In a study soon to appear in the
Journal of Clinical Endocrinology and Metabolism, overweight men commonly report an unsatisfying sex life which may be related to low levels of circulating testosterone. Patients with low testosterone levels also respond less favorably to the Erectile Dysfunction medications.
Simple blood tests can assess for a deficiency in this hormone.
Hydrogen sulphide, the gas responsible for the terrible smell of rotten eggs, has been found to play a role in the biochemical response that leads to an erection. The discovery may lead to a new medical therapy for Erectile Dysfunction.
In the
Proceedings of the National Academy of Sciences, Italian researchers showed that hydrogen sulphide is released into the erectile tissues prior to erections occurring. Current Erectile Dysfunction drugs, such as Viagra, Cialis and Levitra, target
nitric oxide, another mediator in erections.
In some rare cases, men do not respond to the current Erectile Dysfunction drugs which target the nitric oxide pathway. New medications directed at hydrogen sulphide would hold promise for these patients.
The drug
dapoxetine should be in pharmacies by April, according to a Johnson and Johnson spokesman. Unfortunately for the millions of men suffering from premature ejaculation,
the medication will only be available in Europe. For now.
Dapoxetine belongs to the category of drugs known as SSRI's and can be used on demand (similar to erectile dysfunction medicine) to cause a delay in ejaculation of at least several minutes in most men suffering from premature ejaculation.
Other SSRI's such as Zoloft and Paxil are currently widely used for the problem, but they are not officially approved for this use, and do not work in an "on demand" fashion.
Dapoxetine was denied FDA approval in 2005 for reasons that were not clearly elucidated. Speculation was that the medication had an unfavorable interaction with alcohol or might be associated with some unfavorable mood changes.
Johnson and Johnson is considering reapplying to the FDA, armed with additional research information.
Millions more Americans should be taking cholesterol-lowering statins than physicians previously believed.
The JUPITER study, published in the journal Circulation: Cardiovascular Quality and Outcomes, showed that prescribing a statin for patients with a normal cholesterol, but an elevated C-reactive protein (CRP), which detects inflammation, could cut in half the risk for heart attack, stroke, and death.
The study might lead to changes in the guidelines for statin therapy. Whether or not the study will lead to the more widespread use of CRP testing is also uncertain.
Although still in the early stages of research, a promising development in the prevention of
herpes type II virus transmission appears to be emerging.
The January 22nd edition of Cell Host and Microbe reports that a topically applied cream uses a technique called
RNA interference (RNAi) to prevent the virus from infecting an individual coming in contact with it through sexual contact.
The compound creates in the tissues a state which provides resistance for one week following application. In addition, no adverse reactions were observed.
Sometimes we all need reinforcement about common sense things. A new study published in the Journal European Urology looked at the effects of exercise on the development of erectile dysfunction.
Just 30 minutes of mild to moderate exercise was shown to reduce the incidence of ED by 38%. As little as 1000 kilo-calorie expenditure each week reduces the risk.
The study specifically looked at common exercises such as gardening, mowing, and pulling weeds.
Several studies have clearly shown a dramatic benefit to public health as a result of smoking bans.
The most recent, published in the CDC's Morbidity and Mortality Weekly Report, looked at the effect of a smoking ban implemented in Pueblo, Colo. The results show an impressive 41% decline in hospital admissions for heart attacks, since the ban went into effect. Nearby areas without a ban showed no decrease in such events and the demographics of Pueblo residents did not change in any other way.
Prior to being released as an effective medication to treat ED, sildenafil (Viagra) was being investigated as a medication to treat and prevent heart disease.
Now a study published in a recent Journal of Clinical Investigation suggests that Viagra may have a protective effect on the heart muscle in cases of hypertension. Viagra may decrease dangerous hypertrophy in heart muscle which can ultimately lead to heart failure. The study used an animal model and further research will be needed to see if the same beneficial effect exists in humans.
According to a
recent article in the Journal of Hypertension, a simple urine test may offer a highly sensitive way to screen for diabetes and the risk for developing the disease.
The test offers a simple way to detect albumin in the urine sample. Albumin is one of the main proteins present the blood and, normally, is not filtered by the kidneys. Normally, it is not present in the urine.
However, during the stage of pre-diabetes, abnormal amounts of albumin leak out into the urine and are detected by a simple test.
The presence of albumin the urine indicated a 97% greater risk of developing diabetes even in the absence of other risk factors. Also, elevated levels of albumin in the urine might predispose to arterial damage and insulin resistance during later stages of the disease.
Diabetes is one of the main causes of erectile dysfunction, and earlier detection might allow prevention of the development of ED.
New advances might bring detailed diagnostics studies literally at a patient's fingertip.
According to a recent publication in
Proceedings of the National Academy of Sciences, Harvard scientists have developed a paper based chip that can analyze a small amount of blood for a number of diseases. The test material is made of paper and carpet tape.
While the design is intended for future use in developing countries, there are certainly many possible applications including confidential, cost effective testing for lipid disorders, diabetes, cancer screening, and STD testing.
It's becoming increasingly difficult to watch a sporting event on television without being bombarded with ads for both the ED drugs and drugs used for prostate symptoms.
Like it or not, expect to see more of this, now that
Silodosin (Rapaflo) has received FDA approval.
