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Path: senator-bedfellow.mit.edu!bloom-beacon.mit.edu!news.kodak.com!news-nysernet-16.sprintlink.net!newsfeed.nysernet.net!news.nysernet.net!206.229.87.26!news-east.sprintlink.net!news-peer.sprintlink.net!news-backup-east.sprintlink.net!news-in-east.sprintlink.net!news.sprintlink.net!Sprint!207.217.77.43!newsfeed1.earthlink.net!news.alt.net!news.serv.net!drizzle.com!llama From: sine nomine <llama@drizzle.com> Newsgroups: news.answers,alt.answers Subject: Impotence FAQ Followup-To: alt.support.impotence Date: 9 Apr 1998 01:00:54 GMT Organization: llama central Lines: 862 Approved: news-answers-request@MIT.EDU Message-ID: <6gh9ef$ier$2@dns2.serv.net> NNTP-Posting-Host: slug.drizzle.com Summary: This posting contains the answers to frequently asked questions about the causes and treatments of impotence and about the Usenet newsgroup alt.support.impotence. Archive-name: medicine/impotence-faq Posting-Frequency: monthly Maintainer: llama@drizzle.com (sine nomine) Last-posted: 8 April 98 Last-modified: 8 April 98 URL: http://www.palace.net/~llama/asifaq.html Copyright: 1998, Deb Martinson X-Newsreader: TIN [UNIX 1.3 unoff BETA release 970202] Xref: senator-bedfellow.mit.edu news.answers:127394 alt.answers:33333 Subject: 1. General: ASI and Erectile Dysfunction ------------------------------------------------------------------------ 1.1 What is alt.support.impotence? 1.2 Can women post here? 1.3 What is ED? 1.4 I {can't have an orgasm, come too soon, have retrograde ejaculation, etc}; is this ED? 1.5 What causes ED? 1.6 What medications can cause ED? 1.7 When should I seek medical help? Who should I see? 1.8 What can I expect at the doctor's office? 1.9 I'd rather not seek treatment. Is my sex life over? 1.10 My ED has psychological roots. What are my options? 1.11 Won't a young fresh partner solve any problems with impotence? 1.12 I've got a really great sex machine/tape/phone service guaranteed to give you a hard-on. ------------------------------------------------------------------------ Subject: 2. Non-prescription Treatments ------------------------------------------------------------------------ 2.1 What is a cock ring? 2.2 How does a cock ring work? 2.3 Where can I get a cock ring? How much do they cost? 2.4 Are cock rings effective? 2.5 What are some herbal treatments? 2.6 How well do herbal treatments work? 2.7 What are penile sheaths? 2.8 How well do penile sheaths work? ------------------------------------------------------------------------ Subject: 3. Vacuum pumps ------------------------------------------------------------------------ 3.1 What is a vacuum pump? 3.2 How are pumps used? 3.3 Will my penis fall off if I use a vacuum pump and leave the ring on too long? 3.4 Can I urinate with the constriction ring on? 3.5 Why should I spend $400 for a prescription pump when I can get one at a sex shop for $50? ------------------------------------------------------------------------ Subject: 4. Injectables ------------------------------------------------------------------------ 4.1 What injectable medications are available? 4.2 What is bi-mix? Tri-mix? 4.3 Ouch! Won't it *hurt* to inject something into my penis? 4.4 Do injectables work? 4.5 What are the possible side effects of injectables? 4.6 How do I actually do the injection? 4.7 Should I be trying to inject into a vein or artery? 4.8 How long should I wait for my erection to subside before worrying? 4.9 Will injectables affect my partner? 4.10 What dosage should I take? 4.11 Can I raise the dosage myself? 4.12 Why are there daily/weekly limits on how often you can use injectables? 4.13 Do I have to use that huge syringe that came with my medication? How do I get other syringes? 4.14 Can I reuse syringes? 4.15 What are autoinjectors? Are they worth the money? 4.16 After only one injection, the bottle is still mostly full. Do I really have to throw it away? 4.17 What if I don't want to pay for kit syringes I never use? 4.18 Will testosterone treatment help me? ------------------------------------------------------------------------ Subject: 5. Suppositories ------------------------------------------------------------------------ 5.1 What is MUSE? 5.2 Does MUSE work? 5.3 What side effects does MUSE have? 5.4 Doesn't it hurt an awful lot to insert something in your urethra? 5.5 Can MUSE affect my partner? 5.6 MUSE is alprostadil, the same stuff as Caverject. Does that mean that if MUSE doesn't work for me, Caverject won't either? 