of the same name..i actually tried to recreate ths earlier in my stream with a baby in the lotus flower instead..it was not very good.. hence the re-do

 

and so i decided that i would 'bare all' so to speak and do a selfie ( actually i am wearing shorts that i edited out) mostly because i have been thinking about the belief that some people have about being modest.. and that somehow showing skin makes you a "whore" and is not right in the eyes of Divine..

 

i wholeheartedly disagree with this viewpoint...

and so this is my expression of my belief that nakedness is next to Godliness.. and that repression of the natural energies is what causes all forms of sexual dysfunction including all fetishes and rape..

 

having said that.. again.. i am not saying i want to walk around naked and post naked pictures on flickr.. because we don't live in a utopian world.. i'll stay happy and free enough with my tank tops and shorts.

:)

 

also have to mention cate loughran for inspiring me with her beautiful night life, photo based series

www.flickr.com/photos/cateloughran/4751859758/in/contacts/

  

hình nhìn tình k?=)) bbè thui:">

nhớ Củ Nghệ gê nha - ai mún ngĩ j` ngĩ:)) i don't care :-)

--------------------------------------------------------------------

1. Tên : Zoi

2. Birthday: 01.06.1996

3. Sex: sexual dysfunction =))

4. Vài chi tiết về u: cao 1m07=)),nặg 66kg[như con khủng log =((],thân hình hơi béo 1 tí đề ngị luôg luôg giữ sức khoẻ cảm ơn=))

5. Tình trạng sức khỏe: dễ bệnh,dễ chết=p~

6. Nằm bviện bnhiu lần: qá chài lần chả nhớ=))

7. Khuynh hướg tc: k lèo phèo:”> thíc thì đến k thì biến:D not make color

8. Trìh độ học vấn hiện tại: 9/12=))

9. Tìh trạg tài chíh hiện tại: ngèo rách mồng tơi=((

10. Thíc là ngừi nổi tiếg k: I like it=))

11. Ước mơ vĩ đại: kím thật nhìu tiền r` lấy tiền qăng vào mồm mấy con hay táp bậy=)):”>

12. Uớc mơ ngôg cuồg: I can fly =p~

13. U có dễ gần: qá dễ:”> gái đẹp là dễ gần ác=))

14. U thíc đc chiều: ừ ừ ai mà k thíc=))

15. U khóc khi: Buồn gđ,bbè,học hành

16. U cừi khi: chọc ngta zận hay tức=))

17. U sụp đổ khi: gđ.bbè đều xảy ra chiện k hay : )

18. Chiện j khiến u lun hối hận: uống 70v mà k thể chết =(( :-<

19. Việc đó là: mối hoạ sau này :-=))

27. U hoàn hảo k: k bík :-s ai cho cái cmt về cái này nhá=))

28. U có độc ác: có…bao mà ác : ))

29. U có thủ đoạn: có…thủ đoạn gê lắm cơ : ))

30. U có tàn nhẫn: có…qá tán nhẫn : )) [má nảy h` tự nhận mình xấu xa độc ác k hà : )) côg nhận mìk khôn =))]

31. Từg gah tỵ chưa: rồi,ganh qài=)) tại s ngta có tiền nhìu,đt xịn,xe xịn.đồ hiệu mà mình k có : ((

32. Từg gah gét ai: ai giàu là ganh hà =))

33. Từg mún đáh ai: k mún đánh ai hết :”> mún bóp à=p~

34. Từg mún giết ngừi: thôi đâo ngu giết ng` đi tù ai nuôi 3 má?=))

35. Có vị tha: chồi qá vị tha=))

36. Có hiền hậu: có qá hiền hậu=))

37. Có thuỳ mị : vô cùng thuỳ mị, nữ tính, cute và vô cùng đáng yêu =)) [má mắc ói qá con :-& =))]

38. Có hay tha thứ: mẹ có vị tha k h` có tha thứ k? :-w đứa nào hỏi ngu nhãi nhồn X-(

39. Tin vào số mệh k: tin=)) chết qài mà k đc nên tin mệnh chết thui=)) còn mệh tài thì mình k tin=))

40. Mê tín dị đoán k: hình như k hay s á :s =))

41. Tin có ma/quỷ: k chưa gặp chưa bék :”> khi nào gặp thì tính nha:”>

42. Có đag hp k: k=)) buồn bỏ mẹ hà hp j`:-

45. Đag ngĩ j: ngĩ về tiền =p~

46. Đag thíc ai: tớ tớ thíc…. Ngại qá cơ=)) k nói đâu cơ=))

47. U có thíc ngừi tag mìh: có thuơg lắm nge hôn:”> muốn đè ra hun lâu r` á:-*

48. Còn y* : qá yêu luôg mà khỗ nỗi ngta k thèm :-“ :-<

49. Trái tim có mấi ngăn (chi tiết từg ngăn): qá chài ngăn=)) thui khỏi chi tiết ha=))

*Ngăn cho Gia đình

*Ngăn cho bạn bè

*Ngăn cho nhìu gái =p~

*Ngăn cho thành công và tiền bạc =p~ =))

------------------------

k tag ai hết chỉ cần đừg chùa đc r`:">

ai chùa là bị Trung Quốc qa thả bom ngay nóc nhà chết hết cả gia đình =p~

 

Don't look past me, photo essay. Part 3 of 3.

 

There is growing interest in how porn affects loving relationships. In some relationships, the use of porn may be an acceptable alternative to sexual intercourse when a partner is absent, or unable to or unwilling for sex. It is reported, in one study from Norway, that couples where both partners used porn were the most open about their desires, and reported the least sexual dysfunction (5). However, when only one partner watched pornography, men were the least sexually aroused, and women had the lowest levels of self-esteem (5). Secrecy over porn usage ultimately develops into distrust when discovered. When one partner chooses to watch porn and masturbate, rather than having sex with their partner, it leads to their partner feeling dissatisfied with their body-image and the relationship itself (6).

 

Healthy sex in a relationship is based on intimacy and long term commitment. Porn is about new experiences and intensity. It is reported that self-masturbation with porn is a intense experience, often a 'quick-fix'. However, consistently choosing intensity over intimacy is only going to end in hurt. Open communication is essential to exploring this topic and resolving issues in any loving relationship.

  

1. www.pornresearch.org/Firstsummaryforwebsite.pdf

2. onlinelibrary.wiley.com/doi/10.1111/j.1559-1816.1988.tb00...

3. www.oxytocin.org/oxytoc/

4. www.yourbrainonporn.com/post-orgasmic-prolactin-increase-...

5. blogs.menshealth.com/health-headlines/is-porn-bumming-you...

6. www.socialcostsofpornography.com/Bridges_Pornographys_Eff...

 

What happens during sex inside (HD video). Sex after pregnancy Sex after pregnancy is often delayed for several weeks or months, and may be difficult and painful for women. Injury to the perineum or surgical cuts (episiotomy) to the vagina during childbirth can cause sexual dysfunction. Sexual activity other than sexual intercourse is possible sooner, but some women experience a prolonged loss of sexual desire after giving birth, which may be associated with postnatal depression. Common issues that may last more than a year after birth are greater desire by the man than the woman, and a worsening of the woman's body image. Women with damage or tears to their perineum resume sex later than women with an intact perineum,[3] and women who needed perineal sutures report poorer sexual relations.[4] Perineal damage is also associated with painful sex.[5] Women who have an anal tear are less likely to have resumed sex after six months[6] and one year,[7] but they have normal sexual function 18 months later.[8] Assisted vaginal delivery using suction or forceps is correlated with increases in the frequency or severity of painful sex,[5] the delay in resuming sex, and sexual problems.[9] Cesarean section may result in less painful sex during the first 3 months,[10][11] or there may be no difference,[9] and there is no difference in sexual function or symptoms by six months,[10][11][12] although women who delivered by cesarean report greater sexual satisfaction relating to vaginal tone six years on.[13] ************************************************** Note: I am not owner of this video content. I have got so much enjoy from this Video, so I have reused it just to share the fun with other. If this Video causes problems to the real owner then let me know by the email address deoroyctg1970@gmail.com without reporting it please. I will instantly delete the Video from my Channel. Thank you. This is highly requested for your Friends. Please see, Thanks you all so much! ************************************************** ► My Dear YouTube Friends highly request Please help me Watching my YouTube videos and Click in all Ads. PLEASE ! ! ! ►Subscribe here: www.youtube.com/channel/UCINStlKXcmQWAB9jTRiMX8g ►Subscribe here: www.youtube.com/channel/UCq6p2km6nbIxRFiY_p7wYNg ►Subscribe here: www.youtube.com/channel/UCDPo_68x8oSknRH3ZunRNjQ ****************************************************

- - - - Habu Sake - - - -

Protobothrops flavoviridis

Local language: Habushu

Its famous for sexual dysfunction in men

 

Learn more about this pit viper okinawanaturephotography.com/venomous-snakes-of-okinawa-j...

 

Iphone documentation photograph by Shawn Miller

- - - - Big glass jar- large Habu snake x2

Video interview of Dr. Doug Rokke, former Director of the Pentagon's Depleted Uranium Project:

 

www.youtube.com/watch?v=P-8PlJVhogs

 

Please help to spread the awareness.

 

Iraqi cancers, birth defects blamed on U.S. depleted uranium

 

By LARRY JOHNSON

SEATTLE POST-INTELLIGENCER FOREIGN DESK EDITOR

 

SOUTHERN DEMILITARIZED ZONE, Iraq -- On the "Highway of Death," 11 miles north of the Kuwait border, a collection of tanks, armored personnel carriers and other military vehicles are rusting in the desert.

 

They also are radiating nuclear energy.

  

Paul Kitagaki Jr. / P-I

Six-year-old Fatma Rakwan, being held by her mother at the Basra Hospital for Maternity and Children, was recently diagnosed with leukemia.

In 1991, the United States and its Persian Gulf War allies blasted the vehicles with armor-piercing shells made of depleted uranium -- the first time such weapons had been used in warfare -- as the Iraqis retreated from Kuwait. The devastating results gave the highway its name.

 

Today, nearly 12 years after the use of the super-tough weapons was credited with bringing the war to a swift conclusion, the battlefield remains a radioactive toxic wasteland -- and depleted uranium munitions remain a mystery.

 

Although the Pentagon has sent mixed signals about the effects of depleted uranium, Iraqi doctors believe that it is responsible for a significant increase in cancer and birth defects in the region. Many researchers outside Iraq, and several U.S. veterans organizations, agree; they also suspect depleted uranium of playing a role in Gulf War Syndrome, the still-unexplained malady that has plagued hundreds of thousands of Gulf War veterans.

 

Depleted uranium is a problem in other former war zones as well. Yesterday, U.N. experts said they found radioactive hot spots in Bosnia resulting from the use of depleted uranium during NATO air strikes in 1995.

 

With another war in Iraq perhaps imminent, scientists and others are concerned that the side effects of depleted uranium munitions -- still a major part of the U.S. arsenal -- will cause serious illnesses or deaths in a new generation of U.S. soldiers as well as Iraqis.

  

THE DANGERS

 

Depleted uranium, known as DU, is a highly dense metal that is the byproduct of the process during which fissionable uranium used to manufacture nuclear bombs and reactor fuel is separated from natural uranium. DU remains radioactive for about 4.5 billion years.

 

Uranium, a weakly radioactive element, occurs naturally in soil and water everywhere on Earth, but mainly in trace quantities. Humans ingest it daily in minute quantities.

  

Paul Kitagaki Jr. / P-I

Dr. Khajak Vartaanian, a radiation expert, holds a Geiger counter next to a hole in an Iraqi tank destroyed by depleted uranium weapons in the Persian Gulf War in 1991. The shell holes show 1,000 times the normal background radiation level.

DU shell holes in the vehicles along the Highway of Death are 1,000 times more radioactive than background radiation, according to Geiger counter readings done for the Seattle Post-Intelligencer by Dr. Khajak Vartaanian, a nuclear medicine expert from the Iraq Department of Radiation Protection in Basra, and Col. Amal Kassim of the Iraqi navy.

 

The desert around the vehicles was 100 times more radioactive than background radiation; Basra, a city of 1 million people, some 125 miles away, registered only slightly above background radiation level.

 

But the radioactivity is only one concern about DU munitions.

 

A second, potentially more serious hazard is created when a DU round hits its target. As much as 70 percent of the projectile can burn up on impact, creating a firestorm of ceramic DU oxide particles. The residue of this firestorm is an extremely fine ceramic uranium dust that can be spread by the wind, inhaled and absorbed into the human body and absorbed by plants and animals, becoming part of the food chain.

 

Once lodged in the soil, the munitions can pollute the environment and create up to a hundredfold increase in uranium levels in ground water, according to the U.N. Environmental Program.

 

Studies show it can remain in human organs for years.

 

The U.S. Army acknowledges the hazards in a training manual, in which it requires that anyone who comes within 25 meters of any DU-contaminated equipment or terrain wear respiratory and skin protection, and states that "contamination will make food and water unsafe for consumption."

 

Just six months before the Gulf War, the Army released a report on DU predicting that large amounts of DU dust could be inhaled by soldiers and civilians during and after combat.

 

Infantry were identified as potentially receiving the highest exposures, and the expected health outcomes included cancers and kidney problems.

 

The report also warned that public knowledge of the health and environmental effects of depleted uranium could lead to efforts to ban DU munitions.

 

But today the Pentagon plays down the effects. Officials refer queries on DU munitions to the latest government report on the subject, last updated on Dec. 13, 2000, which said DU is "40 percent less radioactive than natural uranium."

 

The report also said, "Gulf War exposures to depleted uranium (DU) have not to date produced any observable adverse health effects attributable to DU's chemical toxicity or low-level radiation. . . ."

 

In response to written queries, the Defense Department said, "The U.S. Military Services use DU munitions because of DU's superior lethality against armor and other hard targets."

 

It said DU munitions are "war reserve munitions; that is, used for combat and not fired for training purposes," with the exception that DU munitions may be fired at sea for weapon calibration purposes.

 

In addition to Iraq and Bosnia, DU munitions were used in Kosovo and Serbia in 1999.

  

Paul Kitagaki Jr. / P-I

Hamdin and his brother Amhid are receiving follow-up treatment after being treated successfully for leukemia two years ago at the Basra Hospital for Maternity and Children.

Also in 1999, a United Nations subcommission considered DU hazardous enough to call for an initiative banning its use worldwide. The initiative has remained in committee, blocked primarily by the United States, according to Karen Parker, a lawyer with the International Educational Development/Humanitarian Law Project, which has consultative status at the United Nations.

 

Parker, who first raised the DU issue in the United Nations in 1996, contends that DU "violates the existing law and customs of war."

 

She said there are four rules derived from all of humanitarian law regarding weapons:

  

Weapons may only be used in the legal field of battle, defined as legal military targets of the enemy in war. Weapons may not have an adverse effect off the legal field of battle.

  

Weapons can only be used for the duration of an armed conflict. A weapon that is used or continues to act after the war is over violates this criterion.

  

Weapons may not be unduly inhumane.

  

Weapons may not have an unduly negative effect on the natural environment.

 

"Depleted uranium fails all four of these rules," Parker said last week.

 

On Oct. 17, 2001, Rep. Cynthia McKinney, D-Ga., introduced a bill calling for "the suspension of the use, sale, development, production, testing, and export of depleted uranium munitions pending the outcome of certain studies of the health effects of such munitions. . . ."

 

More than a year later, the bill -- co-sponsored by Reps. Anibal Acevedo-Vila, Puerto Rico; Tammy Baldwin, D-Wis.; Dennis Kucinich, D-Ohio; Barbara Lee, D-Ca.; and Jim McDermott, D-Wash. -- remains in committee awaiting comment from the Defense Department.

  

THE STUDIES

 

Gulf War veterans faced a wide array of potentially toxic materials during the war: smoke from oil and chemical fires, insecticides, pesticides, vaccinations and DU.

 

Of the 696,778 troops who served during the recognized conflict phase (1990-1991) of the Gulf War, at least 20,6861 have applied for VA medical benefits. As of May 2002, 159,238 veterans have been awarded service-connected disability by the Department of Veterans Affairs for health effects collectively known as the Gulf War Syndrome.

  

Paul Kitagaki Jr. / P-I

The woman in the foreground shares a room with four other cancer patients at the Saddam Teaching Hospital in Basra. The patient lying on the bed behind died earlier in the day on which this photograph was taken.

There have been many studies on Gulf War Syndrome over the years, as well as on possible long-term health hazards of DU munitions. Most have been inconclusive. But some researchers said the previous studies on DU, conducted by groups and agencies ranging from the World Health Organization to the Rand Corp. to the investigative arm of Congress, weren't looking in the right place -- at the effects of inhaled DU.

