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===Alternative medicine===
===Alternative medicine===
The [[United States Food and Drug Administration|Food and Drug Administration]] (FDA) does not recommend alternative therapies to treat sexual dysfunction.<ref>{{cite web |url=http://www.medscape.com/viewarticle/562177 |title=Dangers of Sexual Enhancement Supplements |website= |accessdate=}}</ref> Many products are advertised as "[[herbal viagra]]" or "natural" sexual enhancement products, but no clinical trials or scientific studies support the effectiveness of these products for the treatment of ED, and synthetic chemical compounds similar to sildenafil have been found as [[adulterant]]s in many of these products.<ref>{{cite journal |vauthors=Gryniewicz CM, Reepmeyer JC, Kauffman JF, Buhse LF | title = Detection of undeclared erectile dysfunction drugs and analogues in dietary supplements by ion mobility spectrometry | journal = Journal of Pharmaceutical and Biomedical Analysis | volume = 49 | issue = 3 | pages = 601–06 | year = 2009 | pmid = 19150190 | doi = 10.1016/j.jpba.2008.12.002 }}</ref><ref>{{cite journal |vauthors=Choi DM, Park S, Yoon TH, Jeong HK, Pyo JS, Park J, Kim D, Kwon SW | title = Determination of analogs of sildenafil and vardenafil in foods by column liquid chromatography with a photodiode array detector, mass spectrometry, and nuclear magnetic resonance spectrometry | journal = Journal of AOAC International | volume = 91 | issue = 3 | pages = 580–88 | year = 2008 | pmid = 18567304 }}</ref><ref>{{cite journal |vauthors=Reepmeyer JC, Woodruff JT | title = Use of liquid chromatography-mass spectrometry and a chemical cleavage reaction for the structure elucidation of a new sildenafil analogue detected as an adulterant in an herbal dietary supplement | journal = Journal of Pharmaceutical and Biomedical Analysis | volume = 44 | issue = 4 | pages = 887–93 | year = 2007 | pmid = 17532168 | doi = 10.1016/j.jpba.2007.04.011 }}</ref><ref>{{cite journal |vauthors=Reepmeyer JC, Woodruff JT, d'Avignon DA | title = Structure elucidation of a novel analogue of sildenafil detected as an adulterant in an herbal dietary supplement | journal = Journal of Pharmaceutical and Biomedical Analysis | volume = 43 | issue = 5 | pages = 1615–21 | year = 2007 | pmid = 17207601 | doi = 10.1016/j.jpba.2006.11.037 }}</ref><ref>[http://www.fda.gov/Safety/Recalls/EnforcementReports/ucm217780.htm Enforcement Report for June 30, 2010], [[United States Food and Drug Administration]]</ref> The FDA has warned consumers that any sexual enhancement product that claims to work as well as prescription products is likely to contain such a contaminant.<ref>[http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm048386.htm Hidden Risks of Erectile Dysfunction "Treatments" Sold Online], [[United States Food and Drug Administration]], February 21, 2009</ref>
The [[United States Food and Drug Administration|Food and Drug Administration]] (FDA) does not recommend alternative therapies to treat sexual dysfunction.<ref>{{cite web |url=http://www.medscape.com/viewarticle/562177 |title=Dangers of Sexual Enhancement Supplements |website= |accessdate=}}</ref> Many products are advertised as "[[herbal viagra]]" or "natural" sexual enhancement products, but no clinical trials or scientific studies support the effectiveness of these products for the treatment of ED, and synthetic chemical compounds similar to sildenafil have been found as [[adulterant]]s in many of these products.<ref>{{cite journal |vauthors=Gryniewicz CM, Reepmeyer JC, Kauffman JF, Buhse LF | title = Detection of undeclared erectile dysfunction drugs and analogues in dietary supplements by ion mobility spectrometry | journal = Journal of Pharmaceutical and Biomedical Analysis | volume = 49 | issue = 3 | pages = 601–06 | year = 2009 | pmid = 19150190 | doi = 10.1016/j.jpba.2008.12.002 }}</ref><ref>{{cite journal |vauthors=Choi DM, Park S, Yoon TH, Jeong HK, Pyo JS, Park J, Kim D, Kwon SW | title = Determination of analogs of sildenafil and vardenafil in foods by column liquid chromatography with a photodiode array detector, mass spectrometry, and nuclear magnetic resonance spectrometry | journal = Journal of AOAC International | volume = 91 | issue = 3 | pages = 580–88 | year = 2008 | pmid = 18567304 }}</ref><ref>{{cite journal |vauthors=Reepmeyer JC, Woodruff JT | title = Use of liquid chromatography-mass spectrometry and a chemical cleavage reaction for the structure elucidation of a new sildenafil analogue detected as an adulterant in an herbal dietary supplement | journal = Journal of Pharmaceutical and Biomedical Analysis | volume = 44 | issue = 4 | pages = 887–93 | year = 2007 | pmid = 17532168 | doi = 10.1016/j.jpba.2007.04.011 }}</ref><ref>{{cite journal |vauthors=Reepmeyer JC, Woodruff JT, d'Avignon DA | title = Structure elucidation of a novel analogue of sildenafil detected as an adulterant in an herbal dietary supplement | journal = Journal of Pharmaceutical and Biomedical Analysis | volume = 43 | issue = 5 | pages = 1615–21 | year = 2007 | pmid = 17207601 | doi = 10.1016/j.jpba.2006.11.037 }}</ref><ref>[http://www.fda.gov/Safety/Recalls/EnforcementReports/ucm217780.htm Enforcement Report for June 30, 2010], [[United States Food and Drug Administration]]</ref> The FDA has warned consumers that any sexual enhancement product that claims to work as well as prescription products is likely to contain such a contaminant.<ref>[http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm048386.htm Hidden Risks of Erectile Dysfunction "Treatments" Sold Online], [[United States Food and Drug Administration]], February 21, 2009</ref>

