Erectyle Disfunction Essay, Research Paper

Will we ever be able to produce something capable of making us reach the optimum of one of humankind’s most basic needs? Will there always be a side effect?Since the beginnings of civilization, people have been obsessed about their sexuality. Men and women have always tried to achieve a maximum amount of pleasure in any possible way. For human beings this is obtained through the orgasm. Humans usually attain this is goal through sexual intercourse or masturbation. However, sometimes the psychological and physical conditions of a person can deprive him or her from reaching that goal. Thankfully, science and anatomy have also always interested mankind. This has helped to find solutions for problems dealing with our sexuality, which, as a matter of fact are very common. The most recurrent and drastic of all these dilemmas is that of impotence.The term “impotence” has traditionally been used to signify the inability of the male to attain and maintain erection of the penis sufficient to permit satisfactory sexual intercourse. However, this use has often led to confusing and uninterpretable results in both clinical and basic science investigations. This, together with its pejorative implications, suggests that the more precise term “erectile dysfunction” be used instead to signify an inability of the male to achieve an erect penis as part of the overall multifaceted process of male sexual function. Erectile dysfunction affects millions of men. Although for some men erectile function may not be the best or most important measure of sexual satisfaction, for many men erectile dysfunction creates mental stress that affects their interactions with family and associates. All these things might be very interesting, but to fully understand erectile dysfunction we must first take a look into the physiology of the male erection.In its most common form, the male erectile response is initiated by a central nervous system event that integrates psychogenic stimuli (perception, desire, etc.) and controls the sympathetic and parasympathetic innervation of the penis. Parasympathetic input allows an erection by relaxation of trabecular smooth muscle and dilation of the helicine arteries of the penis. This fills the spongy tissue that forms the penis with blood; a process referred to as the corporal veno occlusive mechanism. The erectile tissues must have sufficient stiffness to compress the blood vessels penetrating it so that venous outflow is blocked and sufficient tumescence and rigidity can occur. Constriction of the trabecular smooth muscle and helicine arteries induced by sympathetic innervation makes the penis flaccid, with blood pressure in the cavernosal sinuses of the penis near venous pressure. When the trabecular smooth muscle relaxes and helicine arteries dilate in response to parasympathetic stimulation and decreased sympathetic tone, increased blood flow fills the cavernous spaces, increasing the pressure within these spaces so that the penis becomes erect. As the venules are compressed against the tunica albuginea, penile pressure approaches arterial pressure, causing rigidity. Once this state is achieved, arterial inflow is reduced to a level that matches venous outflow. After the orgasm, during the resolution, the erection is lost rapidly and the man enters a refractory period where rearousal can be quite difficult for a time.Now that the basic functioning of the male erection has been explained we can go on with the subject of this essay. Because adequate arterial supply is critical for erection, any disorder that impairs blood flow may be implicated in erectile failure. Most of the medical disorders associated with erectile dysfunction appear to affect the arterial system. Some disorders may interfere with the corporal veno occlusive mechanism and result in failure to trap blood within the penis, or produce leakage such that an erection cannot be maintained or is easily lost. Lesions of the somatic nervous pathways may impair reflexogenic erections and may interrupt tactile sensation needed to maintain psychogenic erections. Spinal cord lesions may produce varying degrees of erectile failure depending on the location and completeness of the lesions. Not only do traumatic lesions affect erectile ability, but disorders leading to peripheral neuropathy may also impair neuronal innervation of the penis or of the sensory afferents. The endocrine system itself, particularly the production of androgens, appears to play a role in regulating sexual interest, and may also play a role in erectile function. Psychological processes such as depression, anxiety, and relationship problems can impair erectile functioning by reducing erotic focus or otherwise reducing awareness of sensory experience. This may lead to inability to initiate or maintain an erection.Erectile