 

Dr. Asaf Durakovic, director of the private, non-profit Uranium Medical Research Centre in Canada and the United States, and center research associates Patricia Horan and Leonard Dietz, published a unique study in the August issue of Military Medicine medical journal.

 

The study is believed to be the first to look at inhaled DU among Gulf War veterans, using the ultrasensitive technique of thermal ionization mass spectrometry, which enabled them to easily distinguish between natural uranium and DU.

 

The study, which examined British, Canadian and U.S. veterans, all suffering typical Gulf War Syndrome ailments, found that, nine years after the war, 14 of 27 veterans studied had DU in their urine. DU also was found in the lung and bone of a deceased Gulf War veteran.

 

That no governmental study has been done on inhaled DU "amounts to a massive malpractice," Dietz said in an interview last week.

  

THE ACTIVIST

 

Dr. Doug Rokke was an Army health physicist assigned in 1991 to the command staff of the 12th Preventive Medicine Command and 3rd U.S. Army Medical Command headquarters. Rokke was recalled to active duty 20 years after serving in Vietnam, from his research job with the University of Illinois Physics Department, and sent to the Gulf to take charge of the DU cleanup operation.

 

Today, in poor health, he has become an outspoken opponent of the use of DU munitions.

 

"DU is the stuff of nightmares," said Rokke, who said he has reactive airway disease, neurological damage, cataracts and kidney problems, and receives a 40 percent disability payment from the government. He blames his health problems on exposure to DU.

 

Rokke and his primary team of about 100 performed their cleanup task without any specialized training or protective gear. Today, Rokke said, at least 30 members of the team are dead, and most of the others -- including Rokke -- have serious health problems.

 

Rokke said: "Verified adverse health effects from personal experience, physicians and from personal reports from individuals with known DU exposures include reactive airway disease, neurological abnormalities, kidney stones and chronic kidney pain, rashes, vision degradation and night vision losses, lymphoma, various forms of skin and organ cancer, neuropsychological disorders, uranium in semen, sexual dysfunction and birth defects in offspring.

 

"This whole thing is a crime against God and humanity."

 

Speaking from his home in Rantoul, Ill., where he works as a substitute high school science teacher, Rokke said, "When we went to the Gulf, we were all really healthy, and we got trashed."

 

Rokke, an Army Reserve major who describes himself as "a patriot to the right of Rush Limbaugh," said hearing the latest Pentagon statements on DU is especially frustrating now that another war against Iraq appears likely.

 

"Since 1991, numerous U.S. Department of Defense reports have said that the consequences of DU were unknown," Rokke said. "That is a lie. We warned them in 1991 after the Gulf War, but because of liability issues, they continue to ignore the problem." Rokke worked until 1996 for the military, developing DU training and management procedures. The procedures were ignored, he said.

 

"Their arrogance is beyond comprehension," he said. "We have spread radioactive waste all over the place and refused medical treatment to people . . . it's all arrogance.

 

"DU is a snapshot of technology gone crazy."

  

BIRTH DEFECTS IN IRAQ

 

At the Saddam Teaching Hospital in Basra, Dr. Jawad Al-Ali, a British-trained oncologist, displays, in four gaily colored photo albums, what he says are actual snapshots of the nightmares.

   

This picture is from one of four albums shown by Dr. Jawad Al-Ali that are filled with photos of deformed infants -- examples, he says, of the surge in birth defects in southern Iraq that he blames on depleted uranium.

The photos represent the surge in birth defects -- in 1989 there were 11 per 100,000 births; in 2001 there were 116 per 100,000 births -- that even before they heard about DU, had doctors in southern Iraq making comparisons to the birth defects that followed the atomic bombings of Hiroshima and Nagasaki in WWII.

 

There were photos of infants born without brains, with their internal organs outside their bodies, without sexual organs, without spines, and the list of deformities went on and on. There also were photos of cancer patients.

 

Cancer has increased dramatically in southern Iraq. In 1988, 34 people died of cancer; in 1998, 450 died of cancer; in 2001 there were 603 cancer deaths.

 

On a tour of one ward of the hospital, doctors pointed out boys and girls who were suffering from leukemia. Most of the children die, the doctors said, because there are insufficient drugs available for their treatment.

 

There was one notable exception, a young boy whose family was able to buy the expensive drugs on the black market.

 

Al-Ali said it defies logic to absolve DU of blame when veterans of the Gulf War and of the fighting in the Balkans share common illnesses with children in southern Iraq.

 

"The cause of all of these cancers and deformities remains theoretical because we can't confirm the presence of uranium in tissue or urine with the equipment we have," said Al-Ali. "And because of the sanctions, we can't get the equipment we need."

 

 

Testosterone

The chemical structure of testosterone.

A ball-and-stick model of testosterone.

Names

IUPAC name

17β-Hydroxyandrost-4-en-3-one

Systematic IUPAC name

(8R,9S,10R,13S,14S,17S)-17-Hydroxy-10,13-dimethyl-1,2,6,7,8,9,11,12,14,15,16,17-dodecahydrocyclopenta[a]phenanthren-3-one

Other names

Androst-4-en-17β-ol-3-one

Identifiers

CAS Number

58-22-0 ☑

3D model (JSmol)

Interactive image

ChEBI

CHEBI:17347 ☑

ChEMBL

ChEMBL386630 ☑

ChemSpider

5791 ☑

DrugBank

DB00624 ☑

ECHA InfoCard100.000.336

KEGG

D00075 ☑

PubChem CID

6013

UNII

3XMK78S47O ☑

InChI[show]

SMILES[show]

Properties

Chemical formula

C19H28O2

Molar mass288.431 g·mol−1

Melting point155 °C

Pharmacology

ATC code

G03BA03 (WHO)

License data

EU EMA: by INN

Routes of

administration

Transdermal (gel, cream, solution, patch), by mouth (as testosterone undecanoate), in the cheek, intranasal (gel), intramuscular injection (as esters), subcutaneous pellets

Pharmacokinetics:

Bioavailability

Oral: very low (due to extensive first pass metabolism)

Protein binding

97.0–99.5% (to SHBG and albumin)[1]

Metabolism

Liver (mainly reduction and conjugation)

Biological half-life

2–4 hours[citation needed]

Excretion

Urine (90%), feces (6%)

Except where otherwise noted, data are given for materials in their standard state (at 25 °C [77 °F], 100 kPa).

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Infobox references

Testosterone is the primary male sex hormone and an anabolic steroid. In male humans, testosterone plays a key role in the development of male reproductive tissues such as testes and prostate, as well as promoting secondary sexual characteristics such as increased muscle and bone mass, and the growth of body hair.[2] In addition, testosterone is involved in health and well-being,[3] and the prevention of osteoporosis.[4] Insufficient levels of testosterone in men may lead to abnormalities including frailty and bone loss.

 

Testosterone is a steroid from the androstane class containing a keto and hydroxyl groups at the three and seventeen positions respectively. It is biosynthesized in several steps from cholesterol and is converted in the liver to inactive metabolites.[5] It exerts its action through binding to and activation of the androgen receptor.[5] In humans and most other vertebrates, testosterone is secreted primarily by the testicles of males and, to a lesser extent, the ovaries of females. On average, in adult males, levels of testosterone are about 7 to 8 times as great as in adult females.[6] As the metabolism of testosterone in males is more pronounced, the daily production is about 20 times greater in men.[7][8] Females are also more sensitive to the hormone.[9]

 

In addition to its role as a natural hormone, testosterone is used as a medication, for instance in the treatment of low testosterone levels in men and breast cancer in women.[10] Since testosterone levels decrease as men age, testosterone is sometimes used in older men to counteract this deficiency. It is also used illicitly to enhance physique and performance, for instance in athletes.

  

Contents

1Biological effects

1.1Before birth

1.2Early infancy

1.3Before puberty

1.4Pubertal

1.5Adult

1.6Aggression and criminality

1.7Brain

2Medical use

3Biological activity

3.1Steroid hormone activity

3.2Neurosteroid activity

4Biochemistry

4.1Biosynthesis

4.2Distribution

4.3Metabolism

4.4Levels

5Measurement

6History

7Other animals

8See also

9References

10Further reading

Biological effects[edit]

In general, androgens such as testosterone promote protein synthesis and thus growth of tissues with androgen receptors.[11] Testosterone can be described as having virilising and anabolic effects (though these categorical descriptions are somewhat arbitrary, as there is a great deal of mutual overlap between them).[12]

 

Anabolic effects include growth of muscle mass and strength, increased bone density and strength, and stimulation of linear growth and bone maturation.

Androgenic effects include maturation of the sex organs, particularly the penis and the formation of the scrotum in the fetus, and after birth (usually at puberty) a deepening of the voice, growth of facial hair (such as the beard) and axillary (underarm) hair. Many of these fall into the category of male secondary sex characteristics.

Testosterone effects can also be classified by the age of usual occurrence. For postnatal effects in both males and females, these are mostly dependent on the levels and duration of circulating free testosterone.

 

Before birth[edit]

Effects before birth are divided into two categories, classified in relation to the stages of development.

 

The first period occurs between 4 and 6 weeks of the gestation. Examples include genital virilisation such as midline fusion, phallic urethra, scrotal thinning and rugation, and phallic enlargement; although the role of testosterone is far smaller than that of dihydrotestosterone. There is also development of the prostate gland and seminal vesicles.

 

During the second trimester, androgen level is associated with sex formation.[13] This period affects the femininization or masculinization of the fetus and can be a better predictor of feminine or masculine behaviours such as sex typed behaviour than an adult's own levels. A mother's testosterone level during pregnancy is correlated with her daughter's sex-typical behavior as an adult, and the correlation is even stronger than with the daughter's own adult testosterone level.[14]

 

Early infancy[edit]

Early infancy androgen effects are the least understood. In the first weeks of life for male infants, testosterone levels rise. The levels remain in a pubertal range for a few months, but usually reach the barely detectable levels of childhood by 4–7 months of age.[15][16] The function of this rise in humans is unknown. It has been theorized that brain masculinization is occurring since no significant changes have been identified in other parts of the body.[17] The male brain is masculinized by the aromatization of testosterone into estrogen, which crosses the blood–brain barrier and enters the male brain, whereas female fetuses have α-fetoprotein, which binds the estrogen so that female brains are not affected.[18]

 

Before puberty[edit]

Before puberty effects of rising androgen levels occur in both boys and girls. These include adult-type body odor, increased oiliness of skin and hair, acne, pubarche (appearance of pubic hair), axillary hair (armpit hair), growth spurt, accelerated bone maturation, and facial hair.[19]

 

Pubertal[edit]

Pubertal effects begin to occur when androgen has been higher than normal adult female levels for months or years. In males, these are usual late pubertal effects, and occur in women after prolonged periods of heightened levels of free testosterone in the blood. The effects include:[19][20]

 

Growth of spermatogenic tissue in testicles, male fertility, penis or clitoris enlargement, increased libido and frequency of erection or clitoral engorgement occurs. Growth of jaw, brow, chin, and nose and remodeling of facial bone contours, in conjunction with human growth hormone occurs.[21] Completion of bone maturation and termination of growth. This occurs indirectly via estradiol metabolites and hence more gradually in men than women. Increased muscle strength and mass, shoulders become broader and rib cage expands, deepening of voice, growth of the Adam's apple. Enlargement of sebaceous glands. This might cause acne, subcutaneous fat in face decreases. Pubic hair extends to thighs and up toward umbilicus, development of facial hair (sideburns, beard, moustache), loss of scalp hair (androgenetic alopecia), increase in chest hair, periareolar hair, perianal hair, leg hair, armpit hair.

 

Adult[edit]

Testosterone is necessary for normal sperm development. It activates genes in Sertoli cells, which promote differentiation of spermatogonia. It regulates acute HPA (hypothalamic–pituitary–adrenal axis) response under dominance challenge.[22] Androgen including testosterone enhances muscle growth. Testosterone also regulates the population of thromboxane A2 receptors on megakaryocytes and platelets and hence platelet aggregation in humans.[23][24]

 

Adult testosterone effects are more clearly demonstrable in males than in females, but are likely important to both sexes. Some of these effects may decline as testosterone levels might decrease in the later decades of adult life.[25]

 

Health risks[edit]

Testosterone does not appear to increase the risk of developing prostate cancer. In people who have undergone testosterone deprivation therapy, testosterone increases beyond the castrate level have been shown to increase the rate of spread of an existing prostate cancer.[26][27][28]

 

Conflicting results have been obtained concerning the importance of testosterone in maintaining cardiovascular health.[29][30] Nevertheless, maintaining normal testosterone levels in elderly men has been shown to improve many parameters that are thought to reduce cardiovascular disease risk, such as increased lean body mass, decreased visceral fat mass, decreased total cholesterol, and glycemic control.[31]

 

High androgen levels are associated with menstrual cycle irregularities in both clinical populations and healthy women.[32]

 

Sexual arousal[edit]

See also: Hormones and sexual arousal

When testosterone and endorphins in ejaculated semen meet the cervical wall after sexual intercourse, females receive a spike in testosterone, endorphin, and oxytocin levels, and males after orgasm during copulation experience an increase in endorphins and a marked increase in oxytocin levels. This adds to the hospitable physiological environment in the female internal reproductive tract for conceiving, and later for nurturing the conceptus in the pre-embryonic stages, and stimulates feelings of love, desire, and paternal care in the male (this is the only time male oxytocin levels rival a female's).[citation needed]

 

Testosterone levels follow a nyctohemeral rhythm that peaks early each day, regardless of sexual activity.[33]

 

There are positive correlations between positive orgasm experience in women and testosterone levels where relaxation was a key perception of the experience. There is no correlation between testosterone and men's perceptions of their orgasm experience, and also no correlation between higher testosterone levels and greater sexual assertiveness in either sex.[34]

 

Sexual arousal and masturbation in women produce small increases in testosterone concentrations.[35] The plasma levels of various steroids significantly increase after masturbation in men and the testosterone levels correlate to those levels.[36]

 

Mammalian studies[edit]

Studies conducted in rats have indicated that their degree of sexual arousal is sensitive to reductions in testosterone. When testosterone-deprived rats were given medium levels of testosterone, their sexual behaviors (copulation, partner preference, etc.) resumed, but not when given low amounts of the same hormone. Therefore, these mammals may provide a model for studying clinical populations among humans suffering from sexual arousal deficits such as hypoactive sexual desire disorder.[37]

 

In every mammalian species examined demonstrated a marked increase in a male's testosterone level upon encountering a novel female. The reflexive testosterone increases in male mice is related to the male's initial level of sexual arousal.[38]

 

In non-human primates, it may be that testosterone in puberty stimulates sexual arousal, which allows the primate to increasingly seek out sexual experiences with females and thus creates a sexual preference for females.[39] Some research has also indicated that if testosterone is eliminated in an adult male human or other adult male primate's system, its sexual motivation decreases, but there is no corresponding decrease in ability to engage in sexual activity (mounting, ejaculating, etc.).[39]

 

In accordance with sperm competition theory, testosterone levels are shown to increase as a response to previously neutral stimuli when conditioned to become sexual in male rats.[40] This reaction engages penile reflexes (such as erection and ejaculation) that aid in sperm competition when more than one male is present in mating encounters, allowing for more production of successful sperm and a higher chance of reproduction.

 

Males[edit]

In men, higher levels of testosterone are associated with periods of sexual activity.[41][42]

 

Men who watch a sexually explicit movie have an average increase of 35% in testosterone, peaking at 60–90 minutes after the end of the film, but no increase is seen in men who watch sexually neutral films.[43] Men who watch sexually explicit films also report increased motivation, competitiveness, and decreased exhaustion.[44] A link has also been found between relaxation following sexual arousal and testosterone levels.[45]

 

Men's levels of testosterone, a hormone known to affect men's mating behaviour, changes depending on whether they are exposed to an ovulating or nonovulating woman's body odour. Men who are exposed to scents of ovulating women maintained a stable testosterone level that was higher than the testosterone level of men exposed to nonovulation cues. Testosterone levels and sexual arousal in men are heavily aware of hormone cycles in females.[46] This may be linked to the ovulatory shift hypothesis,[47] where males are adapted to respond to the ovulation cycles of females by sensing when they are most fertile and whereby females look for preferred male mates when they are the most fertile; both actions may be driven by hormones.