==Psychological Impact==

Erectile dysfunction often has a significant impact on the emotional well-being of both men<ref>{{cite journal |last1=Zaman |first1=Huri H |last2=Mat |first2=Sanusi N |last3=Abdul |first3=Razack AH |last4=Mark |first4=R |title=Association of psychological factors, patients' knowledge, and management among patients with erectile dysfunction |journal=Patient Preference and Adherence |date=May 2016 |volume=2016 |issue=10 |pages=807–823 |doi=10.2147/PPA.S99544|pmid=27257374 |pmc=4874731 }}</ref><ref>{{cite web |title=Comprehensive Study on the Impact of Erectile Dysfunction |url=https://edtreatment.info/ed-impact-study/ |website=ED Treatment Information Center |accessdate=15 December 2018 |date=Mar 2018}}</ref><ref>{{cite journal |last1=Latini |first1=DM |last2=Penson |first2=DF |last3=Colwell |first3=HH |last4=Lubeck |first4=DP |last5=Mehta |first5=SS |last6=Henning |first6=JM |last7=Lue |first7=TF |title=Psychological impact of erectile dysfunction: validation of a new health related quality of life measure for patients with erectile dysfunction |journal=Journal of Urology |volume=168 |date=Nov 2002 |issue=168(5) |pages=2086–91 |pmid=12394715 |doi=10.1097/01.ju.0000034365.57110.b7 |doi-broken-date=2019-02-16 }}</ref> and their partners.<ref>{{cite web |title=The Impact of Erectile Dysfunction on Partners of Men with ED |url=https://edtreatment.info/ed-partners-study/ |website=ED Treatment Information Center |accessdate=15 December 2018 |date=13 December 2018}}</ref> Commonly reported problems include loss of self-esteem, a decline in overall happiness, and [[Depression_(mood)|depression]].

Due to feelings of embarrassment and shame, many men do not seek treatment for ED. About 75% of diagnosed cases of ED go untreated.<ref>{{cite journal |last1=Frederick |first1=LR |last2=Cakir |first2=OO |last3=Arora |first3=H |last4=Helfand |first4=BT |last5=McVary |first5=KT |title=Undertreatment of Erectile Dysfunction: Claims Analysis of 6.2 Million Patients |journal=The Journal of Sexual Medicine |date=October 2018 |volume=11 |issue=10 |url=https://www.jsm.jsexmed.org/article/S1743-6095(15)30578-6/fulltext}}</ref>

