Wednesday, May 11, 2011
Tuesday, May 10, 2011
Intra Uterine Insemination (IUI), with Video
Intra Uterine Insemination (IUI)
This video shows a well animated 3D, of how IUI works
Intra Uterine Insemination (IUI) is a method of Artificial insemination, is the process by which sperm is placed into the reproductive tract of a female for the purpose of impregnating the female by using means other than sexual intercourse or natural insemination. In humans, it is used as assisted reproductive technology, using either sperm from the woman's male partner or sperm from a sperm donor (donor sperm) in cases where the male partner produces no sperm or the woman has no male partner (i.e., single women, lesbians). In cases where donor sperm is used the woman is the gestational and genetic mother of the child produced, and the sperm donor is the genetic or biological father of the child.
Artificial insemination is widely used for livestock breeding, especially for dairy cattle and pigs. Techniques developed for livestock have been adapted for use in humans.
Specifically, freshly ejaculated sperm, or sperm which has been frozen and thawed, is placed in the cervix (intracervical insemination – ICI) or, after washing, into the female's uterus (intrauterine insemination – IUI) by artificial means.
In humans, artificial insemination was originally developed as a means of helping couples to conceive where there were 'male factor' problems of a physical or psychological nature affecting the male partner which prevented or impeded conception. Today, the process is also and more commonly used in the case of choice mothers, where a woman has no male partner and the sperm is provided by a sperm donor.
Sperm Preparation
'Washed sperm', that is, spermatozoa which have been removed from most other components of the seminal fluids, can be injected directly into a woman's uterus. If the semen is not washed it may elicit uterine cramping, expelling the semen and causing pain, due to content of prostaglandins. (Prostaglandins are also the compounds responsible for causing the myometrium to contract and expel the menses from the uterus, during menstruation). The woman should rest on the table for 15 minutes after an IUI to optimize the pregnancy rate.
To have optimal chances with IUI, the female should be under 30 years of age, and the man should have a TMS of more than 5 million per ml. In practice, donor sperm will satisfy these criteria. A promising cycle is one that offers two follicles measuring more than 16 mm, and estrogen of more than 500 pg/mL on the day of hCG administration. A short period of ejaculatory abstinence before intrauterine insemination is associated with higher pregnancy rates. However, GnRH agonist administration at the time of implantation does not improve pregnancy outcome in intrauterine insemination cycles according to a randomized controlled trial.
It can be used in conjunction with ovarian hyperstimulation. Still, advanced maternal age causes decreased success rates; Women aged 38–39 years appear to have reasonable success during the first two cycles of ovarian hyperstimulation and IUI. However, for women aged ≥40 years, there appears to be no benefit after a single cycle of COH/IUI. It is therefore recommended to consider in vitro fertilization after one failed COH/IUI cycle for women aged ≥40 years.
Reference(s):
- http://en.wikipedia.org/wiki/Artificial_insemination
- http://putriprameswari.wordpress.com/2010/05/08/
In Vitro Fertilization (IVF), (Bayi Tabung), with Video
In Vitro Fertilization (IVF)
This video shows a well animated 3D, of how IVF works
IVF may be used to overcome female infertility in the woman due to problems of the fallopian tube, making fertilisation in vivo difficult. It may also assist in male infertility, where there is defect sperm quality, and in such cases intracytoplasmic sperm injection (ICSI) may be used, where a sperm cell is injected directly into the egg cell. This is used when sperm have difficulty penetrating the egg, and in these cases the partner's or a donor's sperm may be used. ICSI is also used when sperm numbers are very low. ICSI results in success rates equal to those of IVF.
For IVF to be successful it typically requires healthy ova, sperm that can fertilise, and a uterus that can maintain a pregnancy. Due to the costs of the procedure, IVF is generally attempted only after less expensive options have failed.
IVF can also be used with egg donation or surrogacy where the woman providing the egg isn't the same who will carry the pregnancy to term. This means that IVF can be used for females who have already gone through menopause. The donated oocyte can be fertilised in a crucible. If the fertilisation is successful, the embryo will be transferred into the uterus, within which it may implant.
References:
- http://en.wikipedia.org/wiki/In_vitro_fertilisation
- http://www.mrothery.co.uk/cellcycleandrepro/cellcycleandrepronotes.htm
Monday, May 9, 2011
Intra Cytoplasmic Sperm Injection (ICSI), with Video
INTRA CYTOPLASMIC SPERM INJECTION (ICSI)
This video shows a well animated 3D, of how ICSI works
Intracytoplasmic sperm injection (ICSI, pronounced "eeksee" or "icksy") is an in vitro fertilization procedure in which a single sperm is injected directly into an egg.
Indications
This procedure is most commonly used to overcome male infertility problems, although it may also be used where eggs cannot easily be penetrated by sperm, and occasionally as a method of in vitro fertilization, especially that associated with sperm donation.
It can be used in teratozoospermia. Once the egg is fertilized, abnormal sperm morphology does not appear to influence blastocyst development or blastocyst morphology.Even with severe teratozoospermia, microscopy can still detect the few sperm cells that have a "normal" morphology, allowing for optimal success rate.
History
The technique was developed by Gianpiero Palermo around 1991 at the Vrije Universiteit Brussel, in the Center for Reproductive Medicine headed by Paul Devroey and Andre Van Steirteghem.The first large experience with the technique in the United States was published by Joseph D. Schulman and colleagues at Genetics and IVF Institute in 1995.
Procedure
[caption id="attachment_283" align="alignleft" width="450" caption="ICSI procedure"]
[/caption]The procedure is done under a microscope using multiple micromanipulation devices (micromanipulator, microinjectors and micropipettes). A holding pipette (on the left of picture) stabilizes the mature oocyte with gentle suction applied by a microinjector. From the opposite side a thin, hollow glass micropipette is used to collect a single sperm, having immobilised it by cutting its tail with the point of the micropipette. The micropipette is pierced through the oolemma and into the inner part of the oocyte (cytoplasm). The sperm is then released into the oocyte. The pictured oocyte has an extruded polar body at about 12 o'clock indicating its maturity. After the procedure, the oocyte will be placed into cell culture and checked on the following day for signs of fertilization.
In natural fertilization sperm compete and when the first sperm penetrates the oolemma, the oolemma hardens to block the entry of any other sperm. Concern has been raised that in ICSI this sperm selection process is bypassed and the sperm is selected by the embryologist without any specific testing. However, in mid 2006 the FDA cleared a device that allows embryologists to select mature sperm for ICSI based on sperm binding to hyaluronan, the main constituent of the gel layer (cumulus oophorus) surrounding the oocyte. The device provides microscopic droplets of hyaluronan hydrogel attached to the culture dish. The embryologist places the prepared sperm on the microdot, selects and captures sperm that bind to the dot. Basic research on the maturation of sperm shows that hyaluronan-binding sperm are more mature and show fewer DNA strand breaks and significantly lower levels of aneuploidy than the sperm population from which they were selected. A brand name for one such sperm selection device is PICSI.
'Washed' or 'unwashed' sperm may be used in the process.
Success or failure factors
Potential factors that may influence pregnancy rates (and live birth rates) in ICSI include level of DNA fragmentation as measured e.g. by Comet assay, advanced maternal age and semen quality.
ICSI as a treatment of Sertoli Cell Only Syndrome (Germ Cell Aplasia)
Testicular sperm extraction (TESE) may be offered to couples considering in vitro fertilization (IVF)/ICSI.
At specialty centers, as many as 20%-40% of men with SCO syndrome may have isolated foci of spermatogenesis within the testis; however, the option of using donor sperm must be discussed with the couple. At most centers, sperm recovery rates are much lower.
TESE is a testis biopsy performed with the intent of finding mature sperm within the seminiferous tubules. Multiple and extensive biopsies are typically required when SCO syndrome is present. Because spermatogenesis may be patchy within the testis, occasional pockets of isolated sperm production may be identified, even when the predominant histopathology finding is SCO syndrome.