5.7 Is it true that the makers of MUSE are being sued? ------------------------------------------------------------------------ Subject: 6. Oral medications ------------------------------------------------------------------------ 6.1 What oral medications are available? 6.2 Do oral meds work? 6.3 What are the dosage instructions for Viagra? 6.4 What drugs are harmful when taken with Viagra? 6.5 What side effects are possible? 6.6 How do I get oral meds? ------------------------------------------------------------------------ Subject: 7. Surgical measures ------------------------------------------------------------------------ 7.1 What are penile implants? 7.2 What other kinds of surgery are used to treat ED? ------------------------------------------------------------------------ Subject: 8. Resources ------------------------------------------------------------------------ 8.1 Finding information on the web 8.2 Where to obtain autoinjectors ========================================================= NOTE: This FAQ copyright Deb Martinson, 1998. All rights reserved. I am not a doctor or medical professional; this information comes from medical sources and consensus of opinion on alt.support.impotence. I am not responsible for the results of your following any of this advice. If you have ED, see your doctor. Subject: 1. General: ASI and Erectile Dysfunction ------------------------------------------------------------------------ 1.1 What is alt.support.impotence? alt.support.impotence is a Usenet newsgroup for discussion of issues related to impotence, also called erectile dysfunction (ED). 1.2 Can women post here? Well, the FAQ was begun by a woman. When women have posted seeking information to help their partners, the response has generally been favorable. See 1.9 and 1.10, though. 1.3 What is ED? Erectile Dysfunction is defined as difficulty achieving or maintaining an erection sufficient for penetrative intercourse. Approximately 20 million men have ED to some degree, ranging from complete inability to have an erection to occasional problems with erections. 1.4 I {can't have an orgasm, come too soon, have retrograde ejaculation, etc}; is this ED? NO. See 1.3 above. These sexual dysfunctions have different causes and cures and are not generally related to ED. 1.5 What causes ED? There are two broad classes of causes: organic and psychological. In many cases, both types of factors are present. Organic causes can generally be traced to nerve or vascular damage in the penis, or hormonal imbalance. Normally, when a male is sexually stimulated, several things happen: 1. The smooth muscle tissue inside the penis relaxes and the blood vessels dilate. 2. Blood flows into the erectile bodies of the penis (the corpora cavernosa). 3. The spaces in the corpora cavernosa become engorged with blood, and the penis swells, lengthens, and becomes rigid. The swelling exerts pressure on veins in the penis, trapping the blood inside. Anything that interferes with this process can cause ED. Specific conditions that increase risk for ED include diabetes mellitus, prostate surgery, hypogonadism, high blood pressure, vascular disease, multiple sclerosis, Peyronie's disease, priapism, renal failure, alcoholism, spinal injury, genital trauma, and stroke. Use of certain drugs, including tobacco, can also increase the likelihood of ED. Psychological causes can include depression, fears of inadequacy or other phobias, lack of confidence, lack of information about sexual functioning, and poor sexual technique. 1.6 What medications can cause ED? The most common culprits seem to be blood-pressure medications, tricyclic antidepressants, anxiolytics, antipsychotics, anti-parkinsonian drugs, antihistamines, and hormonal (such as thyroid) medications, but many drugs can interfere with erections. If you suspect that your ED is caused by a medication you're taking, check the side-effects listing in the Package Insert/Patient Information that came with the medication (you can get this from your pharmacist) and consult your doctor about switching to another type of medication. 1.7 When should I seek medical help? Who should I see? If you are consistently having problems achieving or maintaining an erection, you should definitely consult a doctor. You can see a general practitioner, but your best bet would be to consult a urologist, preferably one specializing in ED. For help finding a doctor, try local physician-referral services. If there's a university/teaching hospital in your area, they may have a urology/ED clinic. 