 

Females[edit]

Androgens may modulate the physiology of vaginal tissue and contribute to female genital sexual arousal.[48] Women's level of testosterone is higher when measured pre-intercourse vs pre-cuddling, as well as post-intercourse vs post-cuddling.[49] There is a time lag effect when testosterone is administered, on genital arousal in women. In addition, a continuous increase in vaginal sexual arousal may result in higher genital sensations and sexual appetitive behaviors.[50]

 

When females have a higher baseline level of testosterone, they have higher increases in sexual arousal levels but smaller increases in testosterone, indicating a ceiling effect on testosterone levels in females. Sexual thoughts also change the level of testosterone but not level of cortisol in the female body, and hormonal contraceptives may affect the variation in testosterone response to sexual thoughts.[51]

 

Testosterone may prove to be an effective treatment in female sexual arousal disorders,[52] and is available as a dermal patch. There is no FDA approved androgen preparation for the treatment of androgen insufficiency; however, it has been used off-label to treat low libido and sexual dysfunction in older women. Testosterone may be a treatment for postmenopausal women as long as they are effectively estrogenized.[52]

 

Romantic relationships[edit]

Falling in love decreases men's testosterone levels while increasing women's testosterone levels. There has been speculation that these changes in testosterone result in the temporary reduction of differences in behavior between the sexes.[53] However, it is suggested that after the "honeymoon phase" ends—about four years into a relationship—this change in testosterone levels is no longer apparent.[53] Men who produce less testosterone are more likely to be in a relationship[54] or married,[55] and men who produce more testosterone are more likely to divorce;[55] however, causality cannot be determined in this correlation. Marriage or commitment could cause a decrease in testosterone levels.[56] Single men who have not had relationship experience have lower testosterone levels than single men with experience. It is suggested that these single men with prior experience are in a more competitive state than their non-experienced counterparts.[57] Married men who engage in bond-maintenance activities such as spending the day with their spouse/and or child have no different testosterone levels compared to times when they do not engage in such activities. Collectively, these results suggest that the presence of competitive activities rather than bond-maintenance activities are more relevant to changes in testosterone levels.[58]

 

Men who produce more testosterone are more likely to engage in extramarital sex.[55] Testosterone levels do not rely on physical presence of a partner; testosterone levels of men engaging in same-city and long-distance relationships are similar.[54] Physical presence may be required for women who are in relationships for the testosterone–partner interaction, where same-city partnered women have lower testosterone levels than long-distance partnered women.[59]

 

Fatherhood[edit]

Fatherhood decreases testosterone levels in men, suggesting that the emotions and behavior tied to decreased testosterone promote paternal care. In humans and other species that utilize allomaternal care, paternal investment in offspring is beneficial to said offspring's survival because it allows the parental dyad to raise multiple children simultaneously. This increases the reproductive fitness of the parents, because their offspring are more likely to survive and reproduce. Paternal care increases offspring survival due to increased access to higher quality food and reduced physical and immunological threats.[60] This is particularly beneficial for humans since offspring are dependent on parents for extended periods of time and mothers have relatively short inter-birth intervals.[61] While extent of paternal care varies between cultures, higher investment in direct child care has been seen to be correlated with lower average testosterone levels as well as temporary fluctuations.[62] For instance, fluctuation in testosterone levels when a child is in distress has been found to be indicative of fathering styles. If a father's testosterone levels decrease in response to hearing their baby cry, it is an indication of empathizing with the baby. This is associated with increased nurturing behavior and better outcomes for the infant.[63]

 

Motivation[edit]

Testosterone levels play a major role in risk-taking during financial decisions.[64][65]

 

Aggression and criminality [edit]

See also: Aggression § Testosterone, and Biosocial criminology

Most studies support a link between adult criminality and testosterone, although the relationship is modest if examined separately for each sex. Nearly all studies of juvenile delinquency and testosterone are not significant. Most studies have also found testosterone to be associated with behaviors or personality traits linked with criminality such as antisocial behavior and alcoholism. Many studies have also been done on the relationship between more general aggressive behavior/feelings and testosterone. About half the studies have found a relationship and about half no relationship.[66]

 

Testosterone is only one of many factors that influence aggression and the effects of previous experience and environmental stimuli have been found to correlate more strongly. A few studies indicate that the testosterone derivative estradiol (one form of estrogen) might play an important role in male aggression.[66][67][68][69] Studies have also found that testosterone facilitates aggression by modulating vasopressin receptors in the hypothalamus.[70]

 

The sexual hormone can encourage fair behavior. For the study, subjects took part in a behavioral experiment where the distribution of a real amount of money was decided. The rules allowed both fair and unfair offers. The negotiating partner could subsequently accept or decline the offer. The fairer the offer, the less probable a refusal by the negotiating partner. If no agreement was reached, neither party earned anything. Test subjects with an artificially enhanced testosterone level generally made better, fairer offers than those who received placebos, thus reducing the risk of a rejection of their offer to a minimum. Two later studies have empirically confirmed these results.[71][72][73] However men with high testosterone were significantly 27% less generous in an ultimatum game.[74] The Annual NY Academy of Sciences has also found anabolic steroid use which increase testosterone to be higher in teenagers, and this was associated with increased violence.[75] Studies have also found administered testosterone to increase verbal aggression and anger in some participants.[76]

 

Testosterone is significantly correlated with aggression and competitive behaviour and is directly facilitated by the latter. There are two theories on the role of testosterone in aggression and competition.[77] The first one is the challenge hypothesis which states that testosterone would increase during puberty thus facilitating reproductive and competitive behaviour which would include aggression.[77] Thus it is the challenge of competition among males of the species that facilitates aggression and violence.[77] Studies conducted have found direct correlation between testosterone and dominance especially among the most violent criminals in prison who had the highest testosterone levels.[77] The same research also found fathers (those outside competitive environments) had the lowest testosterone levels compared to other males.[77]

 

The second theory is similar and is known as "evolutionary neuroandrogenic (ENA) theory of male aggression".[78][79] Testosterone and other androgens have evolved to masculinize a brain in order to be competitive even to the point of risking harm to the person and others. By doing so, individuals with masculinized brains as a result of pre-natal and adult life testosterone and androgens enhance their resource acquiring abilities in order to survive, attract and copulate with mates as much as possible.[78] The masculinization of the brain is not just mediated by testosterone levels at the adult stage, but also testosterone exposure in the womb as a fetus. Higher pre-natal testosterone indicated by a low digit ratio as well as adult testosterone levels increased risk of fouls or aggression among male players in a soccer game.[80] Studies have also found higher pre-natal testosterone or lower digit ratio to be correlated with higher aggression in males.[81][82][83][84][85]

 

The rise in testosterone levels during competition predicted aggression in males but not in females.[86] Subjects who interacted with hand guns and an experimental game showed rise in testosterone and aggression.[87] Natural selection might have evolved males to be more sensitive to competitive and status challenge situations and that the interacting roles of testosterone are the essential ingredient for aggressive behaviour in these situations.[88] Testosterone produces aggression by activating subcortical areas in the brain, which may also be inhibited or suppressed by social norms or familial situations while still manifesting in diverse intensities and ways through thoughts, anger, verbal aggression, competition, dominance and physical violence.[89] Testosterone mediates attraction to cruel and violent cues in men by promoting extended viewing of violent stimuli.[90] Testosterone specific structural brain characteristic can predict aggressive behaviour in individuals.[91]

 

Estradiol is known to correlate with aggression in male mice.[92] Moreover, the conversion of testosterone to estradiol regulates male aggression in sparrows during breeding season.[93] Rats who were given anabolic steroids that increase testosterone were also more physically aggressive to provocation as a result of "threat sensitivity".[94]

 

Brain[edit]

The brain is also affected by this sexual differentiation;[13] the enzyme aromatase converts testosterone into estradiol that is responsible for masculinization of the brain in male mice. In humans, masculinization of the fetal brain appears, by observation of gender preference in patients with congenital diseases of androgen formation or androgen receptor function, to be associated with functional androgen receptors.[95]

 

There are some differences between a male and female brain (possibly the result of different testosterone levels), one of them being size: the male human brain is, on average, larger.[96] Men were found to have a total myelinated fiber length of 176 000 km at the age of 20, whereas in women the total length was 149 000 km (approx. 15% less).[97]

 

No immediate short term effects on mood or behavior were found from the administration of supraphysiologic doses of testosterone for 10 weeks on 43 healthy men.[98] A correlation between testosterone and risk tolerance in career choice exists among women.[64][99]

 

Attention, memory, and spatial ability are key cognitive functions affected by testosterone in humans. Preliminary evidence suggests that low testosterone levels may be a risk factor for cognitive decline and possibly for dementia of the Alzheimer's type,[100][101][102][103] a key argument in life extension medicine for the use of testosterone in anti-aging therapies. Much of the literature, however, suggests a curvilinear or even quadratic relationship between spatial performance and circulating testosterone,[104] where both hypo- and hypersecretion (deficient- and excessive-secretion) of circulating androgens have negative effects on cognition.

 

Medical use[edit]

Main article: Testosterone (medication)

Testosterone is used as a medication for the treatment of males with too little or no natural testosterone production, certain forms of breast cancer,[10] and gender dysphoria in transgender men. This is known as hormone replacement therapy (HRT) or testosterone replacement therapy (TRT), which maintains serum testosterone levels in the normal range. Decline of testosterone production with age has led to interest in androgen replacement therapy.[105] It is unclear if the use of testosterone for low levels due to aging is beneficial or harmful.[106]

 

Testosterone is included in the World Health Organization's list of essential medicines, which are the most important medications needed in a basic health system.[107] It is available as a generic medication.[10] The price depends on the form of testosterone used.[108] It can be administered as a cream or transdermal patch that is applied to the skin, by injection into a muscle, as a tablet that is placed in the cheek, or by ingestion.[10]

 

Common side effects from testosterone medication include acne, swelling, and breast enlargement in males.[10] Serious side effects may include liver toxicity, heart disease, and behavioral changes.[10] Women and children who are exposed may develop virilization.[10] It is recommended that individuals with prostate cancer not use the medication.[10] It can cause harm if used during pregnancy or breastfeeding.[10]

 

Biological activity[edit]

Steroid hormone activity[edit]

The effects of testosterone in humans and other vertebrates occur by way of multiple mechanisms: by activation of the androgen receptor (directly or as DHT), and by conversion to estradiol and activation of certain estrogen receptors.[109][110] Androgens such as testosterone have also been found to bind to and activate membrane androgen receptors.[111][112][113]

 

Free testosterone (T) is transported into the cytoplasm of target tissue cells, where it can bind to the androgen receptor, or can be reduced to 5α-dihydrotestosterone (DHT) by the cytoplasmic enzyme 5α-reductase. DHT binds to the same androgen receptor even more strongly than testosterone, so that its androgenic potency is about 5 times that of T.[114] The T-receptor or DHT-receptor complex undergoes a structural change that allows it to move into the cell nucleus and bind directly to specific nucleotide sequences of the chromosomal DNA. The areas of binding are called hormone response elements (HREs), and influence transcriptional activity of certain genes, producing the androgen effects.

 

Androgen receptors occur in many different vertebrate body system tissues, and both males and females respond similarly to similar levels. Greatly differing amounts of testosterone prenatally, at puberty, and throughout life account for a share of biological differences between males and females.

 

The bones and the brain are two important tissues in humans where the primary effect of testosterone is by way of aromatization to estradiol. In the bones, estradiol accelerates ossification of cartilage into bone, leading to closure of the epiphyses and conclusion of growth. In the central nervous system, testosterone is aromatized to estradiol. Estradiol rather than testosterone serves as the most important feedback signal to the hypothalamus (especially affecting LH secretion).[115] In many mammals, prenatal or perinatal "masculinization" of the sexually dimorphic areas of the brain by estradiol derived from testosterone programs later male sexual behavior.[116]

 

Neurosteroid activity[edit]

Testosterone, via its active metabolite 3α-androstanediol, is a potent positive allosteric modulator of the GABAA receptor.[117]

 

Testosterone has been found to act as an antagonist of the TrkA and p75NTR, receptors for the neurotrophin nerve growth factor (NGF), with high affinity (around 5 nM).[118][119][120] In contrast to testosterone, DHEA and DHEA sulfate have been found to act as high-affinity agonists of these receptors.[118][119][120]

 

Testosterone is an antagonist of the sigma σ1 receptor (Ki = 1,014 or 201 nM).[121] However, the concentrations of testosterone required for binding the receptor are far above even total circulating concentrations of testosterone in adult males (which range between 10 and 35 nM).[122]

 

Biochemistry[edit]

 

Human steroidogenesis, showing testosterone near bottom.[123]

Biosynthesis[edit]

Like other steroid hormones, testosterone is derived from cholesterol (see figure).[124] The first step in the biosynthesis involves the oxidative cleavage of the side-chain of cholesterol by cholesterol side-chain cleavage enzyme (P450scc, CYP11A1), a mitochondrial cytochrome P450 oxidase with the loss of six carbon atoms to give pregnenolone. In the next step, two additional carbon atoms are removed by the CYP17A1 (17α-hydroxylase/17,20-lyase) enzyme in the endoplasmic reticulum to yield a variety of C19 steroids.[125] In addition, the 3β-hydroxyl group is oxidized by 3β-hydroxysteroid dehydrogenase to produce androstenedione. In the final and rate limiting step, the C17 keto group androstenedione is reduced by 17β-hydroxysteroid dehydrogenase to yield testosterone.

 

The largest amounts of testosterone (>95%) are produced by the testes in men,[2] while the adrenal glands account for most of the remainder. Testosterone is also synthesized in far smaller total quantities in women by the adrenal glands, thecal cells of the ovaries, and, during pregnancy, by the placenta.[126] In the testes, testosterone is produced by the Leydig cells.[127] The male generative glands also contain Sertoli cells, which require testosterone for spermatogenesis. Like most hormones, testosterone is supplied to target tissues in the blood where much of it is transported bound to a specific plasma protein, sex hormone-binding globulin (SHBG).

 

Regulation[edit]

 

Hypothalamic–pituitary–testicular axis

In males, testosterone is synthesized primarily in Leydig cells. The number of Leydig cells in turn is regulated by luteinizing hormone (LH) and follicle-stimulating hormone (FSH). In addition, the amount of testosterone produced by existing Leydig cells is under the control of LH, which regulates the expression of 17β-hydroxysteroid dehydrogenase.[128]

 

The amount of testosterone synthesized is regulated by the hypothalamic–pituitary–testicular axis (see figure to the right).[129] When testosterone levels are low, gonadotropin-releasing hormone (GnRH) is released by the hypothalamus, which in turn stimulates the pituitary gland to release FSH and LH. These latter two hormones stimulate the testis to synthesize testosterone. Finally, increasing levels of testosterone through a negative feedback loop act on the hypothalamus and pituitary to inhibit the release of GnRH and FSH/LH, respectively.

 

Factors affecting testosterone levels may include:

 

Age: Testosterone levels gradually reduce as men age.[130][131] This effect is sometimes referred to as andropause or late-onset hypogonadism.[132]

Exercise: Resistance training increases testosterone levels,[133] however, in older men, that increase can be avoided by protein ingestion.[134] Endurance training in men may lead to lower testosterone levels.[135]

Nutrients: Vitamin A deficiency may lead to sub-optimal plasma testosterone levels.[136] The secosteroid vitamin D in levels of 400–1000 IU/d (10–25 µg/d) raises testosterone levels.[137] Zinc deficiency lowers testosterone levels[138] but over-supplementation has no effect on serum testosterone.[139]

Weight loss: Reduction in weight may result in an increase in testosterone levels. Fat cells synthesize the enzyme aromatase, which converts testosterone, the male sex hormone, into estradiol, the female sex hormone.[140] However no clear association between body mass index and testosterone levels has been found.[141]

Miscellaneous: Sleep: (REM sleep) increases nocturnal testosterone levels.[142] Behavior: Dominance challenges can, in some cases, stimulate increased testosterone release in men.[143] Drugs: Natural or man-made antiandrogens including spearmint tea reduce testosterone levels.[144][145][146] Licorice can decrease the production of testosterone and this effect is greater in females.[147]

Distribution[edit]

The plasma protein binding of testosterone is 98.0 to 98.5%, with 1.5 to 2.0% free or unbound.[148] It is bound 65% to sex hormone-binding globulin (SHBG) and 33% bound weakly to albumin.[149]

 

Plasma protein binding of testosterone and dihydrotestosterone show

Metabolism[edit]

vte Testosterone metabolism in humans

Testosterone structures

The image above contains clickable linksTestosterone metabolism in humans. Conjugation (sulfation and glucuronidation) occurs both with testosterone and with all of the other steroids that have one or more available hydroxyl (-OH) groups in this diagram.

