My Penis Stuff

Generic name:  Sildenafil
Brand names: Viagra

Viagra relaxes muscles and increases blood flow to particular areas of the body.

Sildenafil under the name Viagra is used to treat erectile dysfunction (impotence) in men. Another brand of sildenafil is Revatio, which is used to treat pulmonary arterial hypertension and improve exercise capacity in men and women.

Do not take Viagra if you are also using a nitrate drug for chest pain or heart problems. This includes nitroglycerin (Nitrostat, Nitrolingual, Nitro-Dur, Nitro-Bid, and others), isosorbide dinitrate (Dilatrate-SR, Isordil, Sorbitrate), and isosorbide mononitrate (Imdur, ISMO, Monoket). Nitrates are also found in some recreational drugs such as amyl nitrate or nitrite (“poppers”). Taking Viagra with a nitrate medicine can cause a serious decrease in blood pressure, leading to fainting, stroke, or heart attack.

Before taking Viagra, tell your doctor if you are allergic to any drugs, or if you have:

• heart disease or heart rhythm problems;
• a recent history (in the past 6 months) of a heart attack, stroke, or heart rhythm disorder;
• congestive heart failure;
• high or low blood pressure;
• coronary artery disease;
• liver disease;
• kidney disease;
• a blood cell disorder such as sickle cell anemia, multiple myeloma, or leukemia;
• a bleeding disorder such as hemophilia;
• a stomach ulcer;
• retinitis pigmentosa (an inherited condition of the eye);
• a physical deformity of the penis (such as Peyronie’s disease); or
• if you have been told you should not have sexual intercourse for health reasons.

If you have any of these conditions, you may need a dose adjustment or special tests to safely take Viagra.

Viagra can decrease blood flow to the optic nerve of the eye, causing sudden vision loss. This has occurred in a small number of people taking Viagra, most of whom also had heart disease, diabetes, high blood pressure, high cholesterol, or certain pre-existing eye problems, and in those who smoke or are over 50 years old. It is not clear whether Viagra is the actual cause of vision loss. Stop using Viagra and get emergency medical help if you have sudden vision loss.

Viagra is usually taken only when needed, 30 minutes to 1 hour before sexual activity. You may take it up to 4 hours before sexual activity. Do not take Viagra more than once per day.

Viagra can help you have an erection when sexual stimulation occurs. An erection will not occur just by taking a pill. Follow your doctor’s instructions.

During sexual activity, if you become dizzy or nauseated, or have pain, numbness, or tingling in your chest, arms, neck, or jaw, stop and call your doctor right away. You could be having a serious side effect of Viagra. Store this medication at room temperature away from moisture and heat.

Seek emergency medical attention if you think you have used too much of Viagra. Overdose symptoms may include chest pain, nausea, irregular heartbeat, and feeling light-headed or fainting.

Avoid drinking alcohol, which can increase some of the side effects of Viagra. Avoid using other medicines to treat impotence, such as alprostadil (Caverject, Muse, Edex) or yohimbine (Yocon, Yodoxin, others), without first talking to your doctor.

Stop using Viagra and call your doctor at once if you have any of these serious side effects:

• sudden vision loss;
• ringing in your ears, or sudden hearing loss;
• chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling;
• irregular heartbeat;
• swelling in your hands, ankles, or feet;
• shortness of breath;
• vision changes;
• feeling light-headed, fainting; or
• penis erection that is painful or lasts 4 hours or longer.

Less serious side effects may include:

• warmth or redness in your face, neck, or chest;
• stuffy nose;
• headache;
• upset stomach; or
• back pain.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect.

You can get more information about Viagra here >>

Premature ejaculation (PE), is also known as rapid ejaculation, premature climax, or early ejaculation. In the United States, PE affects about one in five men ages 18 to 59. Although the problem is often assumed to be psychological, biology also may play a role.

How does ejaculation occur?

Ejaculation, controlled by the central nervous system, happens when sexual stimulation and friction provide impulses that are delivered to the spinal cord and into the brain.

Ejaculation has two phases:

Phase I: Emission
The vas deferens (the tubes that store and transport sperm from the testes) contract to squeeze the sperm toward the base of the penis through the prostate gland. The seminal vesicles release secretions that combine with the sperm to make semen. The ejaculation is unstoppable at this stage.

Phase II: Ejaculation
The muscles at the base of the penis contract forcing semen out of the penis (ejaculation and orgasm) while the bladder neck contracts. Orgasm can occur without the delivery of semen (ejaculation) from the penis. Normally, erections are lost following ejaculation.

Phase II: Ejaculation
The muscles at the base of the penis contract forcing semen out of the penis (ejaculation and orgasm) while the bladder neck contracts. Orgasm can occur without the delivery of semen (ejaculation) from the penis. Normally, erections are lost following ejaculation.

What is premature ejaculation?

Premature ejaculation (PE) is characterized by a lack of voluntary control over ejaculation. Many men occasionally ejaculate sooner than they or their partner would like during sexual activities. PE is a frustrating problem that can reduce the enjoyment of sex, harm relationships and affect quality of life. Occasional instances of PE might not be cause for concern. However, when the problem occurs frequently and causes distress to the man or his partner, treatment may be of benefit.

What causes premature ejaculation?

Although the exact cause of premature ejaculation (PE) is not known, new studies suggest that serotonin, a natural substance produced by nerves, is important. A breakdown of the actions of serotonin in the brain may be a cause. Studies have found that high amounts of serotonin in the brain slow the time to ejaculation while low amounts of serotonin can produce a condition like PE.

Psychological factors also commonly contribute to PE. Temporary depression, stress, unrealistic expectations about performance, a history of sexual repression, or an overall lack of confidence can cause PE. Interpersonal dynamics may contribute to sexual function. PE can be caused by a lack of communication between partners, hurt feelings, or unresolved conflicts that interfere with the ability to achieve emotional intimacy.

Can premature ejaculation develop later in life?

Premature ejaculation (PE) can occur at any age. Surprisingly, aging appears not to be a cause of PE. However, the aging process typically causes changes in erectile function and ejaculation. Erections may not be as firm or as large. Erections may be maintained for a shorter period before ejaculating. The feeling that an ejaculation is about to happen may be shorter. These factors can result in an older man having an ejaculation earlier than when he was younger.

Can both premature ejaculation and erectile dysfunction affect a man at the same time?

Sometimes premature ejaculation (PE) may be a problem in men who have erectile dysfunction (ED)—the inability to achieve and/or maintain an erection sufficient for satisfactory sexual performance. Some men do not understand that the loss of erection normally occurs after ejaculation and may wrongly complain to their doctor that they have ED when the actual problem is PE. It is recommended that the ED be treated first if you experience both ED and PE, since the PE may resolve on its own once the ED has been adequately treated.

When should a doctor be seen?

When premature ejaculation (PE) happens so frequently that it interferes with your sexual pleasure, it becomes a medical problem requiring the care of a doctor. To understand the problem, the doctor will need to ask questions about your sexual history such as the following:

• How often does the PE occur?
• How long have you had this problem?
• Is the problem specific to one partner? Or does it happen with every partner?
• Does PE occur with all or just some attempts at sexual relations?
• How much stimulation results in PE?
• What type of sexual activity (i.e., foreplay, masturbation, intercourse, use of visual clues, etc.) is engaged in and how often?
• How has PE affected sexual activity?
• What is the quality of your personal relationships?
• How does PE affect your quality of life?
• Are there any factors that make PE worse or better (i.e., drugs, alcohol, etc.)?

Usually, laboratory testing is not necessary unless the history and a physical examination reveal something more complicated.