dysfunction is clearly a symptom of many conditions, and certain risk factors have been identified, some of which may be amenable to prevention strategies. Diabetes mellitus, hypogonadism in association with a number of endocrinologic conditions, hypertension, vascular disease, high levels of blood cholesterol, low levels of high density lipoprotein, drugs and neurogenic disorders have al? been demonstrated as risk factors. Others in the list are Peyronie’s disease, priapism, depression, alcohol ingestion, lack of sexual knowledge, poor sexual techniques, inadequate interpersonal relationships or their deterioration, and many chronic diseases and especially renal failure and dialysis. Vascular surgery is also often a risk factor. Age appears to be a strong indirect risk factor in that ?t is associated with an increased likelihood of direct risk factors. Smoking also has an adverse effect ok erectile function by accentuating the effects of other risk factors such as vascular disease or hypertension. To date, vasectomy has not been associated with an increased risk of erectile dysfunction other than causing an occasional psychological reaction that could then have a psychogenic influence. Accurate risk factor identification and characterization are essential for concerted efforts at prevention of erectile dysfunction.Thankfully, prevention is not the only solution. There are many different and effective methods of fighting erectile dysfunction. Some of these are psychotherapy and behavioral therapy, medical therapy, intracavernosal injection therapy, vacuum/constrictive devices, vascular surgery and penile prostheses. These are the most common methods among modern occidental medicine, but there are many others techniques and medicines against impotence that have been and are still being used in oriental medicine. These are not usually taken seriously since it is often thought of as an inefficient science. An example is Ginseng, which is apparently effective and without dangerous or Unpleasant side effects.Even though effective, these ways of fighting or preventing erectile dysfunction are cumbersome, painful or inefficient. However, this problem has apparently been eradicated with the invention of a miraculous little pill. The name of this new blue “friend” of al? men with erectile dysfunction is VIAGRA.Sildenafil citrate is a white to off-white crystalline powder with a solubility of 3.5 mg/mL in water and a molecular weight of 666.7. VIAGRA (sildenafil citrate) is formulated as blue, film-coated rounded-diamond-shaped tablets equivalent to 25 mg, 50 mg and 100 mg of sildenafil for oral administration. In addition to the active ingredient, sildenafil citrate, each tablet contains the following inactive ingredients: microcrystalline cellulose, anhydrous dibasic calcium phosphate, croscarmellose sodium, magnesium stearate, hydroxypropyl methylcellulose, titanium dioxide, lactose, triacetin, and FD & C Blue #2 aluminum lake.The physiologic mechanism of erection of the penis involves release of nitric oxide (NO) in the corpus cavernosum during sexual stimulation. NO then activates the enzyme guanylate cyclase, which results in increased levels of cyclic guanosine monophosphate (cGMP), producing smooth muscle relaxation in the corpus cavernosum and allowing inflow of blood. Sildenafil has no direct relaxant effect on isolated human corpus cavernosum, but enhances the effect of nitric oxide (NO) by inhibiting phosphodiesterase type 5 (PDE5), which is responsible for degradation of cGMP in the corpus cavernosum. When sexual stimulation causes local release of NO, inhibition of PDE5 by sildenafil causes increased levels of cGMP in the corpus cavernosum, resulting in smooth muscle relaxation and inflow of blood to the corpus cavernosum. Sildenafil at recommended doses has no effect in the absence of sexual stimulation.Studies in vitro have shown that sildenafil is selective for PDE5. Its effect is more potent on PDE5 than on other known phosphodiesterases (>80-fold for PDE1,>1,000-fold for PDE2, PDE3, and PDE4). The approximately 4,000-fold selectivity for PDE5 versus PDE3 is important because that PDE is involved in control of cardiac contractility. Sildenafil is only about 10-fold as potent for PDE5 compared to PDE6, an enzyme found in the retina; this lower selectivity is thought to be the basis for abnormalities related to color vision observed with higher doses or plasma levels (see Pharmacodynamics).In addition to human corpus cavernosum smooth muscle, PDE5 is also found in lower concentrations in other tissues including platelets, vascular and visceral smooth muscle, and skeletal muscle. The inhibition of PDE5 in these tissues by sildenafil may be the basis for the enhanced platelet antiaggregatory activity of nitric oxide observed in vitro, an inhibition of platelet thrombus formation