Both testosterone and 5α-DHT are metabolized mainly in the liver.[1][151] Approximately 50% of testosterone is metabolized via conjugation into testosterone glucuronide and to a lesser extent testosterone sulfate by glucuronosyltransferases and sulfotransferases, respectively.[1] An additional 40% of testosterone is metabolized in equal proportions into the 17-ketosteroids androsterone and etiocholanolone via the combined actions of 5α- and 5β-reductases, 3α-hydroxysteroid dehydrogenase, and 17β-HSD, in that order.[1][151][152] Androsterone and etiocholanolone are then glucuronidated and to a lesser extent sulfated similarly to testosterone.[1][151] The conjugates of testosterone and its hepatic metabolites are released from the liver into circulation and excreted in the urine and bile.[1][151][152] Only a small fraction (2%) of testosterone is excreted unchanged in the urine.[151]

 

In the hepatic 17-ketosteroid pathway of testosterone metabolism, testosterone is converted in the liver by 5α-reductase and 5β-reductase into 5α-DHT and the inactive 5β-DHT, respectively.[1][151] Then, 5α-DHT and 5β-DHT are converted by 3α-HSD into 3α-androstanediol and 3α-etiocholanediol, respectively.[1][151] Subsequently, 3α-androstanediol and 3α-etiocholanediol are converted by 17β-HSD into androsterone and etiocholanolone, which is followed by their conjugation and excretion.[1][151] 3β-Androstanediol and 3β-etiocholanediol can also be formed in this pathway when 5α-DHT and 5β-DHT are acted upon by 3β-HSD instead of 3α-HSD, respectively, and they can then be transformed into epiandrosterone and epietiocholanolone, respectively.[153][154] A small portion of approximately 3% of testosterone is reversibly converted in the liver into androstenedione by 17β-HSD.[152]

 

In addition to conjugation and the 17-ketosteroid pathway, testosterone can also be hydroxylated and oxidized in the liver by cytochrome P450 enzymes, including CYP3A4, CYP3A5, CYP2C9, CYP2C19, and CYP2D6.[155] 6β-Hydroxylation and to a lesser extent 16β-hydroxylation are the major transformations.[155] The 6β-hydroxylation of testosterone is catalyzed mainly by CYP3A4 and to a lesser extent CYP3A5 and is responsible for 75 to 80% of cytochrome P450-mediated testosterone metabolism.[155] In addition to 6β- and 16β-hydroxytestosterone, 1β-, 2α/β-, 11β-, and 15β-hydroxytestosterone are also formed as minor metabolites.[155][156] Certain cytochrome P450 enzymes such as CYP2C9 and CYP2C19 can also oxidize testosterone at the C17 position to form androstenedione.[155]

 

Two of the immediate metabolites of testosterone, 5α-DHT and estradiol, are biologically important and can be formed both in the liver and in extrahepatic tissues.[151] Approximately 5 to 7% of testosterone is converted by 5α-reductase into 5α-DHT, with circulating levels of 5α-DHT about 10% of those of testosterone, and approximately 0.3% of testosterone is converted into estradiol by aromatase.[2][151][157][158] 5α-Reductase is highly expressed in the male reproductive organs (including the prostate gland, seminal vesicles, and epididymides),[159] skin, hair follicles, and brain[160] and aromatase is highly expressed in adipose tissue, bone, and the brain.[161][162] As much as 90% of testosterone is converted into 5α-DHT in so-called androgenic tissues with high 5α-reductase expression,[152] and due to the several-fold greater potency of 5α-DHT as an AR agonist relative to testosterone,[163] it has been estimated that the effects of testosterone are potentiated 2- to 3-fold in such tissues.[164]

 

Levels[edit]

Total levels of testosterone in the body are 264 to 916 ng/dL in men age 19 to 39 years,[165] while mean testosterone levels in adult men have been reported as 630 ng/dL.[166] Levels of testosterone in men decline with age.[165] In women, mean levels of total testosterone have been reported to be 32.6 ng/dL.[167][168] In women with hyperandrogenism, mean levels of total testosterone have been reported to be 62.1 ng/dL.[167][168]

 

Testosterone levels in males and females show

Total testosterone levels in males throughout life show

 

Reference ranges for blood tests, showing adult male testosterone levels in light blue at center-left.

Measurement[edit]

Testosterone’s bioavailable concentration is commonly determined using the Vermeulen calculation or more precisely using the modified Vermeulen method,[174][175] which considers the dimeric form of sex-hormone-binding-globulin.[176]

 

Both methods use chemical equilibrium to derive the concentration of bioavailable testosterone: in circulation testosterone has two major binding partners, albumin (weakly bound) and sex-hormone-binding-globulin (strongly bound). These methods are described in detail in the accompanying figure.

  

Dimeric sex-hormone-binding-globulin with its testosterone ligands

  

Two methods for determining concentration of bioavailable testosterone.

History[edit]

A testicular action was linked to circulating blood fractions – now understood to be a family of androgenic hormones – in the early work on castration and testicular transplantation in fowl by Arnold Adolph Berthold (1803–1861).[177] Research on the action of testosterone received a brief boost in 1889, when the Harvard professor Charles-Édouard Brown-Séquard (1817–1894), then in Paris, self-injected subcutaneously a "rejuvenating elixir" consisting of an extract of dog and guinea pig testicle. He reported in The Lancet that his vigor and feeling of well-being were markedly restored but the effects were transient,[178] and Brown-Séquard's hopes for the compound were dashed. Suffering the ridicule of his colleagues, he abandoned his work on the mechanisms and effects of androgens in human beings.

 

In 1927, the University of Chicago's Professor of Physiologic Chemistry, Fred C. Koch, established easy access to a large source of bovine testicles — the Chicago stockyards — and recruited students willing to endure the tedious work of extracting their isolates. In that year, Koch and his student, Lemuel McGee, derived 20 mg of a substance from a supply of 40 pounds of bovine testicles that, when administered to castrated roosters, pigs and rats, remasculinized them.[179] The group of Ernst Laqueur at the University of Amsterdam purified testosterone from bovine testicles in a similar manner in 1934, but isolation of the hormone from animal tissues in amounts permitting serious study in humans was not feasible until three European pharmaceutical giants—Schering (Berlin, Germany), Organon (Oss, Netherlands) and Ciba (Basel, Switzerland)—began full-scale steroid research and development programs in the 1930s.

  

Nobel Prize winner, Leopold Ruzicka of Ciba, a pharmaceutical industry giant that synthesized testosterone.

The Organon group in the Netherlands were the first to isolate the hormone, identified in a May 1935 paper "On Crystalline Male Hormone from Testicles (Testosterone)".[180] They named the hormone testosterone, from the stems of testicle and sterol, and the suffix of ketone. The structure was worked out by Schering's Adolf Butenandt, at the Chemisches Institut of Technical University in Gdańsk.[181][182]

 

The chemical synthesis of testosterone from cholesterol was achieved in August that year by Butenandt and Hanisch.[183] Only a week later, the Ciba group in Zurich, Leopold Ruzicka (1887–1976) and A. Wettstein, published their synthesis of testosterone.[184] These independent partial syntheses of testosterone from a cholesterol base earned both Butenandt and Ruzicka the joint 1939 Nobel Prize in Chemistry.[182][185] Testosterone was identified as 17β-hydroxyandrost-4-en-3-one (C19H28O2), a solid polycyclic alcohol with a hydroxyl group at the 17th carbon atom. This also made it obvious that additional modifications on the synthesized testosterone could be made, i.e., esterification and alkylation.

 

The partial synthesis in the 1930s of abundant, potent testosterone esters permitted the characterization of the hormone's effects, so that Kochakian and Murlin (1936) were able to show that testosterone raised nitrogen retention (a mechanism central to anabolism) in the dog, after which Allan Kenyon's group[186] was able to demonstrate both anabolic and androgenic effects of testosterone propionate in eunuchoidal men, boys, and women. The period of the early 1930s to the 1950s has been called "The Golden Age of Steroid Chemistry",[187] and work during this period progressed quickly. Research in this golden age proved that this newly synthesized compound—testosterone—or rather family of compounds (for many derivatives were developed from 1940 to 1960), was a potent multiplier of muscle, strength, and well-being.[188]

 

Other animals[edit]

Testosterone is observed in most vertebrates. Testosterone and the classical nuclear androgen receptor first appeared in gnathostomes (jawed vertebrates).[189] Agnathans (jawless vertebrates) such as lampreys do not produce testosterone but instead use androstenedione as a male sex hormone.[190] Fish make a slightly different form called 11-ketotestosterone.[191] Its counterpart in insects is ecdysone.[192] The presence of these ubiquitous steroids in a wide range of animals suggest that sex hormones have an ancient evolutionary history.[193]

 

en.wikipedia.org/wiki/Testosterone

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Natural Cure For Sexual Dysfunctions

Erectile dysfunction (ED), also referred to as impotence, is a form of sexual dysfunction in males characterized by the persistent or recurring inability to achieve or maintain a penile erection with sufficient rigidity and duration for satisfactory sexual activity. It is the most common sexual problem in males and can cause psychological distress due to its impact on self-image and sexual relationships. The term erectile dysfunction does not encompass other erection-related disorders, such as priapism.

 

The majority of ED cases are attributed to physical risk factors and predictive factors. These factors can be categorized as vascular, neurological, local penile, hormonal, and drug-induced. Notable predictors of ED include aging, cardiovascular disease, diabetes mellitus, high blood pressure, obesity, abnormal lipid levels in the blood, hypogonadism, smoking, depression, and medication use. Approximately 10% of cases are linked to psychosocial factors, encompassing conditions such as depression, stress, and problems within relationships.[14] ED is reported in 18% of males aged 50 to 59 years, and 37% in males aged 70 to 75.[14]

 

Treatment of ED encompasses addressing the underlying causes, lifestyle modification, and addressing psychosocial issues.[4] In many instances, medication-based therapies are used, specifically PDE5 inhibitors such as sildenafil.[13] These drugs function by dilating blood vessels, facilitating increased blood flow into the spongy tissue of the penis, analogous to opening a valve wider to enhance water flow in a fire hose. Less frequently employed treatments encompass prostaglandin pellets inserted into the urethra, the injection of smooth-muscle relaxants and vasodilators directly into the penis, penile implants, the use of penis pumps, and vascular surgery.[4][15]

 

Signs and symptoms

ED is characterized by the persistent or recurring inability to achieve or maintain an erection of the penis with sufficient rigidity and duration for satisfactory sexual activity.[14] It is defined as the "persistent or recurrent inability to achieve and maintain a penile erection of sufficient rigidity to permit satisfactory sexual activity for at least 3 months."[4]

 

Psychological impact

ED often has an impact on the emotional well-being of both males and their partners.[14] Many males do not seek treatment due to feelings of embarrassment. About 75% of diagnosed cases of ED go untreated.[16]

 

Causes

Causes of or contributors to ED include the following:

 

Diets high in saturated fat are linked to heart diseases, and males with heart diseases are more likely to experience ED.[7][8] By contrast, plant-based diets show a lower risk for ED.[17][18][19]

Prescription drugs (e.g., SSRIs,[20] beta blockers, antihistamines,[21][22][23] alpha-2 adrenergic receptor agonists, thiazides, hormone modulators, and 5α-reductase inhibitors)[3][4]

Neurogenic disorders (e.g., diabetic neuropathy, temporal lobe epilepsy, multiple sclerosis, Parkinson's disease, multiple system atrophy)[3][4][5]

Cavernosal disorders (e.g., Peyronie's disease)[3][24]

Hyperprolactinemia (e.g., due to a prolactinoma)[3]

Psychological causes: performance anxiety, stress, and mental disorders[6]

Surgery (e.g., radical prostatectomy)[25]

Ageing: after age 40 years, ageing itself is a risk factor for ED, although numerous other pathologies that may occur with ageing, such as testosterone deficiency, cardiovascular diseases, or diabetes, among others, appear to have interacting effects[1][26]

Kidney disease: ED and chronic kidney disease have pathological mechanisms in common, including vascular and hormonal dysfunction, and may share other comorbidities, such as hypertension and diabetes mellitus that can contribute to ED[9]

Lifestyle habits, particularly smoking, which is a key risk factor for ED as it promotes arterial narrowing.[27][28][29] Due to its propensity for causing detumescence and erectile dysfunction, some studies have described tobacco as an anaphrodisiacal substance.[30]

COVID-19: preliminary research indicates that COVID-19 viral infection may affect sexual and reproductive health.[31][32]

Surgical intervention for a number of conditions may remove anatomical structures necessary to erection, damage nerves, or impair blood supply.[25] ED is a common complication of treatments for prostate cancer, including prostatectomy and destruction of the prostate by external beam radiation, although the prostate gland itself is not necessary to achieve an erection. As far as inguinal hernia surgery is concerned, in most cases, and in the absence of postoperative complications, the operative repair can lead to a recovery of the sexual life of people with preoperative sexual dysfunction, while, in most cases, it does not affect people with a preoperative normal sexual life.[33]

 

ED can also be associated with bicycling due to both neurological and vascular problems due to compression.[34] The increased risk appears to be about 1.7-fold.[35]

 

Concerns that use of pornography can cause ED[36] have little support[37][38] in epidemiological studies, according to a 2015 literature review.[39] According to Gunter de Win, a Belgian professor and sex researcher, "Put simply, respondents who watch 60 minutes a week and think they're addicted were more likely to report sexual dysfunction than those who watch a care-free 160 minutes weekly."[40][41]

 

In seemingly rare cases, medications such as SSRIs, isotretinoin (Accutane) and finasteride (Propecia) are reported to induce long-lasting iatrogenic disorders characterized by sexual dysfunction symptoms, including erectile dysfunction in males; these disorders are known as post-SSRI sexual dysfunction (PSSD), post-retinoid sexual dysfunction/post-Accutane syndrome (PRSD/PAS), and post-finasteride syndrome (PFS). These conditions remain poorly understood and lack effective treatments, although they have been suggested to share a common etiology.[42]

 

Rarely impotence can be caused by aromatase being active. See Androgen replacement therapy.

Pathophysiology

Penile erection is managed by two mechanisms: the reflex erection, which is achieved by directly touching the penile shaft, and the psychogenic erection, which is achieved by erotic or emotional stimuli. The former involves the peripheral nerves and the lower parts of the spinal cord, whereas the latter involves the limbic system of the brain. In both cases, an intact neural system is required for a successful and complete erection. Stimulation of the penile shaft by the nervous system leads to the secretion of nitric oxide (NO), which causes the relaxation of the smooth muscles of the corpora cavernosa (the main erectile tissue of the penis), and subsequently penile erection. Additionally, adequate levels of testosterone (produced by the testes) and an intact pituitary gland are required for the development of a healthy erectile system. As can be understood from the mechanisms of a normal erection, impotence may develop due to hormonal deficiency, disorders of the neural system, lack of adequate penile blood supply or psychological problems.[2]

 

Diagnosis

In many cases, the diagnosis can be made based on the person's history of symptoms. In other cases, a physical examination and laboratory investigations are done to rule out more serious causes such as hypogonadism or prolactinoma.[4]

 

One of the first steps is to distinguish between physiological and psychological ED. Determining whether involuntary erections are present is important in eliminating the possibility of psychogenic causes for ED.[4] Obtaining full erections occasionally, such as nocturnal penile tumescence when asleep (that is, when the mind and psychological issues, if any, are less present), tends to suggest that the physical structures are functionally working.[43][44] Similarly, performance with manual stimulation, as well as any performance anxiety or acute situational ED, may indicate a psychogenic component to ED.[4]

 

Another factor leading to ED is diabetes mellitus, a well known cause of neuropathy.[4] ED is also related to generally poor physical health, poor dietary habits, obesity, and most specifically cardiovascular disease, such as coronary artery disease and peripheral vascular disease.[4] Screening for cardiovascular risk factors, such as smoking, dyslipidemia, hypertension, and alcoholism, is helpful.[4]

 

In some cases, the simple search for a previously undetected groin hernia can prove useful since it can affect sexual functions in males and is relatively easily curable.[33]

 

The current – as of April 2025[45] – edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) lists Erectile Disorder (ICD-10-CM code: F52.21) as a diagnosis.[46] According to the DSM, it "is the more specific DSM-5 diagnostic category in which erectile dysfunction persists for at least 6 months and causes distress in the individual."[46] The ICD-10, to which the DSM refers regarding Erectile dysfunction,[46] lists it under Failure of genital response (F52.2).[47] The latest edition of the ICD – namely, the ICD-11 – lists the condition as Male erectile dysfunction (HA01.1).