How to talk to your partner about premature ejaculation?

Premature ejaculation (PE) affects not only you but also your partner and your sexual relationship. In an episode of PE, the intimacy shared with a partner suddenly comes to a quick end. You might feel angry, ashamed, and frustrated, and turn away from your partner. At the same time, your partner may be upset with the rapid emotional change, or the outcome of the sexual encounter.

Communication is not only important to successful diagnosis and treatment, but can also help a partner understand the feelings of the individual. Sometimes couple counseling or sex therapy may be useful. Together a couple might develop techniques (for example, the squeeze technique) that may prolong an erection. Most importantly, the couple should try to relax. Anxiety (especially performance anxiety) only makes this condition worse.

What treatments are available?

There are several treatment choices for premature ejaculation: psychological therapy, behavioral therapy and medications. Be sure to discuss these treatments with your doctor and together decide which of the following options is best for you:

• Psychological therapy addresses feelings a man may have about sexuality and sexual relationships.
• Behavioral therapy makes use of exercises to help a man develop tolerance to stimulation and, as a result, delay ejaculation.
• Medical therapy includes medications that are commonly used to treat depression. In addition, topical anesthetic creams may be used.

Psychological therapies

Psychological therapy can be used as the only treatment or can be used together with medical therapy or behavioral therapy. The focus of psychological therapy is to help you to identify and solve any difficulties in your relationships that may have added to the cause of premature ejaculation (PE). This therapy can also help couples to talk about problems with intimacy that occurred after PE began. Psychological therapy can also help a man learn to be less anxious about his sexual performance and have greater sexual confidence. Typically, a man will receive specific advice on how to enhance his and his partner’s sexual satisfaction.

Behavioral therapies

Behavioral therapy can play a key part in the usual treatment of premature ejaculation. Exercises are effective; however, they may not always provide a lasting solution to the problem. Also, they rely heavily on the cooperation of the partner, which in some cases, may be a problem.

With the squeeze method, an exercise developed by Masters and Johnson, the partner stimulates the man’s penis until he is close to ejaculation. At the point when he is about to ejaculate, the partner squeezes the penis hard enough to make him partially lose his erection. The goal of this technique is to teach the man to become aware of the sensations leading up to orgasm, and then begin to control and delay his orgasm on his own.

With the stop-start method, the partner stimulates the man’s penis until just before ejaculation. The partner should then stop all stimulation until the urge to ejaculate subsides. As the man regains control, he instructs the partner to begin stimulating his penis again. This procedure is repeated three times before allowing the man to ejaculate on the fourth time. The couple repeats this exercise three times a week, until the man has gained good control.

Medical therapies

Although not approved by the U.S. Food and Drug Administration (FDA) for this purpose, drugs used for depression and anesthetic creams have been shown to delay ejaculation in men with premature ejaculation (PE).

Medications are a relatively new form of treatment for PE. Doctors first noticed that men and women who were taking drugs for the treatment of depression (antidepressants) also had delayed orgasms. Doctors then began to use these drugs “off-label” (this implies using a medication for a different illness than what it was originally manufactured for) to treat PE. These medications include antidepressants that affect serotonin such as fluoxetine, paroxetine, sertraline and clomipramine.

If one medication fails to work, a second one is usually recommended. If the second one fails, trying a third medication will not likely be beneficial. An alternative is to combine medication with behavioral therapy and/or creams.

For use in PE, the doses of antidepressants are usually lower than those recommended for the treatment of depression. Common side effects of antidepressants can include nausea, dry mouth, drowsiness and reduced desire for sexual activity.

These drugs can be taken either every day or only taken before sexual activity. Your doctor will decide how you should take the medication based on the frequency of intercourse. The best time for taking the antidepressant medications before sexual activity has not been established, but most doctors will recommend from two to six hours depending on the medication. Because PE can recur when the medication is not taken, you most likely will need to take it on a continuing basis.

Local anesthetic creams can be used to treat PE. These creams are applied to the head of the penis about 20 to 30 minutes before intercourse to lessen the sensitivity. Prior to sexual intercourse, a condom (if used) may be removed and the penis washed clean of any remaining cream. A loss of erection can occur if the anesthetic cream is left on the penis for a longer period of time than recommended. Also, the anesthetic cream should not be left on the exposed penis during vaginal intercourse since it may cause vaginal numbness.

See your urologist for evaluation and treatment for the biological aspects of premature ejaculation.

As the channel for semen and urine, the penis serves two important functions in men. But a disease described as early as the mid-18th century by a French physician, Francois Gigot de la Peyronie, which causes hardened patches on the penile shaft, can severely impact a man’s sexual performance. If you have pain and penile curvature characteristic of Peyronie’s disease, the following information should help you understand your condition.

What happens under normal conditions?

The penis is a cylindrical organ consisting of three chambers: paired corpora cavernosa (Two cylinder-shaped bodies that lie side by side in the penis and that, when filled with blood, enlarge to cause the penis to swell and become erect.) that are surrounded by a protective tunica albuginea (The hard covering that covers the testicle.); a dense, elastic membrane or sheath (A tubular covering that protects some body parts.) under the skin; and the corpus spongiosum (A column of erectile tissue in the center of the penis and surrounding the urethra. When filled with blood it enlarges and causes the penis to swell and become erect.), a singular channel, located centrally beneath and surrounded by a thinner connective tissue sheath. It contains the urethra, the narrow tube that carries urine and semen out of the body.

These three chambers are made up of highly specialized, sponge-like erectile tissue filled with thousands of venous cavities, spaces that remain relatively empty of blood when the penis is soft. But during erection, blood fills the cavities, causing the corpora cavernosa to balloon and push against the tunica albuginea. While the penis hardens and stretches, the skin remains loose and elastic to accommodate the changes.

What is Peyronie’s disease?

Peyronie’s disease (also known as fibrous cavernositis) is an acquired inflammatory (Characterized or caused by swelling, redness, heat and/or pain produced in an area of the body as a result of irritation, injury or infection.) condition of the penis.  It is the formation of a plaque or hardened scar tissue beneath the skin of the penis. This scarring is non-cancerous, but often leads to painful erection and curvature of the erect penis (a “crooked penis”).

What are the symptoms of Peyronie’s disease?

This scarring, or plaque, typically develops on the upper side of the penis (dorsum). It reduces the elasticity of the tunica albuginea (The hard covering that covers the testicle.) in that area and, as a result, causes the penis to bend upward during an erection. Although Peyronie’s plaque is most commonly located on the top of the penis, it may occur on the underside or on the lateral side of the penis, causing a downward or lateral bend.  Some patients may even develop a plaque that goes all the way around the penis, causing a “waisting” or “bottleneck” deformity of the penile shaft. The majority of patients complain of generalized shrinkage or shortening of their penis.

Painful erections and difficulty with intercourse usually lead men with Peyronie’s disease to seek medical help. Since there is great variability in this condition, sufferers may complain of any combination of symptoms: Penile curvature, obvious penile plaques, painful erection and diminished ability to achieve an erection.

Any of those physical deformities make Peyronie’s disease a quality-of-life issue. Not surprising, it is linked to erectile dysfunction in 20 to 40 percent of sufferers. While studies have shown that 77 percent of men demonstrate significant psychological effects, the numbers, medical researchers believe, are under reported. Instead, many men affected with this truly devastating condition suffer in silence.

How frequently does Peyronie’s disease occur?

