Ups and Downs
We all have skeletons in our closets. To be human is to err. In a society, however, where appearances, not substance, bankroll a service economy that has long forgotten how to produce anything, where little white lies trigger feeding frenzies, and where the gender gap is rapidly closing, nothing rattles the bones more than perceived or real weakness, whether it be mental or physical. Every man likes to think of himself as king of his homestead, a veritable Don Juan behind four walls, and pharmaceutical companies have entered the profitable arena of male sexuality by dominating the air waves with small, magical orbs that even James Bond would be remiss to leave home without. It matters little whether martinis are shaken or stirred, as long as they are served in the company of friends who go by the colorful and exotic names of Cialis, Levitra, and Viagra. Without making light of male impotence and erectile dysfunction (ED), which can be extremely debilitating and demoralizing, their drug remedies sound more like sheiks of Araby than therapeutic aids.
So, let us embark on a quest for the truth, and perhaps we can either verify or debunk some of the so-called miracles attributed to these pills, while at the same time clarifying their indications, contraindications, mechanisms of action, and side effects. Having said that, the authors concede that boys will be boys, no matter what their ages, and we take no responsibility for creating mountains out of mole hills, or for uncaging sexual tyranosauri.
ED, by definition, is the repeated inability to achieve an erection firm enough for sexual intercourse. The term is often confused with “impotence,” which describes not only erectile issues, but also problems with sexual desire, ejaculation, or orgasm. Now, although we are not proverbial encyclopedias on the matter, we certainly know that it takes two to tango. Unfortunately, fifteen to thirty million American women are forced to dance alone, because for every 1,000 men in the U.S., 22.3 have plumbing problems that preclude dancing lessons. The numbers have increased threefold over the last ten years, and pharmaceutical companies saw a lucrative market back in 1998, when sidenafil citrate (Viagra) was first introduced. Since then, the triumvirate of Cialis, Levitra, and Viagra have rivaled Coca Cola and Budweiser as household names. After all, can a Coke cure the 5% of 40-year-old men and the 15-25% of 65-year-old men who experience ED, which, contrary to popular opinion, is not an inevitable part of the aging process?
Please excuse the pun, but let’s get to the bottom of this. Two chambers in the penis, called the corpora cavernosa and filled with smooth muscles, fibrous tissue, spaces, veins, and arteries, are the culprits. When blood is prevented from flowing into the corpora cavernosa, it takes no Isaac Newton to realize that whatever goes up must come down. Diseases such as diabetes, kidney disease, chronic alcoholism, multiple sclerosis, vascular diseases, and neurologic disease, which cause damage to the structures of the corpora cavernosa, are the perpetrators of the majority of cases of ED. Tight control of blood sugar levels will go far to reverse or check the progression of ED in the 35-50% of diabetic men who have long ago given up “dating” the former prom queen, if you know what we mean. For them and others, smoking cessation, weight control, and regular exercise can also help.
While common medicines (blood pressure drugs, antihistamines, antidepressants, tranquilizers, appetite suppressants, and ulcer drugs), stress, anxiety, guilt, depression, and low self-esteem can also contribute to our ups and downs, the medical arsenal of cures and remedies are no less colorful and varied, ranging from psychotherapy to oral and locally injectable drugs, vacuum devices, surgically implanted devices, and vascular surgery. Some of these therapies are more suited to torture chambers, haunted houses, and Vincent Price than medical science.
We will restrict ourselves here, for purposes of brevity, to oral drug therapy, and, although we would have liked to volunteer as guinea pigs and testers, we must rely instead on second-hand information. Cialis, Levitra, and Viagra are what we call phosphodiesterase inhibitors. They are prescribed by physicians, who must adjust their doses from 25 mg to 100 mg per day, are taken no more than once a day, and are administered one hour before sexual activity. Improving the response to sexual stimulation by relaxing smooth muscle in the corpora cavernosa, they allow increased blood flow to the penis. Side effects include aching in the penis, warmth or a burning sensation in the urethra, redness of the penis due to increased blood flow, minor urethral bleeding, and a wealth of factual and fictional horror stories. The independent and unbiased users we surveyed complained of drug-associated headaches, stomachaches, tunnel vision, burst blood vessels and bloodshot eyes, and anxiety, while nonetheless enthusiastically touting the beneficial effects of oral drug therapy with an end justifies the means philosophy.