This medication is chemically similar to two other medications, Flomax and Uroxatrol, but may have some advantages as far as side effect issues. Namely, there was no noticeable effect on blood pressure, heart rate, or dizziness episodes when combined with one of the ED medications.
Rapaflo may turn out to be the safest option in men with ED and coexisting BP or cardiac issues, who require a medication for prostate symptoms.
A recent article in the journal European Urology reports that nearly 20% of men who underwent radical prostatectomy for prostate cancer later regretted deciding on that treatment option. Interestingly, the rate of dissatisfaction was highest among those that chose robotic prostatectomy. Perhaps patient expectations were unreasonably high for the newer, innovative technique. Common side effects for radical prostatectomy include ED and urinary incontinence.
Approximately 200,000 men will be diagnosed with prostate cancer in 2009. Many options for treatment exist and men should explore all options. Some patients might even consider a program of active surveillance. There are also options which are less invasive than surgery that should be considered for most patients.
A category of medications called statins has revolutionized therapy for elevated cholesterol.
Prior to the introduction of the first statin, Mevacor, in the mid-80's, therapy for elevated cholesterol involved several different medications with limited effectiveness and generally unpleasant side effects. While the statins can certainly have some side effects as well, they are usually well tolerated, particularly if periodic lab tests are conducted. The benefits of lowering cholesterol in preventing heart disease, stroke, and peripheral vascular disease are well established.
Recently, even more potential benefits have been associated with the statins. They may offer a protective effect against the development of prostate cancer. In addition, statin therapy has been show to reverse the development of erectile dysfunction in a significant subgroup of men.
Unfortunately, many younger men, seemingly healthy, have never even been evaluated for elevated cholesterol and it's impossible to know if you have it without a lab test. The sooner the diagnosis is made and treatment initiated, the better.
A recent study published in the Journal of Urology showed a surprising benefit for Cialis (tadalafil) users. Men using a lower daily dose of the ED medication (2.5 or 5mg) were shown to have statistically significant improvement in troublesome urinary symptoms such as waking up at night to urinate (nocturia), urinary frequency, and poor bladder emptying. The mechanism for this action is not well understood at present.
In the future, combination drugs which target ED and prostate symptoms (including possible protective or preventative therapy directed against prostate cancer) are likely to be investigated.
High blood pressure is a major risk factor in the development of life-threatening conditions such as heart attack and stroke. It also predisposes to erectile dysfunction.
A recent study published in the November 24 Archives of Internal Medicine shows that ambulatory blood pressure monitoring (done at a patient's home) gives a more accurate picture of the blood pressure problem than testing done at a physician's office. In cases of severe high blood pressure disorders, (those associated with a 20% incidence of life-threatening complications) the office blood pressure measurements did not predict a single patient that went on to suffer one of these major setbacks.
For very little expense, patients at risk could have much better management, with fewer office visits, using online interpretation and management of changes in their blood pressures. Millions of lives could be saved.
Don't expect that 90 minute wait in the doctor's office to improve anytime soon. Experts predict that the US will be short 200,000 physicians in less than 20 years. One analyst put it this way: "We now have an in-your-face physician shortage and no conversation about correcting it exists."
Many feel that innovative techniques of health care delivery, such as online consultation for specific medical problems, as well as more efficient and cost-effective diagnostic testing and interpretation, are essential to help avert this crisis.
A recent population based study found that ED is not as uncommon in young men as previously thought. Perhaps 7% of men under the age of 30 are affected. As with all categories of ED patients, the key is to obtain a detailed medical history provided by the patient in a non-threatening environment.
While many cases of ED in young men have a psychogenic causes, ie. depression or anxiety, other causes including diminished testosterone blood levels and diabetes can be uncovered with simple lab tests.
As you might guess, the ED drugs are highly effective and safe in treating this population of men with ED.
While numerous well-designed medical studies have shown that alcohol in moderation (especially red wine) has health benefits, the general affect on sexual performance is not good. As Shakespeare wrote in Macbeth, " Drink (alcohol) is a provoker of three things: nose painting, sleep, and urine. It provokes, and unprovokes: it provokes the desire, but it takes away the performance." While it is generally safe to use the ED medications with moderate alcohol intake, the effectiveness of the medications is greater when alcohol is avoided for a few hours before using an ED med. Also, chronic moderate or heavy alcohol use is probably one of the main causes, along with smoking, of ED in the first place.
Erectile dysfunction, to some degree, affects perhaps 50% of men between the ages of 40 and 70. The impact on quality of life as well as a man's sense of well being is truly staggering. With the introduction of sildenafil citrate (Viagra) in 1998, the approach and treatment of men with ED changed dramatically. It was no longer necessary to subject most men to extensive and costly diagnostic testing and often embarrassing face to face encounters in order to safely offer them treatment. But how do Viagra and the other ED drugs work exactly? They work their magic by inhibiting a specific enzyme called phosphodiesterase 5 (PDE5). OK, here's what happens: during sexual stimulation, nitric oxide (NO) is released into the tissues of the penis. NO then causes an increase in cyclic GMP which allow the erectile tissues of the penis to engorge with arterial blood, while the venous drainage of the blood slows down.The ED drugs block the breakdown of cGMP, which allows it to do its job more efficiently and powerfully. While that might be "too much information," it's good to know what medications really do. And besides, now you know more about the mechanism of action of the ED medications than most physicians!
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