1.8 What can I expect at the doctor's office? It varies greatly from patient to patient (and from doctor to doctor). At the least, your doctor will take a detailed medical history and perform a physical exam, including a rectal exam. One important question will be whether you usually wake up with erections; if you do, then it's likely your ED has a psychological cause; if you never do, your problem has organic causes. Usually extensive, complicated testing isn't necessary; for most causes of ED, the treatment options are the same. David L. Casey, a urologist who often posts to a.s.i, had this to say: "For 'goal-directed therapy' which means determining that erectile dysfunction exists, doing some tests to rule out possible concomitant illnesses, and treating the ED with a goal of sexual capability, it's not always necessary (IMHO) to do a bunch of fancy tests such as nocturnal penile testing, penile Doppler ultrasounds, cavernosometry/cavernosography, and the like because the same treatment plans are going to be offered regardless of the findings. The only people this probably doesn't apply to are the very young with absolutely NO medical problems who have a history of pelvic or penile trauma and may have a clearly discrete large vascular lesion, or high grade venous leak--the average man with ED probably needs none of this workup. ... Venous leak surgery and penile revascularization is only for highly select individuals with specific conditions." 1.9 I'd rather not seek treatment. Is my sex life over? Not necessarily. Many men with ED (for example, most diabetics) are capable of reaching orgasm without an erection. It is quite possible to satisfy your partner and yourself without becoming erect, but you may have to increase the amount of time you devote to manual and oral stimulation of your partner. You may find yourself becoming a more creative and versatile lover. 1.10 My ED has psychological roots. What are my options? The traditional treatment for psychogenic ED is talk or behavioral therapy, or a combination of the two. Some doctors are now treating psychogenic ED as if it were organic in nature, hoping that if a man can successfully achieve and maintain an erection a few times, it may give him the confidence to overcome psychologically-caused impotence. In fact, Viagra (an oral medication for ED) seems to have a better chance of working in cases of psychogenic ED. 1.11 Won't a young fresh partner solve any problems with impotence? If the nerves and vessels in the penis aren't working right or you're paralyzed by anxiety and fear of failure, it doesn't matter who your partner is. Impotence rarely has anything to do with sexual desire (although in cases of partial ED, strong stimulation may increase the degree of erection present). 1.12 I've got a really great sex machine/tape/phone service guaranteed to give you a hard-on. That's nice; why don't you go play with it now? The people on this newsgroup aren't here because they can't get horny -- they're here because they can't get hard. You, on the other hand, seem to be here because you can't get a clue. ========================================================= Subject: 2. Non-prescription Treatments ------------------------------------------------------------------------ 2.1 What is a cock ring? A cock ring is a strap or ring that fits behind the scrotum around the base of the penis. (Some rings just fit around the base of the shaft, such as the ones that come with pumps.) It keeps blood from flowing back out of the penis, keeping it hard longer. They vary from simple rubber rings to straps that fasten with a snap or Velcro to truly complex leather systems of straps and rings that are used more for bondage than for ED. There is also a prescription constriction band called Actis that has a slide closure. 2.2 How does a cock ring work? It constricts the base of the penis, preventing blood from flowing back out of the corpora cavernosa. If you filled a water balloon with water until it was rigid and then just let go of it, the water would leak back out and the balloon would collapse. If you fill the balloon and then fasten a rubber band around the base, the water stays in and the balloon stays rigid. Cock rings work on the same principle as the rubber band. 2.3 Where can I get a cock ring? How much do they cost? Just about any shop or catalog that sells sex toys should have them. I've seen them ranging in price from about $5-10US for a basic model to as much as $100US for the complicated bondage gear. Some people use rubber O-rings from auto-supply or hardware stores, and Vivus (the company that makes MUSE) makes a constriction ring they call Actis. Actis is fairly expensive and requires a prescription. 