So, let the buyer beware! Opening Pandora’s box can lead to much more than simple ups and downs.
© 2006, Albert M. Balesh, M.D. All rights reserved.
So, let us embark on a quest for the truth, and perhaps we can either verify or debunk some of the so-called miracles attributed to these pills, while at the same time clarifying their indications, contraindications, mechanisms of action, and side effects. Having said that, the authors concede that boys will be boys, no matter what their ages, and we take no responsibility for creating mountains out of mole hills, or for uncaging sexual tyranosauri.
ED, by definition, is the repeated inability to achieve an erection firm enough for sexual intercourse. The term is often confused with “impotence,” which describes not only erectile issues, but also problems with sexual desire, ejaculation, or orgasm. Now, although we are not proverbial encyclopedias on the matter, we certainly know that it takes two to tango. Unfortunately, fifteen to thirty million American women are forced to dance alone, because for every 1,000 men in the U.S., 22.3 have plumbing problems that preclude dancing lessons. The numbers have increased threefold over the last ten years, and pharmaceutical companies saw a lucrative market back in 1998, when sidenafil citrate (Viagra) was first introduced. Since then, the triumvirate of Cialis, Levitra, and Viagra have rivaled Coca Cola and Budweiser as household names. After all, can a Coke cure the 5% of 40-year-old men and the 15-25% of 65-year-old men who experience ED, which, contrary to popular opinion, is not an inevitable part of the aging process?
Please excuse the pun, but let’s get to the bottom of this. Two chambers in the penis, called the corpora cavernosa and filled with smooth muscles, fibrous tissue, spaces, veins, and arteries, are the culprits. When blood is prevented from flowing into the corpora cavernosa, it takes no Isaac Newton to realize that whatever goes up must come down. Diseases such as diabetes, kidney disease, chronic alcoholism, multiple sclerosis, vascular diseases, and neurologic disease, which cause damage to the structures of the corpora cavernosa, are the perpetrators of the majority of cases of ED. Tight control of blood sugar levels will go far to reverse or check the progression of ED in the 35-50% of diabetic men who have long ago given up “dating” the former prom queen, if you know what we mean. For them and others, smoking cessation, weight control, and regular exercise can also help.
While common medicines (blood pressure drugs, antihistamines, antidepressants, tranquilizers, appetite suppressants, and ulcer drugs), stress, anxiety, guilt, depression, and low self-esteem can also contribute to our ups and downs, the medical arsenal of cures and remedies are no less colorful and varied, ranging from psychotherapy to oral and locally injectable drugs, vacuum devices, surgically implanted devices, and vascular surgery. Some of these therapies are more suited to torture chambers, haunted houses, and Vincent Price than medical science.
We will restrict ourselves here, for purposes of brevity, to oral drug therapy, and, although we would have liked to volunteer as guinea pigs and testers, we must rely instead on second-hand information. Cialis, Levitra, and Viagra are what we call phosphodiesterase inhibitors. They are prescribed by physicians, who must adjust their doses from 25 mg to 100 mg per day, are taken no more than once a day, and are administered one hour before sexual activity. Improving the response to sexual stimulation by relaxing smooth muscle in the corpora cavernosa, they allow increased blood flow to the penis. Side effects include aching in the penis, warmth or a burning sensation in the urethra, redness of the penis due to increased blood flow, minor urethral bleeding, and a wealth of factual and fictional horror stories. The independent and unbiased users we surveyed complained of drug-associated headaches, stomachaches, tunnel vision, burst blood vessels and bloodshot eyes, and anxiety, while nonetheless enthusiastically touting the beneficial effects of oral drug therapy with an end justifies the means philosophy.
So, let the buyer beware! Opening Pandora’s box can lead to much more than simple ups and downs.
© 2006, Albert M. Balesh, M.D. All rights reserved.
posted by Dr. Al at
11/01/2006 01:27:00 PM
|
1 comments