Peyronie’s disease affects a reported one to 3.7 percent  (about one to four in 100) of males between ages 40 and 70, even though severe cases have been reported in younger men. Medical researchers believe the actual prevalence may be higher due to patient embarrassment and limited reporting by physicians. Since the introduction of sildenafil citrate, an oral therapy for impotence, doctors have reported increased incidence of Peyronie’s cases. With more men being treated successfully for erectile dysfunction in the future, an increasing number of cases presenting to urologists are anticipated.

What causes Peyronie’s disease?

Ever since Francois Gigot de la Peyronie, personal physician to King Louis XV, first reported penile curvature in 1743, scientists have been mystified by the causes of this well-recognized disorder. Yet medical researchers have speculated on a variety of factors that might be at work.

Most experts believe that acute or short-term cases of Peyronie’s disease are likely the consequence of a minor penile trauma, sometimes caused by sports injuries, but more often by vigorous sexual activity (e.g., the penis accidentally being jammed into a mattress). In injuring the tunica albuginea, that trauma triggers a cascade of inflammatory and cellular events resulting in the abnormal fibrosis (excess fibrous tissue), plaque and calcifications characteristic of this disease.

Such trauma, however, may not account for those Peyronie’s cases that begin slowly and become so severe that they require surgery. Researchers believe genetics or relationship with other connective tissue disorders may play a role. Studies already suggest that if you have a relative with Peyronie’s disease you have a greater risk of developing it yourself.

How is Peyronie’s disease diagnosed?

A physical examination is sufficient to diagnose curvature of the penis. The hard plaques can be felt with or without erection. It may be necessary to use injectable medications to induce an erection for proper evaluation of the penile curvature. The patient may also provide pictures of the erect penis for evaluation by the physician. Ultrasound of the penis may demonstrate the lesions in the penis but is not always necessary.

How is Peyronie’s disease treated?

Because Peyronie’s disease is a wound-healing disorder, changes are constantly occurring in the early stages. In fact, this disease can be classified into two stages: 1) an acute inflammatory phase persisting for six to 18 months during which men experience pain, slight penile curvature and nodule formations and 2) a chronic phase during which men develop a stable plaque, significant penile curvature and erectile dysfunction.

Occasionally the condition regresses spontaneously with symptoms resolving themselves. In fact, some studies show that approximately 13 percent of patients have complete resolution of their plaques within a year. There is no change in 40 percent of cases, with progression or worsening of symptoms in 40 to 45 percent. For these reasons, most physicians recommend a non-surgical approach for the first 12 months.

Conservative approaches:  Instead of requiring invasive diagnostic procedures or treatments, men who experience only small plaques, minimal penile curvature and no pain or sexual limitations, need only be reassured that the condition will not lead to malignancy or another chronic disease. Pharmaceutical agents have shown promise for early-stage disease but there are drawbacks. Because of a lack of controlled studies, scientists have yet to establish their true effectiveness. For instance:

• Oral vitamin E: It remains a popular treatment for early-stage disease because of its mild side effects and low cost. While uncontrolled studies as far back as 1948 demonstrated decreases in penile curvature and plaque size, investigation continues concerning its effectiveness.
• Potassium aminobenzoate: Recent controlled studies have shown that this B-complex substance popular in Central Europe yields some benefits. But it is somewhat expensive, requiring 24 pills each day for three to six months. It is also often associated with gastrointestinal issues, making compliance low.
• Tamoxifen: This non-steroidal, antiestrogen medication has been used in the treatment of desmoid tumors, a condition with properties similar to Peyronie’s disease. Researchers claim that inflammation and the production of scar tissue are inhibited. But early-stage disease studies in England have found only marginal improvement with tamoxifen. Like other research in this area, however, these studies include few patients, and no controls, objective improvement measures or long-term follow up.
• Colchicine: Another anti-inflammatory agent that decreases collagen development, colchicine has been shown to be slightly beneficial in a few small, uncontrolled studies. Unfortunately, up to 50 percent of patients develop gastrointestinal upset and must discontinue the drug early in treatment.

Injections:  Injecting a drug directly into the penile plaque is an attractive alternative to oral medications, which do not specifically target the lesion, or invasive surgical procedures, which carry the inherent risks of general anesthesia, bleeding and infection. Intralesional injection therapies introduce drugs directly into the plaque with a small needle after appropriate anesthesia. Because they offer a minimally invasive approach, these options are popular among men with either early phase disease or who are reluctant to have surgery. Yet their effectiveness is also under investigation. For instance:

•  Verapamil: Early uncontrolled studies demonstrated that this substance interferes with calcium, a factor shown by in vitro cattle connective tissue cell studies to support collagen transport. As such, intralesional verapamil reduced penile pain and curvature while improving sexual function. Other studies have concluded that it is a reasonable treatment in men with non-calcified plaques and penile angles of less than 30 degrees.
• Interferon: The use of these naturally-occurring antiviral, antiproliferative and anti-tumorigenic glycoproteins to treat Peyronie’s disease was born out of experiments demonstrating the antifibrotic effect on skin cells of two different disorders — keloids, overgrowth of collagenous scar tissue and scleroderma, a rare autoimmune disease affecting the body’s connective tissue. In addition to inhibiting proliferation of fibroblast cells, interferons, such as alpha-2b, also stimulate collagenase, which breaks down collagen and scar tissue. Several uncontrolled studies have demonstrated intralesional interferon’s effectiveness in reducing penile pain, curvature and plaque size while improving some sexual function. A current multi-institutional, placebo-controlled trial will hopefully answer many of the questions about intralesional therapy in the near future.

Other investigative therapies:  The medical literature is replete with reports on less invasive methods for treating Peyronie’s disease. But the effectiveness of treatments such as high-intensity focused ultrasound and radiation therapy, topical verapamil and iontophoresis, introducing soluble salt ions into the tissue via electric current, must still be investigated before these alternative therapies are considered clinically useful. Likewise, controlled studies using larger patient groups with longer follow ups are necessary to prove that the same high-energy shock waves used to break up kidney stones will have positive effects on Peyronie’s disease.

Surgery:  Surgery is reserved for men with severe disabling penile deformities that prevent satisfactory sexual intercourse. But, in most cases, it is not recommended for the first six to 12 months, until the plaque has stabilized. Since a spin-off of this disease is an abnormal blood supply to the penis, a vascular evaluation using vasoactive agents (drugs that cause erections by opening the vessels) is done prior to any surgery. A penile ultrasound if performed can also illustrate the anatomy of the deformity. The images allow the urologist to determine which patients are most likely to benefit from reconstructive procedures versus a penile prosthesis. The three surgical approaches include:

• Nesbit procedure: First described to correct congenital penile curvature by cutting a portion of tissue from the tunica albuginea and shortening the unaffected side of the penis, this procedure is used by many surgeons today for Peyronie’s disease. Variations on the approach include the plication technique, where sutured tucks are placed into the side of maximum curvature to shorten and straighten the penis and the corporoplasty technique, where a longitudinal or lengthwise incision is closed transversely to correct the curvature. Nesbit and its variations are simple to perform and involve limited risk. They are most beneficial in men with ample penile length and lesser degrees of curvatures. But they are not recommended in individuals with short penises or severe curvatures as this procedure is recognized to shorten the penis somewhat.
• Grafting procedures: defect with a When plaques are large and curvatures severe, the surgeon may choose to incise or cut out the hardened area and replace the tunicagraft material of some type. While the choice of materials depends on the doctor’s experience, preferences and what is available, some are more attractive than others. For instance:
  • Autograft tissue grafts: Taken from the patient’s body during surgery and thus less likely to cause an immunologic reaction, these materials usually require a second incision. They are also known to undergo postoperative contracture or tightening and scarring.
  • Synthetic inert substances: Materials such as Dacron^® mesh or GORE-TEX^® can cause significant fibrosis, a spreading of connective tissue cells. Occasionally palpated or felt by the patient, these grafts may cause more scarring.
  • Allografts or xenografts: Harvested human or animal tissues are the focus of most grafting material today These substances are uniformly strong, easy to work with and readily available because they are “off-the-shelf” in the operating room, so to speak. They act as scaffolds for the tunica albuginea tissue to grow over as the graft is naturally dissolved by the patient’s body.