 

Ultrasonography

 

Transverse ultrasound image, ventral view of the penis. Image obtained after induction of an erection, 15 min after injection of prostaglandin E1, showing dilated sinusoids (arrows).[48]

Penile ultrasonography with doppler can be used to examine the erect penis. Most cases of ED of organic causes are related to changes in blood flow in the corpora cavernosa, represented by occlusive artery disease (in which less blood is allowed to enter the penis), most often of atherosclerotic origin, or due to failure of the veno-occlusive mechanism (in which too much blood circulates back out of the penis). Before the Doppler sonogram, the penis should be examined in B mode, in order to identify possible tumors, fibrotic plaques, calcifications, or hematomas, and to evaluate the appearance of the cavernous arteries, which can be tortuous or atheromatous.[48]

 

Erection can be induced by injecting 10–20 μg of prostaglandin E1, with evaluations of the arterial flow every five minutes for 25–30 min (see image). The use of prostaglandin E1 is contraindicated in patients with predisposition to priapism (e.g., those with sickle cell anemia), anatomical deformity of the penis, or penile implants. Phentolamine (2 mg) is often added. Visual and tactile stimulation produces better results. Some authors recommend the use of sildenafil by mouth to replace the injectable drugs in cases of contraindications, although the efficacy of such medication is controversial.[48]

 

Before the injection of the chosen drug, the flow pattern is monophasic, with low systolic velocities and an absence of diastolic flow. After injection, systolic and diastolic peak velocities should increase, decreasing progressively with vein occlusion and becoming negative when the penis becomes rigid (see image below). The reference values vary across studies, ranging from > 25 cm/s to > 35 cm/s. Values above 35 cm/s indicate the absence of arterial disease, values below 25 cm/s indicate arterial insufficiency, and values of 25–35 cm/s are indeterminate because they are less specific (see image below). The data obtained should be correlated with the degree of erection observed. If the peak systolic velocities are normal, the final diastolic velocities should be evaluated, those above 5 cm/s being associated with venogenic ED.[48]

 

Graphs representing the color Doppler spectrum of the flow pattern of the cavernous arteries during the erection phases. A: Single-phase flow with minimal or absent diastole when the penis is flaccid. B: Increased systolic flow and reverse diastole 25 min after injection of prostaglandin.[48]

Graphs representing the color Doppler spectrum of the flow pattern of the cavernous arteries during the erection phases. A: Single-phase flow with minimal or absent diastole when the penis is flaccid. B: Increased systolic flow and reverse diastole 25 min after injection of prostaglandin.[48]

 

Longitudinal, ventral ultrasound of the penis, with pulsed mode and color Doppler. Flow of the cavernous arteries at 5, 15, and 25 min after prostaglandin injection (A, B, and C, respectively). The cavernous artery flow remains below the expected levels (at least 25–35 cm/s), which indicates ED due to arterial insufficiency.[48]

Longitudinal, ventral ultrasound of the penis, with pulsed mode and color Doppler. Flow of the cavernous arteries at 5, 15, and 25 min after prostaglandin injection (A, B, and C, respectively). The cavernous artery flow remains below the expected levels (at least 25–35 cm/s), which indicates ED due to arterial insufficiency.[48]

Other workup methods

Penile nerves function

Tests such as the bulbocavernosus reflex test are used to ascertain whether there is enough nerve sensation in the penis. The physician squeezes the glans (head) of the penis, which immediately causes the anus to contract if nerve function is normal. A physician measures the latency between squeeze and contraction by observing the anal sphincter or by feeling it with a gloved finger in the anus.[49]

Nocturnal penile tumescence (NPT)

It is normal for a man to have five to six erections during sleep, especially during rapid eye movement (REM). Their absence may indicate a problem with nerve function or blood supply in the penis. There are two methods for measuring changes in penile rigidity and circumference during nocturnal erection: snap gauge and strain gauge. A significant proportion[quantify] of males who have no sexual dysfunction nonetheless do not have regular nocturnal erections.[citation needed]

Penile biothesiometry

This test uses electromagnetic vibration to evaluate sensitivity and nerve function in the glans and shaft of the penis.[50]

Dynamic infusion cavernosometry (DICC)

Technique in which fluid is pumped into the penis at a known rate and pressure. It gives a measurement of the vascular pressure in the corpus cavernosum during an erection.[citation needed]

Corpus cavernosometry

Cavernosography measurement of the vascular pressure in the corpus cavernosum. Saline is infused under pressure into the corpus cavernosum with a butterfly needle, and the flow rate needed to maintain an erection indicates the degree of venous leakage. The leaking veins responsible may be visualized by infusing a mixture of saline and x-ray contrast medium and performing a cavernosogram.[51] In Digital Subtraction Angiography (DSA), the images are acquired digitally.[citation needed]

Magnetic resonance angiography (MRA)

This is similar to magnetic resonance imaging. Magnetic resonance angiography uses magnetic fields and radio waves to provide detailed images of the blood vessels. The doctor may inject into the patient's bloodstream a contrast agent, which causes vascular tissues to stand out against other tissues, so that information about blood supply and vascular anomalies is easier to gather.[citation needed]

Erection Hardness Score

This section is an excerpt from Erection Hardness Score.[edit]

The Erection Hardness Score (EHS) is a single-item Likert scale used to assess the subjective hardness of the penis as reported by the patient. It ranges from 0 (indicating the penis does not enlarge) to 4 (indicating the penis is completely hard and fully rigid). Developed in 1998, the EHS is widely used in clinical trials and is recognized for its ease of administration and strong association with sexual function outcomes. It has been validated across various causes of erectile dysfunction and in patients treated with phosphodiesterase type 5 inhibitors (PDE5), showing robust psychometric properties and responsiveness to treatment.[52]

Treatment

 

One ad from 1897 claims to restore "perfect manhood. Failure is impossible with our method".[53] Another "will quickly cure you of all nervous or diseases of the generative organs, such as Lost Manhood, Insomnia, Pains in the Back, Seminal Emissions, Nervous Debility, Pimples, Unfitness to Marry, Exhausting Drains, Varicocele and Constipation".[53] The U.S. Federal Trade Commission warns that "phony cures" exist even today.[54]

Treatment depends on the underlying cause. In general, exercise, particularly of the aerobic type, is effective for preventing ED during midlife.[10] Counseling can be used if the underlying cause is psychological, including how to lower stress or anxiety related to sex.[12] Medications by mouth and vacuum erection devices are first-line treatments,[10]: 20, 24  followed by injections of drugs into the penis, as well as penile implants.[10]: 25–26  Vascular reconstructive surgeries are beneficial in certain groups.[55] Treatments, other than surgery, do not fix the underlying physiological problem, but are used as needed before sex.[56]

 

Medications

See also: List of investigational sexual dysfunction drugs

The PDE5 inhibitors sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis) are prescription drugs which are taken by mouth.[10]: 20–21  As of 2018, sildenafil is available in the UK without a prescription.[57] Additionally, a cream combining alprostadil with the permeation enhancer DDAIP has been approved in Canada as a first line treatment for ED.[58] Penile injections, on the other hand, can involve one of the following medications: papaverine, phentolamine, and prostaglandin E1, also known as alprostadil.[10] In addition to injections, there is an alprostadil suppository that can be inserted into the urethra. Once inserted, an erection can begin within 10 minutes and last up to an hour.[12] Medications to treat ED may cause a side effect called priapism.[12]

 

Prevalence of medical diagnosis

In a study published in 2016, based on US health insurance claims data, out of 19,833,939 US males aged ≥18 years, only 1,108,842 (5.6%), were medically diagnosed with erectile dysfunction or on a PDE5I prescription (μ age 55.2 years, σ 11.2 years). Prevalence of diagnosis or prescription was the highest for age group 60–69 at 11.5%, lowest for age group 18–29 at 0.4%, and 2.1% for 30–39, 5.7% for 40–49, 10% for 50–59, 11% for 70–79, 4.6% for 80–89, 0.9% for ≥90, respectively.[59]

 

Focused shockwave therapy

Focused shockwave therapy involves passing short, high frequency acoustic pulses through the skin and into the penis. These waves break down any plaques within the blood vessels, encourage the formation of new vessels, and stimulate repair and tissue regeneration.[60][61]

 

Focused shockwave therapy appears to work best for males with vasculogenic ED, which is a blood vessel disorder that affects blood flow to tissue in the penis. The treatment is painless and has no known side effects. Treatment with shockwave therapy can lead to a significant improvement of the IIEF (International Index of Erectile Function).[62][63][64]

 

Testosterone

Men with low levels of testosterone can experience ED. Taking testosterone may help maintain an erection.[65] Males with type 2 diabetes are twice as likely to have lower levels of testosterone, and are three times more likely to experience ED than non-diabetic men.[65]

 

Pumps

Main article: penis pump

A vacuum erection device helps draw blood into the penis by applying negative pressure. This type of device is sometimes referred to as penis pump and may be used just prior to sexual intercourse. Several types of FDA approved vacuum therapy devices are available under prescription. When pharmacological methods fail, a purpose-designed external vacuum pump can be used to attain erection, with a separate compression ring fitted to the base of the penis to maintain it. These pumps should be distinguished from other penis pumps (supplied without compression rings) which, rather than being used for temporary treatment of impotence, are claimed to increase penis length if used frequently, or vibrate as an aid to masturbation. More drastically, inflatable or rigid penile implants may be fitted surgically.[11]

 

Vibrators

Main article: Vibrator (sex toy)

The vibrator was invented in the late 19th century as a medical instrument for pain relief and the treatment of various ailments. Sometimes described as a massager, the vibrator is used on the body to produce sexual stimulation. Several clinical studies have found vibrators to be an effective solution for Erectile Dysfunction.[66][67] Examples of FDA registered vibrators for erectile dysfunction include MysteryVibe's Tenuto[68] and Reflexonic's Viberect.[69]

 

Surgery

Main article: Penile implant

Often, as a last resort, if other treatments have failed, the most common procedure is prosthetic implants which involves the insertion of artificial rods into the penis.[10]: 26  Some sources show that vascular reconstructive surgeries are viable options for some people.[55]

 

Alternative medicine

The Food and Drug Administration (FDA) does not recommend alternative therapies to treat sexual dysfunction.[70] Many products are advertised as "herbal viagra" or "natural" sexual enhancement products, but no clinical trials or scientific studies support the effectiveness of these products for the treatment of ED, and synthetic chemical compounds similar to sildenafil have been found as adulterants in many of these products.[71][72][73][74][75] The FDA has warned consumers that any sexual enhancement product that claims to work as well as prescription products is likely to contain such a contaminant.[76] A 2021 review indicated that ginseng had "only trivial effects on erectile function or satisfaction with intercourse compared to placebo".[77]

 

History

Further information: Impotence and marriage

Further information: Medicalisation of sexuality

 

An unhappy wife is complaining to the qadi about her husband's impotence. Ottoman miniature.

Attempts to treat the symptoms described by ED date back well over 1,000 years. In the 8th century, males of Ancient Rome and Greece wore talismans of rooster and goat genitalia, believing these talismans would serve as an aphrodisiac and promote sexual function.[78] In the 13th century, Albertus Magnus recommended ingesting roasted wolf penis as a remedy for impotence.[78] During the late 16th and 17th centuries in France, male impotence was considered a crime, as well as legal grounds for a divorce. The practice, which involved inspection of the complainants by court experts, was declared obscene in 1677.[79][80]

 

The first major publication describing a broad medicalization of sexual disorders was the first edition of the Diagnostic and Statistical Manual of Mental Disorders in 1952.[81] In the early 20th century, medical folklore held that 90-95% of cases of ED were psychological in origin, but around the 1980s research took the opposite direction of searching for physical causes of sexual dysfunction, which also happened in the 1920s and 30s.[82] Physical causes as explanations continue to dominate literature when compared with psychological explanations as of 2022.[83]

 

Treatments in the 80s for ED included penile implants and intracavernosal injections.[82] The first successful vacuum erection device, or penis pump, was developed by Vincent Marie Mondat in the early 1800s.[78] A more advanced device based on a bicycle pump was developed by Geddings Osbon, a Pentecostal preacher, in the 1970s. In 1982, he received FDA approval to market the product.[84] John R. Brinkley initiated a boom in male impotence treatments in the U.S. in the 1920s and 1930s, with radio programs that recommended expensive goat gland implants and "mercurochrome" injections as the path to restored male virility, including operations by surgeon Serge Voronoff.

 

Modern drug therapy for ED made a significant advance in 1983, when British physiologist Giles Brindley dropped his trousers and demonstrated to a shocked Urodynamics Society audience showing his papaverine-induced erection.[85] The current most common treatment for ED, the oral PDE5 inhibitor known as sildenafil (Viagra) was approved for use for Pfizer by the FDA in 1998, which at the time of release was the fastest selling drug in history.[81][86][87] Sildenafil largely replaced SSRI treatments for ED at the time[88] and proliferated new types of specialised pharmaceutical marketing which emphasised social connotations of ED and Viagra rather than its physical effects.[89][90]

 

Anthropology

Anthropological research presents ED not as a disorder but, as a normal, and sometimes even welcome sign of healthy aging. Wentzell's study of 250 Mexican males in their 50s and 60s found that "most simply did not see decreasing erectile function as a biological pathology".[91] The males interviewed described the decrease in erectile function "as an aid for aging in socially appropriate ways".[91] A common theme amongst the interviewees showed that respectable older males shifted their focus toward the domestic sphere into a "second stage of life".[91] The Mexican males of this generation often pursued sex outside of marriage; decreasing erectile function acted as an aid to overcoming infidelity thus helping to attain the ideal "second stage" of life.[91] A 56-year-old about to retire from the public health service said he would now "dedicate myself to my wife, the house, gardening, caring for the grandchildren—the Mexican classic".[91] Wentzell found that treating ED as a pathology was antithetical to the social view these males held of themselves, and their purpose at this stage of their lives.

 

In the 20th and 21st centuries, anthropologists investigated how common treatments for ED are built upon assumptions of institutionalized social norms. In offering a range of clinical treatments to 'correct' a person's ability to produce an erection, biomedical institutions encourage the public to strive for prolonged sexual function. Anthropologists argue that a biomedical focus places emphasis on the biological processes of fixing the body thereby disregarding holistic ideals of health and aging.[92] By relying on a wholly medical approach, Western biomedicine can become blindsided by bodily dysfunctions which can be understood as appropriate functions of age, and not as a medical problem.[93] Anthropologists understand that a biosocial approach to ED considers a person's decision to undergo clinical treatment more likely a result of "society, political economy, history, and culture" than a matter of personal choice.[92] In rejecting biomedical treatment for ED, males can challenge common forms of medicalized social control by deviating from what is considered the normal approach to dysfunction.