2.4 Are cock rings effective? Maybe. If you can't get any sort of erection at all, then no. If you can get a partial erection, then a cock ring can help you maintain it and maybe help you get a little harder. If you can get fully erect but lose the erection (usually due to venous leakage), a cock ring may solve your problem. 2.4 What are some herbal treatments? Among the herbs used for this are yohimbine, gingko biloba (to increase blood flow), ginseng, pygeum, and muira puama. 2.5 How well do herbal treatments work? It varies. The only studies I know of have been on yohimbine, and they found that it works about 15-20% of the time, usually on psychogenic ED. 2.6 What are penile sheaths? A penile sheath or prosthesis is a rigid or semi-rigid support put over the penis to support it for intercourse. The support is placed on top of the penis and anchored behind the scrotum with a loose rubber band. A condom is then put on over the penis and prosthesis. One popular sheath is made by Condex. 2.7 How well do penile sheaths work? Some people say they help a great deal; others complain of reduced sensation. You might see if you can try one out and decide whether you like it before you buy. ========================================================= Subject: 3. Vacuum pumps ------------------------------------------------------------------------ 3.1 What is a vacuum pump? A vacuum pump is a mechanical or electrical device. The penis is inserted into a cylinder, vacuum is applied to draw blood into the penis, and a constriction ring is placed around the base of the penis to keep the blood from escaping. 3.2 How effective are pumps? They seem to work for most people. Common complaints are lack of spontaneity and the hassle of messing with the equipment. A few men find that pumps don't produce an erection that's as hard as they'd like. Also, applying vacuum too quickly can result in pinpoint hemorrhages or bruising. Some complain that the constriction rings inhibit ejaculation. 3.3 Will my penis fall off if I use a vacuum pump and leave the ring on too long? The manufacturers recommend leaving the ring on no more than 30 minutes, but posters to the group have reported leaving rings on for much longer with no problems. Osbon, a major pump manufacturer, says they have no reports of serious side effects from pump use (losing your penis would be a serious side effect). The rule here seems to be: don't be stupid. If you notice a loss of sensation in your penis, take the ring off immediately. 3.4 Can I urinate with the constriction ring on? Sure, though you might want to urinate before putting the ring on in any case. 3.5 Why should I spend $400 for a prescription pump when I can get one at a sex shop for $50? Insurance coverage, for starters. It's likely that your insurance will cover part or all of the cost of a prescription pump (Medicare, for example, covers them). Also, prescription pumps tend to be better-built, to work better, and to come from companies with superior customer service reputations. According to Medic Discount Drugstores of Cleveland, Osbon's Erec-Aid system can now be obtained without a prescription (though insurance carriers may still require one in order to reimburse you). ========================================================= Subject: 4. Injectables ------------------------------------------------------------------------ 4.1 What injectable medications are available? Three injectable drugs are used, alone or in combination, to treat ED: Prostaglandin E1 (PGE1 -- generic name of injectable is Alprostadil; brand names are Caverject, Edex), Phentolamine, and Papaverine. The only drug approved by the US Food and Drug Administration for injection treatment of ED is alprostadil, although phentolamine and papaverine are approved as vasodilators for treatment of cardiac arrhythmia and vascular disorders. These drugs are injected directly into the corpora cavernosa, where they cause the smooth-muscle relaxation and blood-vessel dilation that are necessary for an erection. A new preparation, Invicorp, is in the process of gaining approval in the UK and Europe. Invicorp combines vasoactive intestinal polypeptide (VIP) (a vasodilator) with phentolamine. 