Men and couples who are dealing with the impact of ED on their relationship may benefit from counseling by a qualified relationship counselor or coach. Successful ED treatment can also reduce the emotional impact.<ref>{{cite journal |last1=Costa |first1=Pierre |last2=Grandmotter |first2=Giles |last3=Mai |first3=Hein Duc |last4=Droupy |first4=Stéphane |title=Impact of a First Treatment with Phosphodiesterase Inhibitors on Men and Partners' Quality of Sexual Life: Results of a Prospective Study in Primary Care |journal=The Journal of Sexual Medicine |date=July 2013 |volume=10 |issue=7 |pages=1850–1860 |url=https://www.jsm.jsexmed.org/article/S1743-6095(15)30410-0/fulltext|doi=10.1111/jsm.12186 |pmid=23679019 }}</ref><ref>{{cite journal |last1=Tomlinson |first1=John |last2=Wright |first2=David |title=Impact of erectile dysfunction and its subsequent treatment with sildenafil: qualitative study |journal=British Journal of Medicine |date=1 May 2004 |issue=328(7447): 1037 |pmc=403839 }}</ref>



==History==
==History==

Revision as of 21:18, 16 February 2019

Erectile dysfunction
Other namesImpotence
SpecialtyUrology

Erectile dysfunction (ED), also known as impotence, is a type of sexual dysfunction characterized by the inability to develop or maintain an erection of the penis during sexual activity. Erectile dysfunction can have psychological consequences as it can be tied to relationship difficulties and self-image.

A physical cause can be identified in about 80% of cases.[1] These include cardiovascular disease, diabetes mellitus, neurological problems such as following prostatectomy, hypogonadism, and drug side effects. Psychological impotence is where erection or penetration fails due to thoughts or feelings; this is somewhat less frequent, in the order of about 10% of cases.[1] In psychological impotence, there is a strong response to placebo treatment.

Treatment involves addressing the underlying causes, lifestyle modifications, and addressing psychosocial issues.[1] In many cases, a trial of pharmacological therapy with a PDE5 inhibitor, such as sildenafil, can be attempted. In some cases, treatment can involve inserting prostaglandin pellets into the urethra, injecting smooth muscle relaxants and vasodilators into the penis, a penile prosthesis, a penis pump, or vascular reconstructive surgery.[1][2] It is the most common sexual problem in men.[3]

Signs and symptoms

Erectile dysfunction is characterized by the regular or repeated inability to achieve or maintain an erection of sufficient rigidity to accomplish sexual activity.

It is defined as the "persistent or recurrent inability to achieve and maintain a penile erection of sufficient rigidity to permit satisfactory sexual activity for at least 3 months."[1]

Psychological

Erectile dysfunction often has an impact on the emotional well-being of both men and their partners. Due to feelings of embarrassment many men do not seek treatment about 75% of diagnosed cases of ED go untreated.[4]

Causes

Surgical intervention for a number of conditions may remove anatomical structures necessary to erection, damage nerves, or impair blood supply.[9] Erectile dysfunction is a common complication of treatments for prostate cancer, including prostatectomy and destruction of the prostate by external beam radiation, although the prostate gland itself is not necessary to achieve an erection. As far as inguinal hernia surgery is concerned, in most cases, and in the absence of postoperative complications, the operative repair can lead to a recovery of the sexual life of people with preoperative sexual dysfunction, while, in most cases, it does not affect people with a preoperative normal sexual life.[14]

ED can also be associated with bicycling due to both neurological and vascular problems due to compression.[15] The increase risk appears to be about 1.7-fold.[16]

Concerns that use of pornography can cause erectile dysfunction[17] have not been substantiated in epidemiological studies according to a 2015 literature review.[18]

Pathophysiology

Penile erection is managed by two mechanisms: the reflex erection, which is achieved by directly touching the penile shaft, and the psychogenic erection, which is achieved by erotic or emotional stimuli. The former uses the peripheral nerves and the lower parts of the spinal cord, whereas the latter uses the limbic system of the brain. In both cases, an intact neural system is required for a successful and complete erection. Stimulation of the penile shaft by the nervous system leads to the secretion of nitric oxide (NO), which causes the relaxation of smooth muscles of corpora cavernosa (the main erectile tissue of penis), and subsequently penile erection. Additionally, adequate levels of testosterone (produced by the testes) and an intact pituitary gland are required for the development of a healthy erectile system. As can be understood from the mechanisms of a normal erection, impotence may develop due to hormonal deficiency, disorders of the neural system, lack of adequate penile blood supply or psychological problems.[19] Spinal cord injury causes sexual dysfunction including ED. Restriction of blood flow can arise from impaired endothelial function due to the usual causes associated with coronary artery disease, but can also be caused by prolonged exposure to bright light.