• Penile prostheses: A penile prosthesis may be the only good option for Peyronie’s disease patients with significant erectile dysfunction and insufficient blood vessels verified by ultrasound. In most cases, implanting such a device alone will straighten the penis, correcting its rigidity. But when that does not work, the surgeon may manually “model” the organ, bending it against the plaque to break the deformity, or the surgeon may need to remove the plaque over the prosthesis and apply a graft to completely straighten the penis.

What can be expected after treatment for Peyronie’s disease?

Routinely, a light pressure dressing is applied for 24 to 48 hours after the surgery to prevent any accumulation of blood. The Foley catheter is removed after the patient recovers from anesthesia and most patients are discharged later the same day or the following morning. During the healing process, medications to counteract erections are usually prescribed. The patient is also asked to take antibiotics for seven to 10 days postoperatively to ward off infection, and analgesics for any discomfort. If patients have no penile pain or other complications, they can resume sexual intercourse in six to eight weeks.

Frequently asked questions:

What happens to the cells following penile trauma?

In theory, following any penile trauma, there is a release of growth factors and cytokines or daughter cells that activate fibroblasts, cells that produce connective tissue. They, in turn, cause abnormal collagen deposition or scarring, which damages the internal elastic framework of the penis. Similar wound-healing disorders are commonly seen in the practice of dermatology, with conditions such as keloids and hypertrophic scarring, both involving tissue overgrowth in wound healing.

Are Peyronie’s disease sufferers prone to other related conditions?

About 30 percent of Peyronie’s disease sufferers also develop other systemic fibrosis in other connective tissue in the body. Common sites are the hands and feet. In Dupuytren’s contracture, scarring or thickening of the fibrosis tissue in the palm leads progressively to a permanent bending of the pinkie and ring fingers into the hand. While the fibrosis occurring in both diseases is similar, it is not clear yet what causes either plaque type or why men with Peyronie’s disease are more likely to develop Dupuytren’s contracture.

Will Peyronie’s disease evolve into cancer?

No. There are no documented cases of progression of Peyronie’s disease to malignancy. However, if your doctor observes other findings that are not typical with this disease—such as external bleeding, obstructed urination, prolonged severe penile pain—he or she may elect to perform a biopsy on the tissue for pathological examination.

What should men remember about Peyronie’s disease?

Peyronie’s disease is a well-recognized but poorly understood urological condition. Interventions need to be individualized to each patient, based on the timing and severity of the disease. The objective of any treatment should be on reducing pain, normalizing penile anatomy so that intercourse is comfortable and restoring erectile function in patients who suffer erectile dysfunction. Although surgical correction is ultimately successful in the majority of cases, the early acute phase of this disease is customarily treated by either oral and/or intralesional approaches. As medical researchers continue to develop basic and clinical research for a better understanding of this disease, more therapies and targets for intervention will become available.

Erectile dysfunction (ED) is the inability of a man to attain and/or maintain an erection sufficient for sexual activity. Fortunately, most men who have ED only lose the ability to have satisfactory erections. In other words, for most of these men, penile sensation is normal and the ability to have an orgasm and ejaculate (The fluid that is expelled from a man’s penis during sexual climax (orgasm). To release semen from the penis during an orgasm.) remains. Today, there are several treatment options available to men suffering from this disorder. Lifestyle changes are the first line of treatment with weight loss, smoking cessation and exercise associated with improved erections. For most men, the initial medical treatment will be an oral medication such as sildenafil citrate. If this treatment is unsuccessful, second-line treatment options are ordinarily considered. These include using a vacuum erection device (A device used for treatment of impotence that features a pump that draws air from a plastic cylinder placed over the penis and creates a vacuum that allows increased blood flow to the penis which causes and erection.), intraurethral medication (Medication administered via the urethra, the tube that carries urine outside the body from the bladder.) or penile injection therapy (Treatment for impotence that utilizes a combination of drugs that are injected into the side of the penis. The drugs relax the muscles and increase blood flow to create an erection.). If these second-line treatments fail or if the patient and his partner reject them, then the third-line treatment option, penile prosthesis implantation, is considered.

What are penile prostheses?

Penile prostheses are devices that are implanted completely within the body. They produce an erection-like state that enables the man who has one of these implants to have normal sexual intercourse. Neither the operation to implant a prosthesis nor the device itself will interfere with sensation, orgasm, ejaculation or urination. What are the different types of penile prostheses?

There are two erection chambers (corpora cavernosa) in the penis. All penile prostheses have a pair of components that are implanted within both of these erection chambers. The simplest penile prostheses consist simply of paired flexible rods that are usually made of medical-grade silicone, and produce a degree of permanent penile rigidity or firmness that enables the man to have sexual intercourse. These devices are either malleable (Able to be shaped or bent.) or inflatable. A malleable rod prosthesis can be bent downward for urination or upward for intercourse. Inflatable penile prostheses are fluid-filled devices that can be inflated for erection. They are the most natural feeling of the penile implants, as they allow for control of rigidity and size.

The inflatable devices have fluid-filled cylinders that are implanted within the erection chambers. Tubing connects these cylinders to a pump that is implanted inside the scrotum (Also referred to as the scrotal sac. The sac of tissue that hangs below the penis and contains the testicles.), the sac that contains the testicles (Also known as testis. Either of the paired, egg-shaped glands contained in a pouch (scrotum) below the penis. They produce sperm and the male hormone testosterone.). In the simplest of these inflatable devices, the pump transfers a small amount of fluid into the cylinders for erection, which then transfers out of the cylinders when erection is no longer needed. These devices are often referred to as two-component penile prostheses. One component is the paired cylinders and the second component is the scrotal pump.

Three-component inflatable penile prostheses have paired cylinders, a scrotal pump and an abdominal fluid reservoir. With these three-component devices, a larger volume of fluid is pumped into the cylinders for erection and out of the cylinders when erection is no longer needed.

What does penile prosthesis implantation involve?

Penile prostheses are usually implanted under anesthesia. Usually one small surgical cut is made either above the penis where it joins the abdomen or under the penis where it joins the scrotum. No tissue is removed, blood loss is small and blood transfusion (The transfer of blood from a healthy donor into the bloodstream of somebody who has lost blood or has a blood disorder.) is almost never required. A patient will typically spend one night in the hospital.

Most men have pain after penile prosthesis implantation for about four weeks. Initially, oral narcotic pain medication is required and driving is prohibited. If men limit their physical activity while pain is present, it usually resolves sooner. Men can often be instructed in using the prosthesis for sexual activity one month after surgery, but if pain and tenderness are still present, this is sometimes delayed for another month.

What are the complications of penile prosthesis surgery?

Infection occurs in 1 to 5 percent of cases. This is a significant complication because in order to eliminate the infection, it is almost always necessary to remove the prosthesis. In 1 to 3 percent of cases, erosion (The wearing away of surface tissue by disease, ulceration, cancer or the chemical processes associated with inflammation.) occurs when some part of the prosthesis protrudes outside the body. Erosion often is associated with infection and removal of the device is frequently necessary.