Complications
There is some suggestion that birth defects are increased with the use of IVF in general, and ICSI specifically, though results of different studies differ. In a summary position paper, the Practice Committee of the American Society of Reproductive Medicine has said it considers ICSI safe and effective therapy for male factor infertility, but may carry an increased risk for the transmission of selected genetic abnormalities to offspring, either through the procedure itself or through the increased inherent risk of such abnormalities in parents undergoing the procedure.
At specialty centers, as many as 20%-40% of men with SCO syndrome may have isolated foci of spermatogenesis within the testis; however, the option of using donor sperm must be discussed with the couple. At most centers, sperm recovery rates are much lower.
Religious objections
The Roman Catholic Church, under the papacy of Benedict XVI, has condemned the practice of intracytoplasmic sperm injection, in the magisterial instruction Dignitas Personae because it causes a complete separation between the marital act and childbearing.
References:
- http://en.wikipedia.org/wiki/Intracytoplasmic_sperm_injection
- http://emedicine.medscape.com/article/437884-treatment#a1128
- http://www.differencebetween.net/science/health/difference-between-ivf-and-icsi/
Erectile Dysfunction Video, The Causes, and The Treatments
You must be over 18 years-old to watch this video !
Erectile dysfunction (ED, "male impotence") is sexual dysfunction characterized by the inability to develop or maintain an erection of the penis during sexual performance.
To achieve and maintain and erection, you need
1. Healthy penile nerves
2. Strong blood flow to penis
3. Sexual stimulus to the brain
Due to this complex mechanisms, the causes of Erectile Dysfunction (ED) vary greatly. From lack of stimulus to the brain, stress, medications, diseases, also injury directly to the penis or the spinal cord.
If you want to measure whether you have an ED or not you may want to do yourself a simple tests. The most commonly used tests is EHS and IIEF.
If you have an ED, you may want to contact your doctor immediately, because in order to cure erectile dysfunction, you must know first what is the cause of it. Then you and your doctor will then talk about the best possible solution for your problem.
Talking self medications such as sildenafil (viagra), tadalafil (cialis), or vardenafil (levitra) may help, but they should be used after your consultation with your doctor and shouldn't be taken freely without any supervision.
If the cause of your ED is due to lack of stimulation, you shouldn't take any medication, but need to refresh yourself, and variate yourself in your sexual life with your partner.
Usually, diet and exercise may improve your sexual life without needing of any special treatment. So start your healthy life style from now.
Human Sperm Made From Bone Marrow, A New Hope for Male Infertility, Also for Lesbians?
Immature sperm cells have been created from stem cells in human bone marrow – they might one day lead to treatments for male infertility.
The study, outlined Last week in the journal Reproduction: Gamete Biology, was however unable to produce mature sperm and experts caution that much more research would be required before the method could be used to produce viable sperm for fertility treatments.
Last year German biologist Karim Nayernia successfully used sperm cells created from mouse embryonic stem cells to fertilise mice eggs, resulting in seven live births.
Prof Karim Nayernia - currently with the North-east England Stem Cell Institute at Newcastle University – has now led a team that had translated that discovery to human trials.
The researchers took bone marrow from human volunteers and isolated a type of adult stem cell that usually turns into muscle - stem cells are able to turn into many different types of tissue.
[caption id="attachment_260" align="alignleft" width="203" caption="Scientists have grown artificial sperm precursor cells"]
[/caption]They then cultured the cells in the laboratory in such a way that they became male reproductive cells, bearing genetic markers specific to partly-developed sperm. In most men, these "proto-sperm" develop into mature, functioning sperm, but in the experiment the growth stopped at the most preliminary stage.
"We're very excited about this discovery, particularly as our earlier work in mice suggests that we could develop this work even further," said Nayernia. "Our next goal is to see if we can get the spermatagonial stem cells to progress in mature sperm in the laboratory," he said.
Stem cells isolated from bone marrow of male volunteers
In laboratory, stem cells cultured and identified. Some induced to become spermatological cells - which normally become sperm cells
Transplantation of cells into testicle - so far performed in mice
But some independent experts argued that it is too soon to conclude that therapies could evolve directly out of these experiments.
"The observations are interesting but one must be cautious about drawing conclusions based purely on the expression of a few [genetic] markers, without supporting functional data," said Peter Andrews, a bio-medical scientist and co-director of the Centre for Stem Cell Biology at the University of Sheffield in England. In general, manipulating stems cells, can cause lasting genetic changes with unpredictable results, warned Andrews.
[caption id="attachment_262" align="alignleft" width="300" caption="How Prof Nayernia and his team cultured from human bone marrow. (Credit: Newcastle University, England)"]
[/caption]Stem cell research faces not only scientific barriers, but legal and ethical ones as well. Many countries - including the United States and France - have placed very strict limitations on stem cell research, especially when the cells originate from human embryos.
The British government has recently proposed a ban on using artificially created sperm or eggs in human reproduction – meaning that is these results did lead to a fertility treatment it might not be legal to use it in the U.K..
Earlier this month, researchers at the Imperial College in London, announced that they had succeeded in growing human heart valve-like tissue from bone marrow stem cells, opening up the possibility that the replacement tissue could be used in transplants for heart disease patients.
Growing replacement tissue from a patients own stem cells has been a key goal of scientists, as damaged body parts replaced by genetically-matched tissue would be much less likely to be rejected than current transplants.
To date, scientists have grown tendons, cartilage and bladders from stem cells, but not complex organs.
Similar researches also conducted in many countries such as Germany and UK, and all showed very promising results. But Professor Harry Moore of the Centre for Stem Cell Biology at The University of Sheffield said that we are still many years away from developing any therapies for infertility using such technique.
This therapy is giving a bright hope for a patient which have no sperm available in the testes such as patient with Sertoli Cell Only (SCO) syndrome/ Del Castillo's Syndrome or so called Germ Cell Aplasia.
Let's hope for the best because this kind of new treatment will surely face major obstacles such as ethics problem and many more. This Also means that lesbian couples could soon have children that shared the DNA of both women, rather than having one male biological father. A sperm cell created from one partner could fertilize her partner’s egg.
Prof Karim Nayernia also said: Ok, so it may be overstating it a bit to say that males will be irrelevant. Just because we’re not technically needed to breed doesn’t mean women will no longer find men attractive, right? After all, we’re good for a lot more than just baby making. We’ve got tons to offer! For instance, just the other day I assembled a chair from Ikea, and it only wobbles a tiny bit when you sit on it. Also, I’m frequently asked to kill insects. I think we men have a bright future. LOL
The lengths to which Nayernia’s research can proceed will depend upon legislation being prepared by the British government to replace the existing Human Fertilisation and Embryology Act.
References:
- http://news.bbc.co.uk/2/hi/health/6547675.stm
- http://www.cosmosmagazine.com/news/1183/human-sperm-made-bone-marrow#comment-57989
- http://www.buzzle.com/articles/all-female-conception-women-may-be-able-to-produce-sperm.html
- http://www.environmentalgraffiti.com/sciencetech/men-no-longer-necessary-for-sperm-production/750
- http://www.sciencedaily.com/releases/2007/04/070412211409.htm
Saturday, May 7, 2011
Easy Quick Self Test for Your Prostate Health !
The International Prostate Symptom Score (IPSS) is an 8 question (7 symptom questions + 1 quality of life question) written screening tool used to screen for, rapidly diagnose, track the symptoms of, and suggest management of the symptoms of the disease benign prostatic hyperplasia (BPH). Created in 1992 by the American Urological Association, it originally lacked the 8th QOL question, hence its original name: the American Urological Association symptom score (AUA-7).
The IPSS was designed to be self-administered by the patient, with speed and ease in mind. Hence, it can be used in both urology clinics as well as the clinics of primary care physicians (i.e. by general practitioners) for the diagnosis of BPH. Additionally, the IPSS can be performed multiple times to compare the progression of symptoms and their severity over months and years.