Diagnosis

In many cases, the diagnosis can be made based on the person's history of symptoms. In other cases, a physical examination and laboratory investigations are done to rule out more serious causes such as hypogonadism or prolactinoma.[1]

One of the first steps is to distinguish between physiological and psychological ED. Determining whether involuntary erections are present is important in eliminating the possibility of psychogenic causes for ED.[1] Obtaining full erections occasionally, such as nocturnal penile tumescence when asleep (that is, when the mind and psychological issues, if any, are less present), tends to suggest that the physical structures are functionally working.[20][21] Similarly, performance with manual stimulation, as well as any performance anxiety or acute situational ED, may indicate a psychogenic component to ED.[1]

Other factors leading to erectile dysfunction are diabetes mellitus, which is a well-known cause of neuropathy).[1] ED is also related to generally poor physical health, poor dietary habits, obesity, and most specifically cardiovascular disease, such as coronary artery disease and peripheral vascular disease.[1] Screening for cardiovascular risk factors, such as smoking, dyslipidemia, hypertension, and alcoholism is helpful.[1]

In some particular cases, the simple search for a previously undetected groin hernia can prove useful since it can affect sexual functions in men and is relatively easily curable.[14]

The current diagnostic and statistical manual of mental diseases (DSM-IV) has included a listing for ED.

Duplex ultrasound
Duplex ultrasound is used to evaluate blood flow, venous leak, signs of atherosclerosis, and scarring or calcification of erectile tissue. Injecting prostaglandin, a hormone-like stimulator produced in the body, induces the erection. Ultrasound is then used to see vascular dilation and measure penile blood pressure.
Penile nerves function
Tests such as the bulbocavernosus reflex test are used to determine if there is sufficient nerve sensation in the penis. The physician squeezes the glans (head) of the penis, which immediately causes the anus to contract if nerve function is normal. A physician measures the latency between squeeze and contraction by observing the anal sphincter or by feeling it with a gloved finger inserted past the anus.
Nocturnal penile tumescence (NPT)
It is normal for a man to have five to six erections during sleep, especially during rapid eye movement (REM). Their absence may indicate a problem with nerve function or blood supply in the penis. There are two methods for measuring changes in penile rigidity and circumference during nocturnal erection: snap gauge and strain gauge. A significant proportion of men who have no sexual dysfunction nonetheless do not have regular nocturnal erections.
Penile biothesiometry
This test uses electromagnetic vibration to evaluate sensitivity and nerve function in the glans and shaft of the penis.
Dynamic infusion cavernosometry (DICC)
technique in which fluid is pumped into the penis at a known rate and pressure. It gives a measurement of the vascular pressure in the corpus cavernosum during an erection.
Corpus cavernosometry
Cavernosography measurement of the vascular pressure in the corpus cavernosum. Saline is infused under pressure into the corpus cavernosum with a butterfly needle, and the flow rate needed to maintain an erection indicates the degree of venous leakage. The leaking veins responsible may be visualized by infusing a mixture of saline and x-ray contrast medium and performing a cavernosogram.[22] In Digital Subtraction Angiography (DSA), the images are acquired digitally.
Magnetic resonance angiography (MRA)
This is similar to magnetic resonance imaging. Magnetic resonance angiography uses magnetic fields and radio waves to provide detailed images of the blood vessels. Doctors may inject a "contrast agent" into the person's bloodstream that causes vascular tissues to stand out against other tissues. The contrast agent provides for enhanced information regarding blood supply and vascular anomalies.

Treatment

Treatment depends on the underlying cause. In general, exercise, particularly of the aerobic type, is effective for preventing ED during midlife. Exercise as a treatment is under investigation.[23]: 6, 18–19  For tobacco smokers, cessation often results in a significant improvement.[24] Oral pharmacotherapy and vacuum erection devices are first-line treatments,[23]: 20, 24  followed by injections of drugs into the penis, as well as penile implants.[23]: 25–26  Vascular reconstructive surgeries are beneficial in certain groups.[25]

Medications

The PDE5 inhibitors sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis) are prescription drugs which are taken orally.[23]: 20–21  Additionally, a cream combining alprostadil with the permeation enhancer DDAIP has been approved in Canada as a first line treatment for erectile dysfunction.[26] Penile injections, on the other hand, can involve one of the following medications: papaverine, phentolamine, and prostaglandin E1, also known as alprostadil.[23]: 25 

Pumps

Main article: penis pump

A vacuum erection device helps draw blood into the penis by applying negative pressure. This type of device is sometimes referred to as penis pump and may be used just prior to sexual intercourse. Several types of FDA approved vacuum therapy devices are available under prescription. When pharmacological methods fail, a purpose-designed external vacuum pump can be used to attain erection, with a separate compression ring fitted to the base of the penis to maintain it. These pumps should be distinguished from other penis pumps (supplied without compression rings) which, rather than being used for temporary treatment of impotence, are claimed to increase penis length if used frequently, or vibrate as an aid to masturbation. More drastically, inflatable or rigid penile implants may be fitted surgically.