Mechanical failure is more likely to occur with inflatable than with rod prostheses. The fluid present inside the inflatable prosthesis leaks into the body; however, these prostheses contain normal saline (Containing salt.) that is absorbed without harm. After mechanical failure, another operation for prosthesis replacement or repair is necessary if the man wants to remain sexually active. Today’s three-component inflatable penile prostheses have about a 10 to 15 percent likelihood of failure in the first five years following their implantation.

Frequently asked questions:

Is penile prosthesis implantation covered by insurance?

Although all third-party payers do not cover penile prosthesis implantation, most including Medicare do if the prosthesis is implanted to treat erectile dysfunction caused by an organic disorder.

Will a penile prosthesis interfere with urination?

It normally does not.

Generic name: Vardenafil
Brand names: Levitra

Levitra is an oral drug for male impotence, also known as erectile dysfunction (ED).

Levitra is a phosphodiesterase inhibitor. It works by helping to increase blood flow into the penis during sexual stimulation. This helps you to achieve and maintain an erection.

Levitra causes erections only during sexual excitement. It does not work in the absence of arousal and does not increase sexual desire.

Take one Levitra tablet about one hour before sexual activity, with or without food.

Take Levitra only before sexual activity, but no more than once a day. Do not take two doses at once.

Store Levitra at room temperature.

Do not take Levitra if you are also using a nitrate drug for chest pain or heart problems. Levitra with a nitrate medicine can cause a serious decrease in blood pressure, leading to fainting, stroke, or heart attack.

Levitra can decrease blood flow to the optic nerve of the eye, causing sudden vision loss. This has occurred in a small number of people taking Levitra, most of whom also had heart disease, diabetes, high blood pressure, high cholesterol, or certain pre-existing eye problems, and in those who smoke or are over 50 years old. It is not clear whether Levitra is the actual cause of vision loss.

Stop using Levitra and get emergency medical help if you have sudden vision loss.

Before taking Levitra, tell your doctor if you are allergic to any drugs, or you have:

• heart disease or heart rhythm problems;
• a recent history (in the past 6 months) of a heart attack, angina (chest pain), or congestive heart failure;
• a recent history of stroke or blood clots;
• a personal or family history of “Long QT syndrome”;
• high or low blood pressure;
• liver disease;
• kidney disease (or if you are on dialysis);
• a blood cell disorder such as sickle cell anemia, multiple myeloma, or leukemia;
• a bleeding disorder such as hemophilia;
• a stomach ulcer;
• retinitis pigmentosa (an inherited condition of the eye);
• a physical deformity of the penis (such as Peyronie’s disease); or
• if you have been told you should not have sexual intercourse for health reasons.

If you have any of these conditions, you may need a dose adjustment or special tests to safely take Levitra.

Seek emergency medical attention if you think you have used too much of Levitra. Overdose symptoms may include back pain, muscle pain, or vision problems.

Avoid drinking alcohol, which can increase some of the side effects of Levitra.

Grapefruit and grapefruit juice may interact with Levitra. Discuss the use of grapefruit products with your doctor. Do not increase or decrease the amount of grapefruit products in your diet without first talking to your doctor.

Do not use any other drug to treat impotence, such as alprostadil (Caverject, Muse, Edex) or yohimbine (Yocon, Yodoxin, others), unless your doctor tells you to.

Stop using Levitra and call your doctor at once if you have any of these serious side effects:

• sudden vision loss;
• ringing in your ears, or sudden hearing loss;
• chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling;
• irregular heartbeat;
• swelling in your hands, ankles, or feet;
• shortness of breath;
• vision changes;
• feeling light-headed, fainting; or
• penis erection that is painful or lasts 4 hours or longer.

Less serious side effects may include:

• warmth or redness in your face, neck, or chest;
• stuffy nose;
• headache;
• upset stomach; or
• back pain.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect.

Vardenafil is available with a prescription under the brand name Levitra.

You may buy/order Levitra (Vardenafil) online here.

Erectile dysfunction (ED) is a medical term that describes the inability to achieve and or maintain an erect penis adequate for sexual function. This condition is one of the most common sexual problems for men and the number of men suffering from ED increases with age. Approximately 25 million American men suffer from ED, although not all men are equally distressed by the problem.

What happens under normal conditions?

Achieving a normal erection is a complex process involving psychological impulses from the brain, adequate levels of the male sex hormone testosterone (Male hormone responsible for sexual desire and for regulating a number of body functions.), a functioning nervous system, and adequate and healthy vascular tissue in the penis. The simplest way to describe the process of erection is to think of a washing machine. The “on-off” switch (the brain) initiates the process; the wires in the washing machine (the nerves) carry the electrical signal to the pipes (the blood vessels), when an appropriate signal arrives a valve opens to allow water to flow in (the arteries carry blood into the penis) and the drain shuts (the penile veins close). Water flows in and fills the tank (the penis fills with blood and becomes erect) and the wash cycle begins (enjoys sexual activity). At the end of the wash cycle this process reverses, the switch goes to the off position (the brain terminates erection), the valve closes (the arteries markedly decrease blood inflow) and the drain opens draining the wash tank of water (the veins open, blood leaves the penis and erection subsides).

What are the risk factors for ED?

There are risk factors for the development of ED. As men age, the level of circulating testosterone decreases, which may interfere with normal erection. While a low testosterone level itself is rarely the cause of ED (5 percent or less), low testosterone can be an additional contributing factor in many men who have other risk factors for ED. Low levels of sexual desire, lack of energy, mood disturbances and depression can all be symptoms of low testosterone. A simple blood test can determine if the testosterone level is abnormally low, and testosterone can be replaced using a number of different delivery systems (e.g., shots, skin patches, gels, pills placed under the tongue).

What are some causes of ED?

By far, the most important cause of the development of ED is the presence of illnesses like high blood pressure, diabetes mellitus (A condition characterized by high blood sugar resulting from the body’s inability to use sugar (glucose) as it should. In type 1 diabetes, the pancreas is not able to make enough insulin; in type 2 diabetes, the body is resistant to using available insulin.), high cholesterol levels and cardiovascular disease. These processes, acting over time, can lead to a degeneration of the penile blood vessels, leading to restriction of blood inflow through the arteries and also to leakage of blood through the veins during erection.

The choices we make in life can lead to degeneration of the erectile tissue and the development of ED. Smoking, drug or alcohol abuse, particularly over a long period of time, will compromise the blood vessels of the penis. Lack of exercise and a sedentary lifestyle will contribute to the development of ED. Correction of these conditions will contribute to overall health and may in some individuals correct mild ED. Treatment of many medical conditions can interfere with normal erections. Drugs used to treat these risk factors listed above may also lead to or worsen ED. Patients undergoing surgery or radiation therapy for cancer of the prostate (In men, a walnut-shaped gland that surrounds the urethra at the neck of the bladder. The prostate supplies fluid that goes into semen.), bladder, colon (Large intestine.) or rectum (The lower part of the large intestine, ending in the anal opening.) are at high risk for the development of ED.

How is ED diagnosed?

For most patients, the diagnosis will require a simple medical history, physical examination and a few routine blood tests. Most patients do not require extensive testing before beginning treatment. The choice of testing and treatment depends on the goals of the individual. If erection returns with simple treatment like oral medication and the patient is satisfied, no further diagnosis and treatment are necessary. If the initial treatment response is inadequate or the patient is not satisfied,then further steps may be taken. In general, as more invasive treatment options are chosen, testing may be more complex.

What are some non-surgical treatments?