4.2 What is bi-mix? Tri-mix? Bi-mix, also called PP, is a mixture of the two vasodilators phentolamine and papaverine. Tri-mix or PPP is bi-mix with prostaglandin E1 added. Some people report that bi- and tri-mixes work where alprostadil (PGE1) alone fails. You will likely have to have your pharmacist compound PP or PPP for you. 4.3 Ouch! Won't it *hurt* to inject something into my penis? It may hurt a little, but there are things you can do to reduce the pain. Some people report that using an autoinjector helps, and it also helps a great deal to use a 29- or 30-gauge insulin syringe instead of the largish syringe that often comes with the medication (use the large syringe to inject diluent into the powder, then use the insulin syringe to draw the fluid out of the bottle and inject it into the penis). Most of those for whom injectables work say the minor pain is worth it. 4.4 Do injectables work? In about 70-80% of cases, yes. You will achieve an erection within 5-20 minutes of injection. If it seems as though the medication is not working, try varying the dose. Sometimes a smaller dose works better than a larger one; there's a great deal of individual variation. Also check your injection technique with your doctor. Sometimes rolling the penis between the palms after injection helps distribute the medication and promotes erection. Finally, if one injectable doesn't seem to work, try another. PP and PPP may work where PGE1 alone fails. 4.5 What are the possible side effects of injectables? The most common side effect is mild to moderate pain after injection (although in the approval studies for Caverject, only 3% of participants dropped out because of this). Priapism, an erection that will not go away after more than six hours, is a fairly rare side effect and may be dose-related. If you experience, this, it's essential that you contact a doctor immediately. Read Jerry's post about a seven-hour erection if you think priapism is no big deal. Prolonged use of injectables may result in scarring, but as of yet there isn't enough data to determine what the risk factors for this are. 4.6 How do I actually do the injection? Your urologist should show you, but a few important points to note: * Injecting further toward the tip of the penis (generally not more than 3/4 the length away from the body, though) can help make sure the medication stays in the cavernosa longer. * It can also help to use your hand or a cock ring to get a tourniquet effect at the base of the penis. Leave the tourniquet in place for a few minutes. * After injecting, gently massage the penis to distribute the medication evenly. * Try to have the needle at a 90-degree angle to the penis when injecting. If you miss the cavernosum, not much is going to happen. 4.7 Should I be trying to inject into a vein or artery? Definitely not. For the medication to work, it needs to be in the spongy bodies along the sides of the penis, the corpora cavernosa. The precise reason most doctors recommend that you inject on the side of the penis is that injecting on the top makes hitting veins, arteries, or nerves more likely. Injecting on the bottom puts you in danger of injecting into the urethra, will which mean the shot is more or less wasted. 4.8 How long should I wait for my erection to subside before worrying? If an erection lasts more than four hours, contact your doctor or the emergency room (My partner's urologist said, "If it's hard as a table after four hours, call."). Priapism can be incredibly painful (see the seven-hour erection story) and can lead to permanent loss of penile function. 4.9 Will injectables affect my partner? There is no physical effect on your partner. The medicine is injected directly into one of the cavernosa and does not come in contact with your partner's body. 4.10 What dosage should I take? This varies greatly from person to person. The best way to find out is to consult a urologist. You generally will do at least one test injection in the doctor's office; the results of that will lead your doctor to recommend that dose or a higher or lower one. 4.11 Can I raise the dosage myself? Many people do this. The best approach would seem to be to change doses slowly and watch for side effects. Given that the most painful side effects are dose-related, it makes sense to be very very cautious about changing dosages without input from your doctor. Some people have found that a lower dose works better for them than a higher dose. 4.12 Why are there daily/weekly limits on how often you can use injectables? Good question. No one seems to be quite sure; several people on the newsgroup report using injectables more frequently than recommended without any side effects. The most likely reason for the limits has to do with US FDA regulations: unlike individual physicians, drug companies can *only* recommend usages that are approved by the FDA, and the only usages/dosages approved by the FDA are the ones the company has submitted studies on. So the weekly limits reflect the actual usages of study participants. 