Persistent URL: digital.lib.muohio.edu/u?/tradecards,2594

 

Subject (TGM): Children; Children playing musical instruments; Ducks; Patent medicines; Pharmacists; Drugstores; Testimonials;

Persistent URL: digital.lib.muohio.edu/u?/tradecards,3761

 

Subject (TGM): Coffee industry; Humorous pictures; Satires (Visual works); Ethnic groups; Ethnic stereotypes; Immigrants;

Persistent URL: digital.lib.muohio.edu/u?/tradecards,1511

 

Subject (TGM): Children; Infants; Paper toys; Maintenance & repair; Clock & watch industry; Clock & watch making; Silverware; Eyeglasses; Pencils; Jewelry stores;

Persistent URL: digital.lib.muohio.edu/u?/tradecards,2999

 

Subject (TGM): Maps; Industry; Coffee industry; Food industry;

Persistent URL: digital.lib.muohio.edu/u?/tradecards,3944

 

Subject (TGM): Coffee industry; Maps; Statehood; Animals; Bear hunting; Bears;

Persistent URL: contentdm.lib.muohio.edu//cdm/ref/collection/postcards/id...

 

Subject (TGM): Rivers; Nature;

Persistent URL: contentdm.lib.muohio.edu//cdm/ref/collection/postcards/id...

 

Subject (TGM): Swimmers; Water slides; Roller coasters;

Persistent URL: digital.lib.muohio.edu/u?/tradecards,2144

 

Subject (TGM): Women; Men; Paintings; Picture frames; Starch industry; Flour & meal industry; Laundry; Cookery;

Persistent URL: digital.lib.muohio.edu/u?/tradecards,2948

 

Subject (TGM): Women; Clothing & dress; Hats; Palettes; Shoe industry; Testimonials; Shoe stores; Shoe shining; Chemical industry;

Persistent URL: digital.lib.muohio.edu/u?/tradecards,3935

 

Subject (TGM): Coffee industry; Maps; Sugar industry; Corn; Statehood;

Persistent URL: digital.lib.muohio.edu/u?/tradecards,2291

 

Subject (TGM): Birds; Chickens; Flowers; Plants; Roses; Patent medicines;

Persistent URL: digital.lib.muohio.edu/u?/tradecards,1610

 

Subject (TGM): Children; Boys; Girls; Wells; Drowning; Laundry; Household soap; Chemical industry; Starch industry; Grocery stores;

Persistent URL: contentdm.lib.miamioh.edu/cdm/compoundobject/collection/p...

 

Subject: Fraternal organizations; Fraternal lodges; Clubs; Ohio--Hamilton; miami digital collections; bowden postcard collection

Persistent URL: digital.lib.muohio.edu/u?/tradecards,518

 

Subject (TGM): Animals; Hippopotamuses; Sunrises & sunsets; Rivers; Tobacco; Smoking; Tobacco products; Tobacco industry; Poetry; Cattle; Bulls; Tobacco package labels; Postcards;

Persistent URL: digital.lib.muohio.edu/u?/tradecards,3179

 

Subject (TGM): Servants; Laundresses; Laundry; Ethnic groups; Ethnic stereotypes; Racism; Wash tubs; Household soap; Women; Women domestics; Dressing & grooming equipment; Cosmetics industry;

Bain News Service,, publisher.

 

Mrs. Vernon Castle

 

[no date recorded on caption card]

 

1 negative : glass ; 5 x 7 in. or smaller.

 

Notes:

Title from data provided by the Bain News Service on the negative.

Photograph shows ballroom dancer Irene (Foote) Castle (1893-1969) who taught and danced with her husband, Vernon Castle (1887-1918). (Source: Flickr Commons project, 2012)

Forms part of: George Grantham Bain Collection (Library of Congress).

 

Format: Glass negatives.

 

Rights Info: No known restrictions on publication.

 

Repository: Library of Congress, Prints and Photographs Division, Washington, D.C. 20540 USA, hdl.loc.gov/loc.pnp/pp.print

 

General information about the Bain Collection is available at hdl.loc.gov/loc.pnp/pp.ggbain

 

Higher resolution image is available (Persistent URL): hdl.loc.gov/loc.pnp/ggbain.23688

 

Call Number: LC-B2- 4122-6

  

[Sydney] : Govt. Printing Office, 1888.

 

Title from index.; In the album: Photographs of The National Park.; Also available in an electronic version via the Internet at: nla.gov.au/nla.pic-vn3065847.

 

Persistent URL

nla.gov.au/nla.pic-vn3065847

Persistent URL: digital.lib.muohio.edu/u?/tradecards,3932

 

Subject (TGM): Coffee industry; Children; Boys; Children eating & drinking;

Una storia d’amore, dolore e rabbia per una bellissima città del “mio” sud, Taranto

 

Oggi voglio raccontarvi una mia storia legata alla recente visita a Taranto, la “giovane Taranto antica”, come la chiamava Giuseppe Ungaretti.