in vivo and peripheral arterial-venous dilatation in vivo.The U.S. Food and Drug Administration (MA) approved Viagra in March 1998. lt immediately became a topselling drug in its first weeks on the market. Viagra was found to be significantly more Effective than placebos in clinical trials involving more than 3,000 men with varying degrees of erectile dysfunction. Success rates varied from 60 percent to 80 percent in clinical trials. Viagra fails to work for three out of 10 men, according to Pfizer, the company that makes the drug. And, even when it does work, it does not always make impotent men feel and function completely normal.Although there has been speculation in the media that the drug may affect sexual performance in normal men and perhaps in women, such “off label” uses are discouraged because they have not been studied in terms Of safety or effectiveness. However, Viagra works for both men and women by increasing the blood flow to the genitals. Women need this blood flow, just as men do, to achieve sexual arousal. Pfizer researcher Dr. lrwin Goldstein said, ‘It has shown evidence of enhanced lubrication, less pain, more arousal, less problems with orgasm.”The FDA says that men who have certain medical conditions (i.e., sickle cell anemia, leukemia or multiple myeloma) that may cause sustained erections may not be able to take Viagra. The drug should not be used by anyone who is taking nitrate or nitrate containing compounds, including nitroglycerin. It’s also recommended that you don’t combine Viagra with any other treatments for erectile dysfunction because the safety and effectiveness of such combinations have not been studied. Early evidence suggests that Viagra is less effective in men who have diabetes or who have had radical prostate surgery compared with groups of men who have erectile dysfunction from other causes.VIAGRA was administered to over 3700 patients (aged 19-87 years) during clinical trials worldwide. Over 550 patients were treated for longer than one year. In placebo controlled clinical studies, the discontinuation rate due to adverse events for VIAGRA (2.5%) was not significantly different from placebo (2.3%). The adverse events were generally transient and mild to moderate in nature. In fixed dose studies, the incidence of some adverse events increased with dose. The nature of the adverse events in flexible dose studies, which more closely reflect the recommended dosage regimen, was similar to that for fixed dose studies.When VIAGRA was taken as recommended (on an as needed basis) in flexible dose, placebo controlled clinical trials, the following adverse events were reported:Adverse EventVIAGRAPLACEBON=734N=725Headache16%4%Flushing10%1%Dyspepsia7%2%Nasal congestion4%2%Urinary tract infection3%2%Abnormal vision*3%0%Diarrhea3%1%Dizziness2%1%Rash2%1%Abnormal vision: Mild and transient, predominantly color tinge to vision, but also increased sensitivity to light or blurred vision. In these studies, only one patient discontinued due to abnormal vision.Viagra has many possible side effects, but most of them occur in extremely rare cases. Those that affect the body as a whole are face edema, photosensitivity reaction, shock, asthenia, pain, chills, loss of coordination leading to accidental fall and injury, abdominal pain, allergic reaction and chest pain. Other side effects can be cardiovascular, digestive, hemic and lymphatic, metabolic and nutritional, musculoskeletal, nervous, respiratory, dermatological and urogenital. At higher doses, the drug caused a temporary bluish tinge to the field of vision in some men.Viagra is a new drug and not much is still known about. This is one of the reasons why people should not put all their faith into this new and impressive drug. The likelihood of erectile dysfunction increases progressively with age but is not an inevitable consequence of aging. Other age related conditions increase the likelihood of its occurrence. Contrary to present public and professional opinion, many cases of erectile dysfunction can be successfully managed with appropriately selected therapy. Important information on many aspects of erectile dysfunction is lacking; major research efforts are essential to the improvement of our understanding of the appropriate diagnostic assessments and treatments of this condition. Erectile dysfunction is an important public health problem deserving of increased support for basic science investigation and applied research. Viagra may not be the best option against erectile dysfunction, but it is the easiest to get access to and take, so we shall have to deal with its adverse effects for now. Perhaps later on another pharmaceutical company might come up with a better method against erectile dysfunction, and even a version specially made for women’s needs. Bibliographyhttp://www.viagra.comhttp://www.mensclinic.com