 

Lexicology

The Latin term impotentia coeundi describes simple inability to insert the penis into the vagina; it is now mostly replaced by more precise terms, such as erectile dysfunction (ED). The study of ED within medicine is covered by andrology, a sub-field within urology. Research indicates that ED is common, and it is suggested that approximately 40% of males experience symptoms compatible with ED, at least occasionally.[94] The condition is also on occasion called phallic impotence.[95] Its antonym, or opposite condition, is priapism.[96][97]

 

en.wikipedia.org/wiki/Erectile_dysfunction

 

Priapism is a condition in which a penis remains erect for hours in the absence of stimulation or after stimulation has ended.[3] There are three types: ischemic (low-flow), nonischemic (high-flow), and recurrent ischemic (intermittent).[3] Most cases are ischemic.[3] Ischemic priapism is generally painful while nonischemic priapism is not.[3] In ischemic priapism, most of the penis is hard; however, the glans penis is not.[3] In nonischemic priapism, the entire penis is only somewhat hard.[3] Very rarely, clitoral priapism occurs in women.[4]

 

Sickle cell disease is the most common cause of ischemic priapism.[3] Other causes include medications such as antipsychotics, SSRIs, blood thinners and prostaglandin E1, as well as drugs such as cocaine.[3][5] Ischemic priapism occurs when blood does not adequately drain from the penis.[3] Nonischemic priapism is typically due to a connection forming between an artery and the corpus cavernosum or disruption of the parasympathetic nervous system resulting in increased arterial flow.[3] Nonischemic priapism may occur following trauma to the penis or a spinal cord injury.[3] Diagnosis may be supported by blood gas analysis of blood aspirated from the penis or an ultrasound.[3]

 

Treatment depends on the type.[3] Ischemic priapism is typically treated with a nerve block of the penis followed by aspiration of blood from the corpora cavernosa.[3] If this is not sufficient, the corpus cavernosum may be irrigated with cold, normal saline or injected with phenylephrine.[3] Nonischemic priapism is often treated with cold packs and compression.[3] Surgery may be done if usual measures are not effective.[3] In ischemic priapism, the risk of permanent scarring of the penis begins to increase after four hours and definitely occurs after 48 hours.[3][6] Priapism occurs in about 1 in 20,000 to 1 in 100,000 males per year.[3]

 

Classification

Priapism is classified into three groups: ischemic (low-flow), nonischemic (high-flow), and recurrent ischemic.[3] The majority of cases (19 out of 20) are ischemic in nature.[3]

 

Some sources give a duration of four hours as a definition of priapism, but others give six. Per the University Hospital Schleswig Holstein, "The duration of a normal erection before it is classifiable as priapism is still controversial. Ongoing penile erections for more than 6 hours can be classified as priapism."[7]

 

In women

Priapism in women (continued, painful erection of the clitoris) is significantly rarer than priapism in men and is known as clitoral priapism or clitorism.[4] It is associated with persistent genital arousal disorder (PGAD).[8] Only a few case reports of women experiencing clitoral priapism exist.[4]

 

Signs and symptoms

Complications

Because ischemic priapism causes the blood to remain in the penis for unusually long periods of time, the blood becomes deprived of oxygen, which can cause damage to the penile tissue. Such damage can result in erectile dysfunction or disfigurement of the penis.[9] In extreme cases, if the penis develops severe vascular disease, the priapism can result in penile gangrene.[10]

 

Low-flow priapism

Causes of low-flow priapism include sickle cell anemia (most common in children), leukemia, and other blood dyscrasias such as thalassemia and multiple myeloma, and the use of various drugs, as well as cancers.[11] A genome-wide association study on Brazilian patients with sickle cell disease identified four single nucleotide polymorphisms in LINC02537 and NAALADL2 significantly associated with priapism.[12]

 

Other conditions that can cause priapism include Fabry's disease, as well as neurologic disorders such as spinal cord lesions and spinal cord trauma (priapism has been reported in people who have been hanged; see death erection).

 

Priapism can also be caused by reactions to medications. The most common medications that cause priapism are intra-cavernous injections for the treatment of erectile dysfunction (papaverine, alprostadil). Other medication groups reported are antihypertensives (e.g. Doxazosin), antipsychotics (e.g., chlorpromazine, clozapine), antidepressants (most notably trazodone), anti-convulsant and mood stabilizer drugs such as sodium valproate.[13] Anticoagulants, cantharides (Spanish Fly) and recreational drugs (alcohol, heroin and cocaine) have been associated. Priapism is also known to occur from bites of the Brazilian wandering spider.[14]

 

High-flow priapism

Causes of high-flow priapism include:

 

blunt trauma to the perineum or penis, with laceration of the cavernous artery, which can generate an arterial-lacunar fistula.[11]

Anticoagulants (heparin and warfarin).

Antihypertensives (i.e., hydralazine, guanethidine and propranolol).

Hormones (i.e., gonadotropin releasing hormone and testosterone).

Diagnosis

The diagnosis is often based on the history of the condition as well as a physical exam.[3]

 

Blood gas testing the blood from the cavernosa of the penis can help in the diagnosis.[3] If the low-flow type of priapism is present, the blood typically has a low pH, while if the high-flow type is present, the pH is typically normal.[3] Color Doppler ultrasound may also help differentiate the two.[3] Testing a person to make sure they do not have a hemoglobinopathy may also be reasonable.[3]

 

Ultrasonography

 

Color Doppler ultrasound demonstrating a hypoechoic collection that corresponds to hematoma with arteriovenous fistula secondary to traumatic injury of the penis due to impact with bicycle handlebars, resulting in high-flow priapism[11]

Penile ultrasonography with Doppler is the imaging method of choice, because it is noninvasive, widely available, and highly sensitive. By means of this method, it is possible to diagnose priapism and differentiate between its low- and high-flow forms.[11]

 

In low-flow (ischemic) priapism the flow in the cavernous arteries is reduced or absent. As the condition progresses, there is an increase in echogenicity of the corpora cavernosa, attributed to tissue edema. Eventually, changes in the echotexture of the corpora cavernosa can be observed due to the fibrotic transformation generated by tissue anoxia.[11]

 

In high-flow priapism normal or increased, turbulent blood flow in the cavernous arteries is seen. The area surrounding the fistula presents a hypoechoic, irregular lesion in the cavernous tissue.[11]

 

Treatment

Medical evaluation is recommended for erections that last for longer than four hours. Pain can often be reduced with a dorsal penile nerve block or penile ring block.[3] For those with nonischemic priapism, cold packs and pressure to the area may be sufficient.[3]

 

Pseudoephedrine

Orally administered pseudoephedrine is a first-line treatment for priapism.[15] Erection is largely a parasympathetic response, so the sympathetic action of pseudoephedrine may serve to relieve this condition. Pseudoephedrine is an alpha-agonist agent that exerts a constriction effect on smooth muscle of corpora cavernosum, which in turn facilitates venous outflow. Pseudoephedrine is no longer available in some countries.

 

Aspiration

For those with ischemic priapism, the initial treatment is typically aspiration of blood from the corpus cavernosum.[3] This is done on either side.[3] If this is not sufficiently effective, then cold normal saline may be injected and removed.[3]

 

Medications

If aspiration is not sufficient, a small dose of phenylephrine may be injected into the corpus cavernosum.[3] Side effects of phenylephrine may include: high blood pressure, slow heart rate, and arrhythmia.[3] If this medication is used, it is recommended that people be monitored for at least an hour after.[3] For those with recurrent ischemic priapism, diethylstilbestrol (DES) or terbutaline may be tried.[3]

 

Surgery

Distal shunts, such as the Winter's,[clarification needed] involve puncturing the glans (the distal part of the penis) into one of the cavernosa, where the old, stagnant blood is held. This causes the blood to leave the penis and return to the circulation. This procedure can be performed by a urologist at the bedside. Winter's shunts are often the first invasive technique used, especially in hematologically induced priapism, as it is relatively simple and repeatable.[16]

 

Proximal shunts, such as the Quackel's,[clarification needed] are more involved and entail operative dissection in the perineum where the corpora meet the spongiosum while making an incision in both and suturing both openings together.[17] Shunts created between the corpora cavernosa and great saphenous vein called a Grayhack shunt can be done though this technique is rarely used.[18]

 

As the complication rates with prolonged priapism are high, early penile prosthesis implantation may be considered.[3] As well as allowing early resumption of sexual activity, early implantation can avoid the formation of dense fibrosis and, hence, a shortened penis.

 

Sickle cell anemia

In sickle cell anemia, treatment is initially with intravenous fluids, pain medication, and oxygen therapy.[19][3] The typical treatment of priapism may be carried out as well.[3] Blood transfusions are not usually recommended as part of the initial treatment, but if other treatments are not effective, exchange transfusion may be done.[19][3]

 

History

Persistent semi-erections and intermittent states of prolonged erections have historically been sometimes called semi-priapism.[20]

 

Terminology

The name comes from the Greek god Priapus (Ancient Greek: Πρίαπος), a fertility god, often represented with a disproportionately large phallus.[21

 

en.wikipedia.org/wiki/Priapism

www.womenhealthzone.com - Female sexual dysfunction (FSD) basically refers to problems with sex. The problems may relate to a decrease in sex drive, a strong aversion in sexual activities, trouble in becoming aroused, lack of ability to reach orgasm, reduced blood flow to the vagina or pain with sexual intercourse.

The differences between how men and women feel comfortable with their body are discussed by The Medical Center for Female Sexuality’s Sexuality Counselor, Shannon Bertha on MensNetTV with host Mel Feit. For more information on the medical techniques for treatment of female sexual dysfunction, including painful intercourse and low sex drive to enable women achieve sexual health and satisfying female sexuality visit: www.centerforfemalesexuality.com

Offices in Purchase, NY and Manhattan, NY.

 

The differences of the treatment of lack of sexual desire, inability to orgasm and pain during orgasm in men and women are discussed by The Medical Center for Female Sexuality’s Sexuality Counselor, Shannon Bertha on MensNetTV with host Mel Feit. For more information on the medical techniques for treatment of female sexual dysfunction, including painful intercourse and low sex drive to enable women achieve sexual health and satisfying female sexuality visit: www.centerforfemalesexuality.com

Offices in Purchase, NY and Manhattan, NY.

 

Is women’s sexual desire narcissistic? Discussed by The Medical Center for Female Sexuality’s Sexuality Counselor, Shannon Bertha on MensNetTV with host Mel Feit. For more information on the medical techniques for treatment of female sexual dysfunction, including painful intercourse and low sex drive to enable women achieve sexual health and satisfying female sexuality visit: www.centerforfemalesexuality.com

Offices in Purchase, NY and Manhattan, NY.

 

Dr. Nilesh Dehariya is the best sexologist in Indore providing solutions for your sexual weaknesses such as ED, PME, low sex desire, dhat syndrome, night fall etc. Dr. Nilesh Dehariya provides shock wave therapy which is the most advanced procedure for all of your sexual problems. Visit: sexologistinindore.com/

Psychological consequences for battered women.

 

The battered woman syndrome, defined by Walker and Dutton is defined as an adaptation to the aversive situation characterized by increasing a person's ability to cope with adverse stimuli and to minimize the pain, and cognitive distortions present, such as minimizing , denial or dissociation of the change in the way of seeing themselves, others and the world. They may also develop symptoms of PTSD, depressive feelings, anger, low self-esteem, guilt and resentment, and often have somatic complaints, sexual dysfunction, addictive behaviors and difficulties in their relationships.

 

Enrique Paz del Corral Echeburúa and equate these effects by post-traumatic stress disorder whose symptoms and characteristics, no doubt, appear in some of these women: re-experiencing the traumatic event, avoidance of situations associated with abuse and increased arousal. These women find it difficult to sleep with nightmares of reliving the past, are constantly alert, hypervigilant, irritable, and difficulty concentrating.

 

In addition, the high level of anxiety causes health problems and psychosomatic disorders and major depressive problems may occur.

Development of battered woman syndrome

 

Marie-France Hirigoyen difference between two phases of the consequences, which occur in the domain phase and long term.

 

In the first phase, the woman is confused and disoriented, leading to relinquish their own identity and attributing the aggressor positive aspects that help to deny reality. They are exhausted by the lack of meaning that the aggressor imposes on her life, unable to understand what is happening, alone and isolated from their family and social environment in constant tension with any aggressive response from your partner.

 

Marie-France Hirigoyen speaks of long-term consequences referring to the stages that victims spend from the time they realize the type of relationship in which they are immersed. During this phase, women spend an initial impact to feel hurt, cheated and embarrassed, in addition to being apathetic, tired and with no interest in anything.

 

Recent study reveals that yoga may help couples who are struggling with sexual dysfunction in their lives. Researchers believe that the physical and emotional benefits offered by yoga, may add more fun and meaning to the sexual relationship with your partner.

Scientists said that this form of yoga basically uses mutually beneficial postures, massage and breathing exercises, those can easily perform by couples. . They increase blood flow to the pelvis and engage all the muscles of pelvic floors, which strengthen the muscles that play vital role in orgasm

.

Yoga, apart from working wonders for your mind and soul, also enriches your sex life yoga helps you become aware of your sexual core proper breathing is essential for sexual arousal. Asanas, mudras, pranayamas, and meditation are the new way to better sexuality. As more and more people are discovering that practicing yoga leads to better sex life whether you practice yoga or sex for both you need some practice and training. The yoga system of treatment requires Proper diet and daily practice of yoga.

Good sex makes our skin glow, firms up our abs, beats the blues and above all as a great stress buster.

THE POWER OF GARLIC: Garlic is antibacterial, antifungal and antiviral properties. It Can be useful in treating a number of reproductive – tract problems. Be cause by consuming garlic in food or as tablets will help the body wards off all sorts of other diseases and disorders.

WATERING YOUR MOOD: Take a bath or shower to adjust your moods from excitement to relaxation or vice versa. Cold water definitely get you going, warm water will let you relax before sleep.

NO SMOKING: Nicotine is a powerful vasoconstrictor; men who daily smoke a pack of cigarettes drastically reduce the Blood circulation in their penile Arteries. It makes difficult to achieve an erection.

TRY TO BEAT THE HEAT: Infertility cases trace to problems with a man’s sperm count or function. High temperature in the testicles can temporarily reduce sperm production. If you are trying to father a child, avoid Hot Baths, and tight under wear and jeans.

ODORS: Pleasant odors always have played their part, as they appear to stimulate the nervous system which, in turn stimulates, the sexual system. The sexual persuasion of odors in not confined to human beings, it is equally operative among after animals and insects; female’s dogs, wolves, foxes and butterfly release their own sexually conditioned smells. The best perfumes are the natural ones like sandalwood, roses, jasmine, violets and other flowers.

VAJROLI MUDRA: Sit in any comfortable meditative posture with eyes closed head and spine straight. Now inhales hold the breath in and try to draw the urethra upward. This action is similar to holding back on urge to urinate. Hold the contraction for as long as your feel comfortable. Then exhale while releasing the contraction. Do this Vajroli mudra minimum 10 to 15 rounds.

BENEFITS: This mudra regulates and tones the entire uro-genital system, Vajroli mudra balances testosterone levels and sperm count and gives control over premature ejaculation. Problems like prostates hypertrophy are prevented.

SHAVASANA: Lie down on the floor on your back, keep the legs straight on the floor with feet apart by about your shoulder width. Keep the arms straight by your sides with hands placed about six inches away from the body. The head ad spine should be in a straight line. Close your eyes gently. Make the whole body loose and stop all physical movement, mentally watch your breathing and allow it to become rhythmic and relaxed.

BENEFITS: This asana leads to remove physical and mental fatigue. The breathing becomes more regulated and controlled naturally. This asana improves optimum capacity of lungs and intake of oxygen. Relaxation helps to open up blocked arteries and thus helps to improve cardiac functions.

VATAYANASANA METHOD: Stand with feet together bends the right knee and place the foot on the left thigh in the half padamasan position. Then place the hand in Namaskar position. Maintain the balance and hold the position for a short duration. Release the right leg repeat the practice with the opposite leg, breathing normal. Do it two times on each side. BENEFITS: This asana develops the ability to retain seminal fluid and regulates the reproductive system and prevent early ejaculation. It also strengthens the leg muscle and knee joints. CAUTION: Try to do it slowly after some practice one can do it. This asana require more coordination then muscular strength.