Reference:
- http://en.wikipedia.org/wiki/International_Prostate_Symptom_Score
- http://www.urologychannel.com/HealthProfiler/healthpro_bph.shtml
Friday, May 6, 2011
Thursday, May 5, 2011
Practical and Step by Step Ways to Do Kegel Exercises
Kegel exercises for men
PC muscles control the flow of semen and urine, the firmness of your penis during erection and the shooting power of your ejaculation. They are important, and if kept very strong, will see you into your golden years with a fantastical hard on. The great thing about Kegel exercises for men is that you can do them anywhere, anytime -- and nobody will know the difference.
You will be able to have better sex by being able to better control your orgasms and ejaculations, and last for longer, plus you may get the added kudos of being able to hold up a wet towel with your erection if you practice these Kegel exercises for men.
How do I know where my PC muscles are?
The easiest way to find them is to stop your flow of urine next time you go to the bathroom. Another way to isolate them is to put your finger inside your anus; when you contract the right muscles, your anus will tighten. However you decide to find them, once they are found you need to practice feeling exactly where they are located -- it is easy to overcompensate for weak muscles by using the abdominals, buttocks or thighs. These must all stay relaxed when doing Kegel exercises for men.
What can I expect from exercises for men? Do they work?
Yes they do! You will experience such benefits if you do Kegels on a regular basis:
- Stronger pelvic muscles
- Increase the bloodflow to the genital area, and so support sexual arousal mechanisms
- Reduced "leaking" of urine and urinary incontinence (if you have any)
- Increased pleasure with your sexual activity
- Increased ability to have erections (longer and harder)
Now, on to the daily Kegel exercises for men.
Note: These exercises are done hands-free. You do not “squeeze” anything with your hands as they are all done with your PC muscles.
kegel session 1
Exercise A
Sets: 3
Quickly clench and release repeatedly for 10 seconds.
Take a 10-second break between sets.
Exercise B
Sets: 10
Clench and release repeatedly for 5 seconds.
Take a 5-second break between sets.
Exercise C
Sets: 3
Tighten and hold your PC muscle for 30 seconds.
Take a 30 second break between sets.
That’s it for today, but repeat these Kegel exercises for men daily for one week.
kegel session 2
Exercise A
Sets: 10
Clench and hold your PC muscle for 5 seconds.
Release and repeat.
Exercise B
Sets: 3
Quickly clench and release your PC muscle 10 times.
Exercise C
Sets: 3
Clench and release your PC muscle alternatively in long and short bursts for counts of 10.
Exercise D
Sets: 1
Tighten your PC muscle and hold for as long as you can. Aim for 2 minutes.
You can do the session 2 Kegel exercises for men for a week; however, feel free to progress if you feel you are strong enough. Remember that these are strengthening exercises, so start off slowly and build up, just like you would with any other muscle.
kegel session 3
Exercise A
Sets: 30 (work your way up to more than 100)
Clench and release your PC muscle over and over again.
Exercise B
Sets: 5
Tighten as much as you possibly can (ensure that you are only squeezing your PC muscle).
Hold for 20 seconds.
Take a 30-second break between sets.
kegel session 4
Exercise A
Sets: As many as you like.
Clench and release your PC muscle for 2 minutes every day.
Work your way up to doing 20 minutes 3 times a day -- you should eventually be able to perform 200 repetitions per session.
I can't hold them even for two seconds!
When you start to do Kegels at first you may find that you can't even squeeze for a second or two. Guys, don't worry. This is typical. You can't keep it tight because the muscles just don't strength enough. Stop if you just can't squeeze them tight and your muscles have become fatigued. It's enough for that session. With an everyday practice, your muscles will become stronger and stronger. After a few weeks or months, you will be able to squeeze this PC muscles really tight for a full ten seconds doing the long exercises.
Some tips?
- Empty your bladder before starting the exercises.
- Don't do Kegels while urinating. This may eventually lead to some voiding difficulties.
- Keep your thigh and abdominal muscles relaxed.
- Try to get the maximum tightening with each muscle contraction.
- Do not forget to breathe holding the muscles contracted.
- It is better to do fewer cycles, each with good form and tight control, than to do more cycles with poor form and weak control
- Good idea to contract the muscles while you are in different positions: sitting, standing, lying.
Am I doing the exercises correctly?
You are NOT doing the exercises correctly if:
- If you are holding your breath. (If you can talk normally and comfortably, then you are probably doing the exercises correctly.)
- Squeezing any other muscles, than the pelvic floor. These muscles are the only muscles that should be squeezed during the Kegel exercises. If you find yourself squeezing/stretching any other - hips, thighs, the lower abdomen, or elsewhere - stop and correct yourself. You will not benefit from such exercises.
How can I remember to do my Kegel exercises regularly?
Good idea to make Kegel exercises a Habit (did you read Stephen Covey?) The following tips may help you remember to do your Kegel exercises:
- Schedule your exercises at the same time every day. It can be your favorite regular TV show, while you do the dishes, when you wake up in the morning, after lunch or just before you go to bed.
- Reward yourself for each day that you do PC exercises twice a day. You could put a nice gold star on your calendar:)
It is normal if you forget to do your exercises for a few days. It's common to have a few slips when trying to make any new change. Just get back to your exercises and don't get discouraged!
Basically, you can do Kegel exercises for men anytime, anywhere; there are very few places you can’t practice this. It is not recommended, however, to do these exercises when you are trying to concentrate on something else, as you may find yourself quite distracted. A great place to do them is on the couch in front of the TV or while stuck at traffic lights.
How will I know when something is happening?
You will know because you will be able to feel it, and so will your lover. A harder penis, better control and longer lasting sex are all benefits of having strong PC muscles. There is absolutely no excuse for not having these important sexual muscles in excellent working order. If you have trouble with premature ejaculation, try these exercises before you head to the pharmacy or your health professional.
What not to do
Don’t overdo it. It is often tempting to throw yourself into something head on, especially when it means better sex. However, as with any other muscle you are working out, you need to give it some time to heal between sessions. This means regular rests and not overdoing it. If you follow the exercise schedule as you see fit, you should soon be great -- listen to your body. It knows what it’s talking about!
Don’t use any other muscle during the exercises. It is sometimes difficult to isolate the PC muscles, especially if they are weak. Be aware of what you are doing, and if you feel like you are contracting any other muscles (mainly abdominals and thighs), then you need to relax and start again. Just remember that it might take a few weeks to build up some strength. Keep at it.
Benefits of kegel exercises for women
Everyone can do these exercises, and they improve sex for everyone. If you and your partner do these exercises, you will both see and feel the difference within weeks. Women will have more intense orgasms and be able to “squeeze” your penis while it’s inside her.
Testing it
You can do a little sexual experiment with her by resting your erection inside of her vagina, but not thrusting. Both of you can flex your PC muscles -- this stimulates her G-spot, and tickles you too. This is a fun way to test your progress.
Kegel kopulation
Your sexual virility is dependent on many factors. Most of these you can control -- eating nutritious food, exercising regularly and keeping your prostate healthy. Since your PC muscle is so important to the function of your sexuality, it pays to keep it in good working order. Now you have the means, there’s no room for excuses.
Reference:
- http://www.askmen.com/dating/love_tip_60/67b_love_tip.html
- http://noprematureejaculation.com/kegel-exercises.html
Testosterone Therapy in Adult Men with Androgen Deficiency Syndromes: An Endocrine Society Clinical Practice Guideline
CLINICAL PRACTICE GUIDELINE
Testosterone Therapy in Adult Men with Androgen Deficiency Syndromes: An Endocrine Society Clinical Practice Guideline
Shalender Bhasin, Glenn R. Cunningham, Frances J. Hayes, Alvin M. Matsumoto, Peter J. Snyder, Ronald S. Swerdloff and Victor M. Montori
Boston University School of Medicine (S.B.), Boston, Massachusetts 02118; Baylor College of Medicine/Veterans Affairs Medical Center (G.R.C.), Houston, Texas 77030; Massachusetts General Hospital/Harvard Medical School (F.J.H.), Boston, Massachusetts 02114; University of Washington/Veterans Affairs Puget Sound Health Care System (A.M.M.), Seattle, Washington 98108; University of Pennsylvania School of Medicine (P.J.S.), Philadelphia, Pennsylvania 19104; Harbor University of California, Los Angeles Medical Center (R.S.S.), Torrance, California 90502; and Mayo Clinic (V.M.M.), Rochester, Minnesota 55905
Objective: The objective was to provide guidelines for the evaluationand treatment of androgen deficiency syndromes in adult men.