Surgery

Main article: Penile prosthesis

Often, as a last resort if other treatments have failed, the most common procedure is prosthetic implants which involves the insertion of artificial rods into the penis.[23]: 26  Some sources show that vascular reconstructive surgeries are viable options for some people.[27]

Alternative medicine

The Food and Drug Administration (FDA) does not recommend alternative therapies to treat sexual dysfunction.[28] Many products are advertised as "herbal viagra" or "natural" sexual enhancement products, but no clinical trials or scientific studies support the effectiveness of these products for the treatment of ED, and synthetic chemical compounds similar to sildenafil have been found as adulterants in many of these products.[29][30][31][32][33] The FDA has warned consumers that any sexual enhancement product that claims to work as well as prescription products is likely to contain such a contaminant.[34]

History

An unhappy wife is complaining to the Qadi about her husband's impotence. Ottoman miniature.

Attempts to treat erectile dysfunction date back well over 1,000 years. In the 8th century, men of Ancient Rome and Greece wore talismans of rooster and goat genitalia, believing these talismans would serve as an aphrodisiac and promote sexual function.[35] In the 13th century Albertus Magnus recommended ingesting roasted wolf penis as a remedy for impotence[35].

During the late 16th and 17th centuries in France, male impotence was considered a crime, as well as legal grounds for a divorce. The practice, which involved inspection of the complainants by court experts, was declared obscene in 1677.[36][37]

The first successful vacuum erection device, or penis pump, was developed by Vincent Marie Mondat in the early 1800s.[35] A more advanced device, based on a bicycle pump, was developed by Geddings Osbon, a Pentecostal preacher, in the 1970s. In 1982, he received FDA approval to market the product as the ErecAid®.[38]

John R. Brinkley initiated a boom in male impotence cures in the U.S. in the 1920s and 1930s. His radio programs recommended expensive goat gland implants and "mercurochrome" injections as the path to restored male virility, including operations by surgeon Serge Voronoff.

Modern drug therapy for ED made a significant advance in 1983, when British physiologist Giles Brindley dropped his trousers and demonstrated to a shocked Urodynamics Society audience his papaverine-induced erection.[39] The drug Brindley injected into his penis was a non-specific vasodilator, an alpha-blocking agent, and the mechanism of action was clearly corporal smooth muscle relaxation. The effect that Brindley discovered established the fundamentals for the later development of specific, safe, and orally effective drug therapies.[40][better source needed][41][better source needed]

The current first=line treatment for erectile dysfunction, the oral PDE5 inhibitor, was introduced by Pfizer in 1999.[42]

Lexicology

The Latin term impotentia coeundi describes simple inability to insert the penis into the vagina; it is now mostly replaced by more precise terms, such as erectile dysfunction (ED). The study of ED within medicine is covered by andrology, a sub-field within urology. Research indicates that ED is common, and it is suggested that approximately 40% of males experience symptoms compatible with ED, at least occasionally.[43] The condition is also on occasion called phallic impotence.[44] Its antonym, or opposite condition, is priapism.[45][46]

