Many women become very worried if vaginal bleeding occurs long after their periods have stopped. If the bleeding stops by itself, you might be tempted to postpone consulting your physician. If you use female hormones, bleeding may occasionally occur as a result. However, there may be other, more serious causes of bleeding even if you take these hormones. In all cases you should report any bleeding or any change in amount of bleeding or predictability to your doctor.
Sometimes the wall of the vagina becomes thin because of a lack of hormonal (estrogen) stimulation and causes bleeding, itching, or irritation. This is called senile vaginitis. Often a small amount of estrogen cream applied to the area relieves the symptoms. For those women already receiving cyclical hormone therapy this is usually not necessary. Prevention of and treatment of senile vaginitis decreases the pain that might be associated with intercourse during the later years.
An important cause of bleeding is the presence of tumors, either benign or malignant. Unless the cause is obvious from a gynecological examination, many physicians will recommend a dilatation and curettage (D and C) to diagnose the cause and ensure that no tumors are present. The D and C consists of widening the entrance to the cervix while you are anesthetized and “scraping” the lining of the uterus to obtain tissue for analysis. With this procedure the cause of the bleeding can usually be identified and proper treatment recommended.
*185\166\2*
Before the AIDS virus was identified, some people received blood and blood products (for example, plasma, serum to treat hemophilia) that was tainted with the AIDS virus. Since the discovery of methods to test donated blood for the virus, the risk of acquiring the AIDS virus from a blood transfusion is extremely small. Similar procedures have been used to screen blood for the hepatitis virus, thereby reducing the risk of this virus as well, which on occasion can cause a lethal form of hepatitis.
In general, blood transfusions are given for illnesses of such a severity that to withhold the transfusion would be very risky. Now that blood is more carefully screened, the risk of the transfusion in terms of acquiring the AIDS or the hepatitis virus is extremely small. Concern about this possibility has led some people to donate their own blood during the period before elective (planned) surgery, to be used for a transfusion if one is needed. In some medical centers this program is already being used for elective open-heart and hip surgery. Whether this practice becomes common remains to be seen. If your physician decides that you require a blood transfusion, you can be confident that effective steps have been taken to supply you with safe, uninfected blood. There is no danger in donating blood and the Red Cross depends on reliable, healthy donors to assure a safe blood supply for the population.
*172\166\2*
Ron, a forty-one-year-old electrician, was one of the first men who enroled in the Phase III Vasomax trials that I supervised. Using two thousand patients from around the country, Zonagen, the manufacturer of Vasomax, began additional research. The participating doctors and subjects knew the drug that was being tested. In this case, it happened to be the 40 mg dose of Vasomax. The goal was to get long-term safety experience with the medication prior to applying to the Food and Drug Administration for formal approval.
“I felt that the sex I was having was just okay,” Ron told me on his first visit. “I also knew that it should have been a lot better. I’m not looking for the stamina of a teenager,” he admitted, “but now sex doesn’t feel the way I know it can be. Getting an erection isn’t the problem—it’s that I’m not as firm and full as I used to be. Amy, my wife says it doesn’t bother her. But I’m very aware of it—and it upsets me. A lot.”
Ron was so dismayed by his problem that he mentioned it to his family physician after a routine checkup. His results were fine, with the exception of an elevated cholesterol count. At 260 milliliters per deciliter(ml/dl) it was high, and his doctor told him that he should work on lowering it to a healthier level of under 200 ml/dl.
When Ron voiced his sexual concerns, he was stunned by the doctor’s reaction. “You’re in your forties. What do you expect?” he was told. ” Yon have to expect a little letdown in your sexual performance as your age. It’s just the way it is.”
Not for Ron it wasn’t. Dissatisfied with both his doctor’s interpretation of, and insensitivity to, his problem, he made an appointment with a urologist for more detailed testing. Maybe, he thought, his doctor had missed a clue that would solve his ED.
After providing a complete medical history and answering questions about masturbation, morning erections, and his libido, Ron underwent a more complex physical exam which included the health of his genitals and prostate gland. Then he had to undergo what he referred to as “the single most embarrassing event of my adult life.”
The doctor explained to him that in order to fully determine the extent of Ron’s ED, he would begin tests to measure and scrutinize erectile function. Standing naked in front of the doctor, Ron saw what was going to happen next. The urologist was approaching him with an ultra-thin needle and his aim was low. Extremely needle-phobic, Ron tried to calm himself while he was injected in the base of his penis with tri-mix, the combination of papaverine, phentolamine, and prostaglandin E-l.