Participants: The Task Force was composed of a chair, selectedby the Clinical Guidelines Subcommittee of The Endocrine Society,five additional experts, a methodologist, and a professionalwriter. The Task Force received no corporate funding or remuneration.
Evidence: The Task Force used systematic reviews of availableevidence to inform its key recommendations. The Task Force usedconsistent language and graphical descriptions of both the strengthof recommendation and the quality of evidence, using the recommendationsof the Grading of Recommendations, Assessment, Development,and Evaluation group.
Consensus Process: Consensus was guided by systematic reviewsof evidence and discussions during three group meetings, severalconference calls, and e-mail communications. The drafts preparedby the panelists with the help of a professional writer werereviewed successively by The Endocrine Society’s Clinical Guidelines Subcommittee, Clinical Affairs Committee, and Council.The version approved by the Council was placed on The EndocrineSociety’s web site for comments by members. At each stageof review, the Task Force received written comments and incorporatedneeded changes.
Conclusions:
- We recommend making a diagnosis of androgen deficiency only in men with consistent symptoms and signs and unequivocally low serum testosterone levels.
- We suggest the measurement of morning total testosterone level by a reliable assay as the initial diagnostic test.
- We recommend confirmation of the diagnosis by repeating the measurement of morning total testosterone and in some patients by measurement of free or bio available testosterone level, using accurate assays.
- We recommend testosterone therapy for symptomatic men with androgen deficiency, who have low testosterone levels, to induce and maintain secondary sex characteristics and to improve their sexual function, sense of well-being, muscle mass and strength, and bone mineral density.
- We recommend against starting testosterone therapy in patients with breast or prostate cancer, a palpable prostate nodule or induration or prostate-specific antigen greater than 3 ng/ml without further urological evaluation, erythrocytosis (hematocrit > 50%), hyperviscosity, untreatedobstructive sleep apnea, severe lower urinary tract symptomswith International Prostate Symptom Score (IPSS) greater than19, or class III or IV heart failure.
- When testosterone therapyis instituted, we suggest aiming at achieving testosterone levels during treatment in the mid-normal range with any of the approved formulations, chosen on the basis of the patient’s preference, consideration of pharmacokinetics, treatment burden, and cost.
- Men receiving testosterone therapy should be monitored using a standardized plan.
Reference:
http://jcem.endojournals.org/cgi/content/full/91/6/1995?linkType=FULL&resid=91/6/1995&journalCode=jcem
-all rights belong to their respective owner-
Is It Safe to Give Testosterone After Treatment for Prostate Cancer ?
TESTOSTERONE REPLACEMENT THERAPY AFTER PRIMARY TREATMENT FOR PROSTATE CANCER
ABSTRACT
Purpose:
A history of prostate cancer has been an absolute contraindication for testosterone supplementation. We studied a cohort of hypogonadal patients treated with radical retropubic prostatectomy (RRP) for organ confined prostate cancer to determine if testosterone replacement therapy (TRT) could be efficacious and administered safely without causing recurrent prostate tumor.
Materials and Methods:
Ten hypogonadal patients previously treated with RRP for organ confined prostate cancer were identified. They presented with low serum total testosterone (TT) and symptoms of hypogonadism after RRP. Patients had baseline serum determinations of prostate specific antigen (PSA) and TT, and were started on testosterone supplementation. They were assessed periodically for changes in PSA and TT, and for symptomatic improvement using the hormone domain of the Extended Prostate Inventory Composite Health Related Quality of Life questionnaire.
Results:
At a median followup of 19 months no patient had detectable (greater than 0.1 ng/ml) PSA. TT increased significantly after starting TRT from a mean ± SD of 197 ± 67 to 591 ± 180 ng/dl (p = 0.0002). The Hormone Domain of the Extended Prostate Inventory Composite Health Related Quality of Life questionnaire increased significantly from 38 ± 5 to 49 ± 3 (p = 0.00005), primarily due to a decrease in hot flashes and an increase in energy level.
Conclusions:
At a median of 19 months of TRT hypogonadal patients with a history of prostate cancer had no PSA recurrence and had statistically significant improvements in TT and hypogonadal symptoms. In highly select patients after RRP TRT can be administered carefully and with benefit to hypogonadal patients with prostate cancer.
Reference:
http://www.jurology.com/article/S0022-5347%2805%2960535-6/abstract
-for full article please visit the reference above-
Wednesday, May 4, 2011
Exercise Can Increase Testosterone Level
Can You Increase Your Testosterone Level By Exercising?
Because of testosterone's effect on muscle growth, testosterone supplements have become a huge business. This is especially true now that it is no longer possible to buy testosterone precursors, except for DHEA, due to the passing of the Anabolic Steroid Control Act of 2004. This act classifies androstenedione and other steroids as controlled substances and so you can't just go buy them. Of course most testosterone precursors, including DHEA, are going to have some unwanted side effects in addition to the intended effects, which is why the act was passed in the first place - to protect the consumer.
That only leaves supplements available that may raise testosterone levels indirectly, such as through an increase in luteinizing hormone or by blocking aromatase (the enzyme that converts testosterone to estrogen). Still, these supplements are going to produce some unwanted side effects. There must be a better way.
Is It Possible To Raise Testosterone Levels Without Using Supplements?
I've frequently seen the idea that simply lifting weights or performing some sort of heavy exercise will increase testosterone levels. It seems plausible, but lets see what the results of research studies have to say about it.
Testosterone and Exercise Research Studies - Men
Some research studies have shown that it is possible to increase your testosterone level by exercising. For example, in one study Schwab et al. (1993) measured the testosterone level in 2 groups of male study participants to obtain their baseline level. Then they had both groups perform four sets of six squats. One group of men did their squats using heavy weights and the other group of men performed their squats using light weights. After both groups of men were finished doing their squats, Schwab et al. remeasured their testosterone levels. They found that testosterone levels were increased from the baseline in both sets of men, regardless of whether or not the had used heavy or light weights. However, 10 minutes after the men were through exercising their testosterone levels dropped back to the baseline level.
In other study, Vogel et al. (1985) found that men who rode a stationary bike for 15 minutes had an increase in their testosterone levels from baseline. No information was available for how long testosterone levels were raised.
A different study by Craig et al. (1989) found that strength training for 45-60 minutes raised testosterone levels in both young and elderly men, but not to a level that reached statistical significance.
In a more recent study, Marin et al. (2006) found that exercise also increased testosterone levels in men. Men who participated in this study had their testosterone level tested prior to exercising and then again after performing lat pulls, bench presses, leg curls, leg extensions, leg presses, and military presses. Immediately after exercising the mens' testosterone levels were significantly raised, but then dropped back to baseline levels after 20 minutes had passed.
From the studies described above it appears that exercising may increase testosterone levels, but that increased testosterone levels drop back to baseline levels shortly after the exercise is over. However, there are also a few studies that show that exercising decreases testosterone levels in men after exercise (e.g., Wheeler, 2003) and so the jury is still out as to whether or not exercise can increase testosterone levels.
Testosterone and Exercise Research Studies - Women
Not nearly as many studies have been done to test post-exercise testosterone levels in women as with men, but there are a few. One study had college age women partipate in a 10 week resistance training program and found no increase in testosterone levels after exercise (Westerlind et al.,1987). Another study also found no significant increases in women's serum testosterone levels after resistance training (Hakkinen et al., 1992). Unfortunately, there are not many studies using women as participants and so it is difficult to draw firm conclusions.
Type of Exercises
Free weight squats and lunges. Dipping low then pressing up with the legs while carrying a load of weight engages several major leg muscles but also those in the torso. For proper form, see the YouTube link for “Proper Squat Form.”
Note that squat can cause significant injury to the back if performed incorrectly. For the beginner, try squatting with just your body weight, or a barbell with no weights to start. Work up your strength and confidence before attempting very heavy weights.
Cable or elastic band squat-presses.