La prima sensazione, scendendo dalla macchina, parcheggiata accanto alla palazzata dell’isola della città vecchia, è stata olfattiva: un odore persistente di zolfo e lo sguardo è andato subito alle famose ciminiere che, quasi tutte inattive durante il giorno, animano invece la sera di fumi e colore… non ho avuto la forza di scattare neanche una foto agli stabilimenti dell’ILVA, pur essendo una forte componente visiva della città, perché il pensiero andava alle tante, troppe persone di ogni età che hanno sofferto e soffrono le conseguenze di questa presenza ingombrante e velenosa.

 

Quindi, appassionati di storia, arte e architettura e curiosi di vedere e conoscere i luoghi nelle loro radici, io e Marco ci siamo subito inoltrati in un vicolo che si addentrava nel cuore antico della città. Ad ogni passo si coglieva la storia attraverso la visione di antichi palazzi dagli originali particolari architettonici e decorativi, ma, contemporaneamente, aumentava sia la percezione di abbandono, di degrado dei luoghi sia quel timore che inizi ad avvertire quando intorno a te, oltre al degrado, non vedi che qualche sparuto passante e non sai cosa aspettarti. Intanto vediamo la Chiesa di San Domenico, il Palazzo Arcivescovile e la Cattedrale di San Cataldo: bellissimi. Dopo essere anche stati inseguiti da due cani che facevano la guardia ad un cortile deserto, col cuore in gola abbiamo proseguito il nostro giro solitario. Continua sempre più la visione di palazzi spettrali, vuoti e diroccati, vicoli e palazzi con accessi murati, strutture di contenimento per evitare crolli che, come ho successivamente letto in rete, si sono succeduti anche negli ultimi anni privando non solo i tarantini, ma tutti noi di una parte di patrimonio storico e togliendo anche la vita ad alcune persone che vivevano in quei pressi (leggere gli “illuminanti” articoli corrieredelmezzogiorno.corriere.it/lecce/notizie/cronaca/... e www.siderlandia.it/2.0/index.php/se-taranto-vecchia-se-ne...). Commentiamo tra noi che se il centro città di Palermo, stupendo, ma con zone degradate e palazzi sventrati dalla seconda guerra mondiale e mai ricostruiti, ci era apparso “sgarrupato”, quello di Taranto purtroppo vive una condizione ben peggiore e condividiamo la medesima tristezza, la stessa sofferenza che troviamo sottolineata, aumentata da tanti graffiti il cui tema non appare certo ottimistico. Lo stile dei graffiti, dai colori e dall’iconografia, sembra proprio quello di “Cyop & Kaf”, impressione che avrà poi conferma cercando in rete (www.progettoalchimie.it/q-s-cyop-kaf/ e, a dispetto del nome del sito www.associazioneantigraffiti.it/2013/12/16/graffiti-e-dip... ), con i loro omini trafitti, resi minuscoli, impiccati o in procinto di farlo e disegnati spesso proprio su quei muri grigio cemento eretti per motivi di sicurezza sia per impedire di attraversare i vicoli dove le case sono crollate o stanno per farlo sia per chiudere i portali in modo da evitare anche l’accesso a quegli sciacalli che hanno già fatto razzia di beni contenuti nei palazzi antichi. Anche le vecchie porte arrugginite che chiudono l’accesso a edifici storici abbandonati e decadenti e le facciate di palazzi nascosti o affacciati sulle strade principali sono il materiale che fa da sfondo ai dipinti di “Cyop & Kaf” nella città vecchia di Taranto che, come i Quartieri Spagnoli di Napoli dove oltre 200 disegni dei due artisti sono apparsi per i vicoli e i bassi durante un periodo di tre anni, può diventare una sorta di galleria d’arte a cielo aperto. Documento tutto con i miei scatti frettolosi, ma provo dolore nel mettere a fuoco i graffiti ed il loro contesto. Vedere una città bellissima, piena di storia, una capitale della Magna Grecia, una città di quel sud a cui appartengono le mie radici siciliane mi provoca sempre un moto di dolore e di rabbia per l’indifferenza ed il silenzio generale, a livello nazionale intendo perché la rete mi ha fatto conoscere l’indignazione di cittadini, gruppi tarantini che si ribellano giustamente alla noncuranza ed all’indifferenza delle istituzioni, locali e non, anche tramite video come il documentario “Buongiorno Taranto” del regista salentino Paolo Pisanelli (il trailer potete vederlo qui: www.buongiornotaranto.it/web/promo.php; su facebook qui: www.facebook.com/BuongiornoTaranto).