The first line of therapy for uncomplicated ED is use of oral medications known as phosphodiesterase-5 inhibitors (PDE-5)  - sildenafil citrate, vardenafil HCl or tadalafil. Men with ED take these pills before beginning sexual activity and the drugs boost the natural signals that are generated during sex, thereby improving and prolonging the erection itself. These medications are safe and fairly effective, with improvement in erection in nearly 80 percent of patients using these drugs. Early concerns about possible bad effects on the heart have not proven true; after extensive testing and five years of use, sildenafil citrate can be used safely by all heart patients except those using medications called nitrates because of an interaction between these two classes of drugs. The side effects of PDE-5 inhibitors are mild and usually transient, decreasing in intensity with continued use. The most common side effects are headache, stuffy nose, flushing and muscle aches. In rare cases, sildenafil can cause blue-green shading of vision due to high blood levels of sildenafil exerting a brief effect on the retina of the eye. This is of no long-term risk and is gone within a short time as the amount of sildenafil in the blood decreases. It is important to follow the instructions for using these medications in order to get the best results. Tests have shown that 40 percent of men who do not respond to sildenafil will respond when they receive proper instruction on medication use.

For men who do not respond to oral medications another drug, alprostadil, is approved for use in men with ED. This drug comes in two forms: injections that the patient places directly into the side of the penis and a transurethral suppository. Success rates with self-injection can reach 85 percent. Modifying alprostadil to allow transurethral delivery avoids the need for a shot, but reduces the effectiveness of the agent to 40 percent. The most common adverse effects of alprostadil use are a burning sensation in the penis and the risk of over correcting the problem, resulting in a prolonged erection lasting over four hours and requiring medical intervention to reverse the erection.

For men who cannot or do not wish to use drug therapy, an external vacuum device may be acceptable. This device combines a plastic cylinder or tube that slips over the penis, making a seal with the skin of the body. A pump on the opposite end of the cylinder creates a low-pressure vacuum around the erectile tissue, which results in an erection. To keep the erection once the plastic cylinder is removed a rubber constriction band goes around the base of the penis, which maintains the erection. With proper instruction 75 percent of men can achieve a functional erection using a vacuum erection device.

There are some men who have severe degeneration in the tissues of the penis, which makes them unable to respond to any of the treatments listed above. While this is a small number of men, they usually have the most severe forms of ED. Patients most likely to fall into this group are men with advanced diabetes, men who suffered from ED before undergoing surgical or radiation treatment for prostate or bladder cancer and men with deformities of the penis called Peyronie’s disease (A plaque (hardened area) that forms on the penis, preventing that area from stretching. During erection, the penis bends in the direction of the plaque, or the plaque may lead to indentation and shortening of the penis.). For these patients reconstructive prosthetic surgery (placement of a penile prosthesis or “implant”) will restore erection, with patient satisfaction rates approaching 90 percent. Surgical prosthetic placement normally can be performed in an outpatient setting or with one night of hospital observation. Possible adverse effects include infection of the prosthesis or mechanical failure of the device.

What can be expected after treatment?

All of the treatments above, with the exception of prosthetic reconstructive surgery, are temporary and meant for use on demand. The treatments compensate for but do not correct the underlying problem in the penis. So it is important to follow-up with your doctor and report on the success of the therapy. If your goals are not reached, if your erection is not of sufficient quality or duration and you are still distressed, you should explore the alternatives with your doctor. Because the medications used are not correcting the problems leading to ED, your response over time may not be what it once was. If such should occur again, have a repeat discussion with your physician about the remaining treatment options.

Frequently Asked Questions

How do I know my ED is not in my head?

Many years ago most men with ED were thought to have psychological problems. This was the result of our ignorance of the normal mechanism of erection and the causes of ED. We now realize that most men have underlying physical causes.

If I worry about my ability to get an erection can I make a bad condition worse?

Nothing happens in the body without the brain; worrying about your ability to get an erection can itself interfere with the process. This condition is called performance anxiety and can be overcome with education and treatment.

Can I combine treatment options?

This is often done but because of the risk of prolonged erections with drug therapy it should only be performed under physician supervision. Ask your doctor for proper instructions.

I was fine until I began taking this new drug, what should I do?

Many drugs can cause ED, but some cannot be changed because the benefits outweigh the adverse effects. If you are fairly certain that a specific drug has caused the problem, discuss the possibility of a medication change with your doctor. If you must remain on the specific medication causing the problem, the treatment options outlined above can still be used in most cases.

Generic name: Tadalafil
Brand names: Cialis

Cialis is an oral drug for male impotence, also known as erectile dysfunction (ED). It works by dilating blood vessels in the penis, allowing the inflow of blood needed for an erection. Cialis relaxes muscles and increases blood flow to particular areas of the body.

Cialis causes erections only during sexual excitement. It does not work in the absence of arousal and does not increase sexual desire.

Do not take Cialis if you are also using a nitrate drug for chest pain or heart problems. This includes nitroglycerin (Nitrostat, Nitrolingual, Nitro-Dur, Nitro-Bid, and others), isosorbide dinitrate (Dilatrate-SR, Isordil, Sorbitrate), and isosorbide mononitrate (Imdur, ISMO, Monoket). Nitrates are also found in some recreational drugs such as amyl nitrate or nitrite (“poppers”). Taking Cialis with a nitrate medicine can cause a serious decrease in blood pressure, leading to fainting, stroke, or heart attack.

Do not take Cialis more than once a day. Allow 24 hours to pass between doses.

Contact your doctor or seek emergency medical attention if your erection is painful or lasts longer than 4 hours. A prolonged erection (priapism) can damage the penis.

Cialis can decrease blood flow to the optic nerve of the eye, causing sudden vision loss. This has occurred in a small number of people taking Cialis, most of whom also had heart disease, diabetes, high blood pressure, high cholesterol, or certain pre-existing eye problems, and in those who smoke or are over 50 years old. It is not clear whether this medication is the actual cause of vision loss.

Before taking Cialis, tell your doctor if you are allergic to any drugs, or if you have:

• heart disease or heart rhythm problems;
• a recent history a heart attack (within the past 90 days);
• a recent history of stroke or congestive heart failure (within the past 6 months);
• angina (chest pain);
• high or low blood pressure;
• liver disease;
• kidney disease (or if you are on dialysis);
• a blood cell disorder such as sickle cell anemia, multiple myeloma, or leukemia;
• a bleeding disorder such as hemophilia;
• a stomach ulcer;
• retinitis pigmentosa (an inherited condition of the eye);
• a physical deformity of the penis (such as Peyronie’s disease); or
• if you have been told you should not have sexual intercourse for health reasons.

If you have any of these conditions, you may need a dose adjustment or special tests to safely take Cialis.

Take one Cialis tablet before sexual activity, with or without food. The best time to take Cialis depends on how and when the drug works for you, but some men are able to have an erection 30 minutes after taking it. Others are able to wait up to 36 hours after taking Cialis before engaging in sexual activity.

Take Cialis only before sexual activity, but no more than once a day. Do not take two doses at once.

Seek emergency medical attention if you think you have used too much of Cialis. Overdose symptoms may include chest pain, nausea, irregular heartbeat, and feeling light-headed or fainting.

Store Cialis at room temperature.

Avoid drinking alcohol, which can increase some of the side effects of Cialis.

Avoid using other medicines to treat impotence, such as alprostadil (Caverject, Muse, Edex) or yohimbine (Yocon, Yodoxin, others), without first talking to your doctor.