References

  1. ^ a b c d e f g h i j k l m Chowdhury SH, Cozma AI, Chowdhury JH. Erectile Dysfunction. Essentials for the Canadian Medical Liscensing Exam: Review and Prep for MCCQE Part I. 2nd edition. Wolters Kluwer. Hong Kong. 2017.
  2. ^ Montague DK, Jarow JP, Broderick GA, Dmochowski RR, Heaton JP, Lue TF, Milbank AJ, Nehra A, Sharlip ID (July 2005). "Chapter 1: The management of erectile dysfunction: an AUA update". J. Urol. 174 (1): 230–39. doi:10.1097/01.ju.0000164463.19239.19. PMID 15947645.
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  5. ^ Delgado PL, Brannan SK, Mallinckrodt CH, Tran PV, McNamara RK, Wang F, Watkin JG, Detke MJ (2005). "Sexual functioning assessed in 4 double-blind placebo- and paroxetine-controlled trials of duloxetine for major depressive disorder". The Journal of Clinical Psychiatry. 66 (6): 686–92. doi:10.4088/JCP.v66n0603. PMID 15960560.
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  22. ^ Dawson C, Whitfield H (April 1996). "ABC of urology. Subfertility and male sexual dysfunction". BMJ. 312 (7035): 902–05. doi:10.1136/bmj.312.7035.902. PMC 2350600. PMID 8611887.
  23. ^ a b c d e f Wespes E (chair), et al. Guidelines on Male Sexual Dysfunction: Erectile dysfunction and premature ejaculation. European Association of Urology 2013
  24. ^ Pourmand G, Alidaee MR, Rasuli S, Maleki A, Mehrsai A (2004). "Do cigarette smokers with erectile dysfunction benefit from stopping?: a prospective study". BJU Int. 94 (9): 1310–13. doi:10.1111/j.1464-410X.2004.05162.x. PMID 15610111.
  25. ^ "Encyclopedia of Reproduction - 2nd Edition". www.elsevier.com. Retrieved 2019-01-17.
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  28. ^ "Dangers of Sexual Enhancement Supplements".
  29. ^ Gryniewicz CM, Reepmeyer JC, Kauffman JF, Buhse LF (2009). "Detection of undeclared erectile dysfunction drugs and analogues in dietary supplements by ion mobility spectrometry". Journal of Pharmaceutical and Biomedical Analysis. 49 (3): 601–06. doi:10.1016/j.jpba.2008.12.002. PMID 19150190.
  30. ^ Choi DM, Park S, Yoon TH, Jeong HK, Pyo JS, Park J, Kim D, Kwon SW (2008). "Determination of analogs of sildenafil and vardenafil in foods by column liquid chromatography with a photodiode array detector, mass spectrometry, and nuclear magnetic resonance spectrometry". Journal of AOAC International. 91 (3): 580–88. PMID 18567304.
  31. ^ Reepmeyer JC, Woodruff JT (2007). "Use of liquid chromatography-mass spectrometry and a chemical cleavage reaction for the structure elucidation of a new sildenafil analogue detected as an adulterant in an herbal dietary supplement". Journal of Pharmaceutical and Biomedical Analysis. 44 (4): 887–93. doi:10.1016/j.jpba.2007.04.011. PMID 17532168.
  32. ^ Reepmeyer JC, Woodruff JT, d'Avignon DA (2007). "Structure elucidation of a novel analogue of sildenafil detected as an adulterant in an herbal dietary supplement". Journal of Pharmaceutical and Biomedical Analysis. 43 (5): 1615–21. doi:10.1016/j.jpba.2006.11.037. PMID 17207601.
  33. ^ Enforcement Report for June 30, 2010, United States Food and Drug Administration
  34. ^ Hidden Risks of Erectile Dysfunction "Treatments" Sold Online, United States Food and Drug Administration, February 21, 2009
  35. ^ a b c McLaren, Angus (2007). Impotence: A Cultural History. University of Chicago Press. ISBN 978-0226500768.
  36. ^ Roach, Mary (2009). Bonk: The Curious Coupling of Science and Sex. New York: W.W. Norton & Co. pp. 149–52. ISBN 9780393334791.
  37. ^ Darmon, Pierre (1985). Trial by Impotence: Virility and Marriage in Pre-Revolutionary France. Vintage/Ebury. ISBN 978-0701129156.
  38. ^ Hoyland, Kimberley; Vasdev, Nikhil; Adshead, James (2013). "The Use of Vacuum Erection Devices in Erectile Dysfunction After Radical Prostatectomy". Reviews in Urology. 15 (2): 67–71.
  39. ^ Klotz L (Nov 2005). "How (not) to communicate new scientific information: a memoir of the famous Brindley lecture". BJU Int. 96 (7): 956–57. doi:10.1111/j.1464-410X.2005.05797.x. PMID 16225508.
  40. ^ Brindley GS (October 1983). "Cavernosal alpha-blockade: a new technique for investigating and treating erectile impotence". Br J Psychiatry. 143 (4): 332–37. doi:10.1192/bjp.143.4.332. PMID 6626852.
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  42. ^ Valiquette, L (March 2003). "A historical review of erectile dysfunction". Canadian Journal of Urology. 10 (Suppl 1): 7-11.
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External links

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