A variation on the squat is to grasp cables or elastic bands in your hands which you press upward at the top (standing segment) of the squat. This engages the shoulder muscles along with those in the legs and core. Choose a level of resistance that has you fatiguing to failure after ten repetitions.
Row-flyes from a staggered standing position.
Stand with the legs staggered, i.e., one foot about 2-3 feet behind the other, toes on both feet pointed forward, with torso pitched forward (forming a straight line from your back ankle through your hips and to the shoulders). Hold dumbbells at your side, then raise the dumbbells to shoulder level. Pause the weights at the top, then slowly drop them down. To add a lot more to the exercise, hinge both legs down as you lower the weights, then hinge back up as your arms and shoulders raise the dumbbells. Repeat to failure.
Sprinting runs or high-resistance bike spins.
Yes, what we consider “cardio” work can increase testosterone also. These are the high-output sets, when you run or bike at maximum speed, better yet heading uphill or against a high-resistance setting on a trainer bike. Experienced runners and bikers call this interval training; indoor ride (“spin”) classes generally employ this drill. Go hard for ten, 15 or 20 seconds, at 100% effort, then slow to a moderate pace before you pick up that sprinting level of output again. Repeat the cycle between four and ten times.
A note on achieving “failure:” As mentioned, this is the state where you cannot lift another rep. If you are at rep 7 or 8 and aren’t near that, slow your pace dramatically to a ten second lift and ten second drop. This is also a sign you should increase the weight level on the next set.
An added benefit of high intensity training is that it can be accomplished in less time than other types of workouts. In fact, you advised to limit rest in between sets, perhaps packing your high intensity workout into as little as 30 or 45 minutes. For more on this, see the Hub page by this writer titled “Increase exercise intensity: add muscle, reduce body fat and improve overall health with no pills and no steroids.”
For ten additional exercises designed specifically for testosterone-building intensity, see Hub article, "Super-slow, high-intensity exercises to build strength, increase muscle size and raise testosterone levels" by this writer.
Conclusions
Despite some popularity for the idea that certain types of exercise will increase testosterone levels, the results of research studies are mixed, with some studies finding support for increased testosterone levels after exercise and some finding the opposite effect.
So what does this mean? Well, who knows? It seems that it is a possibility that exercise may increase testosterone levels, but there really is no definitive answer at this point. Of course we all know that exercise is good for you, makes you stronger, and improves mood and so if you engage in any type of weight training or exercise in the hopes of increasing your testosterone levels at least you won't be wasting your time. You'll still reap some benefits. And, you may even slightly increase your testosterone levels.
Warning : Don't overstress yourself! Be sure to get adequate rest. Research shows that over-training can actually hurt testosterone levels. A study at the UNC showed that over-training could reduce testosterone levels by as much as 40 percent. Give muscles one full day to recover.
Get a minimum of seven hours of sleep per night. Sleeping is when your body does the bulk of its healing, repairing and producing. Skimp on sleep and you skimp on, you guessed it, testosterone production.
It is best to exercise with a certified professional to ensure best result.
Also you may want to check also: foods that help increase testosterone. libido and sex drive!
Reference:
- http://www.officialfitnessandhealth.com/articles/testosterone.html
- http://www.suite101.com/content/boost-your-testosterone-levels-a35328
- http://hubpages.com/hub/Natural-ways-to-increase-testosterone-levels-with-exercise-and-diet
What Foods Will Help Increase Low Libido?
Libido is usually taken to mean sexual desire, a person's sex drive or sexual urge. Libido does vary from person to person, from female to male.
General levels of libido & sex drive decrease slowly as people enter mid life. If you have a lower than normal libido, then eating the right types of foods and cutting down on the wrong foods can help to increase your libido and rebuild your sex drive.
Changing eating habits can increase libido
The saturated fats in Fast Foods, Take Away's and processed foods have all been linked to a loss of libido. Cutting back on these foods could help towards increasing your libido and get your sex drive back on track.
By increasing your intake of the foods listed below and decreasing these negative libido food sources, you can naturally increase your testosterone levels and restore your libido without medication.
A loss of libido is something that can affect women who are pre or post menopausal. Menopause is a natural event in a woman's’ life and loss of libido may be one of the symptoms experienced around this time.
Whatever the reason for a loss of libido, changing your diet and eating healthily food can help increase libido levels. It certainly won't do you any harm to become fitter and healthier. This applies to female and male libido.
The smells of certain foods have been found to be sexually arousing, notably pumpkin pie and buttered popcorn for men and licorice candy for women.
Testosterone levels control both male and female libido
For both males and females libido all comes down mainly to one hormone - testosterone. Your libido is controlled by your hormone levels, with testosterone being the key. If the balance is off, things may not function as they should.
When it's right, everything falls into place. So one of the keys to getting your libido back is to increase testosterone levels in your body.
Testosterone production is dependent on zinc and vitamin B, both of these are abundant in many of the foods we eat regularly. But, as nutritional deficiencies increase with age, it does make sense to increase the intake of these vitamins and minerals. So adding a few of the foods listed below can boost your libido especially when combine with a little regular exercise.
Foods That increase Testosterone, libido and sex drive
These foods are all know natural libido enhancers, adding a few of them to your diet and getting regular exercise will increase libido.
Raw Oysters
Oysters have a high Zinc content which raises the testosterone and sperm production, which are both considered important for enhancing libido. Scrub shells thoroughly to remove any dirt and bacteria, pry them open and place on a bed of ice!.
Asparagus
Asparagus is rich in vitamin E, which is considered to stimulate the production of sex hormones (testosterone) and may be important for a healthy sex life. Good for both female and male libido levels
Figs
Figs are high in amino acids, which researchers believe can increase libido. It has also been found that Figs can also increase your sexual stamina
Almonds and nuts in general
Almonds are a prime source of essential fatty acids. These are vital as they provide the raw material for a man's healthy production of hormones.
Eggs
These are another source of vitamins (B5 & B6) both of which help fight stress and balance hormone levels, both are crucial to a healthy libido. High levels of stress are a well know cause of low sex drive.
Basil (Sweet basil)
This is said to stimulate the sex drive and boost female fertility.
Brown Rice, Cheese and Turkey
These foods are all good sources if zinc. Testosterone production is dependent on zinc, and testosterone levels control both male and female libido and sex drive.
Liver
Not the sexiest of foods but may increase low or slowed libido. A good source of GLUTAMINE.
Avocado
Avocado contain high levels of folic acid, helping to metabolize proteins. They also contain vitamin B6, helpful in increasing male hormone production. In addition potassium is found in avocado which aids in regulating the female thyroid gland, this helps enhance female libido levels.
Bananas
A great energy giving food source. Contains the bromelain enzyme, which is believed to improve male libido. The phallic shape is said to be partially responsible for the banana being popular as an aphrodisiac food. However, they are rich in potassium and B vitamins like riboflavin which are necessary for sex hormone - testosterone production. Bananas contain bromelain enzyme, which will increase testosterone
Celery
Celery can be a fantastic source food for sexual stimulation because it contains androsterone. This is an odorless hormone released through male perspiration that can turn women on.
Pine Nuts (the edible seeds of pine trees)
Pine nuts being rich in zinc and zinc being necessary to maintain male potency, pine nuts have been used for many years to stimulate the libido.
Salmon & Other Fish
Another good source of essential B vitamins B5, B6, B12, all of which are important in keeping good reproductive health.
Hale to cruciferous vegetables.
Here’s the kicker: Cabbage and other cruciferous vegetables (broccoli, bok choi, Brussels sprouts, cauliflower, kale, collard greens, radishes, kohlrabi and rutabagas), long heralded for anti-cancer and other healthful properties, are testosterone boosters as well. The link on “Zinc-testosterone foods” below lists generic and commercially prepared foods in their relative levels of zinc content. Cabbage nets in with roughly six times the zinc content per calories consumed compared to a shank of beef.