4.13 Do I have to use that huge syringe that came with my medication? NO! Almost everyone on the newsgroup using injectables tosses those syringes in favor of thinner, more comfortable insulin syringes. Proper technique (injecting at right angles to the penis and being sure that you're injecting directly into the cavernosa) are what you should be concerned with. The type of syringe doesn't seem to be a factor. Save yourself some pain and buy a box of 29 or 30 gauge insulin syringes. They're usually available over the counter in pharmacies, but in some locations you may need a doctor's prescription; the children with Diabetes web site maintains a summary of syringe prescription laws at http://www.castleweb.com/diabetes/d_09_700.htm 4.14 Can I reuse syringes? Well, yes, *but*... syringes are pretty cheap. Reusing them presents a minor risk of infection and a much larger risk of pain -- repeated use dulls the needle and removes the special lubricated coating from the metal.You could also be introducing bacteria into the vial. If you're desperate and don't mind the extra pain, you can probably get away with reusing a needle. Syringes are cheap and fairly easy to obtain, though; reusing them consistently doesn't make a lot of sense. 4.15 What are autoinjectors? Are they worth the money? An autoinjector is a device that makes injecting medication easier. One poster to a.s.i. said, "[After a filled syringe is loaded into it,] the autoinjector is placed against the penis, a push button is pressed, and the autoinjector quickly and painlessly inserts the needle to the correct depth. The point of the autoinjector is to precisely control the penetration force, speed, and depth. Once the needle is in [the penis], the user manually depresses the plunger to administer the drug. . . . I tried one out last week (on my abdomen first, didn't trust it for my penis without a test) and I swear I did not feel a thing! I slowly withdrew the needle, watching in disbelief to verify that the needle had actually penetrated." Several people who have used the devices say they make it very easy to obtain the correct angle of insertion and make the injections virtually painless. See the resources section for more information on obtaining autoinjectors. 4.16 After only one injection, the bottle is still mostly full. Do I really have to throw it away? According to most urologists, no. Once mixed, injectable solutions will remain effective for 72 hours without refrigeration and three weeks with. Keep the bottle clean and refrigerated, and wipe the rubber stopper with an alcohol pad before drawing a new injection from that bottle. 4.17 What if I don't want to pay for kit syringes I never use? You can purchase PGE1 or various mixes without syringes. Consult your pharmacists to find out what you should use to reconstitute the mix (for example, you can buy Edex without syringes, but you also need to buy sterile saline solution or bacteriostatic water for mixing it. You can generally get diluent at the same pharmacy where you get the medication. 4.18 Will testosterone treatment help me? Probably not. Only about 3% of cases of ED are helped by testosterone injections, mostly because most men with erectile difficulties don't have testosterone deficiencies. Adding hormones only helps if you're got hormonal imbalances, which are fairly rare, to begin with. If you do have a testosterone deficiency, you will likely be given shots or transdermal patches. The risks of testosterone replacement therapy far outweigh the benefits in men who have or have had breast or prostate cancer, and it is not prescribed for them. ========================================================= Subject: 5. Suppositories ------------------------------------------------------------------------ 5.1 What is MUSE? MUSE (Medicated Urethral Suppository for Erection) is a small pellet of alprostadil (PGE1, the active ingredient in Caverject) and a plastic device for placing it in the urethra. Unlike injectables, MUSE comes in only four set doses (125 mcg, 250 mcg, 500 mcg, and 1000 mcg) -- you can't adjust your dose beyond that. 5.2 Does MUSE work? Theoretically, but most of the men on the newsgroup who've tried it report a great deal of pain and little or no improvement in erectile function (their descriptions of the pain make me wince, and I don't even have a penis). The MUSE package insert indicates that significant penile pain was reported by 36% of men in their studies, urethral pain by 13%, and testicular pain by 5%. Seven percent of the study group dropped out because of pain. Still, if you absolutely do not want to use needles, MUSE may be an option. 