 

Si sono fatte intanto le due e, iniziando ad avere un certo languore, cerchiamo un posto dove mangiare, ma è tutto serrato, non troviamo nulla. Proseguiamo allora verso il “mar piccolo” e, dopo esserci rifatti gli occhi con il restaurato palazzo dell’Università degli studi, con le colonne doriche del tempio di Poseidone, o forse di Diana, e con il castello Aragonese, arriviamo ad un bar. Beviamo qualcosa e chiediamo alla proprietaria del bar e ad un suo cliente se ci possono indicare un posto, una trattoria, una focacceria dove poter mangiare, ma la risposta è negativa. All’improvviso la signora ci propone una spaghettata con cozze cucinata da lei avendo già preparato il sugo per il marito. Ci guardiamo, il posto non ispirerebbe una grande fiducia nel risultato dell’offerta, ma, vista la spontaneità ed il calore della signora ed essendo noi privi di preconcetti e pronti sempre a provare nuove avventure, diciamo di si alla proposta. Ci accomodiamo quindi in una saletta del bar con televisore, del quale ci viene subito fornito gentilmente il telecomando, frigo grande a vista con bibite, pile di casse della tarantina birra Raffo, la “birra dei due mari”, che ordiniamo ovviamente, ed accompagnamento di chiacchiere con il cliente di cui sopra che ci racconta di lui che, con figli e nipoti, è l’unico dei suoi dieci fratelli a vivere ancora nella città vecchia perché il resto della famiglia si è sparpagliato tra la Puglia e l’Italia. Parliamo appunto della città vecchia manifestandogli le nostre considerazioni ed anche il nostro timore, essendo anche memori di com’era la situazione di Bari vecchia prima della “bonifica”, ristrutturazione e rivalutazione. In risposta riceviamo sia l’invito a farci da guida nella città vecchia sia la possibilità, girando da soli, di rispondere ad un eventuale malintenzionato di essere suoi amici, essendo la sua famiglia rispettata da tutti. Nel frattempo il figlio della signora, con due occhi scuri vispi e curiosi, apparecchia il nostro tavolo come può teneramente fare un bambino che fa suo un compito da adulto ed arriva una prima portata inaspettata, fettine di salame piccantello con formaggio saporito, seguita da una seconda altrettanto inaspettata, un appetitoso sautè di cozze. Arriva per ultimo il piatto originariamente proposto, una montagnola di spaghetti con un’infinità di cozze succulente. Che dire, ottimo è dire poco! Scopriamo quindi, dopo i nostri complimenti vivissimi alla signora, che lei ha lavorato per trent’anni nella ristorazione e che il suo sogno, purtroppo non avverato, era quello di aprire un ristorante. Un peccato davvero! Il marito, che nel frattempo era arrivato, scherza sul fatto di aver mangiato noi il sugo preparato per il suo pranzo e ci fornisce il suo numero di cellulare nel caso in cui volessimo tornare a gustare un piatto, un qualsiasi piatto ci venisse voglia di mangiare.

Come ho letto in un articolo di febbraio scorso sulla città vecchia che vi invito a leggere (corrieredelmezzogiorno.corriere.it/lecce/notizie/cronaca/...): “È un mondo a parte l’isola (la città vecchia). Una zona franca dove s’incontra la bellezza dell’ingenuità della gente, rimasta attaccata alle tradizioni e all’ospitalità, dove si assiste a scene di un’Italia povera e dimenticata, come quella descritta da Carlo Levi in Cristo si è fermato a Eboli, o il brutto delle favelas di Rio o di Scampia.”.

Ci guardiamo davvero soddisfatti, sorpresi e contenti di aver accettato l’invito. L’avventura, come quasi sempre è accaduto, ha avuto il lieto fine agognato permettendoci ancora una volta di conoscere l’essenza e non l’apparenza di persone semplici, ospitali e piene di calore… nui simm' 'ro Sud!

 

Un’ultima considerazione: come diceva Giulio Carlo Argan, “La questione del centro storico tarantino è una questione di importanza nazionale e non soltanto locale. Si tratta di conservare un complesso monumentale che interessa tutto il Paese e alla cui conservazione tutto il Paese deve concorrere.”. Chissà se qualcuno se ne ricorderà... prima o poi...

 

Persistent URL: contentdm.lib.muohio.edu//cdm/ref/collection/postcards/id...

 

Subject (TGM): Oceans; Bays (Bodies of water); Landscape prints;

Persistent URL: digital.lib.muohio.edu/u?/tradecards,209

 

Subject (TGM): Afro-Americans; Ethnic stereotypes; Musical instruments; Fictitious characters; Household soap; Cosmetics & soap; Chemical industry;

Persistent URL: digital.lib.muohio.edu/u?/tradecards,2378

 

Subject (TGM): Women; Men; Biblical events; Camels; Palms; Wells; Cactus; Deserts; Turbans; Shepherds; Staffs (Sticks); Patent medicines; Drugstores; Pharmacists;

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

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Runestone (Ög 181) at Ledberg churchyard. The runestone has mythological images, depicting Ragnarök, with the Fenris wolf devouring Odin. The inscription, on three sides, says: "Bise placed this stone in memory of Torgöt... his father, (Bise) and Gunna, both (raised the stone). Thistle, mistletoe, casket".

 

Runsten (Ög 181) "Ledbergsstenen" på Ledbergs kyrkogård. Runstenen har mytologiska bilder, med en framställning av Ragnarök, med Fenrisulven som slukar Oden. Ristningen, på tre sidor, säger: ”Bise satte denna sten efter Torgöt .. sin fader, de båda (Bise) och Gunna (reste stenen). Tistel, mistel, kistel".

 

Parish (socken): Ledberg

Province (landskap): Östergötland

Municipality (kommun): Linköping

County (län): Östergötland

 

Photograph by: Arthur Nordén

Date: 1945

Format: Glass plate negative

 

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