Damiana
Damiana is a small shrub with smooth, pale green oval leaves and aromatic yellow flowers. It grows in Mexico and Central America. Damiana (or Turnera diffusa) is said to help with impotence, relieve anxiety, promote general well being and act as a sexual stimulant for male and females alike. This plant has been traditionally used as an aphrodisiac for men and women in Central America, because it helps to re balance your hormones and also has mildly stimulating properties.
Disclaimer: The text on these pages is for your information only. It is not a substitute for professional medical advice. Please consult your doctor if you have any questions or concerns about your general health, libido or sex drive.
Reference:
- http://www.libido-increasing-food.com/
- http://hubpages.com/hub/Natural-ways-to-increase-testosterone-levels-with-exercise-and-diet
- http://newshealth.net/foods-that-boost-testosterone/
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Erection Hardness Score (EHS)
Erection Hardness Score (EHS) is a much simple than the International Index of Erectile Function (IIEF) scoring. Therefore it is much easier and faster to use when we need to diagnose patient with erectile dysfunction.
EHS rates the hardness of erection on a scale of one to four, with four being the maximal score. The language used is simple and direct, so that men with ED can use the scale to assess the severity of their condition and to monitor the impact of treatment.
A score of 1 indicates that the penis is larger than normal, but not hard;--> correlates with severe dysfunction (IIEF score 0-6)
A score of 2 indicates that the penis is hard, but not hard enough for penetration;--> correlates with moderate dysfunction (IIEF score 7-12)
A score of 3 indicates that the penis is hard enough for penetration but not completely hard; --> correlates with mild to moderate dysfunction (IIEF score 13-24)
A score of 4 indicates that the penis is completely hard and fully rigid; --> correlates with no dysfunction (IIEF score 25-30)
To compare it with IIEF Scoring, you might want to see about the IIEF scoring right here.
Reference:
http://www.viagra.com/about-erectile-dysfunction/erectile-dysfunction-symptoms/erection-hardness-score.aspx
Tuesday, May 3, 2011
Premature Ejaculation Diagnostic Tool (PEDT)
PEDT Questionnaire is the most commonly tool to diagnose premature ejaculation. This tool was developed by Pfizer Inc. It is simple and worldwide approved as a standard to confirm a diagnosis of premature ejaculation in a patient.
This questionnaire to help identify men who may have a problem with ejaculating too soon during sexual activity. Even if you do not have difficulties, please answer all the questions. Please select the answer that best represented your response for each of the questions below. While your experiences may change from time to time, please report your general experiences with intercourse.
Definition: Ejaculation here refers to ejaculation (release of semen) after penetration (when your penis enters your partner)
Answer the following questions!
Q1. How difficult is it for you to delay ejaculation?
score 0 --> Not Difficult at all
score 1 --> Somewhat Difficult
score 2 --> Moderately Difficult
score 3 --> Very Difficult
score 4 --> Extremely Difficult
Q2. Do you ejaculate before you want to?
score 0 --> Almost never or never 0%
score 1 --> Less than half the time 25%
score 2 --> About half the time 50%
score 3 --> More than half the time 75%
score 4 --> Almost always or always 100%
Q3. Do you ejaculate with very little stimulation?
score 0 --> Almost never or never 0%
score 1 --> Less than half the time 25%
score 2 --> About half the time 50%
score 3 --> More than half the time 75%
score 4 --> Almost always or always 100%
Q4. Do you feel frustrated because of ejaculating before you want to?
score 0 --> Not at all
score 1 --> Slightly
score 2 --> Moderately
score 3 --> Very
score 4 --> Extremely
Q5. How concerned are you that your time to ejaculation leaves your partner sexually unfulfilled?
score 0 --> Not at all
score 1 --> Slightly
score 2 --> Moderately
score 3 --> Very
score 4 --> Extremely
Clinical Interpretation
Total scores can be interpreted as follows:
| Score | Interpretation |
| 0-8 | A score of 0 to 8 indicates a low likelihood of premature ejaculation (PE). |
| 9-10 | A score of 9 or 10 indicates a probable diagnosis of premature ejaculation (PE). |
| 11-20 | A score of 11 to 20 indicates a diagnosis of premature ejaculation (PE). |
References:
- http://www.sexhealthmatters.org/resources/premature-ejaculation-diagnostic-tool
- http://www.pehomepage.com/premature_ejaculation_test_pfizer.asp
Premature Ejaculation, Definition, Mechanism, and How to Overcome It
Videos Presented by: Dr Andrew L. Siegel. He is a urological surgeon at Hackensack University Medical Center, and is the director of The Center of Continence Care.
Part 1 of 2
Part 2 of 2
Premature ejaculation (PE) is a condition in which a man ejaculates earlier than he or his partner would like him to. Premature ejaculation is also known as rapid ejaculation, rapid climax, premature climax, or early ejaculation. Masters and Johnson defines PE as the condition in which a man ejaculates before his sex partner achieves orgasm, in more than fifty percent of their sexual encounters. Other sex researchers have defined premature ejaculation as occurring if the man ejaculates within two minutes of penetration; however, a survey by Alfred Kinsey in the 1950s demonstrated that three quarters of men ejaculate within two minutes of penetration in over half of their sexual encounters. Self reported surveys report up to 75% of men ejaculate within 10 minutes of penetration. Today, most sex therapists understand premature ejaculation as occurring when a lack of ejaculatory control interferes with sexual or emotional well-being in one or both partners.
Most men experience premature ejaculation at least once in their lives. PE affects 25%-40% of men in the United States.Because there is great variability in both how long it takes men to ejaculate and how long both partners want sex to last, researchers have begun to form a quantitative definition of premature ejaculation. Current evidence supports an average intravaginal ejaculation latency time of six and a half minutes in 18-30 year olds. If the disorder is defined as an IELT percentile below 2.5, then premature ejaculation could be suggested by an IELT of less than about 2 minutes. Nevertheless, it is well accepted that men with IELTs below 1.5 minutes could be "happy" with their performance and do not report a lack of control and therefore would not be defined as having PE. On the other hand, a man with 2 minutes IELT may have the perception of poor control over his ejaculation, distressed about his condition, has interpersonal difficulties and therefore be diagnosed with PE.
Possible psychological and environmental factors
Psychological factors commonly contribute to premature ejaculation. While men sometimes underestimate the relationship between sexual performance and emotional well-being, premature ejaculation can be caused by temporary depression, stress over financial matters, unrealistic expectations about performance, a history of sexual repression, or an overall lack of confidence. Interpersonal dynamics strongly contribute to sexual function, and premature ejaculation can be caused by a lack of communication between partners, hurt feelings, or unresolved conflicts that interfere with the ability to achieve emotional intimacy. Neurological premature ejaculation can also lead to other forms of sexual dysfunction, or intensify the existing problem, by creating performance anxiety. In a less pathological context, premature ejaculation could also be caused simply by extreme arousal.
According to the theories developed by Wilhelm Reich, premature ejaculation may be a consequence of a stasis of sexual energy in the pelvic musculature, which prevents the diffusion of such energy to other parts of the body.
One study of young married couples (Tullberg, 1999) reported that the husband's IELT seems to be affected by the phases of the wife's menstrual cycle, the IELT tending to be shortest during the fertile phase. Other studies suggest that young men with older female partners reach the ejaculatory threshold sooner, on average, than those whose partners are their own age or younger
Possible physical factors
Science of mechanism of ejaculation
The physical process of ejaculation requires two sequential actions: emission and expulsion.
The emission phase is the first phase. It involves deposition of seminal fluid from the ampullary vas deferens, seminal vesicles, and prostate gland into the posterior urethra. The second phase is the expulsion phase. It involves closure of bladder neck, followed by the rhythmic contractions of the urethra by pelvic-perineal and bulbospongiosus muscle, and intermittent relaxation of external urethral sphincters.
It is believed that the neurotransmitter serotonin (5HT) plays a central role in modulating ejaculation. Several animal studies have demonstrated its inhibitory effect on ejaculation. Therefore, it is perceived that low level of serotonin in the synaptic cleft in these specific areas in the brain could cause premature ejaculation. This theory is further supported by the proven effectiveness of selective serotonin reuptake inhibitors (SSRIs), which increase serotonin level in the synapse, in treating PE.