5.3 What side effects does MUSE have? Pain in the penis, urethra, testes and pelvic area, as well as slight urethral bleeding. Rarer but possible are priapism, lightheadedness, and rapid pulse. 5.4 Doesn't it hurt an awful lot to insert something in your urethra? Apparently, application of the drug doesn't hurt as much as the drug itself can. You lubricate the urethra by urinating, then place the tip of the plastic applicator about an inch into your urethra and push a button on the part of the applicator that's in your hand. 5.5 Can MUSE affect my partner? Yes. I couldn't find any information about male partners, but female partners of MUSE users reported vaginal itching and burning. It seems as though the drug can be transmitted during sexual intercourse or oral sex, and use of a condom is recommended. 5.6 MUSE is alprostadil, the same stuff as Caverject. Does that mean that if MUSE doesn't work for me, Caverject won't either? No. It appears as though the problem with MUSE isn't so much the efficacy of the medication as the way it is delivered. Transurethral delivery appears to be ineffective in most men. 5.7 Is it true that the makers of MUSE are being sued? Yes. A class-action lawsuit has been filed against Vivus by a group of investors who say that Vivus made inflated claims about the success rate of MUSE and thus misled them into investing in Vivus stock. ========================================================= Subject: 6. Oral medications ------------------------------------------------------------------------ 6.1 What oral medications are available? The only one currently approved by the US FDA for treatment of ED is Viagra (sildenafil). It works by inhibiting an enzyme in the penis and allowing cyclic guanosine monophosphate (a chemical produced during sexual stimulation) to stay around longer. The longer GMP is around, the more time there is for blood to flow into the penis and the better chance you have of getting an erection. Vasomax (an oral version of phentolamine, a vasodilator used for injection therapy) is being explored as an oral treatment for ED, as is apomorphine. Vasomax causes smooth muscle relaxation and blood vessel dilation, and apomorphine, taken by dissolving a tablet under the tongue, apparently affects neurotransmitters and stimulates the brain to cause erections. Yohimbine, an herbal medicine, is available by prescription in a standardized form. It isn't clear how it works. 6.2 Do oral meds work? Viagra has reported success rates between 65-88% overall, as opposed to 39% for placebo. Pfizer reports that patients who kept sexual activity diaries in their studies reported an average of 2.0 attempts/week at intercourse, and 1.3 successes/week (as opposed to 0.3 successes/week for placebo). However, the American Urology Association has expressed concerns that it may not work as well in men whose ED has organic causes. In the package insert, Pfizer gives these figures from their studies: Cause % Successful attempts % reporting erection (from diary) improvement overall Diabetes 48 57 Spinal-cord injury 59 83 Radical prostatectomy NA 43 Overall 84 70 Success rates of about 40% have been reported for Vasomax, and apomorphine has been successful in about 70% of cases. Yohimbine works in 15-20% of patients. Unlike the other drugs, which are taken around 30 minutes before an erection is desired, yohimbine must be taken three times daily and ED can return when it is stopped. 6.3 What are the dosage instructions for Viagra? Pfizer recommends that you take 50 mg of Viagra anywhere from 4 hour to 30 minutes before an erection is desired, with one hour being the suggested optimal time. Dose can be raised to 100 mg if 50 mg is not effective. You do not have to take Viagra on an empty stomach. There appears to be no interaction between Viagra and alcohol, either. 6.4 What drugs are harmful when taken with Viagra? Viagra taken with organic nitrates (like nitroglycerin tablets) can cause dangerously low blood pressure. Check with your doctor about any medications you may be taking. 6.5 What side effects are possible? In trials, Viagra caused headaches (16%), flushing (10%), indigestion (7%), nasal congestion (4%), urinary tract infection (3%), abnormal vision (3%), diarrhea (3%), and dizziness (1%). Vasomax can cause stuffy nose and lightheadedness due to low blood pressure. Apomorphine can cause lightheadedness, fatigue, and nausea. Yohimbine can cause headaches, sweaty palms, dizziness, and nausea. 