Stop using Cialis and call your doctor at once if you have any of these serious side effects:

• sudden vision loss;
• ringing in your ears, or sudden hearing loss;
• chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling;
• irregular heartbeat;
• swelling in your hands, ankles, or feet;
• shortness of breath;
• vision changes;
• feeling light-headed, fainting; or
• penis erection that is painful or lasts 4 hours or longer.

Less serious side effects may include:

• warmth or redness in your face, neck, or chest;
• stuffy nose;
• headache;
• upset stomach; or
• back pain.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect.

You may buy/order Cialis (Tadalafil) online here.

Infertility is a common yet complex problem affecting approximately 15 percent of couples attempting to conceive a baby. In up to 50 percent of couples having difficulty getting pregnant, the problem is at least in part related to male reproductive issues. It is essential that men be assessed to pinpoint the treatable or untreatable causes of this heartbreaking health issue. Fortunately, with today’s high-tech procedures and powerful drugs, a diagnosis of infertility may simply mean the road to parenthood may be challenging but not impossible. So read below to learn more about the available treatment options so you are better prepared when talking with your urologist and/or fertility specialist.

What happens under normal conditions?

Male fertility depends on the production of normal sperm (Also referred to as spermatozoa. Male germ cells (gametes or reproductive cells) that are produced by the testicles and that are capable of fertilizing the female partner’s eggs. Cells resemble tadpoles if seen by the naked eye.) and the delivery of it to a female partner’s vagina. The process begins with spermatogenesis, or the development of sperm in the testicles (Also known as testis. Either of the paired, egg-shaped glands contained in a pouch (scrotum) below the penis. They produce sperm and the male hormone testosterone.). Sperm cells (spermatozoa) are produced by a complicated process of cell division that occurs over a period of several months. Once formed, sperm leave the testicle and are stored in the epididymis (A coiled tube attached to the back and upper side of the testicle that stores sperm and is connected to the vas deferens) where they fully develop. They are then pushed through the vas deferens (Also referred to as vas. The cordlike structure that carries sperm from the testicle to the ejaculatory duct, whicn in turn carries it to the urethra.) and urethra (In males, this narrow tube carries urine from the bladder to the outside of the body and also serves as the channel through which semen is ejaculated. Extends from the bladder to the tip of the penis. In females, this short, narrow tube carries urine from the bladder to the outside of the body.) during ejaculation (Release of semen from the penis during sexual climax (orgasm).). The production and maturation of sperm require the presence of an intact genetic blueprint in addition to a favorable environment. In particular, the presence of adequate levels of the male hormone testosterone (Male hormone responsible for sexual desire and for regulating a number of body functions.) and a slightly decreased scrotal temperature are necessary.

What is male infertility?

Male infertility is any condition in which the man adversely affects the chances of initiating a pregnancy with his female partner. Most commonly, those problems arise when the man is unable to produce or deliver fully-functioning sperm.

What causes male infertility?

Your doctor will be interested in any factor, including possible structural and other defects in the reproductive system, hormonal deficiencies, illness or even trauma that might be impairing your fertility. Their investigation will center on many possible combinations of factors, the most common of which are:

Sperm disorders: Problems with the production and development of sperm are the most common problems of male infertility. Sperm may be underdeveloped, abnormally shaped or unable to move properly. Or, normal sperm may be produced in abnormally low numbers (oligospermia, low number of sperm in the ejaculate. ) or seemingly not at all (azoospermia, absence of sperm in the ejaculate fluid.).

Varicoceles: These dilated scrotal veins are present in 16 percent of all men but are more common in infertile men—40 percent. They impair sperm development by preventing proper drainage of blood. Varicoceles are easily discovered on physical examination since the veins feel distinctively like a bag of worms. They may also be enlarged and twisted enough to be visible in the scrotum (Also referred to as the scrotal sac. The sac of tissue that hangs below the penis and contains the testicles.). This is the most common correctable cause of male infertility.

Retrograde ejaculation: Retrograde ejaculation occurs when semen pushes backwards into the bladder instead of out the penis. This is caused by the failure of nerves and muscles in the bladder neck (Area of thickened muscle fiber where the bladder joins the urethra. Acting on signals from the brain, bladder neck muscles can either tighten to hold urine in the bladder or relax to allow urine out and into the urethra. These muscles also tighten during ejaculation to prevent backflow of semen into the bladder.) to close during orgasm. It is one of several difficulties couples may have delivering sperm to the vagina during intercourse. Retrograde ejaculation can be caused by previous surgery, medications or diseases affecting the nervous system. Signs of this condition may include cloudy urine after ejaculation and diminished or “dry” ejaculation with orgasm.

Immunologic infertility: Triggered by a man’s immunologic response to his own sperm, antibodies (Proteins that fight infections.) are usually the product of injury, surgery or infection. In attacking the sperm, they prevent normal movement and function of the sperm. Although researchers do not yet understand just exactly how antibodies damage fertility, they know that these antibodies can make it more difficult for sperm to swim to the uterus and penetrate eggs.

Obstruction: Blocking sperm from its normal passage, obstructions can be caused by a number of factors, such as repeated infections, prior surgery (including vasectomy), inflammation or development problems. Any portion of the male reproductive tract, such as the vas deferens or epididymis, can be obstructed, preventing normal transport of sperm from the testicles to the urethra, where it leaves the body during ejaculation.

Hormones: Hormones produced by the pituitary gland (The main endocrine gland. It is a small oval shaped structure in the head and it regulates growth, sexual maturing and metabolism.) are responsible for stimulating the testicles to make sperm. Therefore, when levels are severely low, poor sperm development can result.

Genetics: Genetics play a central role in fertility, particularly since sperm carry half of the DNA mix to the partner’s egg. Abnormalities in chromosomal numbers and structure as well as deletions on the important Y chromosome present in normal males can also impact fertility.

Medication: Certain medications can affect sperm production, function and ejaculation. Such medications are usually prescribed to treat conditions like arthritis, depression, digestive problems, infections, hypertension (High blood pressure, which can be caused either by too much fluid in the blood vessels or by the narrowing of blood vessels.) and even cancer.

How is male infertility diagnosed?

The process begins with a complete history and physical exam and is usually followed by blood work and semen analysis.

From a sample of semen routinely obtained through masturbation into a sterilized cup, the physician will be able to assess factors—volume, count, concentration, movement and structure of spermatozoa—that help or hinder conception.

Even if the semen analysis shows low sperm numbers, or even no sperm, it does not necessarily mean absolute infertility. Low values in any of the above categories may just indicate a problem with the development or delivery of sperm that simply requires further evaluation.

For instance, your physician may order a transrectal ultrasound (Also referred to as TRUS. This is a special kind of ultrasound test in which the sound waves are produced by a probe inserted into the rectum. In men, the structures most commonly examined with this test are the prostate, bladder, seminal vesicles and ejaculatory ducts.), an imaging test that places a probe into the rectum (The lower part of the large intestine, ending in the anal opening.) to beam high-frequency sound waves to nearby ejaculatory ducts (The passage through which semen enters the urethra.). This test can help your physician determine if these structures are either poorly developed or obstructed with cysts (An abnormal sac containing gas, fluid or a semisolid material. Cysts may form in kidneys or other parts of the body.), calcifications (Abnormal hardening or stiffening of a body part.) or other blockages.

A testicular biopsy (Removal of a sample of testicle tissue for laboratory examination.) comes into play when a semen analysis shows very low number of sperm or no sperm. This test is performed in an operating room under general or regional anesthesia through a small cut in the scrotum. It may also be done in a clinic using a needle inserted through skin over the testicle that has been anesthetized. In either case, a small piece of tissue is removed from each testicle for microscopic evaluation. The biopsy serves two purposes: to determine the cause of infertility, and, if necessary, to retrieve sperm for use in assisted reproduction.