Sympathetic motor neurons control the emission phase of ejaculation reflex, and expulsion phase is executed by somatic and autonomic motor neurons. These motor neurons are located in the thoracolumbar and lumbosacral spinal cord and are activated in a coordinated manner when sufficient sensory input to reach the ejaculatory threshold has entered the central nervous system.
Several areas in the brain, and especially the nucleus paragigantocellularis, have been identified to be involved in ejaculatory control. Scientists have long suspected a genetic link to certain forms of premature ejaculation. In one study, ninety-one percent of men who have had premature ejaculation for their entire lives also had a first-relative with lifelong premature ejaculation. Other researchers have noted that men who have premature ejaculation have a faster neurological response in the pelvic muscles. Simple exercises commonly suggested by sex therapists can significantly improve ejaculatory control for men with premature ejaculation caused by neurological factors. Often, these men may benefit from anti-anxiety medication or SSRIs, such as sertraline or paroxetine, as these slow down ejaculation times. Some men prefer using anaesthetic creams; however, these creams may also deaden sensations in the man's partner, and are not generally recommended by sex therapists.
Differential diagnosis
Premature ejaculation should be distinguished from erectile dysfunction related to the development of a general medical condition. Some individuals with erectile dysfunction may omit their usual strategies for delaying orgasm. Others require prolonged noncoital stimulation to develop a degree of erection sufficient for intromission. In such individuals, sexual arousal may be so high that ejaculation occurs immediately. Occasional problems with premature ejaculation that are not persistent or recurrent or are not accompanied by marked distress or interpersonal difficulty do not qualify for the diagnosis of premature ejaculation. The clinician should also take into account the individual's age, overall sexual experience, recent sexual activity, and the novelty of the partner. When problems with premature ejaculation are due exclusively to substance use (e.g., opioid withdrawal), a substance-induced sexual dysfunction can be diagnosed.
Other ejaculation disorder types
- Delayed ejaculation - Ejaculation takes a long time
- Retrograde ejaculation - Semen flows from the prostate gland into the bladder rather than exiting out of the penis.
- Inhibited orgasm in males
Medical Care
Medical treatment for premature ejaculation (rapid ejaculation) includes several options. Any serious primary medical condition (eg, angina) should be treated; for the purpose of the following discussion, the male is assumed to be healthy and premature ejaculation is assumed to be his only problem. In addition, any accompanying erection problem can be treated with various methods with excellent success (see Erectile Dysfunction); thus, only passing reference is made to treatment of erectile dysfunction (ED) that may accompany the premature ejaculation problem.
Include the female partner as much as possible in the treatment and counseling sessions in order to achieve the best outcome.
1. Relieve any underlying performance pressure on the male.
- Assuming that premature ejaculation occurs when intercourse is attempted, the couple should be instructed that intercourse should not be attempted until premature ejaculation is treated. The male may use manual stimulation, oral sex, or other means to satisfy the female partner in the meantime.
- If the male always experiences ejaculation with initial sexual excitement or early foreplay, this is a serious problem and probably indicates primary premature ejaculation (the history should reveal this), which then most likely requires treatment in conjunction with a mental health care professional. These more difficult cases should be screened out.
2. The couple should then be instructed on sexual therapy, such as the stop-start or squeeze-pause technique popularized by Masters and Johnson.
- The female partner should slowly begin stimulation of the male and should stop as soon as he senses a feeling of excessive excitement that may lead to ejaculatory inevitability.
- Then, she should administer a firm compression of the penis just behind the glans, pressing mainly under the penis. This should be uncomfortable but not painful.
- Stimulation then should begin again after the male has a feeling that the ejaculation is no longer imminent.
- The process should be repeated and practiced at least 10 or more times.
- Gradually, most males find this technique helps decrease the impending inevitable need to ejaculate.
- After a period of practicing this method, the couple can sit facing each other, with the woman's legs crossing on top of the male's legs. She can stimulate him by manipulating his penis close to, then with friction against, her vulval area. Each time he senses excessive excitement, she can apply the squeeze and stop all stimulation until he calms down enough for the process to be repeated.
- Finally, coitus may be attempted, with the female partner in the superior position so that she may withdraw immediately and again apply a squeeze to remove his urge to climax.
- Most couples find this technique to be highly successful. It can also help the female partner to be more aroused and can shorten her time to climax because it constitutes a form of extended foreplay in many cases.
3. Another therapeutic modality is the use of desensitizing cream for the male.
- In Korea and other areas of the Far East, SS cream (a combination of 9 ingredients, mainly herbal; SS stands for Super Secret) has been shown to desensitize the penis, decrease the vibratory threshold, and help men with premature ejaculation to significantly delay their ejaculatory response.[12, 13]
- Unfortunately, SS Cream is not yet approved by the US Food and Drug Administration (FDA), but simple combinations of lidocaine cream or related topical anesthetic agents can be used with similar effects and they are safe as long as the patient has no history of allergy to the substance.
4. If the male is relatively young and can achieve another erection in a few minutes following an episode of premature ejaculation, he may find that his control is much better the second time.
- Some therapists advise young men to masturbate (or have their partner stimulate them rapidly to climax) 1-2 hours before sexual relations are planned.
- The interval for achieving a second climax often includes a much longer period of latency, and the male can usually exert better control in this setting.
- In an older man, such a strategy may be less effective because the older man may have difficulty achieving a second erection after his first rapid sexual release. If this occurs, it can damage his confidence and may result in secondary impotence.
5. The most effective pharmacologic modality found to aid men with premature ejaculation is a drug from the selective serotonin reuptake inhibitors (SSRIs) class, drugs which are used normally as antidepressants in the clinical setting.
- Some tricyclic antidepressants with SSRI-like activity yield the same result.
- As a side effect, many of these agents have been found to cause a significant delay in reaching orgasm in both male and female patients.
- For this reason, medications with SSRI side effects have been used in men who experience premature ejaculation.
References:
1. http://en.wikipedia.org/wiki/Premature_ejaculation
2. http://emedicine.medscape.com/article/435884-treatment#a1127
3. http://www.bergenurological.com
Pelvic Floor Muscle Exercise
Dr. Andrew Siegel, a urologist in Hackensack, New Jersey, discusses pelvic floor muscle exercises.
Part 1 of 2.
Part 2 of 2.
A Kegel exercise, named after Dr. Arnold Kegel, consists of contracting and relaxing the muscles that form part of the pelvic floor (which are now sometimes colloquially referred to as the "Kegel muscles").
Explanation
The aim of Kegel exercises is to improve muscle tone by strengthening the pubococcygeus muscles of the pelvic floor. Kegel is a popular prescribed exercise for pregnant women to prepare the pelvic floor for physiological stresses of the later stages of pregnancy and vaginal childbirth. Kegel exercises are said to be good for treating vaginal prolapse and preventing uterine prolapse in women and for treating prostate pain and swelling resulting from benign prostatic hyperplasia (BPH) and prostatitis in men. Kegel exercises may be beneficial in treating urinary incontinence in both men and women.Kegel exercises may also increase sexual gratification and aid in reducing premature ejaculation.
Benefits for women
Factors such as pregnancy, childbirth, aging, being overweight, and abdominal surgery such as cesarean section, often result in the weakening of the pelvic muscles. This can be assessed by either digital examination of vaginal pressure or using a Kegel perineometer. Kegel exercises are useful in regaining pelvic floor muscle strength in such cases.
Urinary incontinence
The consequences of weakened pelvic floor muscles may include urinary or bowel incontinence, which may be helped by therapeutic strengthening of these muscles. A meta-analysis of randomized controlled trials by the Cochrane Collaboration concluded that "PFMT [Pelvic floor muscle training] be included in first-line conservative management programs for women with stress, urge, or mixed, urinary incontinence...The treatment effect might be greater in middle aged women (in their 40's and 50's) with stress urinary incontinence alone...".
Pelvic prolapse
The exercises are also often used to help prevent prolapse of pelvic organs. A meta-analysis of randomized controlled trials by the Cochrane Collaboration concluded that "there is some encouragement from a feasibility study that pelvic floor muscle training, delivered by a physiotherapist to symptomatic women in an outpatient setting, may reduce severity of prolapse".