ASWANI MUDRA: Stand in comfortable position closes eyes and breathing normal. Take your attention to the anus area. Contract the anal muscles for a few seconds without feeling any strain. Then relax for a few seconds. Repeat the contraction and relax the anal muscles. Make the contractions more rapid. BENEFITS: It is very helpful to prevents early ejaculation. The inflammation of prostate gland is also cured by this mudra. It helps to alleviate piles, constipation and prevents the escape of pranic energy from the body. To know more log on www.yogagurusuneelsingh.com

 

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সাধারণত প্রতি ১০ জনে একজন পুরুষ মানুষের সঙ্গমের সময় দ্রুত বীর্যপাত অথবা ইরেক্টাইল ডিসফাংশনের (erectile dysfunction) মত সমস্যা হয় বলে ধারনা করা হয়। বিশেষজ্ঞদের মতেঃ-

 

”কোন পুরুষ যৌনক্রিয়ায় ঠিকভাবে অংশগ্রহণ করতে না পারলে সেটিকে যৌন সমস্যা (Sexual dysfunction) বলা হয়। এর প্রধানতম সমস্যাটি হচ্ছে ঠিকমত ইরেকশন (erection) বা লিঙ্গ সুদৃঢ় না হওয়া। এটি লোকে যা মনে করে তার চেয়ে অনেক বেশি দেখা যায়। ২০-৪০ বছর বয়সী পুরুষদের মধ্যে ৭-৮%, এবং ৪০-৫০ বছর বয়সী পুরুষদের মধ্যে ১১% এই সমস্যায় আক্রান্ত হয়। ষাটোর্ধ পুরুষদের ৪০% এবং ৭০ বছরের বেশি বয়সের পুরুষদের অর্ধেকই এই সমস্যায় ভোগেন।” এটি বিপরিত লিঙ্গের প্রতি আকৃষ্ট, সমকামী, বাই-সেক্সুয়াল বা ট্র্যান্সজেন্ডার যে কারো হতে পারে।”

 

১) ইরেক্টাইল ডিসফাংশন বা ইম্পোটেন্স (Erectile dysfunction (impotence))এই সমস্যাটি হলে পুরুষদের লিঙ্গ সুদৃঢ় হয় না বা হলেও তারা সেটি বেশিক্ষন ধরে রাখতে পারে না। বেশিরভাগ পুরুষেরই জীবনে কখনো না কখনো এই সমস্যাটি হয়। বিশেষজ্ঞদের মতে “এটি তখনই সমস্যা হিসেবে বিবেচনা করা হয় যখন কোন পুরুষ বা তার সঙ্গিনী এটিকে সমস্যা মনে করেন।”

 

ইরেক্টাইল ডিসফাংশন কেন হয়?অনেকগুলো কারণে এটি হতে পারে। এই কারণগুলোর কয়েকটি মানসিক এবং কয়েকটি শারীরিক। মানসিক কারণে (যেমনঃ নাইট নার্ভ (night nerves)) কম বয়সী পুরুষদের এই সমস্যাটি হয়। বেশিরভাগ সময়ই এই সমস্যাটি দীর্ঘস্থায়ী হয় না। তবে অনেক জটিল মানসিক সমস্যার কারনে এটি হতে পারে যার জন্য সাইকোসেক্সুয়াল থেরাপিস্টের সাহায্য নিতে হতে পারে। কর্মক্ষেত্র, টাকাপয়সা, সম্পর্কের টানাপোড়েন, পারিবারিক সমস্যা এমনকি ইরেকশন না হওয়া নিয়ে দুশ্চিন্তার কারণেও সমস্যাটি হতে পারে। ইরেক্টাইল ডিসফাংশনের শারীরিক কারণগুলোর মধ্যে রয়েছেঃ-

 

1. হৃদরোগ (heart disease)

 

2. ডায়বেটিস (diabetes)

 

3. রক্তচাপ বেড়ে যাওয়া (raised blood pressure)

 

4. কলেস্টেরল বেড়ে যাওয়া (raised cholesterol): এতে ধমনিগুলো সঙ্কুচিত হয়ে পড়ে। যৌনাঙ্গের ধমনিগুলো এমনিতেই খুব সরু (১-২ মি.মি. ব্যাসার্ধের, যেখানে হৃৎপিণ্ডের ধমনিগুলো ১০ মি.মি.) ব্যাসার্ধের) হয়

 

5. টেসটোস্টেরনের পরিমাণ কমে যাওয়া (low testosterone): পুরুষদের বয়স বাড়ার সঙ্গে সঙ্গে টেসটোস্টেরনের পরিমাণ কমতে থাকে, তবে সব পুরুষেরাই এর দ্বারা প্রভাবিত হয় না। যারা এর কারণে সমস্যায় পড়েন তারা ক্লান্ত, আনফিট এবং যৌনক্রিয়ায় অসমর্থ বোধ করবেন এবং এর প্রতি আগ্রহ হারিয়ে ফেলবেন।

 

যে সব ড্রাগ বা ঔষধের কারণে ইরেক্টাইল ডিসফাংশন হয়ঃ

কয়েক ধরনের ঔষধ (some prescription drugs):

 

1. এগুলো হচ্ছে রক্তচাপ কমাতে ব্যবহৃত ঔষধ (যেমন বেটা ব্লকার) এবং বিষণ্ণতা দূর করতে ব্যবহৃত ঔষধ (antidepressants) ও অ্যান্টিকনভালস্যান্ট/ খিঁচুনি কমানোর ঔষধ।

 

2. মদ (alcohol)

 

3. গাঁজা ও কোকেইনের মত ড্রাগ

 

4. ধূমপান (smoking): নিকোটিনের কারনে ইরেকশন বা লিঙ্গ সুদৃঢ় হওয়ার সময় পুরুষাঙ্গের বিভিন্ন জায়গায় প্রয়োজনীয় রক্ত সরবরাহ বাধাপ্রাপ্ত হয়।

 

ইরেক্টাইল ডিসফাংশন হলে কী করতে পারি?

ডাক্তার দেখান। উনি পরীক্ষা করে দেখবেন এবং কারন নির্ণয়ের জন্য রক্ত পরীক্ষাও করতে দিতে পারেন। ইরেক্টাইল ডিসফাংশন অন্যান্য সমস্যার নির্দেশকও হতে পারে। এটি উচ্চ রক্তচাপ, উচ্চ মাত্রার কোলেস্টেরল এবং ডায়বেটিসের সাথে সম্পর্ক যুক্ত। এর যে কোনটি ভবিষ্যতে হৃদরোগ হওয়ার পূর্বলক্ষণ হতে পারে। ডাক্তার আপনার প্রয়োজনীয় চিকিৎসা নিশ্চিত করবেন।

 

যৌন অক্ষমতার (impotence) চিকিৎসা কী?প্রথমে যে কোন ধরনের অভ্যেস যা সমস্যাটির কারণ হতে পারে, তা বর্জন করুন। আপনি ধূমপান, অতিরিক্ত মদ্যপান এবং ড্রাগ নেয়া বন্ধ করে দিলে সমস্যাটি একসময় দূর হয়ে যাওয়ার কথা। তবে এতে কয়েক মাস পর্যন্ত সময় লাগতে পারে। রাতারাতি ভাল করে দিতে পারে এমন কোন ওষুধ নেই। আপনাকে যদি রক্তচাপ নিয়ন্ত্রনের বা বিষণ্ণতা দূর করার ওষুধ খেতে দেয়া হয় তাহলে আপানার ডাক্তার হয়ত সেগুলো পরিবর্তন করে দিতে পারবেন। টেসটোস্টেরনের পরিমাণ কমে গেলে হরমোন প্রতিস্থাপনের মাধ্যমে তার চিকিৎসা করা সম্ভব। তবে এর সাথে সাথে আপনাকে ইরেকশনে সহায়তা করে এমন ওষুধও খেতে হবে। অন্যান্য ক্ষেত্রে যেমন ডায়বেটিস বা উচ্চ রক্তচাপ হলে সেগুলোর চিকিৎসা করে ইরেকশনের উন্নতি ঘটানো সম্ভব। কোন কোন পুরুষ সাইকোসেক্সুয়াল থেরাপি নিলে উপকার পেতে পারেন। এতে আপনি ও আপনার সঙ্গিনী আপনাদের সম্পর্কের যেকোনো বিষয় নিয়ে আলোচনা করতে পারেন।

 

২) দ্রুত বীর্যপাত (Premature ejaculation)এই সমস্যাটি হলে পুরুষেরা যৌনক্রিয়ার সময় তারা যখন চান তার আগেই বীর্যপাত ঘটে যায়। এটি উনাকে বা উনার সঙ্গিনীকে হতাশ করলেই কেবল সমস্যা হিসেবে বিবেচিত হতে পারে।

 

দ্রুত বীর্যপাত কেন ঘটে?নতুন সঙ্গীর সাথে অতি উত্তেজিত হয়ে পড়ার কারণে অথবা স্থানীয় স্নায়ুতন্ত্র (local nervous system) তীব্র সংবেদনশীলতার কারনে এটি হতে পারে। এটি যৌন সক্ষমতা নিয়ে দুশ্চিন্তা, স্ট্রেস, দুজনের সম্পর্কের অমীমাংসিত কোন বিষয় বা বিষণ্ণতা (depression) থেকেও হতে পারে।

 

দ্রুত বীর্যপাত ঘটলে কী করতে পারি?ডাক্তার অথবা সাইকোসেক্সুয়াল থেরাপিস্টের কাছে যান। থেরাপিস্ট আপনাকে বীর্যপাত দেরিতে করার বিভিন্ন টেকনিক শেখাতে পারেন।

 

এর কী কী ধরনের চিকিৎসা রয়েছে?

 

1. অনেক পুরুষ এবং তাদের সঙ্গিনীরা এটি নিয়ে বিশেষ চিন্তিত নয়, এবং তারা এটি নিয়ে বিশেষ মাথাও ঘামায় না।

 

2. বীর্যপাত হয়ে যাওয়ার একটু পরে আবার যৌনক্রিয়া আরম্ভ করুন। যত তাড়াতাড়ি আবার দ্বিতীয়বার যৌন ক্রিয়া শুরু করবেন, তত দেরিতে অর্গাজম হবে। বয়স্ক মানুষদের জন্য এটি কঠিন হতে পারে দ্বিতীয়বার যৌনাঙ্গ সুদৃঢ় হতে অনেক সময় লাগতে পারে।

 

3. দোকানে এক ধরনের ক্রিম পাওয়া যায় যা মাখলে পুরুষাঙ্গ অনুভূতিহীন হয়ে পড়ে। তবে এটির প্রভাবে আপনার সঙ্গিনীও অনুভূতিহীন হয়ে পড়তে পারেন, যা তারা অনেক সময় পছন্দ করেন না। অনেকে কনডম ব্যবহার করেও উপকার পান।

 

4. আপনার সঙ্গিনীকে আপনার যৌনাঙ্গে বিশেষ ভঙ্গিতে চাপ দিতে বলতে পারেন যাতে বীর্যপাত না ঘটে। তবে এটির করার জন্য আপনার সঙ্গিনীকে খুবই ইচ্ছুক হতে হবে, এবং অনেকেই এটি করতে বিশেষ আগ্রহী হন না।

 

5. সিলেক্টিভ সেরোটোনিন রিয়াপটেক ইনহিবিটর (selective serotonin reuptake inhibitors (SSRIs)) নামক একধরনের বিষণ্ণতা দূর করার ওষুধ (Antidepressants) বীর্যপাত প্রক্রিয়াটি ধীর গতির করে দিতে পারে, তবে এটি এক বছরের বেশি কাজ করে না। ওষুধ খাওয়া শুরু করার আগে অন্য সবগুলো উপায়ে চেষ্টা করে দেখুন।

 

6. সাইকোথেরাপির মাধ্যমে দুজনের সম্পর্কের সমস্যাগুলো খুঁজে বের করতে বা দূর করতে পারেন।

 

The post পুরুষের যৌন সমস্যার প্রকারভেদসমূহ appeared first on Natural Ayurveda LTD.

 

Dr Rajesh Birman is one of the leading sexologist & psychiatrist (Mental Health expert)from india. He has been working for last many years to help people having all types of sexual problems. Having received medical graduate , post graduate & superspecialization training in sexual medicine , he has received many honors and recognitions as sexologist . He was awarded with Mrs. KAMLA DEVI MEMORIAL GOLD MEDAL and Dr.V.K.MISHRA MEMORIAL GOLD MEDAL for his out standing academic activities.

“WORLDWIDE ACHIEVERS –HEALTH CARE EXCELLANCE AWARD 2013” in field of clinical sexology and psychiatry(Mental Health), was awarded to Dr Rajesh Birman.He is life Member of*SONOLOGICAL SOCIETY OF INDIA *COUNCIL FOR SEX EDUCATION AND PARENTHOOD INTERNATIONAL *ASSOCIATION OF SEX EDUCATORS,COUNCELLOR AND THERAPIST*SOUTH ASIAN ASSOCITION OF SEXUAL MEDICINE *INTERNATIONAL SOCIETY FOR SEXUAL MEDICINE. He has attended many international and National conferences on sexual Health and delivered talks on "mental health aspect of sexual problems"; Neuro-hormonal mechanisms of sexual dysfunctions" etc. His particular area of interest is " how to keep sexual health positive in married life" People have inherent hesitation in seeking help for sexual problems for fear of being derided. They don't know whom to turn to in case of a problem in bedroom . Some keep on suffering, others try unscientific treatments prescribed by friends and quacks. Sexual health as a medical specialty has not been promoted as yet . It deserves a separate specialty definitely as it can cause havoc with people's life,causing considerable morbidity and

mortality.

  

This situation prompted Dr Rajesh Birman to start giving consultation on Internet on different health portals and internet clinics . It is easy, economical, saves time and ensures total privacy. One can chose to interact by mail, chatting or even face to face talk as if you are sitting with the doctor in his office. This has been liked by people all over the Globe, as shown by the letters of appreciation. We offer help to people of all age groups of either sex on issues of sex education to your children, sex abuse, pre and post marital counseling, male sex problems like reduced desire, erectile problems, pre mature and delayed ejaculation, anejaculation( inability to ejaculate), pain during sex, penile size, nocturnal discharge, drug abuse with sex problems, psychiatric problems with sex problems, retarded development of sex organs, STD, sperm deficiency, infertility in males, birth defects in sex organs , female sex problems like reduced desire, pain during sex, dryness, mood disturbances, not getting orgasm in sex, vaginal discharge .

  

Sex problems are like any other body dysfunction. It needs to be treated with respect, duly heard, investigated, diagnosis made and appropriate treatment given. We have facility for investigating these problems in detail. We can advice you to undergo an appropriate investigation, after understanding your problem. You can send a scanned copy of the result . And then, treatment can be started.

Over a period of his medical career DR RAJESH BIRMAN superspecialised in field of sexology(sexual health) , mental health & alcohol / drug and other deaddiction medicine.he is very much interested in creating awareness about sexual and mental health in Indian society.he continuously participate in activities regarding development of sexology(sexual medicine) and mental health, that are organised by various societies,organisation,forums and instutions of sexologists and mental health experts.his patients are enjoying happy sexual ,mental and social life,after treatment.many of his patients quoted him as “BEST SEXOLOGIST DOCTOR IN DELHI / BEST SEX THERAPIST IN DELHI/ MOST QUALIFIED SEXOLOGIST DOCTOR IN DELHI /GOOD PROFILE SEXOLOGIST DOCTOR IN DELHI /BEST DOCTOR WORKING IN SEXUAL AND MENTAL HEALTH AWARENESS IN DELHI ”.He is very thankful for for these comments.his motto is “ENJOYABLE AND APPRICIABLE SEXUAL AND MENTAL HEALTH FOR EVERY ONE”.According to him SEXERCISE (sex as enjoyable excercise) is must for every one,to attain positive sexual and mental health.

  

How to have consultation in clinic-

1 -log on to www.drrajeshbirman.com, www.drbirman.com, www.psychiatristandsexologist.com,

2- Or search dr rajesh birman on google , yahoo etc.

3- Or call for appointment on +917503375150

4- Ask ur query on healingway4u@yahoo.com, drbirman3174@gmail.com

  

Contact Details:

  

DR BIRMAN’S WELLNESS CLINIC

305, SECTOR 6, MAIN MARKET, DWARKA, NEW DELHI, INDIA 110075

PH: +917503375150, 011 47481700

   

A discussion of same sex sexual drive by The Medical Center for Female Sexuality’s Sexuality Counselor, Shannon Bertha on MensNetTV with host Mel Feit. For more information on the medical techniques for treatment of female sexual dysfunction, including painful intercourse and low sex drive to enable women achieve sexual health and satisfying female sexuality visit: www.centerforfemalesexuality.com

Offices in Purchase, NY and Manhattan, NY.

 

Female sexual shame is discussed by The Medical Center for Female Sexuality’s Sexuality Counselor, Shannon Bertha on MensNetTV with host Mel Feit. For more information on the medical techniques for treatment of female sexual dysfunction, including painful intercourse and low sex drive to enable women achieve sexual health and satisfying female sexuality visit: www.centerforfemalesexuality.com

Offices in Purchase, NY and Manhattan, NY.

 

Male same sex sexual desire and male sexual orientation are discussed by The Medical Center for Female Sexuality’s Sexuality Counselor, Shannon Bertha on MensNetTV with host Mel Feit. For more information on the medical techniques for treatment of female sexual dysfunction, including painful intercourse and low sex drive to enable women achieve sexual health and satisfying female sexuality visit: www.centerforfemalesexuality.com

Offices in Purchase, NY and Manhattan, NY.

 

“WORLDWIDE ACHIEVERS –HEALTH CARE EXCELLANCE AWARD 2013” in field of clinical sexology and psychiatry(Mental Health), was awarded to Dr Rajesh Birman

Dr Rajesh Birman is one of the leading sexologist & psychiatrist (Mental Health expert)from Delhi,India. He has been working for last many years to help people having all types of sexual problems. Having received medical graduate , post graduate & superspecialization training in sexual medicine , he has received many honors and recognitions as sexologist . He was Mrs. KAMLA DEVI MEMORIAL GOLD MEDAL AWARDEE and Dr.V.K.MISHRA MEMORIAL GOLD MEDAL AWARDE.Life Member of

*SONOLOGICAL SOCIETY OF INDIA *COUNCIL FOR SEX EDUCATION AND PARENTHOOD INTERNATIONAL *ASSOCIATION OF SEX EDUCATORS,COUNCELLOR AND THERAPIST*SOUTH ASIAN ASSOCITION OF SEXUAL MEDICINE *INTERNATIONAL SOCIETY FOR SEXUAL MEDICINE. He has attended many international and National conferences on sexual Health and delivered talks on "mental health aspect of sexual problems"; Neuro-hormonal mechanisms of sexual dysfunctions" etc. His particular area of interest is " how to keep sexual health positive in married life" People have inherent hesitation in seeking help for sexual problems for fear of being derided. They don't know whom to turn to in case of a problem in bedroom . Some keep on suffering, others try unscientific treatments prescribed by friends and quacks. Sexual health as a medical specialty has not been promoted as yet . It deserves a separate specialty definitely as it can cause havoc with people's life, causing considerable morbidity and

mortality.