Within five minutes, the drugs began to take effect, resulting in an erection. But Ron’s experience wasn’t about to end there. Left alone in the examining room, he was instructed to remain standing and masturbate. Erotic materials were provided in the event that he needed them. Then, in order to test the effectiveness of the tri-mix, the doctor had to know whether or not he had successfully masturbated and how long his erection lasted. To ascertain this information, he checked on Ron every ten minutes to note penis rigidity and fullness. For almost twenty minutes after the injection, his erection was still hard, then began to subside. Needless to say, nothing about this episode even vaguely approached normal sexual response.
Nevertheless; comparing the test results with his medical history, the urologist was able to diagnose a mild blood flow disruption to the penis. He believed that Ron’s erection problem was triggered by early arteriosclerosis, or hardening on the arteries. This, the doctor informed him, was most likely linked to his elevated cholesterol. That, in turn, was connected to arterial blockage, which resulted in his mild blood flow problem.
Ron left the doctor’s office feeling, as he later put it, “about as lousy as I’ve ever felt. Telling me to inject myself every time I wanted to have sex with my wife was not what I wanted to hear. I had to find another way.”
*44\138\8*
Testing a potential mass-market drug is no small matter. It takes time, plenty of money, and patience. When a pharmaceutical company believes it has a marketable drug, it must be submitted to rigorous scientific trials. They consist of actual tests on human subjects and can take a decade or more to complete, with time spent to assemble, correlate, and disseminate the data. Pharmaceutical companies estimate that taking a new medication from the research phase through each of the three, sometimes four, individual experimental trials, to the final submission of the data to the Food and Drug Administration costs $500 million on average. For all the time and money spent, the pharmaceutical company is afforded some protection from competitors. Once a drug gets FDA approval, the company then has two decades in which to exclusively produce and sell that drug.
The procedure for drug trials is always the same. Each promising drug starts out with a relatively small Phase I trial in which the new medication is offered to a select group of patients who have not been helped by conventional therapy. This is not without risk: although the drugs have been tested on animals, toxicity to humans is, at this point, unknown. Phase I trials are usually limited to just a dozen or so patients and generally last up to a year.
If the drug appears to be effective and has acceptable side effects. Phase II begins. Now, dozens of people will receive the drug, while dozens more will take placebos (inert substances). At this time, the searchers are looking at the safety and side-effect profile, but they especially want to know if the experimental drug is more effective than both the placebo and any current therapy used to treat the same aliment. If the drug still seems to be working, then Phase III trials start in which hundreds of subjects, some of whom receive the drug, some of whom get a placebo, are used. Neither group, nor the administering physicians, know who is taking which one. Researchers examine the side effects and effectiveness very closely and also seek to determine optimal dosages of the drug. By Phase IV, the drug has been proven to be effective and researchers are fine-tuning the treatment on test sub-in is, not checking for efficacy, but seeking to determine whether or not any disturbing side effects appear.
Time-consuming as they are, these medical trials are very important. They strive to prove whether the drug works the way researchers claim it will. And they check to make sure that, when dosage reommendations are followed carefully, the patient will be helped. In the end, the overall safety of a drug is a more crucial consideration than its efficacy.
*34\183\8*
ED can be experienced when there are problems with the nerves that are responsible for erections. The nerves are signal carriers, relaying information from the brain to the penile arteries. Alerted, the blood vessels open, allowing enough blood to rush in to cause hardness. If, however, there is a problem with these nerves, either from spinal cord, brain, prostate, or groin injuries, the messages aren’t transmitted correctly. The outcome is an impaired erection—or none at all.
The major nerve problem is produced by diabetes mellitus, a chronic disorder usually caused by a deficient secretion of insulin, the hormonal substance manufactured by the endocrine glands in the pancreas. It is now estimated that the prevalence of ED in men with diabetes is between 35 percent and 75 percent. More than half of them notice the first onset of ED within ten years of developing the disease.
Genetic predisposition, along with obesity, are the most significant factors known to trigger diabetes. In either case, the condition adveresely affects the nerves, making it progressively more difficult for nerve impulses to reach the penis. In some cases, diabetes delivers a double threat: it can also damage blood vessels, causing them to become blocked and interrupt blood flow to the penis.
