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Graedons’ Guide to Treatments for Impotence People have been searching for sexual enhancers for centuries. Artichokes, asparagus, truffles, oysters, ginseng, garlic, ground-up rhinoceros tusk and crocodile kidneys are just a few of the agents that have been used to pique desire or improve performance. There is little evidence that any of these exotic ingredients has any measurable effect on human sexuality. Prunes, sometimes referred to as the “funny fruit,” were once considered so sexually stimulating by Shakespeare’s contemporaries that “owners of brothels distributed them free to clients so that the customers’ performance would match their passion.” Ginseng has been touted to increase stamina and counteract impotence for at least 2,000 years. Current claims for its ability to promote sexual potency are only semi-substantiated by animal research. Some studies report that ginseng facilitates mating behavior in rats, increases gonadal weight, accelerates ovulation in frogs, and stimulates egg-laying in hens. But whether enhanced egglaying or faster frog ovulation has any relevance for human sexuality is yet to be established. The problem is that when it comes to sex, researchers have been surprisingly reticent. There is still a lot we don’t know about both male and female sexuality. Erections, for example, are extremely complex events, involving the brain and nervous system, hormones and blood vessels. If any one of these systems fails, it can have negative consequences. For example, a man who is under emotional stress may find it difficult to become aroused. A variety of medications can also lower libido or interfere with the ability to achieve an erection. Nerve damage or blockage of blood vessels leading to the penis can also impair erectile functioning. Once a problem occurs, it can create a vicious cycle. Performance anxiety may make it hard for a man even to initiate lovemaking. It is estimated that up to 30 million American men are affected by erection difficulties. Before considering any specific treatment program it is essential to have a proper medical workup and diagnosis. Smoking, excessive alcohol consumption, diabetes and high blood pressure can all contribute. So can a wide range of drugs. In recent years, Prozac (fluoxetine) and related antidepressants (Effexor, Luvox, Paxil, Serzone, Zoloft) have been found to affect sexuality in a variety of ways. Such drugs may diminish desire, make it difficult to achieve an erection or interfere with the ability to achieve orgasm. The popularity of these medications has created a virtual epidemic of sexual dysfunction for both men and women. You will find a list of common culprits in the accompanying Guide to Drugs That Affect Sexuality. A book by Theresa Crenshaw, M.D., titled Sexual Pharmacology (Norton), explores this issue in depth. Of course, no one should ever stop any prescription drug without careful medical supervision. Discontinuing a blood pressure medicine suddenly could lead to rebound hypertension or even a heart attack. A caring and patient physician should be willing to try to find medications that are less likely to interfere with a satisfying sex life. It is extremely important to discuss any aspect of sexual dysfunction with a knowledgeable and sympathetic physician. Urologists can be very helpful in this regard. Once a proper diagnosis is made, a variety of treatment options is available. Selecting the best one will require frank communication among both partners and the doctor. © 1998 Graedon Enterprises, Inc. Yohimbine: For ages, West African healers have used the bark of the yohimb tree to restore sexual vigor. Studies have shown that yohimbine may indeed be beneficial for 30 to 40 percent of men with either psychological or physiological problems with erections. Yohimbine is available by prescription (Erex, Yocon, Yohimex, etc.) and should only be used under medical supervision. Side effects may include elevated blood pressure, heart palpitations, increased pulse, nausea, headache, nervousness, dizziness, flushing, tremors and sweating. People with diabetes, blood pressure problems, heart, liver or kidney disease should avoid this drug unless a physician deems it appropriate. Erection Medications: For years, urologists have been prescribing medications that can be injected directly into the penis to cause an erection that lasts for up to an hour. The usual selfinjectable drug is Caverject (alprostadil), a form of prostaglandin. It has been demonstrated effective about 90 percent of the time, whether impotence is due to vascular, psychological or nervous system problems. Side effects are generally tolerable, but about half the men in one study reported that the injections occasionally caused penile pain. Other complications included bruising; erections prolonged beyond two hours (this requires emergency treatment); and the development of fibrous tissue in the penis which can lead to Peyronie’s disease (curvature of the penis). For men who do not wish to inject themselves, there is now an identical prescription medicine, MUSE (alprostadil). This is a tiny pellet inserted into the urethra with a special device. Erection occurs quickly for most men. Approximately one third may experience pain in the penis, while 12 to 13 percent report pain in the urethra. Muse is not appropriate for men with sickle cell disease, multiple myeloma or leukemia. A pregnant woman should not be exposed to either MUSE or Caverject. Viagra (sildenafil) is an eagerly awaited pill for impotence. Originally developed for high blood pressure, it blocks an enzyme that interferes with erection and helps 40 to 80 percent of men with severe erectile problems. Viagra is taken 30 minutes to an hour before sexual activity. Side effects are reportedly mild, but may include headache, digestive upset, visual disturbances or muscle aches. Vacuum Devices: These machines consist of a cylinder that fits over the penis, a pump and a ring to fit around the base of the penis. Once the cylinder has been placed over the penis, the pump pulls air out of the cylinder. This creates a vacuum which pulls blood in. Once the penis is erect, the ring goes around the base to help hold the erection, and the cylinder is removed. The ring may stay in place for up to half an hour. Most men are able to master the use of this equipment with little difficulty. Patient education improves the success rate, and many couples report satisfaction with the device. A vacuum device may be inappropriate for men with blood clotting problems, sickle cell disease, leukemia or pelvic infections. Hormone Replacement: For a few men, sexual difficulties are related to a hormonal imbalance. Correcting the imbalance may solve the problem. There is now a testosterone patch (Testoderm) designed to be applied daily to the scrotum. In most men, this drug delivery system can raise blood levels of the male hormone to normal within three to four weeks of steady use. Periodic blood testing is needed to assess dose. Surgery: When impotence is due to a blocked artery or a leaky vein in the penis, vascular surgery may be helpful. Doctors use techniques developed for working on the heart--but in miniature, since genital blood vessels are much smaller than their cardiac counterparts. If you are a candidate, get all the information you need about risks, recovery time and effectiveness rates. It’s best to seek a surgeon with lots of experience in this specialized field. Implants: Several types of penile prostheses are available for the man who does not respond to other treatment. Such a device, surgically implanted in the penis, allows an erection because it is either semirigid, the simplest type, or inflatable. Questions about the incidence of postsurgical infections and silicone reactions have been raised but remain to be resolved.