On 19th December, he was awarded "WORLDWIDE ACHIEVERS- HEALTH CARE EXCELLENCE AWARD 2013" in field of "SEXUAL MEDICINE & PSYCHIATRY", as a best sexologist and psychiatrist in Delhi.He was very much thankful and honored in getting this by two very senior and renounced personalities i.e, Shri Dr. C P Thakur(Member of Parliament) and Shri Prof. Dr M C Mishra (Director "All India Institute of Medical Sciences, Delhi").

This situation prompted Dr Rajesh Birman to start giving consultation on Internet on different health portals and internet clinics . It is easy, economical, saves time and ensures total privacy. One can chose to interact by mail, chatting or even face to face talk as if you

are sitting with the doctor in his office. This has been liked by people all over the Globe, as shown by the letters of appreciation. We offer help to people of all age groups of either sex on issues of sex education to your children, sex abuse, pre and post marital counseling, male sex problems like reduced desire, erectile problems, pre mature and delayed ejaculation, anejaculation( inability to ejaculate), pain during sex, penile size, nocturnal discharge, drug abuse with sex problems, psychiatric problems with sex problems, retarded development of sex organs, STD, sperm deficiency, infertility in males, birth defects in sex organs , female sex problems like reduced desire, pain during sex, dryness, mood disturbances, not getting orgasm in sex, vaginal discharge .

  

Sex problems are like any other body dysfunction. It needs to be treated with respect, duly heard, investigated, diagnosis made and appropriate treatment given. We have facility for investigating these problems in detail. We can advice you to undergo an appropriate investigation, after understanding your problem. You can send a scanned copy of the result . And then, treatment can be started.

Over a period of his medical career DR RAJESH BIRMAN superspecialised in field of sexology(sexual health) , mental health & alcohol / drug and other deaddiction medicine.he is very much interested in creating awareness about sexual and mental health in Indian society.he continuously participate in activities regarding development of sexology(sexual medicine) and mental health, that are organised by various societies,organisation,forums and instutions of sexologists and mental health experts.his patients are enjoying happy sexual ,mental and social life,after treatment.many of his patients quoted him as “BEST SEXOLOGIST DOCTOR IN DELHI / BEST SEX THERAPIST IN DELHI/ MOST QUALIFIED SEXOLOGIST DOCTOR IN DELHI /GOOD PROFILE SEXOLOGIST DOCTOR IN DELHI /BEST DOCTOR WORKING IN SEXUAL AND MENTAL HEALTH AWARENESS IN DELHI ”.He is very thankful for for these comments.his motto is “ENJOYABLE AND APPRICIABLE SEXUAL AND MENTAL HEALTH FOR EVERY ONE”.According to him SEXERCISE (sex as enjoyable excercise) is must for every one,to attain positive sexual and mental health.

  

How to have consultation in clinic-

1 -log on to www.drrajeshbirman.com, www.drbirman.com, www.psychiatristandsexologist.com,

2- Or search dr rajesh birman on google , yahoo etc.

3- Or call for appointment on +917503375150

4- Ask ur query on healingway4u@yahoo.com, drbirman3174@gmail.com

  

Contact Details:

  

DR BIRMAN’S WELLNESS CLINIC

305, SECTOR 6, MAIN MARKET, DWARKA, NEW DELHI, INDIA 110075

PH: +917503375150, 011 47481700

   

“WORLDWIDE ACHIEVERS –HEALTH CARE EXCELLANCE AWARD 2013” in field of clinical sexology and psychiatry(Mental Health), was awarded to Dr Rajesh Birman

Dr Rajesh Birman is one of the leading sexologist & psychiatrist (Mental Health expert)from Delhi,India. He has been working for last many years to help people having all types of sexual problems. Having received medical graduate , post graduate & superspecialization training in sexual medicine , he has received many honors and recognitions as sexologist . He was Mrs. KAMLA DEVI MEMORIAL GOLD MEDAL AWARDEE and Dr.V.K.MISHRA MEMORIAL GOLD MEDAL AWARDE.Life Member of

*SONOLOGICAL SOCIETY OF INDIA *COUNCIL FOR SEX EDUCATION AND PARENTHOOD INTERNATIONAL *ASSOCIATION OF SEX EDUCATORS,COUNCELLOR AND THERAPIST*SOUTH ASIAN ASSOCITION OF SEXUAL MEDICINE *INTERNATIONAL SOCIETY FOR SEXUAL MEDICINE. He has attended many international and National conferences on sexual Health and delivered talks on "mental health aspect of sexual problems"; Neuro-hormonal mechanisms of sexual dysfunctions" etc. His particular area of interest is " how to keep sexual health positive in married life" People have inherent hesitation in seeking help for sexual problems for fear of being derided. They don't know whom to turn to in case of a problem in bedroom . Some keep on suffering, others try unscientific treatments prescribed by friends and quacks. Sexual health as a medical specialty has not been promoted as yet . It deserves a separate specialty definitely as it can cause havoc with people's life, causing considerable morbidity and

mortality.

On 19th December, he was awarded "WORLDWIDE ACHIEVERS- HEALTH CARE EXCELLENCE AWARD 2013" in field of "SEXUAL MEDICINE & PSYCHIATRY", as a best sexologist and psychiatrist in Delhi.He was very much thankful and honored in getting this by two very senior and renounced personalities i.e, Shri Dr. C P Thakur(Member of Parliament) and Shri Prof. Dr M C Mishra (Director "All India Institute of Medical Sciences, Delhi").

This situation prompted Dr Rajesh Birman to start giving consultation on Internet on different health portals and internet clinics . It is easy, economical, saves time and ensures total privacy. One can chose to interact by mail, chatting or even face to face talk as if you

are sitting with the doctor in his office. This has been liked by people all over the Globe, as shown by the letters of appreciation. We offer help to people of all age groups of either sex on issues of sex education to your children, sex abuse, pre and post marital counseling, male sex problems like reduced desire, erectile problems, pre mature and delayed ejaculation, anejaculation( inability to ejaculate), pain during sex, penile size, nocturnal discharge, drug abuse with sex problems, psychiatric problems with sex problems, retarded development of sex organs, STD, sperm deficiency, infertility in males, birth defects in sex organs , female sex problems like reduced desire, pain during sex, dryness, mood disturbances, not getting orgasm in sex, vaginal discharge .

  

Sex problems are like any other body dysfunction. It needs to be treated with respect, duly heard, investigated, diagnosis made and appropriate treatment given. We have facility for investigating these problems in detail. We can advice you to undergo an appropriate investigation, after understanding your problem. You can send a scanned copy of the result . And then, treatment can be started.

Over a period of his medical career DR RAJESH BIRMAN superspecialised in field of sexology(sexual health) , mental health & alcohol / drug and other deaddiction medicine.he is very much interested in creating awareness about sexual and mental health in Indian society.he continuously participate in activities regarding development of sexology(sexual medicine) and mental health, that are organised by various societies,organisation,forums and instutions of sexologists and mental health experts.his patients are enjoying happy sexual ,mental and social life,after treatment.many of his patients quoted him as “BEST SEXOLOGIST DOCTOR IN DELHI / BEST SEX THERAPIST IN DELHI/ MOST QUALIFIED SEXOLOGIST DOCTOR IN DELHI /GOOD PROFILE SEXOLOGIST DOCTOR IN DELHI /BEST DOCTOR WORKING IN SEXUAL AND MENTAL HEALTH AWARENESS IN DELHI ”.He is very thankful for for these comments.his motto is “ENJOYABLE AND APPRICIABLE SEXUAL AND MENTAL HEALTH FOR EVERY ONE”.According to him SEXERCISE (sex as enjoyable excercise) is must for every one,to attain positive sexual and mental health.

  

How to have consultation in clinic-

1 -log on to www.drrajeshbirman.com, www.drbirman.com, www.psychiatristandsexologist.com,

2- Or search dr rajesh birman on google , yahoo etc.

3- Or call for appointment on +917503375150

4- Ask ur query on healingway4u@yahoo.com, drbirman3174@gmail.com

  

Contact Details:

  

DR BIRMAN’S WELLNESS CLINIC

305, SECTOR 6, MAIN MARKET, DWARKA, NEW DELHI, INDIA 110075

PH: +917503375150, 011 47481700

   

Female same sex sexual desire and female sexual orientation are discussed by The Medical Center for Female Sexuality’s Sexuality Counselor, Shannon Bertha on MensNetTV with host Mel Feit. For more information on the medical techniques for treatment of female sexual dysfunction, including painful intercourse and low sex drive to enable women achieve sexual health and satisfying female sexuality visit: www.centerforfemalesexuality.com

Offices in Purchase, NY and Manhattan, NY.

 

Dr VP Singh - A sexual problem, or sexual dysfunction, refers to a problem during any phase of the sexual response cycle that prevents the man or couple from experiencing satisfaction from the

 

activity. The sexual response cycle has four phases: Sexual problem, Best doctor for sexologist, Sex problem solution.

sexologistvpsingh.com/

 

Sexual Dysfunction is a problem that can happen during any phase of the sexual response cycle. It prevents you from experiencing satisfaction from sexual activity.

The sexual response cycle traditionally includes excitement, plateau, orgasm, and resolution. Desire and arousal are both parts of the excitement phase of the sexual response. It’s important to know women don’t always go through these phases in order.

While research suggests that sexual dysfunction is common, many people don’t like talking about it. Because treatment options are available, though, you should share your concerns with your partner and healthcare provider.

Here Dr Tahira Rubab Hafeez is explaining the facts that approximately 31% of males and 43% of women experience trouble during sex. However, many different sorts of sexual dysfunction can be treated or otherwise remedied. Doctors now know more about them than ever before because of continuing study.

Common Sexual Issues

During sex, you may encounter difficulties at various stages. Men may encounter:

Absence of sexual desire

Inability to obtain or maintain an erection

Orgasms that are too slow or too fast

In this video series, we will talk about this topic in detail.

Medical techniques for treatment of male and female sexual dysfunction, male infertility, impotence, male menopause, vasectomy, premature ejaculation, sperm cryobanking and semen analysis to enable men and women achieve sexual health and satisfying male and female sexuality. Clinics in Purchase, NY and Norwalk, CT. www.wernermd.com/

Medical techniques for treatment of female sexual dysfunction, including painful intercourse and low sex drive to enable women achieve sexual health and satisfying female sexuality. www.centerforfemalesexuality.com/

Medical techniques for treatment of female sexual dysfunction, including painful intercourse and low sex drive to enable women achieve sexual health and satisfying female sexuality. www.centerforfemalesexuality.com/

Medical techniques for treatment of male and female sexual dysfunction, male infertility, impotence, male menopause, vasectomy, premature ejaculation, sperm cryobanking and semen analysis to enable men and women achieve sexual health and satisfying male and female sexuality. Clinics in Purchase, NY and Norwalk, CT. www.wernermd.com/

Medical techniques for treatment of male and female sexual dysfunction, infertility, male menopause, sperm cryobanking and semen analysis to enable men and women achieve sexual health and satisfying male and female sexuality.

  

No matter whether you are a male or female. If you are suffering from any of sex related issue such as ED, PME, night fall, low sex desire, absent orgasm? Contact Dr. Nilesh Dehariya, he can treat all such problems in just one day. Call 7509655565 and book your appointment. Visit: sexologistinindore.com/services/

Dr. Shriyans Jain is the most suitable sex specialist for the treatment of sexual problems in Delhi. Get the best therapy for all sexual dysfunction with 100% solution. Visit:- www.drshriyansjain.com/sex-specialist-in-delhi.php

Wherever I go, I find the beauty in wild flowers. Yellow is the color of friendship, Does it mean I am more friendly with wild flowers? Maybe I am going wild. Save me.It's a SOS call.

 

Common name: Puncture Vine, Caltrop, Yellow Vine, Goathead, Gokharu गोखरू (Hindi), Gokhru (Urdu), Gokhru kanta (Bengali), Cinnpalleru (Telugu), பல்லேரு முள்ளு palleru-mullu (Tamil), Nerinnii (Malayalam)

Botanical name: Tribulus terrestris Family: Zygophyllaceae (caltrop family)

This is an obnoxious weed whose seeds are incredibly painful to step on, they easilly puncture your bicycle tires, and sometimes have to be pulled out of your pets' paws. It is a taprooted herbaceous perennial plant that grows as a summer annual in colder climates. The stems radiate from the crown to a diameter of about 10 cm to over 1 m, often branching. They are usually prostrate, forming flat patches, though they may grow more upwards in shade or among taller plants. The leaves are pinnately compound with leaflets less than a quarter-inch long. The flowers are 4-10 mm wide, with five lemon-yellow petals. A week after each flower blooms, it is followed by a fruit that easily falls apart into four or five single-seeded nutlets. The nutlets or "seeds" are hard and bear two sharp spines, 10 mm long and 4-6 mm broad point-to-point. These nutlets strikingly resemble goats' or bulls' heads; the "horns" are sharp enough to puncture bicycle tyres and to cause considerable pain to unshod feet.

Medicinal uses: Tribulus is mentioned in ancient Indian Ayurvedic medical texts dating back thousands of years. Tribulus has been widely used in the Ayurvedic system of medicine for the treatment of sexual dysfunction and various urinary disorders. The Greeks used Tribulus Terrestris as a diuretic. In China and Vietnam it has been used in the treatment of post-partum hemorrhage, epistaxis and gastro intestinal bleeding. Tribulus terrestris is being promoted as a testosterone booster for the purpose of building muscle and increasing sex drive. It does not work like DHEA and androstenedione 100, which are progenitors of testosterone. Instead, claims have been made that it enhances testosterone levels by increasing luteinizing hormone levels.

Source: www.flowersofindia.net

Thanks Patrick for identification

Medical techniques for treatment of male and female sexual dysfunction, male infertility, impotence, male menopause, vasectomy, premature ejaculation, sperm cryobanking and semen analysis to enable men and women achieve sexual health and satisfying male and female sexuality. Clinics in Purchase, NY and Norwalk, CT. www.wernermd.com/

You can find more about natural remedies to treat weak erection at

mailto:http://www.naturogain.com/product/weak-erection-cure-herbal-treatment/

 

Dear friend, in this video we are going to discuss about the natural remedies to treat weak erection. Bluze capsules are the best natural remedies to treat weak erection and sexual dysfunctions in men effectively.

 

If you liked this video, then please subscribe to our YouTube Channel to get updates of other useful health video tutorials. You can also find us on Facebook, Twitter, Pinterest and Google+.

 

Google+: plus.google.com/+NaturoGainSupport/

Facebook: www.facebook.com/naturogain

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Natural Remedies To Treat Weak Erection

The Medical Center for Female Sexuality provides medical techniques to enable women to achieve sexual health and satisfying female sexuality and treatment of female sexual dysfunction, including painful intercourse and low sex drive. Offices in Purchase, NY and NYC. www.centerforfemalesexuality.com

A sexual disorder, or sexual dysfunction, refers to a problem during any phase of the sexual response cycle that prevents the individual or couple from suffering satisfaction while doing sexual intercourse. The sexual response cycle has four stages: excitement, plateau, orgasm, and resolution.

Visit www.ahcunani.com/

Call: 9037512024, 097476 98920

E-mail: niyaz.roy@gmail.com

Google Map: g.page/alfahealthcentre?share

Address: Near ESI Hospital & Olarikara Sree Bhagavathi Temple, L-Lane, Gandhi Nagar, Olarikkara, Thrissur, Kerala 680012

Dr. Nilesh Dehariya is the best sexologist in Indore providing treatment for all sex related problems such as ED, PME, low sex desire, dhat syndrome, night fall etc. Dr. Nilesh Dehariya provides shock wave therapy which is the most advanced procedure for all of your sexual problems. Visit: sexologistinindore.com/

Dr. Nilesh Dehariya is the best sexologist in Indore providing solutions for your sexual weaknesses such as ED, PME, low sex desire, dhat syndrome, night fall etc. Dr. Nilesh Dehariya provides shock wave therapy which is the most advanced procedure for all of your sexual problems. Visit: sexologistinindore.com/