Besides a semen analysis, your doctor may order a hormonal profile to discover the sperm-producing ability of your testicles and to rule out serious conditions. For instance, follicle-stimulating hormone (FSH) is the pituitary hormone responsible for stimulating testicles to produce sperm. High levels may indicate that the pituitary is trying to stimulate the testicles to make sperm though they are not responding.

How is male infertility treated?

The treatment for male infertility depends on the specific problem. In some severe cases, no treatment is available. However, many times there are a mix of medications, surgical approaches and assisted reproductive techniques (ART) available to overcome many of the underlying fertility problems. The options are:

Surgery: Minor outpatient surgery (varicocelectomy, the ligation (tying off) of a varicocele.) is frequently used to repair dilated scrotal veins (varicoceles, dilated varicose veins in the scrotum that drain the testis and can impair the process of formation of sperm.). Studies have shown that repairing these dilated veins results in improved sperm movement, concentration and structure. In some cases, obstruction causing infertility can also be surgically corrected. In the case of a previous vasectomy, surgery using an operating microscope has been found to be very successful in reversing the obstruction.

Medication: Drugs are key in correcting retrograde ejaculation and immunologic infertility. In addition, pituitary hormone deficiency may be corrected with drugs such as clomiphene or gonadotropin.

If these techniques fail, fertility specialists have a variety of other high-tech assisted reproductive techniques that promote conception without intercourse. Depending on your problem your physician may look to:

Intrauterine insemination (IUI): By placing sperm directly into the uterus via a catheter, IUI bypasses cervical mucus that may be hostile to the sperm and puts them close to the fallopian tubes (There are two fallopian tubes, one on each side of the uterus. They transport an egg from the ovary to the uterus.) where fertilization occurs. IUI is often successful in overcoming sperm count and movement problems, retrograde ejaculation, immunologic infertility and other causes of infertility.

In vitro fertilization (IVF): Refers to fertilization taking place outside the body in a laboratory Petri dish. There, the egg of a female partner or donor is joined with sperm. With IVF, the ovaries must be overly stimulated, usually with fertility drugs that allow retrieval of multiple mature eggs. After 48 to 72 hours of incubation, the fertilized egg (embryo) is inserted in the uterus and normal pregnancy should result. While IVF is employed mostly for women with obstructed fallopian tubes, it is occasionally used for men with oligospermia.

Intracytoplasmic sperm injection (ICSI): A variation of in vitro fertilization, this procedure has revolutionized treatment of severe male infertility, permitting couples previously thought infertile to conceive. It involves injecting a single sperm directly into the egg with a microscopic needle and then, once it is fertilized, transferring it to the female partner’s uterus. Your doctor is likely to use ICSI if you have very poor semen quality or lack of sperm in the semen caused by an obstruction or testicular failure. In some cases, sperm may be surgically extracted from the testicles or epididymis for this procedure.

Frequently asked questions:

What diseases can cause male factor infertility?

A variety of diseases—from kidney disease to testicular cancer—can result in male infertility. For instance, systemic conditions and metabolic disorders, along with ordinary fevers and infections, can impair the development of sperm. In addition, sexually transmitted diseases (Any of a diverse group of infections caused by biologically dissimilar pathogens and transmitted by sexual contact.) can lead to obstruction and scarring of the reproductive tract while genetic conditions, such as cystic fibrosis, may result in lack of sperm due to missing vas deferens or seminal vesicles. Since any number of illnesses can be a factor, it is essential that both you and your partner know and share your family and personal medical histories with your doctor.

Can cigarette smoke affect semen?

Yes. Research has shown that regular smoking impacts the sperm in a variety of ways. It decreases the size and movement of these cells and damages their DNA content. Smoking also can impact the seminal fluid, ejaculated with the sperm.

Can the use of steroids for body building cause infertility?

Yes. Steroids taken either by mouth or injection can shut down the production of hormones needed for sperm production.

Do abnormal semen analyses or sperm lead to children with birth defects?

Not necessarily. For the majority of couples seeking fertility treatment, the risk of conceiving a child with a birth defect is the same as the general population. Though, some disorders (especially genetic disorders) that cause infertility may also cause an increased risk of conceiving a child with birth defects. It is for this reason that couples need thorough evaluation and counseling prior to proceeding with some forms of assisted reproductive techniques.

What is the most important thing I should remember about male infertility?

Neither you nor your partner should be blamed for any problems you have with fertility. The American Society of Reproductive Medicine (ASRM) estimates that roughly one-third of infertility cases can be attributed to male factors, with another one-third due to women. In the remaining one-third of infertile couples, infertility is caused by either a combination of factors, or, in 20 percent of cases, is still unexplained. (In men, few or no sperm is the biggest problem; in women, the common problems are ovulation disorders and blocked tubes.) But today, physicians have the technology and surgical tools to address many of those problems.

Earlier this year a number of reports surfaced in the scientific literature suggesting that Viagra might be associated with a very dramatic and dangerous retinal condition, known as nonarteritic anterior ischemic optic neuropathy (NAION), which could lead to permanent blindness.

In typical “sky-is-falling” style, some news items trumpeted this possible relationship to make it appear that almost everyone who took Viagra was at risk for serious damage to their eyes. The reality is quite different.

Viagra and the other PDE5 inhibitors, Levitra and Cialis, work by selectively inhibiting the action of a specific enzyme, PDE5, found in all the body’s vascular tissues (blood vessels). To some extent, these drugs also selectively inhibit another enzyme in the same family, PDE6, which tends to be located in the rod and cone receptors in the eye.

This is the reason for occasional mild to moderate vision side effects in men taking a PDE5. These effects, such as blue-tinged vision, lights that appear too bright, blurry vision, and difficulties with color discrimination, are almost always mild and usually disappear rather quickly.

Careful studies in people with and without eye disease have shown repeatedly that Viagra does not permanently affect visual acuity (sharpness), fields of vision, or sensitivity to visual contrast.

Over several years, isolated case reports in the medical literature have indicated that NAION and other serious visual conditions have been associated with PDE5 treatment. These reports represent the experiences of a handful of the more than 27 million men who’ve taken a PDE5 drug. At least some of these reported cases may be due to the fact that men who suffer from ED also tend to have multiple risk factors for the vascular problems that make a person vulnerable to NAION.

To date, there is no compelling evidence that taking Viagra places anyone at increased risk for NAION or related conditions affecting the retina or other important structures of the eye. Once again, the real story on this complex subject is not as simple as some news headlines.

Erectile dysfunction (ED), or the inability to get an erection, is a complex condition with many possible causes. The cardiovascular system, specifically the thin layer of cells lining the blood vessels called the endothelium, is believed to play a major role in some cases of ED.

The presence of ED can often be one of the earliest signs of problems in endothelial function that may later progress to heart disease. In such cases of ED, the vascular endothelium loses its capacity to form nitric oxide, which is necessary to dilate the blood vessels in the penis that cause an erection.

If this hypothesis is correct, then a drug designed to treat this damaged vascular endothelium, such as a statin, should help men with ED who do not respond to treatment with Viagra.

One small but promising study involved men who previously failed treatment with Viagra alone. The men were given 80 mg daily of the statin Lipitor or a placebo. Both groups also received 100 mg tablets of Viagra to use for sexual purposes. After 12 weeks, the Viagra-plus-Lipitor group had statistically significant improvement in erectile function, while the placebo group showed no such improvement.

Although the number of men in the study was small, the results nonetheless are promising enough for the authors to call for larger trials to be done.