Benefits for men
Though most commonly used by women, men can also use Kegel exercises. Kegel exercises are employed to strengthen the pubococcygeal muscle and other muscles of the pelvic diaphragm. Kegels can help men achieve stronger erections and gain greater control over ejaculation. The objective of this may be similar to that of the exercise in women with weakened pelvic floor: to increase bladder and bowel control and sexual function.
Incontinence
Regarding postprostatectomy urinary incontinence, a meta-analysis of randomized controlled trials by the Cochrane Collaboration found "conflicting information about the benefit of pelvic floor muscle training for either prevention or treatment of urine leakage".
Sexual function
Kegel workouts can provide men with stronger erections. Research published in 2005 issue of BJU International, have shown that pelvic floor exercises could help restore erectile function in men with erectile dysfunction. There are said to be significant benefits for the problem of premature ejaculation from having more muscular control of the pelvis. It is also possible that strengthening the pelvic floor may allow some men to achieve a form of orgasm without allowing ejaculation, and thereby perhaps reach multiple "climaxes" during sexual activity. In men, this exercise lifts up the testicles, also strengthening the cremaster muscle, as well as the anal sphincter muscles, as the anus is the main area contracted when a Kegel is done. This is because the pubococcygeus muscle begins around the anus and runs up to the urinary sphincter.
Reference: http://en.wikipedia.org/wiki/Kegel_exercise
Kadar Testosteron Normal dan Beberapa Parameter Lain, pada Laki-laki Dewasa
Tabel ini menunjukkan kadar normal dalam darah, pada laki-laki dewasa (>18 th).
Kadar ini bisa bervariasi tergantung dari usia dan kondisi klinis masing masing orang.
-bagi yang mau kopi paste harap menyertakan link ke blog ini ya-
Malang, May 3rd, 2011
Monday, May 2, 2011
International Index of Erectile Function Questionnaire (IIEF)
The International Index of Erectile Function
Questionnaire (IIEF)
Please complete and bring this questionnaire to your appointment (circle
your answers and add up the total).
The first five questions refer to erectile function
Q1. Over the last month, how often were you able to get an erection during sexual activity?
0 No sexual activity
5 Almost always or always
4 Most times (much more than half the time)
3 Sometimes (about half the time)
2 A few times (much less than half the time)
1 Almost never or never
Q2. Over the last month, when you had erections with sexual stimulation, how often were your erections hard enough for penetration?
0 No sexual activity
5 Almost always or always
4 Most times (much more than half the time)
3 Sometimes (about half the time)
2 A few times (much less than half the time)
1 Almost never or never
Q3. Over the last month, when you attempted intercourse, how often were you able to penetrate your partner?
0 No sexual activity
5 Almost always or always
4 Most times (much more than half the time)
3 Sometimes (about half the time)
2 A few times (much less than half the time)
1 Almost never or never
Q4. Over the last month, during sexual intercourse, how often were you able to maintain your erection after you had pentrated your partner?
0 No sexual activity
5 Almost always or always
4 Most times (much more than half the time)
3 Sometimes (about half the time)
2 A few times (much less than half the time)
1 Almost never or never
Q5. Over the last month, during sexual intercourse, how difficult was it to maintain your erection to completion of intercourse?
0 No sexual activity
1 Extremely difficult
2 Very difficult
3 Difficult
4 Slightly difficult
5 Not difficult
The next three questions refer to satisfaction with intercourse
Q6. Over the last month, how many times have you attempted sexual intercourse?
0 No attempts
1 1-2 times
2 3-4 times
3 5-6 times
4 7-10 times
5 11-20 times
Q7. Over the last month, when you attempted sexual intercourse how often was it satisfactory for you?
0 Did not attempt intercourse
5 Almost always or always
4 Most times (much more than half the time)
3 Sometimes (about half the time)
2 A few times (much less than half the time)
1 Almost never or never
Q8. Over the last month, how much have you enjoyed sexual intercourse?
0 No intercourse
5 Very highly enjoyable
4 Highly enjoyable
3 Fairly enjoyable
2 Not very enjoyable
1 No enjoyment
The next two questions refer to orgasmic function
Q9. Over the last month, when you had sexual stimulation or intercourse, how often did you ejaculate?
0 No sexual stimulation/intercourse
5 Almost always or always
4 Most times (much more than half the time)
3 Sometimes (about half the time)
2 A few times (much less than half the time)
1 Almost never or never
Q10. Over the last month, when you had sexual stimulation or intercourse, how often did you have the feeling of orgasm (with or without ejaculation)?
0 No sexual stimulation/intercourse
5 Almost always or always
4 Most times (much more than half the time)
3 Sometimes (about half the time)
2 A few times (much less than half the time)
1 Almost never or never
The next two questions ask about sexual desire. In this context, sexual desire is defined as a feeling that may include wanting to have a sexual experience (for example masturbation or sexual intercourse), thinking about having sex, or feeling frustrated due to lack of sex.
Q11. Over the last month, how often have you felt sexual desire?
5 Almost always or always
4 Most times (much more than half the time)
3 Sometimes (about half the time)
2 A few times (much less than half the time)
1 Almost never or never
Q12. Over the last month, how would you rate your level of sexual desire?
5 Very high
4 High
3 Moderate
2 Low
1 Very low or not at all
The next two questions refer to overall sexual satisfaction.
Q13. Over the last month, how satisfied have you been with your overall sex life?
5 Very satisfied
4 Moderately satisfied
3 About equally satisfied and dissatisfied
2 Moderately dissatisfied
1 Very dissatisfied
Q14. Over the last month, how satisfied have you been with your sexual relationship with your partner?
5 Very satisfied
4 Moderately satisfied
3 About equally satisfied and dissatisfied
2 Moderately dissatisfied
1 Very dissatisfied
The last question refers to erectile function
Q15. Over the last month, how do you rate your confidence that you can get and keep your erection?
5 Very high
4 High
3 Moderate
2 Low
1 Very low
What the Scores Mean
All the questions break down into five specific areas, as follows. Add your scores to the appropriate column.
Clinical Interpretation
I. Erectile function total scores can be interpreted as follows:
| Score | Interpretation |
| 0-6 | Severe dysfunction |
| 7-12 | Moderate dysfunction |
| 13-18 | Mild to moderate dysfunction |
| 19-24 | Mild dysfunction |
| 25-30 | No dysfunction |
II. Orgasmic function total scores can be interpreted as follows:
| Score | Interpretation |
| 0-2 | Severe dysfunction |
| 3-4 | Moderate dysfunction |
| 5-6 | Mild to moderate dysfunction |
| 7-8 | Mild dysfunction |
| 9-10 | No dysfunction |
III. Sexual desire total scores can be interpreted as follows:
| Score | Interpretation |
| 0-2 | Severe dysfunction |
| 3-4 | Moderate dysfunction |
| 5-6 | Mild to moderate dysfunction |
| 7-8 | Mild dysfunction |
| 9-10 | No dysfunction |
IV. Intercourse satisfaction total scores can be interpreted as follows:
| Score | Interpretation |
| 0-3 | Severe dysfunction |
| 4-6 | Moderate dysfunction |
| 7-9 | Mild to moderate dysfunction |
| 10-12 | Mild dysfunction |
| 13-15 | No dysfunction |
V. Overall satisfaction total scores can be interpreted as follows:
| Score | Interpretation |
| 0-2 | Severe dysfunction |
| 3-4 | Moderate dysfunction |
| 5-6 | Mild to moderate dysfunction |
| 7-8 | Mild dysfunction |
| 9-10 | No dysfunction |
If you suffered mild to severe dysfunction, go seek professional help immediately!
Source: Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A.
The international index of erectile function (IIEF) a multidimensional scale for assessment of erectile dysfunction. Urology. 1997 Jun; 49(6):822-30. Copyright 1997 by Elsevier Science, Inc.
References:
http://www.menshealthboston.com/forms/IIEF.pdf
http://www.seekwellness.com/mensexuality/questionnaire.htm