Multiple sclerosis, a progressive nervous system disorder, and Parkinson’s disease, a degenerative brain syndrome, also create neurological disturbances that can lead to ED. Other nerve disruptions can be brought on by back surgery, as well as disk herniation in the lower back (If a patient tells me his erections were normal before sustaining a back injury, I immediately suspect nerve damage.) Other sources include cancer surgery or any radiation therapy on the pelvic area. If the prostate gland is removed, or an operation is performed to remove cancer in the lower rectum or colon, delicate nerves can also be damaged, leading to erection problems.
*25\183\8*
Vacuum erection therapy was developed in 1961 by Geddings Osbon. A .sufferer of ED, he refused to accept the fact that he could no longer have sexual intimacy with his wife of three decades. Working intently the next couple of years, he invented a plastic device, actually an external vacuum, that was capable of inducing an erection. A reversible, noninvasive form of dealing with ED, the vacuum device was used by Obson for more than twenty years. In 1983, he was awarded a patent for it. The company he founded, Osbon Medical Systems, still manufactures and distributes his Erecaid vacuum device worldwide.
The device acts in a very simple way. When a man wants to have in erection, he places a clear plastic cylinder over his penis, and either a manual or special electrical pump is used to create negative pressure in the tube. Regardless of the source of the erection problem, this PRESSURE causes vessels in the penis to fill with blood, just as they would in a normal erection. Once an erection is achieved—it may take two minutes or so—a flexible tension ring is slipped off the bottom of cylinder around the base of the penis to keep blood from flowing out of the penis, thereby allowing it to stay hard when the cylinder is removed. The resulting erection may be safely sustained for at least thirty minutes. Allowing the erection to last longer than that can produce damage to delicate erectile tissue.
The pump does have several advantages, the primary ones being that it is very safe and free of side effects. And it can be utilized whenever an erection is desired. Some urologists are now recommending pump use following prostate and penile surgery to promote erections and thereby protect the penis from potential damage caused by the lack of regularly occurring nocturnal erections.
In day-to-day use, some pump users complain that their penis feels numb, or that it becomes discolored, misshapen, and cold to the touch. Many speak of the interruption of intimacy that using it brings during lovemaking. Research shows that about 7 percent of men using it experience mild discomfort upon ejaculation or varying degrees of ejaculation impairment. The pump costs between $400 to $500 and is available only with a physician’s prescription.
*16\183\8*
ED has always been with us; treatments have been employed to combat it for thousands of years. Not surprisingly, the view of the problem, as well as the remedies for it, grows out of the culture and belief system of a particular time.
To fully understand how far back erectile problems go, we need only look to the Bible. In Genesis, ED is regarded as a punishment for committing adultery. Abimelech was stricken with it after just thinking about having sex with Abraham’s wife. Two thousand years ago, the Egyptians, a sophisticated and innovative people, recorded their recipes cure ED. In their culture, it was attributed to the wrath of a particular god, and a typical corrective included pacifying the appropriate idol with offerings. At other times, herbal enhancers were used to restore diminished or lost virility.
The ancient Greeks were also no strangers to ED. At that time, it was commonly believed that a vast array of erectile problems would be experienced by any man who, as a child, had sat on a tomb. The cure was to drink a potion made with the scrapings of a knife used to geld rams.
Interestingly, the very first references to the psychological roots of ED can be traced all the way back to the Greek legend of Iphiclus. As a youh, Iphiclus, the son of King Phylacus, saw his father coming toward him clutching the handle of a bloody knife that had been used to castrate a ram. Terrified by the thought that his father would turn on him with the weapon, Iphiclus soon developed chronic erectile failure. A physician named Melampus figured out a way to help him with a technique later commonly employed in psychiatry. He showed the prince the gelding knife. When he observed that the blood was long dried and the knife itself rusted, Iphiclus was able to overcome his fear and his ED disappeared.
As time went on, most men weren’t as fortunate as the young Greek. By the Middle Ages, the Catholic Church attributed ED to witchcraft, as well as to the effects of demonic possession. A sexual hex known as a “ligature” was commonly used to invoke ED in an unsuspecting foe through the power of suggestion. All the instigator had to do was tie a series of knots in a cord or a strip of leather and hide it in a secret place. He would then let his victim know what he’d done. Depending on both the number and specific configuration of knots, it was believed the victim would then develop partial or total erectile failure. In some cases, total sterility could, it was thought, be achieved. Of course, hexes relied heavily on the belief in magic. If a man accepted their power, he could be influenced by them. Conversely, if he felt that an incantation could actually break the spell, he might achieve some positive results.
*8\183\8*