6.6 How do I get oral meds? Right now, the only oral medication available outside of clinical trials is Viagra (although you might get a doctor to prescribe Vasomax; it's been approved for indications other than ED). Viagra was approved in the US sometime in late March 1998 and should be available in drugstores by the end of April; apomorphine is expected to be approved sometime in 1999. Vasomax has not yet been submitted for FDA approval but is expected to be in time for a 1998 approval. Yohimbine is available by prescription and in health-food stores; it's very hard to be sure of the strength or potency of over-the-counter yohimbine, though. ========================================================= Subject: 7. Surgical measures ------------------------------------------------------------------------ 7.1 What are penile implants? There are three sorts of implants: semi-rigid rods, multi-component inflatables, and self-contained inflatables. The simplest of these, semi-rigid rods, consists of a pair of flexible rods that are implanted in the penis. The penis is always erect; most of the time it is bent down, but when intercourse is desired it is straightened out. It can be hard to hide the always-erect penis under clothing. Multi-component and self-contained inflatables both have three parts: inflatable cylinders, fluid reservoir, and pump. In multi-component implants, the pump goes in the scrotum, the cylinders go in the penis, and the reservoir is in either the abdomen or the scrotum. To have an erection, you squeeze the pump in your scrotum until the cylinders fill; to end the erection, you squeeze a release valve. Self-contained inflatables have all the parts in one unit; erection is achieved by squeezing the head of the penis and released by bending the penis. Implant surgery is not reversible and should be considered only as a last resort. 7.2 What other kinds of surgery are used to treat ED? Vascular surgery can be used to correct blood-vessel problems that hinder erectile function. It is similar to heart bypass surgery, but most men are not candidates for this procedure. Surgery can be done to ligate (tie off) veins that cause venous leak, but this operation does not produce permanent results and has to be redone every few years. ========================================================= Subject: 8. Resources ------------------------------------------------------------------------ 8.1 Finding information on the web Many websites have a great deal of information on ED. A few that were especially helpful in writing this FAQ or have been recommended to me by readers of the newsgroup: United States National Institutes of Health statement on impotence http://text.nlm.nih.gov/nih/cdc/www/91txt.html General information on prescription drugs (PDR-type format) http://www.rxlist.com/ Osbon Foundation http://www.impotence.org/ Obson vacuum device http://www.osbon.com Edex http://www.impotence-info.com/ Caverject http://www.impotent.com/ MUSE and the Actis constriction band http://www.vivus.com/ Viagra Patient Information http://www.viagra.com Invicorp http://www.senetekplc.com Condex http://home.global.co.za/~condex/ ED Research link page http://www.pslgroup.com/ERECTILE.HTM Very good article on oral medications http://www.medscape.com/IMNG/ClinPsychNews/1998/V26.n01/cpn2601.28.02.html American Foundation for Urologic Disease http://www.iiem.org Dr. David L. Casey's home page http://www.wp.com/dlcasey/urology/homeuro.htm The Pill Box Pharmacy's Viagra FAQ http://www.thepillbox.com/frames/viagra.htm Med Help International urology forum (Q&A with urologists) http://www.medhelp.org/perl6/urology/index.htm Medic Drug Impotence Resource Center http://www.medic-drug.com/impotence/impotence.html Northeast Florida Potency Restoration Center (some good info) http://www.impotency.com/ Urology Associates of Kingsport -- "learning quizzes" on urological topics http://www.urologyassociates.com/ Diagnostic Center for Men http://www.for-men.com/impotent.html Information on and drawings of cock rings http://www.babeland.com/cockrings.html 8.2 Where to obtain autoinjectors Several companies make them: Autojector by Ulster Scientific (about $30US) 800-431-8233 Becton-Dickinson (about $18US) 800-344-2557 Instaject (about $50US) Jordan Medical Enterprises 800-541-1193 Ject-Aid Injectec Inc. 11278 Los Alamitos Blvd, Ste 202 Los Alamitos, CA 90720 PenInject 2.25 Pharmacia & Upjohn 800-487-5646 800-795-8451 (Caverject user-support materials) -- sine | deb http://www.palace.net/~llama